EurasiaNet Civil Society - Kyrgyzstan: Exploring Mental Healthcare Alternatives

CIVIL SOCIETY

KYRGYZSTAN: EXPLORING MENTAL HEALTHCARE ALTERNATIVES
Daniel Sershen 11/16/07
Second of a two-part series

For Telegen Abdykaimov, life seemed like one long journey from home to psychiatric hospital and back again. When his schizophrenia became acute, family members inevitably bundled him off to Bishkek’s main mental health facility for a round of intensive treatment, which, he says, left him like a "zombie."

Abdykaimov recalled that during one of his hospitalizations he was restrained so tightly it left him temporarily without feeling below his right knee. "When they would tell me I had to return [to the hospital], I just cried," he said.

Since the spring of 2006, though, Abdykaimov’s schizophrenia has been in remission and he has not been institutionalized. He has also found work: at the same outpatient mental health treatment and rehabilitation program that he says is responsible for his improvement.

Abdykaimov was one of the first patients to benefit from the initiative, said Svetlana Akhmatova, who manages the clinic’s support services. "Our program is focused on rehabilitation," she said. Patients "stay in the hospital three, four, six months, and they lose social skills, and we try to help them reestablish [those] skills."

The program, Akhmatova continued, involves teaching patients how to take care of themselves, avoid conflict and relapse, be active participants in their own treatment, and support each other via self-help groups. [A grantee of the Open Society Institute, Mental Health and Society, runs the rehabilitation program. EurasiaNet operates under OSI’s auspices].

Outside experts and government officials agree that Kyrgyzstan’s mammoth, crumbling mental healthcare system needs radical reform, shifting from a model of long-term hospitalization to services that allow patients to obtain treatment closer to their homes and communities. But some activists, frustrated at the slow pace of reform, are experimenting with their own alternatives to the traditional approach.

Like Abdykaimov, Vitya, who declined to give his last name, was fearful of his regular stays in the psychiatric hospital. "Everyone dreams of being out of there on the second day," he said. "Of course it’s better at home."

Vitya and a handful of other patients now receive residential treatment as part of a joint project between Habitat for Humanity-Kyrgyzstan and the group Family and Society. Under the initiative, Habitat renovates the often run-down homes of the mentally ill, while Family and Society provides regular house calls and support from social workers and psychiatrists. [The project is supported by the Open Society Institute].

"The main goal of this project was to minimize hospitalization," said Indira Aseyin, program development manager with Habitat. "There aren’t any hospitals in the republic where people can get better � they only get worse."

Lilia Panteleyeva, director of Family and Society, said her organization is dedicated to transferring as many institutionalized patients as possible to ambulatory or home-based care. Although not every case could be treated this way, she said, hospitals should be reserved for "crises."

Esenaman Beshkempirov, the country’s chief psychiatrist and deputy director of the Republican Mental Health Center, said he too was pushing to reform the system, but incrementally. "We are planning to cut back, reduce, and re-specialize" the big hospitals, he said, while seeking to "attract" various nongovernmental groups to the process.

But many of those NGOs say the political will to fix the system does not exist. Burul Makenbayeva, executive director of Mental Health and Society, said the government commits to reform only "in words." The current structure � under which three major hospitals receive the bulk of the mental health budget � makes graft easy, she said, whereas a mix of services would reduce the opportunities for corrupt practices.

"To take money in [a less centralized] system, you need agreement with 40 head doctors, and it’s much easier to come to agreement with a few," Makenbayeva said. She criticized the recent allocation of 15 million som (about 430,000 dollars) from the government’s main poverty reduction fund for renovation and reconstruction of the big hospitals. "Most of the money disappear[ed] along the way," she said, because "it’s much easier to skim money from construction."

Keneshbek Usenov, who directs the outpatient clinic that hosts the rehabilitation program, said self-interest made the system resistant to change. Previously the head psychiatrist for Kyrgyzstan’s capital, Bishkek, he said he was pushed out by superiors who did not agree with his goal of establishing mental health departments in each city clinic.

Beshkempirov denied that he and other officials obstructed reform efforts, pointing to a draft reorganization plan he had produced under the aegis of a Ministry of Health working group. "If we had the money, we would come up with completely new approaches," he said. "This structure is not to our advantage."

But Makenbayeva criticized the lack of "transparency and participation" in the official decision making process. She said Beshkempirov’s key role in drafting the reform strategy amounted to a "conflict of interest," since he was deciding the fate of his own institution.

Beshkempirov said the working group was kept small for reasons of efficiency. "The bigger a working group, the harder it is to get work done," he said. Moreover, he added, he gave his critics a chance to comment on the completed plan, but they refused. "I gave this plan to four different NGOs working in the sphere of mental health, and they did nothing," he said.

Usenov said those groups should have been included from the very start. "There should be an independent commission, which is not subservient to the Ministry of Health," he said. "The system that was created is very hard to break."

Editor�s Note: Daniel Sershen is a freelance journalist based in Bishkek.

The Central Eurasia Project aims, through its website, meetings, papers, and grants, to foster a more informed debate about the social, political and economic developments of the Caucasus and Central Asia. It is a program of the Open Society Institute-New York. The Open Society Institute-New York is a private operating and grantmaking foundation that promotes the development of open societies around the world by supporting educational, social, and legal reform, and by encouraging alternative approaches to complex and controversial issues.

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