INFORMATION PAPER IPH/20
According to the President-Elect of the World Psychiatric Association, greater
scientific knowledge about mental disorders, coupled with a more humane attitude toward
sufferers, is revolutionising the treatment of mental illness. No society can claim to be
fair enough towards those who suffer from mental illness. Discrimination and sometimes
violence against mental patients occur in the family, at working places, in health care
settings and in many institutions. They are so common that, in 1992, the United Nations
passed a resolution to defend the rights of mental patients.
Abuse of psychiatry for political, ideological or religious purposes still exists,
although in very few countries, access to health care facilities or coverage for
psychiatric patients is limited when compared with that available to other patients. The
burden of mental diseases for society is extremely high. In the United States, the total
cost of mental and neurological diseases in 1989 exceeded 400 billion dollars. In Europe,
it has been estimated that twenty per cent of all health care cost is due to such
diseases. The World Bank has calculated the disability produced by different diseases.
Eight per cent is due to mental disorders and thirty-four per cent to disorders and
thirty-four per cent is due to behavioural problems. In total, forty-five per cent is due
to behaviour, or to the brain - the organ which controls behaviour.
The World Health Organisation estimates that in 1997, forty-five million persons have
schizophrenia, and that an increase in its prevalence is expected. Some 29 million suffer
from dementia, of which Alzheimer's Disease is the most common form. Global population
ageing will inevitably result in huge increases in the number of cases of dementia. Mood
disorders (including depression) are estimated to affect some 340 million people at any
given time. Tobacco is estimated to cause three million deaths a year. The use of alcohol,
illicit drugs and other psycho-active substances causes at least 123,000 deaths annually.
Alcohol is also implicated in crime, violence, marital breakdown and major losses in
Five factors are helping to change the situation :
(1) For twenty years, the diagnosis of psychiatric disorders has been subject to
intensive research and attention. As a consequence, the validity and reliability of
psychiatric diagnosis across the world has reached the levels and often surpassed those of
other medical specialities, allowing better research and communication among
professionals, better planning of services, and better management of resources.
(2) Research in neuroscience, especially in brain imaging and neurochemistry, has
identified significant changes in brain structure and function, which clearly show that
the nervous system is the playground of psychiatric disorders. As a consequence, mental
diseases are more and more considered as real diseases.
(3) Psychopharmacology is constantly developing and investigating drugs for the
treatment of mental patients, leading to higher efficacy, fewer side effects or higher
patient compliance, and, as a consequence, to better outcomes.
(4) Psychotherapy and social interventions are moving from the interest of delving in
the knowledge of human nature, such as psychoanalysis did, into doing research on specific
methods for specific disorders. This is because techniques which are useful for depressed
patients will not work in schizophrenic ones, and so on.
(5) the status of patients within the family, society and the health care system is
changing. The closing of mental hospitals which started in the 1970's has shown that, if
given support and opportunities, even severely ill mental patients can live productive
lives, like other handicapped individuals. Furthermore, psychiatrists are recognising that
doctor-patient relationships do not need to be guided only by compassionate care, and by
decisions to prevent self-harm or violence against others, but by the same ethics of
autonomy which are becoming more prevalent in the other fields of medicine. Last year, the
World Psychiatric Association produced ethical guidelines, The Madrid
Declaration which state that patients and psychiatrists are partners in the
decision taking process involved in clinical practice.
Better knowledge about their disorders; new treatments and treatment strategies; and
above all, a new more humane status, starting from the practice of psychiatry itself and
expanding to the family, workplace and society at large. These factors, if developed
correctly, will lessen the discrimination, stigma and abuse of mental patients, and will
make this a truly humane world.
WomenAid has, for several years, been assisting psychiatric and
mentally handicapped patients in the republics of the former Soviet Union. The conditions
the patients endure are abysmal and defy description.