Akmal-Alikhan Aliev1, Tessa Roberts2,3, Shakhnoza Magzumova4, Liliia Panteleeva5, Saida Yeshimbetova6, Dzmitry Krupchanka7, Norman Sartorius8, Graham Thornicroft9, Petr Winkler10,11. 1. Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 256 01, Klecany, Czech Republic. 2. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 3. Centre for Society and Mental Health, King's College London, London, UK. 4. Department of Psychiatry and Narcology, Tashkent Medical Academy, Tashkent, Uzbekistan. 5. Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University Named After B. N. Yeltsin, Bishkek, Chuy Province, Kyrgyzstan. 6. Department of Psychiatry, Narcology and Neurology, Kazakh-Russian Medical University, Almaty, Kazakhstan. 7. Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland. 8. Association for the Improvement of Mental Health Programmes, CH, Geneva, Switzerland. 9. Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 10. Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 256 01, Klecany, Czech Republic. petr.winkler@nudz.cz. 11. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. petr.winkler@nudz.cz.
Abstract
PURPOSE: We aimed to map evidence on the development of mental health care in Central Asia after 1991. METHOD: We conducted a scoping review complemented by an expert review. We searched five databases for peer-reviewed journal articles and conducted grey literature searching. The reference lists of included articles were screened for additional relevant publications. RESULTS: We included 53 articles (Kazakhstan: 13, Kyrgyzstan: 14, Tajikistan: 10, Uzbekistan: 9, Turkmenistan: 2, Multinational: 5). Only 9 were published in internationally recognised journals. In the 1990's mental health services collapsed following a sharp decline in funding, and historically popular folk services re-emerged as an alternative. Currently, modernised mental health policies exist but remain largely unimplemented due to lack of investment and low prioritisation by governments. Psychiatric treatment is still concentrated in hospitals, and community-based and psycho-social services are almost entirely unavailable. Stigma is reportedly high throughout the region, psychiatric myths are widespread, and societal awareness of human rights is low. With the exception of Kyrgyzstan, user involvement is virtually absent. After many years of stagnation, however, political interest in mental health is beginning to show, along with some promising service developments. CONCLUSIONS: There is a substantial knowledge gap in the region. Informed decision-making and collaboration with stakeholders is necessary to facilitate future reform implementation.
PURPOSE: We aimed to map evidence on the development of mental health care in Central Asia after 1991. METHOD: We conducted a scoping review complemented by an expert review. We searched five databases for peer-reviewed journal articles and conducted grey literature searching. The reference lists of included articles were screened for additional relevant publications. RESULTS: We included 53 articles (Kazakhstan: 13, Kyrgyzstan: 14, Tajikistan: 10, Uzbekistan: 9, Turkmenistan: 2, Multinational: 5). Only 9 were published in internationally recognised journals. In the 1990's mental health services collapsed following a sharp decline in funding, and historically popular folk services re-emerged as an alternative. Currently, modernised mental health policies exist but remain largely unimplemented due to lack of investment and low prioritisation by governments. Psychiatric treatment is still concentrated in hospitals, and community-based and psycho-social services are almost entirely unavailable. Stigma is reportedly high throughout the region, psychiatric myths are widespread, and societal awareness of human rights is low. With the exception of Kyrgyzstan, user involvement is virtually absent. After many years of stagnation, however, political interest in mental health is beginning to show, along with some promising service developments. CONCLUSIONS: There is a substantial knowledge gap in the region. Informed decision-making and collaboration with stakeholders is necessary to facilitate future reform implementation.
Authors: Anders Gustavsson; Mikael Svensson; Frank Jacobi; Christer Allgulander; Jordi Alonso; Ettore Beghi; Richard Dodel; Mattias Ekman; Carlo Faravelli; Laura Fratiglioni; Brenda Gannon; David Hilton Jones; Poul Jennum; Albena Jordanova; Linus Jönsson; Korinna Karampampa; Martin Knapp; Gisela Kobelt; Tobias Kurth; Roselind Lieb; Mattias Linde; Christina Ljungcrantz; Andreas Maercker; Beatrice Melin; Massimo Moscarelli; Amir Musayev; Fiona Norwood; Martin Preisig; Maura Pugliatti; Juergen Rehm; Luis Salvador-Carulla; Brigitte Schlehofer; Roland Simon; Hans-Christoph Steinhausen; Lars Jacob Stovner; Jean-Michel Vallat; Peter Van den Bergh; Peter Van den Bergh; Jim van Os; Pieter Vos; Weili Xu; Hans-Ulrich Wittchen; Bengt Jönsson; Jes Olesen Journal: Eur Neuropsychopharmacol Date: 2011-09-15 Impact factor: 4.600