NGOs call on Kyrgyz government to revise mental health care strategy

8/22/06

Non-governmental organizations have called on Kyrgyzstan's government to reconsider its plans to reform the country's mental health care system. NGO representatives worry that the government's intended course of action both heightens the chance of human rights violations and expands opportunities for corruption.

Kyrgyz Health Minister Shailoobek Niyazov was reportedly ready to outline the reform plan during a closed government session on August 17, according to local NGO activists. Under the plan, the government supposedly intends to allocate 15 million Kyrgyz soms (roughly $370,000) to renovate three large-scale mental health facilities – the Republican Mental Health Center in Bishkek, the Republican Psychiatric Hospital in Chim-Korgon and the Republican Psychiatric Hospital in Kyzyl Jar. The money for the projects would be drawn from the country's Central Fund for Poverty Reduction.

While applauding the government's desire to address a long-neglected and pressing public health issue, NGO representatives assert that the money would be better spent on community-based programs. In an attempt to prompt the government to reconsider its plans, several NGOs – including the Open Society Institute, the Netherlands-based Global Initiative on Psychiatry and the Budapest-based Mental Disability Advocacy Center – dispatched letters to various Kyrgyz political leaders, arguing that the focus on large institutions will not produce the best results.

"Attempting to ‘improve' the [large] institutions is not the solution," wrote Judith Klein, the director of the Open Society Mental Health Initiative (OSMHI) in an August 14 letter addressed to Kyrgyz President Kurmanbek Bakiyev. "The empirical evidence shows that outcomes for people with mental disabilities are poor and directly correlated to the size of the facility, with those in small community-based homes having the best outcomes." [Both OSMHI and EurasiaNet operate under the auspices of the Open Society Institute].

Klein argued that the government's preference for large institutions ran against the grain of Kyrgyz cultural tradition. "Historically speaking, the tradition of institutionalizing people with mental disabilities is a relatively new one in the Kyrgyz republic," Klein wrote. "The Kyrgyz nomadic people traditionally included people with mental disabilities in their tribes and in their communities ... Thus, moving forward with the development of community-based alternatives to the institutions will have the effect of reviving the ancient Kyrgyz tradition of socially including all members of society."

Meanwhile, the general secretary of the Global Initiative on Psychiatry, Robert van Voren, wrote in an August 15 letter to Niyazov, the health minister, that a re-orientation would better attract foreign assistance. A plan that stressed community services "could be matched by other donors, thus enlarging the amount of funding that would go into mental health care development," Van Voren wrote. "Such a step would, in other words, considerably increase the effect of your applaudable commitment to the improvement of mental health care in your country."

The Mental Disability Advocacy Center, in an August 16 letter to State Secretary Adakan Madumarov, characterized the Kyrgyz government's stance as anachronistic, saying that officials "continue to invest significant [amounts of] money in morally outdated psychiatric facilities."

Klein and other NGO representatives sought to frame the government's response as a gauge of the country's civil society development. The government's refusal to budge from existing plans would thus constitute both a disappointing and disturbing development. "Institutionalization without justification perpetuates the social exclusion of people with mental disabilities and is in itself a violation of human rights," Klein wrote. "The nature of institutions is, in itself, dehumanizing, and the existence of institutions is anathema to the concept of a civil and open society in which the rights of all citizens are respected."

It is too early to tell whether the coordinated NGO letter-writing campaign had any influence in causing the government to rethink its strategy. Officials have remained tight-lipped on the topic.

One Kyrgyz civil society activist, speaking on background, voiced doubt that the government would alter its plans. The activist went on to express concern that the renovation of large facilities potentially offered a prime opportunity for corrupt officials to siphon off funds and/or construction materials. In any event, the NGO activist continued, it would be difficult to track how the money is spent, due to a lack of transparency in the Central Fund for Reducing Poverty.

Posted August 22, 2006 © Eurasianet