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

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

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

4. Norman Sartorius, 2006 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. Norman Sartorius, 2006 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. Norman Sartorius, 2006 Trends affecting psychiatry in the first decades of the 21 st century Globalization Burn-out Attitudes to mental illness New morbidity and new treatments Uneven growth and gaps

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

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

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

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

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

19. Norman Sartorius, 2006 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. Norman Sartorius, 2006 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