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286 R. MONTENEGRO PSYCHIATRIKI 22 (4), 2011edge; in fact, it erases the boundaries between professions,thus leading to confusion.Some other aspects to be mentioned about thislaw are that no reference is made to out patient services,although they are of utmost importance in everydaypractice, and that there is a bureaucratizationof hospitalization. Such decision is no longer madeprofessional by a, as a means to achieve the besttreatment possible, but by a the judge’s, who is expectedto know what is best for the patient. Besides,the law creates a new supervising agency, which willsupervise the judges’ decisions, instead of appointingthe Office of Public Prosecutor to perform thistask, an office which already exists. Consequently,due to bureaucracy, there is little hope that this officewill be created in the near future.By definition, the passing of a good law is promising,as we expect to improve what we have. However,due to various circumstances, my country has seenlaws that promised a lot, but they were never implemented.This necessarily results in high scepticismamong the population. In fact, many of the biggestdevelopments in psychiatry in our country were producedby people who had a clear view of what wouldbe better for psychiatric patients, rather than byspecific laws. For instance, Mauricio Goldenberg, anoutstanding dynamic psychiatrist, managed to carryout many important reforms -such as the creation ofpsychiatric beds in general hospitals, the creation ofoutpatient services in the community, the training ofpsychiatrists by means of a residency training program,which was attended by many colleagues whothen promoted mental health community serviceswithoutnew laws being passed.There are basic contents in this law which are definitelypositive: it defends patients’ rights; it promotesinterdisciplinary team work; it recommends deinstitutionalization,community services and, if necessary,inpatient services in general hospitals. We all agreeon this; however, there are many doubts as regardsthe way this will be put into practice. For example,closing psychiatric institutions is not enough; it isnecessary to build new infrastructure for the treatmentof patients, such as half way houses, day carecenters and so on. This must necessarily be donebefore psychiatric facilities are closed, as dischargedpatients must be well supported under the new cir-cumstances. However, this law does not say anythingabout the creation of these resources which are vitalfor social rehabilitation of such patients. Besides, thelaw says that it guarantees that the necessary fundswill provide care in community services, but it doesnot specify where the money will come from, so itis difficult to believe that the money will be available.In fact, it is important to know that Argentinais made up by twenty-four provinces, each of whichhas its own constitution, laws, authorities, governmentetc., which must comply with the nationalconstitution. Consequently, the central governmentmay pass a law and recommend a certain course ofaction, but it cannot make it obligatory due to thefederal nature of our political organization; it is thetask of each province to adopt and implement it, andwithout specific funds it is not likely for the reform totake place.These problems seem to be the natural consequenceof the passing of a law for which no consensuswas reached beforehand. Many actors were notinvolved in the writing of the law –professional associations,for example– so they feel it is difficult toaccept a law which seems to be inspired by externalrealities rather than by local circumstances. All stakeholdersshould participate in the building of any consensus.Otherwise, there will always be people whowill react to defend their own interests.In most countries psychiatry is also threatened bya shortage of psychiatrists. For example, in Argentinathe number of medical students who choose thisbranch of medicine as their specialty has declinedduring the past twenty years, while the number ofprospective psychologists has soared.These are some of the reasons why many believethat psychiatry is being discredited. In fact, MarioMaj, President of the World Psychiatry Association,has stated "Indeed, we and our profession are stigmatizedin many countries of the world. This is certainlyrelated to our difficulty to convey the newimage of psychiatry: the image of an integrativediscipline, which deals with a broad range of disorders,including some that are very common in thepopulation, using interventions that are at least aseffective as those available to most other branchesof medicine. However, it would not be fair to statethat psychiatry has just a problem with promoting
PSYCHIATRIKI 22 (4), 2011 ADVANCES AND PERSPECTIVES IN MENTAL HEALTH 287more successfully its new image. It has to be acknowledgedthat our profession also has a problem,in several contexts which vary from one country toanother, with matching up to this new image in thereality of clinical practice, research and training.” 4Thus, he places the solution within our reach: wehave to show the public what the new psychiatry is,and live up to it. A WPA Task Force appointed to developa guide on how to combat stigmatization ofpsychiatry and psychiatrists. "...recommended thatnational psychiatric societies establish links withother professional associations, with organizationsof patients and their relatives and with the media,in order to approach the problems of stigma ona broad front. The Task Force also underlined therole that psychiatrists can play in the prevention ofstigmatization of psychiatry, stressing the need todevelop a respectful relationship with patients, tostrictly observe ethical rules in the practice of psychiatryand to maintain professional competence." 5In this scenario, in which there are both internal andexternal risks for psychiatry, the question we shouldask ourselves is: Are we providing patients with whatthey need? Is there any other way of helping them?The answer to these questions should come fromavoiding militant attitudes and the ideologization ofreality. We should learn from past lessons –whetherthey are local or foreign– and, most important of all,focus on the people. In this line, the InternationalNetwork for Person-centered Medicine (INPCM) hasbeen a pioneer in the building of new bonds amongdifferent professions and advocacy groups to improvemedical care. * The original initiative was bornin 2005, focusing on "the whole person of the patientin context as the center and goal of clinical care andhealth promotion, at both individual and communitylevels. This involves the articulation of science andhumanism to optimize attention to the ill and positivehealth aspects of the person. As care is basicallya partnership experience, the program involves theintegration of all relevant health and social services.Furthermore the program also involves advancingpropitious public health policies." 6Let us always remember that our main professionalinterest is basedon in improving our patients’quality of life, which obviously includes their mentalhealth. We have to be as creative as possible tofind the best way to do so.* Members of the International Network for Person-centered Medicine (INPCM)• World Medical Association (WMA)• World Organization of Family Doctors (WONCA)• World Health Organization (WHO)• International Alliance of Patients’ Organizations (IAPO)• International College of Surgeons• International Council of Nurses (ICN)• International Federation of Gynecology and Obstetrics (FIGO)• International Federation of Social Workers (IFSW)• International Federation on Aging• International Pharmaceutical Federation (FIP)• Council for International Organizations of Medical Sciences (CIOMS)• Medical Women’s International Association,• World Federation for Mental Health (WFMH)• World Federation of Neurology (WFN)• World Association for Sexual Health (WAS)• World Association for Dynamic Psychiatry (WADP)• International Federation of Medical Students’ Associations (IFMSA)• World Federation for Medical Education (WFME)• International Association of Medical Colleges (IAOMC)• European Association for Communication in Health Care (EACH)• European Federation of Associations of Families of People with Mental Illness (EUFAMI)• Ambrosiana University• University of Buckingham• University of Geneva• Hospitals of Geneva (HUG)• Paul Tournier Association
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