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Perspectives of mental health care in the 21st century

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Perspectives of mental health care in the 21st century Professor N. Sartorius, MD, PhD Geneva, Switzerland Sources of influence on mental health care Trends and ... – PowerPoint PPT presentation

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Title: Perspectives of mental health care in the 21st century


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

2
Sources of influence on mental health care
Society
Medicine
Psychiatry
Consumers and carers health care staff
Mental health care
3
Trends and developmentssociety
  • Ideological imperialism
  • Growth of gaps between countries and between
    groups within countries
  • Decivilization
  • Decentralization
  • New forms of corruption

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

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

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

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.

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

9
Globalization and the social framework of
psychiatry
Ethical principles
Moral rules
Legal provisions
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

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

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

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

14
The Chimera of Technological Advances
Cost
time
15
The Chimera of Technological Advances
Total cost
Cost
C
B
A
Time
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

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

18
The vicious circle of burn-out
Burn-out
Discrimination
Missing opportunities
Poor reputation
Deterioration of services
Corruption
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

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
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