Improvements in mental health care

Mental health patients in Kyrgyzstan are experiencing greater respect for their human rights and better levels of care, according to UN agencies and patient support groups. "Reforms have occurred, though not as fast as we would like. However, there are many positive moves," Anatoliy Zharekhin, head of a patient support organisation at the Republican Mental Health Centre (RMHC), in the capital, Bishkek, told IRIN. Officially, 40,000 people are registered with mental disorders in Kyrgyzstan. Toktobek Mamytov became a patient at the RMHC 10 years ago when he was diagnosed with schizophrenia. Although he now lives at home, periodically he visits the hospital to receive treatment. He has been working to help patients like himself, many of whom have had a negative experience of institutionalised mental health care in the republic. "Compared to when I entered the mental health system, contact between doctor and patient has improved. Some doctors treat patients individually. People are now let out of hospital more often. Patients are not imprisoned as they used to be," Mamytov told IRIN. Mental health care was repressive under the Soviet system. Patients of mental hospitals were seen as society's outcasts, deprived of most human rights, including job opportunities. Patients were obliged to have life-long registration and forced to be treated in mental hospitals on a regular basis. "In the Soviet Union, patients were gathered in large hospitals and isolated from society. Patients became sicker in many cases, rather than healthy people", Burul Makenbaeva, director of an NGO, Mental Health, told IRIN. After the collapse of the Soviet Union, mental health care remained unchanged. Officially, reforms started in 1998 with the adoption of a national reform programme. But international human rights organisations have registered numerous cases of human rights abuses against patients in recent years. Last April, the Budapest-based Mental Disability Advocacy Centre(MDAC) released a report - "Mental Health Law of the Kyrgyz Republic and Its Implementation" - documenting widespread abuses in the national mental health service. But the picture is not all bleak. Part of the reason for the improvement in the RMHC hospital is due to training conducted by the Polish Association of Psychiatrists for Kyrgyz specialists, with financial assistance from the Organization for Security and Cooperation in Europe (OSCE). "The human rights of patients improved after 20 doctors went to Poland for training," noted the director of the RMHC, Suyutbek Nazarkulov. "Those who passed the training became more progressive. They now understand that it is necessary to be more humane and to understand the nature of mental illness better." Trained doctors have taken their new knowledge to all three mental health hospitals in Kyrgyzstan, two in the north and one in the south. Another improvement in the RMHC facility is that patients now have access to friends and relatives as well as information and the opportunity to communicate with the outside world. The Mental Health NGO opened an information self-help and drop-in centre at the central mental health hospital in Bishkek city. Now patients can make phone calls and meet relatives and friends at the centre in a relaxed and supportive environment. This is a new development; in the past such facilities were not permitted. The information centre was opened with help from the Office of the United Nations High Commissioner for Human Rights (UNHCR) based in Geneva and the United Nations Development Programme (UNDP) in Kyrgyzstan as part of the "Assisting Communities Together" (ACT) Project. ACT aims to support local initiatives for the promotion and protection of human rights through grassroots activities carried out by community-based organisations. "We supported this project because it prevents some violations of human rights of one of the most vulnerable groups in Kyrgyzstan: people with mental illness. A lack of knowledge among medical staff and patients often promotes the violation of the human rights of mentally disabled people," Gulmira Mamatkerimova, a UNDP officer, told IRIN. "We also provide legal services. We consider complaints where the state has allegedly violated the rights of a patient. Previously there was no opportunity for making such complaints," social worker and centre manager, Aygul Kyzalaeva, told IRIN. Zharekhin and nine other patients at the RMHC work as volunteers in the new information centre. He believes the new focus on human rights at the hospital has reduced the level of violence at the facility. "Chiefly, torture of patients by medical staff has stopped." But problems remain. Poor nutrition remains a problem for mental health patients. All the patients interviewed by IRIN pointed to poor food as a major issue. "The quality of the meals very much depends on the season of the year. The worst is in winter, when no fruit or vegetables are available," Zharekhin said. "At present, the budgeted sum for daily meals per patient is 46 US cents, and medicine 15 cents, while according to clinic protocols $1.2 and $1.5 should be available in each case," Nazarkulov told IRIN.