Global Burden of Diseases and Disability (GBD) DALYs in 1998
Disease Global China
Mental-Neuro 14.5 20.8
( Mental disorder ) (10.4) (14.1) Car accident 16.0 12.9 C.V. 10.3 11.9 Lung Disorder 10.7 10.7 Cancer 6.1 10.8 Infection 23.4 5.8 Others 19.0 18.6 World Health Report, WHO, 1999 Problems Relationship between recruitment into specialty and experiences as undergraduate Less time with students Challenges of teaching in a community- based specialty. Solutions Create effective teaching opportunities in primary and general medical settings. Psychiatry as model for community-based teaching Links with rest of medicine – Biological basis of mental illness – Effective and proactive care of chronic illness Solutions Promote position of psychiatry in medical school Challenge negative views Actively recruit capable students Fellowship Programs in the Region
•Argentina: APSA Congress
(2004, 2005) •Venezuela: WPA Regional Congress (2004) •Uruguay: Latin American Congress (2004) •Bolivia: National Congress (2005) Regional Challenges Regional Challenge: Public Attitude Traditional stigmatization, discrimination Big misunderstanding Public: fear of patients Patient: fear of service Result: low rate of treatment and high rate of illness and disability of patient, and loading of Country Regional Challenge: Right of Health Many people unable to obtain mental health care because of stigma and poverty Limited resource and poor service in rural area Urgent for affordable, high- qualified, community-based and government responded mental health service Regional Challenge: The legal framework A main challenge is to establish the rationals mental health laws Right of patients Medical ethics Involuntary treatment and hospitalization Quality of the service Financing responsibility Regulatory bodies to monitor the compliance of the law Problems & Barriers Insufficient awareness or recognition Lack of resources and financial support Deficiency of fundamentally legislation Huge disparities among different areas Insufficient reliable basic information Protect heritage and Creat new model Fear of change Trends affecting regional 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 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. 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 undeveloped world is not of the same kind as that in industrialized world 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 the new
psychiatry will have to face several major challenges 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.