The complex socio-cultural features of Latin peoples throughout the Americas represent a potent challenge to health care planning. Attempting to meet this challenge requires consideration of the suitability of diagnostic systems as key clinical and public health tools, as well as exploration of promising ways for improving them.

Growths in communication technologies, voluntary travel, and forced migration are fostering reciprocal awareness and a sense of interdependence among people from distant parts of the world. In line with these, there is increasing interest in health status and illness conditions across different geographical and cultural regions. Adequate identification of health problems in each region serves not only to enhance planning of treatment and preventive activities for both individuals and communities, but also may point out types of pathology that would require greater attention in diagnostic systems intended for wide international use, such as the prospective 10th Revision of the International Classification of Diseases (ICD) (Sartorius, 1988).

The proliferation of large-scale organisations is a phenomenon of modern society. As Etzioni (1968) puts it, “We are born in organisations, educated by organisations and most of us spend much of our lives working for organisations”. Most public organisations in modern society are bureaucracies and the field of psychiatry is no exception: a trend toward growing bureaucratisation, of both public and private mental health services organisations, can be observed everywhere. To a large extent, this is because, as standards of care become regulated and quality controls increase, the tasks that mental health professionals and administrators perform become better understood, more predictable, and more programmed. There is still room for creativity and innovation, but only in incremental, well controlled steps.