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Perils and opportunities for psychiatry, 2005 2025

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N. Sartorius, Athens, 2005. Perils and opportunities for psychiatry, 2005 2025 ... Is likely to be contagious and can be taken as a model by newcomers ... – PowerPoint PPT presentation

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Title: Perils and opportunities for psychiatry, 2005 2025


1
Perils and opportunities for psychiatry, 2005
2025
  • Professor N. Sartorius,
  • MD, PhD, FRCPsych.
  • Geneva

2
Trends 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

3
Globalization
  • 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

4
Universal 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.

5
Globalization 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.

6
Globalization 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

7
Burn-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

8
The vicious circle of burn-out
Burn-out
Discrimination
Missing opportunities
Poor reputation
Deterioration of services
Corruption
9
Attitudes 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

10
Attitudes 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 .

11
Attitudes 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

12
New Diseases
  • Dromopathies
  • Iatrogenies
  • Toxicopathies
  • HIV related problems,
  • Long lasting comorbidities
  • Subthreshold states
  • Consequences of successes of medicine

13
Old 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

14
New 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

15
The Chimera of Technological Advances
Cost
time
16
The Chimera of Technological Advances
Total cost
Cost
C
B
A
Time
17
Uneven 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

18
Uneven 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

19
The 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

20
Conclusions
  • 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

21
Conclusions
  • 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.
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