1 - Globalisation, psychiatry and human rights: new challenges for the 21st century

Summary

Summary Globalisation is a complex, large-scale social phenomenon that presents mental health services with both challenges and opportunities. These relate to the increased cultural diversity of service users and service providers; the effects of migration on mental health; and the implementation of international protocols in relation to: training, policy and education. In the aftermath of the terrorist attacks of 11 September 2001 in the USA, the relationship between large-scale social change and mental health has also focused attention on the concepts of anomie and social capital. An explicit return to the principles of biopsychosocial psychiatry and a positive engagement with globalisation will advance the development of effective, evidence-based models of care appropriate to the changing needs of patients.

Globalisation means crossing borders. All of the social and economic forces driving globalisation relate to the opening or dismantling of borders: instant communication, easy travel, deregulation of commerce and widened access to information and technology. The internet is often hailed as a good example of globalisation, as it allows people in far-flung corners of the planet to communicate rapidly with each other regardless of their geographical location. Other examples include the establishment of supranational political bodies, enhanced cross-border cultural interaction and globalised approaches to environmental issues (Box 1.1).

From the start, globalisation has attracted robust criticism, chiefly related to the social inequities it appears to accentuate. Critics point out that the internet, for example, remains the realm of a privileged minority as most of the world's population have never made a telephone call, let alone sent an email. The free flow of capital into and out of unstable economies also presents problems, often compounded by the waves of migration that tend to follow financial downturns (Stiglitz, 2002). Perhaps the greatest criticism of globalisation, however, relates to the management of cultural diversity, a phenomenon that presents very great challenges, as well as opportunities, in many societies around the world. These criticisms, along with the terrorist attacks of 11 September 2001 in the USA, have stimulated a worldwide re-evaluation of globalisation and a reconsideration of the strategies that societies and individuals use to manage global change.