Professional Challenges and Opportunities

for Young Psychiatrists

Guillermo Rivera A, MD, MSc, PhD.

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.