Focus on mental health in the south

Health authorities in southern Kyrgyzstan are concerned that mental illness is becoming more common. Official statistics indicate that the number of mentally ill people in the southern Osh province alone has risen almost 20 percent over last year. Nearly 7,000 more people went to a doctor with a stated mental condition in 2002 compared to 2001, while, law enforcement agencies say a rise in certain categories of crime is related to an increase in psychiatric disorders. "The demon has got into me," a businessman in Osh, which had killed his wife, two neighbours and injured three people, recently told police following his arrest. Some health specialist have noted that more and more young people with obvious signs of mental disorder were on the streets of Kyrgyz towns and villages and that the number of suicides was growing. One young woman ended her own life last month by setting fire to herself in public in the city of Osh. But as is often the case, official figures only tell part of the story. The Osh provincial centre for mental health said that the real number of people in need of psychiatric help was many times higher. This is partly because under Kyrgyz law, psychiatric patients are only registered if they apply personally or referred by relatives. The stigma surrounding mental problems is also a big deterrent against people coming forward and declaring themselves in need of mental care. Paul Cutler, a programme manager at Hamlet Trust, a UK-based NGO supporting the development of community-based mental health care in Central Asia, told IRIN from London that the picture in the former Soviet republics gave cause for concern. "The situation for people with mental health problems in Kyrgyzstan is one of great hardship and difficulty," he said, adding that mental health attracted great stigma, which isolated people from their communities. Lack of services and support for those affected directly, along with their families and carers were also growing problems, he added. Some local specialists argue the rise in mental illness in Kyrgyzstan is primarily due to poverty, exacerbated by social problems in the more densely populated parts of southern Kyrgyzstan. Sadykjan Makhmudov of 'Luch Solomona', a local NGO, told IRIN that many people simply couldn't endure the economic hardships and social uncertainty associated with the transition from communism to a market economy. But the link between increased levels of mental illness and more crime is tenuous at best, health officials argue. "Life difficulties can cause psychic disorders, like neurosis, anxiety and depression, but such condition cannot be a cause of committing grave crimes," Guljan Ismailova, the deputy head of the provincial mental health centre, told IRIN in Osh. She was clear though that more mentally ill people were ending up in the arms of the law because so many nowadays were being left unattended and without access to psychotropic medicines that could control their conditions and help them live normal lives. "The majority of my patients are simply persons that are not understood by people surrounding them," Aisalkyn Sazanbayeva, a parapsychologist and the head of the local NGO 'Omur bulagy - Osh', told IRIN in Osh, adding that if they were not given help in time, society could lose them. She also said that more than 600 people applied to her this year complaining of various mental disorders forecasting that the number of such patients would grow in the forthcoming years. "During the Soviet times such patients were provided with continuous medical care - both at hospital and at home," Ismailova explained. "It is impossible to provide such care now - there is not sufficient funding and moreover, the attitude to the organisation of psychiatric care has changed." She added that such care was no longer a priority due to limited resources for health care generally. Another challenge to accepted wisdom on treating mental conditions was coming from an unexpected quarter, some professionals said. Some told IRIN that clairvoyants, psychics and traditional healers were filling the void left by inadequate conventional care. Doctors said that some of these quacks were making fortunes out of people in trouble without providing any practical help. Commenting on the scope of the problem, Abdykerim Temirberdiev, a medical doctor in Osh, highlighted the fact that psychiatric hospitals were badly under funded. According to official data the Kyrgyz state spends just US $0.30 per mental patient per day and just half that amount on drugs. For the shortfall, international aid is the only answer. But such assistance is patchy and depends on the whims of donor organisations. Two years ago pharmaceuticals worth some US $18,000 were given as humanitarian aid to the Osh region, but last year there was no aid at all. This year there was aid worth some US $1,500, Abdykar Maksymbekov, the head of the Osh mental health centre, noted. Equipment is antiquated as there has been no new supply of items like tables, chairs and bed-side tables for almost 20 years. An official report, 'Activities of the Osh province psychiatric service in years 2001-2002' stated that "due to such funding, patients at the in-patient section can't get proper treatment, they leave hospitals early and the ratio of patients with re-occurring illnesses grows from year to year". Last year that ratio stood at more than 65 percent. The same situation was observed in almost all psycho-neurological hospitals around the country, health officials said. For example, at the provincial psycho-neurological hospital in neighbouring Jalal-Abad province a lack of security at the coercive treatment unit has led to many dangerous patients being let loose in surrounding communities with a consequent increase in crime. In addition, it is difficult to get a specialist from the capital Bishkek for counselling and proper patient assessment there is no money for travel or duty station allowances. "Mental health services [in the country] are scarce and poorly funded and still located in the large, decaying psychiatric hospitals which are a legacy of the Soviet era," Cutler of Hamlet Trust added. Local medical staff said that their colleagues in the Chim-Korgon psychiatric hospital located near the Kyrgyz capital Bishkek were better off as that institution had a higher profile and received international assistance, while Jalal-Abad psycho-neurological hospital, located amidst mountains in the vicinity of former uranium mines, was, like many other places, a forgotten institution. Jahangir Omurzakov, the head of the Jalal-Abad provincial central hospital said that there needed to be better funding for provincial mental care and that psychiatric hospitals should be located close to provincial centres to be more convenient for patients, their relatives and health personnel. Bermet Makenbayeva, the head of local NGO 'Mental Health and Society', working to protect the rights of mental patients, told IRIN that human rights abuses were common in forgotten mental institutions in Kyrgyzstan. "Unfortunately, the rights of people suffering from mental diseases and their relatives are being abused by some state bodies, some medical staff and ordinary citizens," she said. Many patients who had survived this experience of mental hospitals reported human rights abuses (including physical and sexual abuse), hunger, isolation from friends and family, and a lack of support to assist them in their recovery, Cutler noted. Makenbaeva's NGO organises free legal assistance, establishes self-help groups, provides psychologists and psychotherapists in an effort to protect the people, suffering from psychiatric disorders. Staff from the NGO told IRIN that every day, at least, one to two people were coming into their office seeking help. The NGO advocates establishing rehabilitation centres for mentally ill people. "It is important [to ensure that] there is a place where they can sit, talk, engage in heart-to-heart conversation and feel they are needed," Makenbaeva said. Bishkek said it is taking the issue seriously. A national programme on improving the population's mental health was adopted two years ago in an effort to address the issue that some say is becoming a national disgrace. Valeri Solojenkin, the president of the Kyrgyz Psychiatric Association (KPA), said that the programme was trying to change society's attitude to mental illness. A key component of the programme is to train doctors to correctly identify conditions like depression, anxiety, neurotic disorders, epilepsy, mental deficiencies, alcoholic and drug dependency. The programme's next step would be the creation of one to two crisis rooms at all district hospitals, where treatment of mental conditions would be shorter and cheaper compared to full capacity facilities. Moreover, it is planned to establish smaller hospitals with out-patient facilities as is the practice in many other countries. Experts also urged health authorities to broaden specialised services, like child psychotherapy and facilities to study suicide cases. But all these measures will cost a huge sum of money to implement, money poverty-stricken Kyrgyzstan does not have. Bishkek is hoping international lending institutions like the World Bank or Asian Development Bank (ADB) will be able to assist.