J Korean Neuropsychiatr Assoc 2014;53(2):75-86 본론 정신건강의학과의환경변화 미래변화의예측고령화시대에따른정신보건서비스변화의필요성 76

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1 online ML Comm SPECIAL ISSUE 2030 정신건강의학과의미래보고서 J Korean Neuropsychiatr Assoc 2014;53(2):75-86 ISSN 가톨릭대학교의과대학의정부성모병원정신건강의학교실, 1 경기북부병무지청, 2 경희대학교의과대학정신건강의학교실, 3 인제대학교의과대학일산백병원정신건강의학교실, 4 가천대학교의학전문대학원정신건강의학교실, 5 순천향대학교의과대학부천병원정신건강의학교실 6 이해국 1 최원석 2 백종우 3 이강준 4 나경세 5 정한용 6 The Future Report for the Innovative Advance of Korean Psychiatry in 2030 Hae Kook Lee, MD, PhD 1, Won Seok Choi, MD 2, Jong Woo Paik, MD, PhD 3, Kang Joon Lee, MD, PhD 4, Kyoung Sae Na, MD 5, and Han Yong Jung, MD, PhD 6 1 Department of Psychiatry, Uijeongbu St. Mary s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea 2 Department of Psychiatry, Military Manpower Administration, Uijeongbu, Korea 3 Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Korea 4 Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea 5 Department of Psychiatry, Gachon University College of Medicine, Incheon, Korea 6 Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea Received December 21, 2013 Revised January 13, 2014 Accepted February 19, 2014 Address for correspondence Han Yong Jung, MD, PhD Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon , Korea Tel Fax hanyjung@schmc.ac.kr Futurology is an interdisciplinary field, studying yesterday s and today s changes, and aggregating and analyzing both lay and professional strategies and opinions with respect to tomorrow. Therefore, the purpose of this article is to provide the future direction and strategy for the advancement of Korean psychiatry based on the author s subjective opinion as well as the objective consideration of future changes in the environmental factors affecting psychiatry. First, we attempted to analyze the pros and cons of our status, according to the SWOT analysis. There are several positive factors in the outer environment, such as the increase of personal income, healthy aging people, interest in mental health, and development of a national mental health plan. Meanwhile, the negative factors affecting our future originated from the excessive control by national health insurance as well as our short capacity for social or general mental health needs. Second, we estimated the needs from future changes that might affect modern psychiatry. The future changes force us to prepare ourselves to be more competent in fulfillment of customer oriented positive mental health needs. Further, greater competency is needed in application of neurobehavioral knowledge to the clinical field. In addition, development of dedicated leadership and partnership for accomplishment of social and community based projects is also needed. In conclusion, the Korean Neuropsychiatric Association, for organizational integration of the profession, must develop a strategic plan for achievement of the ideal goal. In the first step, from 2014 to 2019, we need to develop the vision, mission, strategy and framework of our organization. And, the mission should be carried out by several task forces. Consecutively, achievements of the task force should be applied to the organizational performance. In the second step, from 2020 to 2029, full time employment of a psychiatrist for the function of executive secretary should be established. In the third step, from 2029, we need to formally participate in the national project and community program by establishment of a full time organization for the major strategic area. The suggestions could be realized by the communication and commitment of the psychiatric organization. J Korean Neuropsychiatr Assoc 2014;53(2):75-86 KEY WORDSZZ Future Korean Neuropsychiatric Association Communication Commitment. 서 론 Copyright 2014 Korean Neuropsychiatric Association 75

2 J Korean Neuropsychiatr Assoc 2014;53(2):75-86 본론 정신건강의학과의환경변화 미래변화의예측고령화시대에따른정신보건서비스변화의필요성 76

3 정신건강의학과의미래 HK Lee, et al. - 정보통신기술의발달로인한가상의정신보건사회도래 - - 세계보건기구의종합적정신보건행동계획 2013~ ) 77

4 J Korean Neuropsychiatr Assoc 2014;53(2):75-86 Lancet의 global mental health - 국내외타학회벤치마킹 Disease or injury DALYs millions) Percent of total DALYs 1. Lower respiratory infections Diarrhoeal diseases Unipolar depressive disorders Ischaemic heart disease HIV/AIDS Cerebrovascular disease Prematurity and low birth weight Birth asphyxia and birth trauma Roadtraffic accidents Neonatal infections and other Tuberculosis Malaria COPD Refractive errors Hearing loss, adult onset Congenital anomalies Alcohol use disorders Violence Diabetes mellitus Self-inflicted injuries Fig. 1. Leading causes of burden of disease (DALYs). 23,24) This picture was received a citation permission from the author. The original picture was in the 2011 epidemiological survey of mental disorders in Korea and Global burden of disease

5 정신건강의학과의미래 HK Lee, et al. - 대한응급의학회 26) 2004 Disease or injury Lower respiratory infrctions AS % of total DALYs 6.2 Rank 1 Rank 1 As % of total DALYs Disease or injury Unipolar depressive disorders Diarrhoeal diseases Ischaemic heart disease Unipolar depressive disorders Road traffic accidents Ischaemic heart disease Cerebrovascular disease HIV/AIDS COPD Cerebrovascular disease Lower respiratory infections Prematurity and low birth weight Hearing loss, adult onset Birth asphyxia and birth trauma Road traffic accidents Neonatal infections and other COPD Refractive errors Hearing loss, adult onset Diabetes mellitus Refractived errors HIV/AIDS Diabetes mellitus Neonatal infections and other Prematurity and low birth weight Birth asphyxia and birth trauma Diarrhoeal diseases Fig. 2. Changes in the leading cause of DALYs globally from 2004 to ,24) This picture was received a citation permission from the author. The original picture was in the 2011 epidemiological survey of mental disorders in Korea and Global burden of disease

6 J Korean Neuropsychiatr Assoc 2014;53(2): 대한의학회 27) 미국정신과학회 (American Psychiatry Association, APA) 80

7 정신건강의학과의미래 HK Lee, et al

8 J Korean Neuropsychiatr Assoc 2014;53(2): 미국신경과학회 (American Academy of Neurology, AAN) Table 1. The role and function of APF and APIRE APF APIRE stigma Performance-in-Practice PIP DSM-5: Diagnostic and Statistical Manual of Mental Disorders-5 Judges Leadership Initiatives APF : American Psychiatric Foundation, APIRE : American Psychiatric Institute for Research and Education 82

9 정신건강의학과의미래 HK Lee, et al. 호주뉴질랜드정신의학회 (The Royal Australian & New Zealand College of Psychiatrist, RANZCP) - 결론 83

10 J Korean Neuropsychiatr Assoc 2014;53(2): 성숙 성숙과발전 2029 도전 미래준비선언 2014 도전성과의확인 2019 국가정책참여확대 집단적연구과제참여확대 정신건강증진서비스세팅정착과확대 사무국상근조직구축 전략사업일상수행조직구축운영 국가정책공식파트너 국책연구과제연구개발의조직적수행 다양한임상서비스체계유지지원 지역사회리더로서정체성구축및확대 각영역별특화, 분화된일상조직구축 비전, 미션, 전략수립 범정신과합의 범사회적검증 전략사업의시행조직의시험적운영 성과관리와평가및조정 Fig. 3. The roadmap to the successful future of the psychiatric professional. 84

11 정신건강의학과의미래 HK Lee, et al. 중심단어 Acknowledgments Conflicts of Interest The authors have no financial conflicts of interest. REFERENCES 1) Statistics Korea population and housing census. Daejeon: Statistical Korea; ) Yoon HD, Ministry of Health and Welfare. Health at a glance Sejong: Ministry of Health and Welfare; ) Statistics Korea. Causes of death statistics in Daejeon: Statistics Korea; ) Ministry of Health and Welfare. Comprehensive mental health promotion policy Be worthy life, healthy society. Sejong: Ministry of Health and Welfare; ) Kinsella K. Demographic aspects. In: Ebrahim S, Kalache A, editors. Epidemiology in old age. London: BMJ Publishing Group; ) Fries JF, Green LW, Levine S. Health promotion and the compression of morbidity. Lancet 1989;1: ) Colvez A. Disability free life expectancy. In: Ebrahim S, Kalache A, editors. Epidemiology in old age. London: BMJ Publishing Group; ) Statistics Korea statistics on the aged. Daejeon: Statistics Korea; ) Connolly M. Futurology and mental health services: are we ready for the demographic transition? Psychiatrist 2012;36: ) Hampson RE, Gerhardt GA, Marmarelis V, Song D, Opris I, Santos L, et al. Facilitation and restoration of cognitive function in primate prefrontal cortex by a neuroprosthesis that utilizes minicolumn-specific neural firing. J Neural Eng 2012;9: ) Mattout J. Brain-computer interfaces: a neuroscience paradigm of social interaction? A matter of perspective. Front Hum Neurosci 2012;6: ) Griffiths KM. A virtual mental health community - a future scenario. Aust N Z J Psychiatry 2013;47: ) Frost JH, Massagli MP. Social uses of personal health information within PatientsLikeMe, an online patient community: what can happen when patients have access to one another s data. J Med Internet Res 2008;10:e15. 14) Lee SS, Crawley L. Research 2.0: social networking and direct-toconsumer (DTC) genomics. Am J Bioeth 2009;9: ) Griffiths KM, Mackinnon AJ, Crisp DA, Christensen H, Bennett K, Farrer L. The effectiveness of an online support group for members of the community with depression: a randomised controlled trial. PLoS One 2012;7:e ) World Health Organization. Mental health action plan Geneva: World Health Organization; ) Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet 2007;370: ) Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007;370: ) Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, De Silva M, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 2007;370: ) Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ, et al. Mental health systems in countries: where are we now? Lancet 2007;370: ) Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, et al. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 2007;370: ) Lancet Global Mental Health Group, Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S, et al. Scale up services for mental disorders: a call for action. Lancet 2007;370: ) Cho MJ, Sung SJ, Shin SY, Kim JS, Jeon SB, Kim MJ. The epidemiological survey of mental disorders in Korea. Seoul: Ministry of Health and Welfare; ) World Health Organization. Global Health Estimates. Geneva: World Health Organization; ) Drucker PF. Managing the nonprofit organization: principles and practices. New York, NY: Harper Collins; ) Emergency.or.kr [homepage on the Internet]. Seoul: The Korean So- 85

12 J Korean Neuropsychiatr Assoc 2014;53(2):75-86 ciety of Emergency Medicine [cited 2013 Nov 23]. Available from: 27) Kwon TH. The institute development strategy through experience of organization diagnosis. The twelfth academy for executive directors of the member societies. Seoul: Korean Academy of Medical Sciences;2013, p ) Psych.org [homepage on the Internet]. Pursuing wellness across the lifespan. Arlington: American Psychiatric Association [cited 2013 Nov 23]. Available from: 29) Aan.com [homepage on the Internet]. Minneapolis: American Academy Neurology. Available from: 30) Ranzcp.org [homepage on the Internet]. The strategic plan Melbourne: The Royal Australian and New Zealand College of Psychiatrists [cited 2013 Nov 23]. Available from: ranzcp.org. 86

J Korean Neuropsychiatr Assoc 2014;53(2):61-71 보험회사의 합리적 선택은 무엇이게 되는가 그리고 그 합리 성을 넘어설 수 있는 원리는 무엇이어야 하는가 보험을 유지하는 또 다른 요소는 사회적 연대 - 이다 사회적 연대는 합리성과 대척

online ML Comm SPECIAL ISSUE 정신질환자 보험차별의 법적 쟁점과 과제 J Korean Neuropsychiatr Assoc 2014;53(2):61-71 ISSN 1015-4817 www.knpa.or.kr 서울시립대학교 법학전문대학원 신 권 철 A Study on the Legal Issues and Challenges of Insurance