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Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia

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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.

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Acknowledgments

The study was supported by the project “Sustainability for the National Institute of Mental Health” (Grant LO1611), with a financial support from the Ministry of Education, Youth and Sports of the Czech Republic. GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust, and by the NIHR Asset Global Health Unit award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. GT also receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (Cobalt study). GT is supported by the UK Medical Research Council in relation the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. TR is funded by an ESRC fellowship (ES/T007125/1). We would like to acknowledge everyone who contributed to this study by expressing their valuable opinions with regard to the countries where they work: Natalia Raspopova, Bakhyt Tumenova (Kazakhstan); Sandjar Akhmedov, Zarif Ashurov, (Uzbekistan). We are grateful to the Ministry of Foreign Affairs of Turkmenistan for their cooperation. We express our gratitude to Roza Userbaeva who conducted grey literature review in Uzbekistan. We also thank those who wished to stay anonymous. DK is a staff members of the World Health Organization (WHO). The authors alone are responsible for the views expressed in this paper and they do not necessarily represent the decisions or policies of the WHO.

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Authors and Affiliations

  1. Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 256 01, Klecany, Czech Republic

    Akmal-Alikhan Aliev & Petr Winkler

  2. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Tessa Roberts & Petr Winkler

  3. Centre for Society and Mental Health, King’s College London, London, UK

    Tessa Roberts

  4. Department of Psychiatry and Narcology, Tashkent Medical Academy, Tashkent, Uzbekistan

    Shakhnoza Magzumova

  5. Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University Named After B. N. Yeltsin, Bishkek, Chuy Province, Kyrgyzstan

    Liliia Panteleeva

  6. Department of Psychiatry, Narcology and Neurology, Kazakh-Russian Medical University, Almaty, Kazakhstan

    Saida Yeshimbetova

  7. Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland

    Dzmitry Krupchanka

  8. Association for the Improvement of Mental Health Programmes, CH, Geneva, Switzerland

    Norman Sartorius

  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

    Graham Thornicroft

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  1. Akmal-Alikhan Aliev
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Aliev, AA., Roberts, T., Magzumova, S. et al. Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia. Soc Psychiatry Psychiatr Epidemiol 56, 1329–1340 (2021). https://doi.org/10.1007/s00127-021-02064-2

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