Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

WHO places Chile among countries with greater morbidity burden for psychiatric diseases in the world (23,2%). Major depression and alcohol consumption disorders hold the first and second place in disabilities attributed to adults. Almost a third of the population older than 15 years have suffered a psychiatric disorder during life span and 22,2% persons have had one in the last year. Anxiety disorders have more prevalence, followed by major depression and alcohol consumption disorders. Only 38,5% of those diagnosed receive some type of mental health care, by an specialist or a primary health care physician. In children and adolescent, prevalence of any psychiatric disorder is 22,5% (19,3% for boys and 25,8% for girls). These disorders are mainly disruptive and of anxiety. Prevalence is higher for children between 4 to 11 years (27,8%) than between 12 and 18 years, and this difference is due mainly to disruptive disorders. Prevalence of anxiety disorders is the second highest, even though less associated with disabilities, while many children and adolescents with affective disorders are disabled and only a fifth of persons with health care needs look for some form of care. Almost a fourth of those that use health care services did not present psychiatric diagnosis during last year. Co morbidity occurs in 27% of those with disorders, but only 7% have three or more diagnosis. Not addressing treatment gap in mental health has serious implications in public health.

Historical and conceptual aspects of Global Health and Global Mental Health are examined and topics such as resources, professional and social attitudes toward mental disorders, the multidimensional experience of getting ill and the presence of world systems of psychiatric diagnosis and classification, are reviewed. The application of these areas of knowledge in medical practice require the integrated use of clinical and socio-cultural perspectives whose precise alignment is an essential component of accurate diagnoses, successful treatments and a consistent improvement of mental health as a component of public health. The latter includes preventive measures applicable to general populations, communities and health care proper. Management of socio-cultural aspects of diagnosis and treatment is imperative as is that of the growing relationship between mental health and neurosciences. The operationalization of this series of interactive processes must be part of legislations which, in turn, can make training, research and dissemination of the resulting data, possible.

Mental diseases are common, chronic and disabling, representing a problem in public health of importance in our country and in the world. For most common mental diseases, currently we dispose of medical and psycho social interventions with proven efficacy. Nevertheless, these are not sufficient yet, and their availability does not diminish the morbidity and mortality produced by mental diseases. In order to solve this, a considerable effort has been carried out in the last 15 years to develop techniques of early detection for persons with high clinical risk to develop mental illness and precocious interventions to prevent or delay the progression of full illness. A greater emphasis in mental health and integrating mental health care in all relevant development programs will strengthen the general development effort, as well as it will ensure, for the first time, sustained attention to investment and research to the main world contributor to loss of productivity and disease burden.

This paper aims at presenting a perspective on a global ethics useful for conducting and evaluating research on global mental health. It includes the proposal of expanding the scope of “global” to include different aspects of cultural diversity and a plea for a “differential ethics” approach that accepts diversity and sociocultural determinants of health. The contention is advanced that ethics is a linguistic justification of moral norms based on customs, beliefs, and traditions. Besides its foundation on rational or religious beliefs, ethics should also be conceived of as a way of attaining human fulfillment of interests and expectations in the context of different forms of humanity.

After delimiting the concepts of moral and ethics the author makes a conceptual difference between psychiatry and mental health. He proposes that the former is a medical specialty while the latter is built in the health concept. Psychiatric problems correspond to mental disorders that affect individual persons while mental health problems, such as underdevelopment and poverty, generalized corruption and violence affect the whole society and interfere with human development and economic growth. To mix up both concepts as if they were synonymous, especially in third world countries, leads to scientific, economic and socio-political risks that attempt against their developments as nations.

Introduction: Human trafficking, including forced prostitution, is a form of human rights violation regarding right to life and respect for human dignity. The Physician-patient relationship may serve as a process for victim identification on the basis of physicians’ responsibilities to detect human trafficking. Method: This empirical study was based on a survey among physicians who may have been in contact with foreign sex workers. Almost eighty physicians in three health facilities were selected according to their high potentiality for coming into contact with foreign sex workers as patients. 228 physicians selected to that aim. 82 of them responded to the questionnaire which was performed in order to evaluate their perception and knowledge human trafficking and their attitudes towards sex work. Results: All physicians think that some women among the sex workers are exploited, exposed to violence and coerced to work against their will (100%). Almost all of them know that it is compulsory for the healthcare professionals to inform the security forces of the women who are exploited (80.0%). Nearly half of them have given medical care to a sex worker (46.9%) and 39.0 percent have thought that it may be related to human trafficking. The ones who have informed the police of a human trafficking case are only 10 per cent. Conclusions: We think that the professional should be equipped with ethical values encompassing both a patient’s dignity and general welfare. This may include the professional’s responsibility to make an assessment as to whether the patient is a victim or a sex worker. Furthermore human trafficking in sex work and sexual health are public health issues therefore it should be covered under standards of practice and ethical codes of conduct.