Title: Perils and opportunities for psychiatry, 2005 2025
1Perils and opportunities for psychiatry, 2005
2025
- Professor N. Sartorius,
- MD, PhD, FRCPsych.
- Geneva
2Trends affecting psychiatry in the first decades
of the 21st century
- Globalization
- Burn-out
- Attitudes to mental illness
- New morbidity and new treatments
- Uneven growth and gaps
3Globalization
- Osmosis of ideas, of value systems and of
knowledge/information - Free circulation of people
- Free circulation of goods
- Interdependence in the protection of the
environment - Harmonization of laws
4Universal developments possibly influenced by
globalization
- Decentralization of authority
- New forms of corruption
- Commoditification of disease and health
- Replacement of collective health strategies by
individual health strategies. - Growth of gaps between rich and poor
- Stigmatization of the impaired.
5Globalization and psychiatry
- Globalization leads to
- The disruption of traditional strategies of
dealing with illness - Selective brain drain
- A significant diminution of the social capital of
societies worldwide - The imposition of value systems by the
economically and militarily powerful.
6Globalization and psychiatry
- Globalization also leads to
- Faster development of technology for science,
health care and other purposes - Recognition of human rights and better
information about abuses of psychiatry - Growth of self-help movements
- Outsourcing of research
7Burn-out
- Particularly vicious among those working in
peripheral services, with responsibilities but
without authority - Affects personnel, patients and families
- Can introduce a vicious circle
- Is likely to be contagious and can be taken as a
model by newcomers - Is reinforced by globalization
8The vicious circle of burn-out
Burn-out
Discrimination
Missing opportunities
Poor reputation
Deterioration of services
Corruption
9Attitudes to mental illness
- Stigma attached to mental illness is pervasive
and marks patients, families, mental health
personnel, mental health institutions, budgets
for programmes and treatments - Stigma leads to severe discrimination
- Attitudes to mental illness are improving in
patches and are unstable
10Attitudes to mental illness
- Reforms of mental health care have only marginal
effects on stigma (unless destigmatization is a
major stated goal of the reform and the
programme) - New (and effective !) treatments are a major
weapon in fighting stigma and heightening the
priority for mental health care .
11Attitudes to mental illness
- Reduction of stigma and discrimination is
possible - The reduction of stigma must start by changes in
attitudes and actions of psychiatrists and other
staff - Fighting stigma must involve patients and
families - Media reflect public opinions and strengthen
them they rarely make them
12New Diseases
- Dromopathies
- Iatrogenies
- Toxicopathies
- HIV related problems,
- Long lasting comorbidities
- Subthreshold states
- Consequences of successes of medicine
13Old diseases in a new garb
- Schizophrenia and other psychoses
- In people who have aged with them
- In less virulent forms
- Neurasthenia and other discoveries in primary
health care - Mild cognitive disorders in a more demanding world
14New treatments are also new challenges for health
care
- Developing countries are facing the double burden
of diseases with insufficient resources - Modern times bring new treatments but also
diminish traditional resources for care - Technological advances have the tendency of
increasing cost of care
15The Chimera of Technological Advances
Cost
time
16The Chimera of Technological Advances
Total cost
Cost
C
B
A
Time
17Uneven growth and gaps
- Previous uneven development (of different parts
of a country or of services for population
groups) leads to a growth of gaps between them - Psychiatry is in an acute danger of falling even
further behind other branches of medicine and
social services
18Uneven growth and gaps
- The fact that psychiatry remains underdeveloped
might facilitate the creation of an alliance of
stakeholders (government, professions, industry,
family and patient organizations) - Psychiatry in the third world is not of the same
kind as that in industrialized world
19The hidden constraints
- "I have seen the enemy and it is us" psychiatry
remains divided across theoretical positions,
places of work and subdisciplines and does not
speak with one voice or in the same language - The subdivisions of psychiatry are leaving it
- Education in psychiatry is outdated which results
in late untoward consequences
20Conclusions
- Society is likely to request a major contribution
from psychiatry in the years to come because of
the vertiginous growth and gradual recognition of
mental health problems - To make this contribution psychiatry will have to
face several major challenges
21Conclusions
- Psychiatry can overcome the challenges before it
if psychiatrists become aware that this is
central to their existence and accept to do the
necessary. - The perils for psychiatry are great, the
opportunities for major advances are numerous and
hope should spring eternal.