Globalisation and the future of psychiatry

Prof Norman Sartorius presented a virtual address at the College of Psychiatrists of Ireland Winter Conference 2023 entitled, ‘The future of psychiatry in a globalised world’. He is a former Director of Mental Health at the World Health Organisation, and former President of the World Psychiatric Association and European Psychiatric Association.

In his presentation, Prof Sartorius outlined the major socio-economic trends influencing the future of mental healthcare globally, one of which was urbanisation.

“[Urbanisation] has a variety of consequences – most of the people going into towns are unlikely to [form] a community. So, the notion that the community will be the carrier of most of the care for people with mental illnesses is gradually disappearing with urbanisation. [The people in these] communities rarely work together and help each other.”

The second trend he highlighted is commodification. Health services, including mental healthcare, become commodities when “you have to pay for them… [or] make money with them”.

The third trend is the change in the world’s demographic structure, with an increasingly aging population.

The fourth trend is ‘horizontalisation’. This is where members of society communicate in horizontal layers with people in the same age group as themselves. Because vertical communication was being reduced, wisdom that older people can pass to younger people was not being transmitted, he argued.

The fifth aspect was the fragmentation within professions, including psychiatry.

The notion that the community will be the carrier of most
of the care for people with mental illnesses is gradually disappearing with urbanisation

“Even in psychiatry there are a whole range of sub-disciplines, which do not talk to each other.” Another trend was de-civilisation. He said one measure of civilisation was the level of care and attention society provides to vulnerable groups. Such care was being eroded at individual and local level and the State was often unwilling to bridge the gap, according to his presentation.

One major consequence of these trends was loneliness. “Gradually, as communities vanish or fall apart, there is an incredible increase on the burden of care. Carers are suffering, with many reports of carers [experiencing] burnout and an increase in physical morbidity.”

He added: “Staff burnout is at much higher levels than ever before, and a number of people are now employed to do jobs for which they are not very well qualified. Equally, medicine has changed in many ways. Previously, being a doctor was a very special thing, now it is becoming a profession with all the professional advantages and disadvantages. Previously healthcare was an ethical imperative, now it has become an economic opportunity.”

In conclusion, Prof Sartorius said the capacity for empathy should be assessed when selecting candidates for entry into medical schools. Prof Sartorius further stressed the need for a review and revision of health legislation, while a greater emphasis on the primary prevention of mental disorders was also required. “At least one-third or half of all mental and neurological disorders are amenable to primary prevention. [Therefore] society must be made aware of the many opportunities for primary intervention.”