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

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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 .

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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

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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

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The Chimera of Technological Advances
Cost
time
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The Chimera of Technological Advances
Total cost
Cost
C
B
A
Time
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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

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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

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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

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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

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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.