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Guillermo Rivera A, MD, MSc, PhD .Guillermo Rivera A, MD, MSc, PhD .

Professional Challenges and Opportunities 

 for Young Psychiatrists 

Professional Challenges and Opportunities 

 for Young Psychiatrists 

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Global Burden of Diseases andDisability (GBD)

DALYs in 1998

Disease Global China

Mental-Neuro 14.5 20.8Mental disorder(10.4) (14.1)Car accident 16.0 12.9C.V. 10.3 11.9Lung Disorder 10.7 10.7Cancer 6.1 10.8Infection 23.4 5.8Others 19.0 18.6

World Health Report, WHO, 1999

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ProblemsProblems Relationship between recruitment into

specialty and experiences as undergraduate

Less time with students

Challenges of teaching in a community-

 based specialty.

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SolutionsSolutions 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

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Solutions

Solutions

Promote position of psychiatry in medical

school

Challenge negative views

Actively recruit capable students

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FellowshipFellowship

Programs in thePrograms in theRegionRegion

Argentina: APSA Congress Argentina: APSA Congress(2004, 2005)(2004, 2005)

Venezuela: WPA Regional Venezuela: WPA RegionalCongress (2004)Congress (2004)

Uruguay: Latin AmericanUruguay: Latin AmericanCongress (2004)Congress (2004)

Bolivia: National Congress (2005) Bolivia: National Congress (2005)

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 Regional RegionalChallengesChallenges

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Regional Challenge: PublicAttitude

Traditional stigmatization,discrimination

Big misunderstanding

Public: fear of patients

Patient: fear of service

Result: low rate of treatmentand high rate of illness anddisability of patient, and

loading of Country

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Regional Challenge:Right of Health

Many people unable to obtainmental health care because of 

stigma and poverty Limited resource and poor

service in rural area

Urgent for affordable, high-qualified, community-basedand government respondedmental health service

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Regional Challenge: The legal

framework A main challenge is to establish the

rationals mental health laws

Right of patients Medical ethics

Involuntary treatment andhospitalization

Quality of the service Financing responsibility

Regulatory bodies to monitor thecompliance of the law

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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

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U niversal developments possibly influenced U niversal developments possibly influenced 

 by globalization  by globalization  Decentralization of authority

New forms of corruption

Commoditification of disease and health

Replacement of collective healthstrategies by individual health

strategies. Growth of gaps between rich and poor 

Stigmatization of the impaired.

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U neven growth and gaps 

The fact that psychiatry remainsThe fact that psychiatry remains

underdeveloped might facilitate theunderdeveloped might facilitate the

creation of an alliance of stakeholderscreation of an alliance of stakeholders(government, professions, industry,(government, professions, industry,

family and patient organizations)family and patient organizations)

Psychiatry in the undeveloped world isPsychiatry in the undeveloped world isnot of the same kind as that innot of the same kind as that in

industrialized worldindustrialized world

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ConclusionsConclusions

Society is likely to request a majorSociety is likely to request a majorcontribution from psychiatry in thecontribution from psychiatry in the

years to come because of theyears to come because of thevertiginous growth and gradualvertiginous growth and gradualrecognition of mental health problemsrecognition of mental health problems

To make this contribution the newTo make this contribution the newpsychiatry will have to face severalpsychiatry will have to face severalmajor challengesmajor challenges

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ConclusionsConclusions

Psychiatry can overcome the challengesbefore it if psychiatrists become aware

that this is central to their existenceand accept to do the necessary.

The perils for psychiatry are great, theopportunities for major advances arenumerous and hope should springeternal.