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The presence in the Basque Country of a sharp income inequality and of unemployment will increase the prevalence of some mental problems like depression, violence and suicide; the growing number of immigrants, with very different beliefs, values and attitudes; the modification of the sexual practices, which will increase the virtual sexual acts on the Internet; the change to the family structure and paternity, like parthenogenesis without male intervention, homosexual or transsexual parents or single parents are all factors which will modify psychiatric practice in the coming decades. The "Managed mental health systems" will offer "cost-effective" therapies (behavioural, cognitive) with the help of people with little training, supported by occasional supervision. Dynamic psychotherapies will be practiced to a lesser extent in the public mental health services. In order to work in this environment, the therapists will have to be willing and technically prepared in order to establish communication with the other professionals who relate with the patient or their close environment (combined therapy). They must therefore be willing to allow the bodies which reimburse the treatment to review the quality of their work, and must prefer for their patients the use of less restrictive environments (outpatient clinics as opposed to hospital admissions). Moreover, private practitioners would be motivated to develop multidisciplinary team practices, based on networks. The reimbursement of psychiatric treatment (hospital and outpatient) will be confronted with more restrictions than in the case of patients suffering from somatic illnesses, both in terms of length of stay and in the number and type of outpatient consultations. Moreover, financial compensation for a mental handicap will be lower than that granted for a physical handicap. Overall, psychiatric patients will continue to have more difficulty than the rest of the population in obtaining care, particularly in the case of elderly patients or those suffering from mental retardation. Nowadays there is already a trend towards developing different subspecialties in the field of Mental health, according to the age (child, adolescent, adult, elderly), the pathology (neuropsychiatry, psychosomatic, substance abuse) or even gender (for example psychiatry for women). It is likely that this trend will continue to grow. The life expectancy of the world population is increasing rapidly. The EUROSTAT statistics show that the Spanish people who have just been born, for example, are going to live longer than those born in most other countries around the world. Emigration within Europe will partly rejuvenate some countries. In the Basque Country there will therefore be a clear rise in the number of active good quality years of life. Not only we will live longer, but rather we will live hopefully more healthily beyond 60 years old, with slight disabilities, due to the fact that the factors which affect life expectancy are the same as those which improve health. However, the disabilities will accumulate above 85 years old and affect women most. Mental health however will worsen in the elderly which will contribute towards an increase in the disabilities, suicides, depression and cognitive disorders. There will without doubt be significant progress in the detection of dementia, in predicting the risk of suicide and controlling other symptoms using biological methods. The health progress of this aging population should however come hand in hand with more unspecific actions. Diet, physical exercise, lifestyle changes are all ways to achieve a "positive mental health" amongst this aging population which will be characterized by enjoying sufficient welfare and autonomy allowing for realistic ambitions to be fulfilled. This should encourage to assure the factors which protect mental health: individual skills which boost the "resilience" factors; family and occupational relations, and social benefits; social networks which give the individual confidence; solidarity amongst neighbours and the community. The psycho-geriatric care in the future should stress the current trend to substitute the asylum concept for more adapted psychosocial re-adaptation formulae. A psycho-geriatric service cannot completely substitute the family setting or the environment of the elderly patient, and this is why they must be helped so that they can provide the emotional support needed for the re-adaptation of the patient, and in each particular case provide guidelines to the family on how to act.
