Perspectives of mental health care in the 21 st century

1. Perspectives of mental health care in the 21st century Professor N. Sartorius, MD, PhD Geneva, Switzerland Norman Sartorius, 2006

2. Sources of influence on mental health care Society Medicine Psychiatry Consumers and carers; health care staff Mental health care Norman Sartorius, 2006

3. Trends and developments:society • Ideological imperialism • Growth of gaps between countries and between groups within countries • Decivilization • Decentralization • New forms of corruption Norman Sartorius, 2006

4. Trends and developments: medicine • Comoditification • Brain drain • Eclecticism in the selection of treatments • Reliance on apparatus • Replacement of collective by individual responsibility for health Norman Sartorius, 2006

5. Trends and developments:medicine • The duty to live is being replaced by the right to die • Striving for cure is giving way to learning how to live with disease and impairment • Enhancing the quality of life and protecting patients' rights have gained in priority Norman Sartorius, 2006

6. 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 Norman Sartorius, 2006

7. 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. Norman Sartorius, 2006

8. 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 Norman Sartorius, 2006

9. Globalization and the social framework of psychiatry Ethical principles Moral rules Legal provisions Norman Sartorius, 2006

10. 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 Norman Sartorius, 2006

11. New Diseases • Dromopathies • Iatrogenies • Toxicopathies • HIV related problems, • Long lasting comorbidities • Subthreshold states • Consequences of successes of medicine Norman Sartorius, 2006

12. 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 Norman Sartorius, 2006

13. 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 Norman Sartorius, 2006

14. The Chimera of Technological Advances Cost time Norman Sartorius, 2006

15. The Chimera of Technological Advances Total cost Cost C B A Time Norman Sartorius, 2006

16. Consumers, carers and health care staff • Increasing importance of carer and consumer organizations and voices • Uncertainty about the transferability of models of care (e.g. community care, PHC, GP centred care) • The epidemic of burn-out syndrome Norman Sartorius, 2006

17. 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 Norman Sartorius, 2006

18. The vicious circle of burn-out Burn-out Discrimination Missing opportunities Poor reputation Deterioration of services Corruption Norman Sartorius, 2006

19. Conclusions • Mental health care is gaining in importance because of the huge public health importance of mental disorders and mental ill health • While the components of care have greatly advanced, models of care are rapidly becoming obsolete and unsuitable Norman Sartorius, 2006

20. Conclusions • The gaps in service provision are growing in most of the developing and in many developed countries • A reform of mental health care will be successful if it meets the challenges of • Synthetizing evidence and experience • Developing a consensus among stakeholders • Being harmonius with changes in society and medicine • Balancing ethical, moral and legal requirements Norman Sartorius, 2006