Globalisation and psychiatry

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). From its inception, 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 e-mail. 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. In this article, I examine the effects of globalisation on the practice of psychiatry and suggest strategies for their optimal management in relation to mental health with a view to exploiting the opportunities it presents for the development of psychiatric services.