L24 Sartorius

Perils and opportunities for psychiatry, 2005 – 2025 : 

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

Trends affecting psychiatry in the first decades of the 21st century: 

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

Globalization : 

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

Universal developments possibly influenced by globalization : 

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.

Globalization and psychiatry: 

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.

Globalization and psychiatry : 

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

Burn-out: 

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

The vicious circle of burn-out: 

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

Attitudes to mental illness: 

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

Attitudes to mental illness: 

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 .

Attitudes to mental illness: 

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

New Diseases: 

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

Old diseases in a new garb: 

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

New treatments are also new challenges for health care: 

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

The Chimera of Technological Advances : 

The Chimera of Technological Advances Cost time

The Chimera of Technological Advances: 

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

Uneven growth and gaps : 

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

Uneven growth and gaps : 

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

The hidden constraints : 

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

Conclusions: 

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

Conclusions : 

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.