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
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