Recommendations for Mental Health Reforms in Uzbekistan: A Policy Report

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Akmal Alikhan Aliev
Tatiana Taylor Salisbury

Аннотация

Introduction: There are large differences in the development of mental health systems of the West and the countries of the former Eastern Bloc. The latter is characterized by a more biological approach to mental health and reliance on psychiatric hospitals. In 2018, Uzbekistan authorities showed interest in reforming mental health care of the country. The policy report provides an overview of progress towards the provision of community mental health (CMH) care across Eastern Europe and recommendations for this transition within Uzbekistan.

Methods: A literature search on mental health care in Uzbekistan was conducted to understand its strengths and weaknesses. Progress towards the provision of CMH care across Eastern Europe was assessed using data on the number of psychiatric beds and availability of mental health services in community settings reported within the published literature. Countries identified as making the greatest progress towards CMH care were reviewed in detail to better understand the process of reform assets and barriers.

Results: Mental health care in Uzbekistan is highly institutionalized, underfunded and understaffed. Social care services are poorly developed. However, current leadership has kindled the promise of mental health reform. Georgia, Lithuania and Poland have made the most progress in terms of CMH care availability. However, due to various obstacles such as dual financial burden, high stigma and lack of political will, their programs lack social integration and/or uniform availability and underfunding along with scarcity of mental health specialists are common. On the other hand, research and evaluation, involvement of service users into service planning and cooperation with donors facilitated reform implementation.

Conclusion: Uzbekistan may develop into a modern mental health system and avoid the setbacks encountered by other countries in the region, through careful financial planning, stigma reduction, improving mental health literacy, human resources strategic development and civil society engagement.

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Как цитировать
Aliev, A. A., & Salisbury, T. T. (2020). Recommendations for Mental Health Reforms in Uzbekistan: A Policy Report. Central Asian Journal of Global Health, 9(1). https://doi.org/10.5195/cajgh.2020.513
Раздел
Reviews

Библиографические ссылки

UN. United Nations regional groups of member states. Accessed February 02, 2019. http://www.un.org/depts/DGUzaUACM/RegionalGroups.shtml

Knapp M, McGrother C, Haverman MJ. Balance of care (deinstitutionalisation in Europe). Results from the Mental Health Econonomics European Network MHEEN. Int J Integr Care. 2009;9.

Koyanagi C. Learning from History: Deinstitutionalization of People with Mental Illness as Precursor to Long-Term Care Reform. Henry J. Kaiser Family Foundation; 2007.

Parker C. Developing mental health policy: a human rights perspective1. Ment Health Policy Pract Eur. Published online 2006:308.

Freeman M, Pathare S. WHO Resource Book on Mental Health, Human Rights and Legislation. World Health Organization; 2005.

Bachrach LL. Deinstitutionalization: An analytical review and sociological perspective. Published online 1976.

Tomov T, Van Voren R, Keukens R, Puras D. Mental health policy in former eastern bloc countries. Ment Health Policy Pract Eur Future Dir Ment Health Care. Published online 2006:397–426.

Salisbury TT, Killaspy H, King M. An international comparison of the deinstitutionalisation of mental health care: Development and findings of the Mental Health Services Deinstitutionalisation Measure (MENDit). BMC Psychiatry. 2016;16(1):54.

Krupchanka D, Winkler P. State of mental healthcare systems in Eastern Europe: do we really understand what is going on? BJPsych Int. 2016;13(4):96–99.

The World Bank. The World Bank in Uzbekistan.; 2017. Accessed February 03, 2019. https://www.worldbank.org/en/country/uzbekistan/overview

Mundt A, Heinz A, Ströhle A. Uzbekistan: psychiatry in transition. Eur Psychiatry. 2009;24(8):526–528.

Postanovleniye Prezidenta Respubliki Uzbekistan o Merakh Po Korennomu Sovershenstvovaniyu Psikhiatricheskoy Pomoshchi [Decree of the President of the Republic of Uzbekistan on Measures for Fundamental Improvement of Psychiatric Care]; 2018. Accessed February 02, 2019 http://lex.uz/ru/docs/3588132

Thornicroft G, Alem A, Drake RE, et al. Community Mental Health: Putting Policy into Practice Globally. Vol 29. John Wiley & Sons; 2011.

Winkler P, Krupchanka D, Roberts T, et al. A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry. 2017;4(8):634–642.

Gustavsson A, Svensson M, Jacobi F, et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21(10):718-779. doi:10.1016/j.euroneuro.2011.08.008

World Health Organisation. Atlas: Country Profiles of Mental Health Resources 2001. Geneva; 2001.

World Health Organisation. Mental Health Atlas; 2011.

World Health Organisation. Mental Health Atlas 2014.

World Health Organisation. Mental Health Atlas 2005.

Winkler P, Krupchanka D, Roberts T, et al. Appendix. A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry. 2017;4(8):634–642.

Zakon Respubliki Uzbekistan o psikhiatricheskoy pomoshchi [Law of the Republic of Uzbekistan on Psychiatric Care]. 2000. Accessed August 15, 2018. http://lex.uz/ru/docs/14460

O vnesenii izmeneniy i dopolneniy v zakon Respubliki Uzbekistan o psikhiatricheskoy pomoshchi [On the Amendments to the Law of the Republic of Uzbekistan on Psychiatric Care]. Published online July 26, 2018. Accessed August 15, 2018. http://minzdrav.uz/documentation/discussion.php?ID=55101

World Health Organisation. WHO-AIMS Report on Mental Health System in Uzbekistan.; 2007.

Kurbanova SM, Harabara GI. About the measures taken to improve the mental health service in the Republic of Uzbekistan for 2013-2016. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(5):114.

Kharabara G, Khodjaeva N. State of mental health care in the Republic of Uzbekistan. In: Routledge Handbook of Psychiatry in Asia. Routledge; 2015:49–54.

Ahmedov M, Azimov R, Mutalova Z, Huseynov S, Tsoyi E, Rechel B. Uzbekistan: health system review. Health Syst Transit. 2014;16(5):1-137, xiii.

Mundt AP, Fakhriddinov S, Fayzirahmanova M, et al. Use of psychiatric inpatient capacities and diagnostic practice in Tashkent/Uzbekistan as compared to Berlin/Germany. Soc Psychiatry Psychiatr Epidemiol. 2011;46(12):1295–1302.

Gazizova D, Mazgutov A, Kharabara G, Tsoyi E. Mental health in Uzbekistan. Int Psychiatry. 2011;8(1):10-11. doi:10.1192/S1749367600006160

Yеshimbetova S, Chembaev B. Clinical and Sociocultural Characteristics of Individuals with Schizophrenia Who Commited Serious Assualtive Acts in Uzbekistan. Eur Med Health Pharm J. 2014;7(2).

Puzynski S, Moskalewicz J. Evolution of the mental health care system in Poland. Acta Psychiatr Scand. 2001;104:69–73.

Puras D, Germanavicius A, Povilaitis R, Veniute M, Jasilionis D. Lithuania mental health country profile. Int Rev Psychiatry. 2004;16(1-2):117–125.

Puras D. Lithuania, in International Perspectives on Mental Health. In: H. Ghodse, ed. International Perspectives on Mental Health. Royal College of Psychiatrists: Cambridge; 2011:343-347.

Puras. Evidence-Based Mental Health Policy in Lithuania. Mental Health Reforms . 11(1-2): 5-7. 2011;(11(1-2)):5-7.

Bomba J. Poland, in International Perspectives on Mental Health. In: Ghodse H, ed. International Perspectives on Mental Health. Royal College of Psychiatrists: Cambridge; :363-347.

Makhashvili N, van Voren R. Balancing community and hospital care: a case study of reforming mental health services in Georgia. PLoS Med. 2013;10(1):e1001366.

Zavradashvili N, Donisi V, Grigoletti L, et al. Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia. Soc Psychiatry Psychiatr Epidemiol. 2010;45(8):779–783.

Ombudsman of Georgia. Report on the Monitoring of Mental Health Institutions.; 2015.

Smith KE, Katikireddi SV. A glossary of theories for understanding policymaking. J Epidemiol Community Health. 2013;67(2):198–202.

Petrea I. Mental Health in Former Soviet Countries:From Past Legacies to Modern Practices. Public Health Rev. 2012;34(2):1-21. doi:10.1007/BF03391673

World Health Organisation | The WHO mental health policy and service guidance package. WHO. Accessed May 31, 2020. http://www.who.int/mental_health/policy/essentialpackage1/en/

Thornicroft G, Mehta N, Brohan E, Kassam A. Stigma and discrimination. Princ Soc Psychiatry. Published online 2010:331.

Almeida HW, Mahoney J. 13 Mental Health Policy Development and Implementation. Glob Ment Health Princ Pract. Published online 2013:190.

Martini M. Overview of Corruption and Anti-Corruption: Uzbekistan. Transparency International; 2015. Accessed February 11, 2019. https://www.transparency.org/files/content/corruptionqas/Country_profile_Uzbekistan_2015.pdf

Ulikpan A, Mirzoev T, Jimenez E, Malik A, Hill PS. Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes? Glob Health Action. 2014;7(1):24978.

Abramson DM. A critical look at NGOs and civil society as means to an end in Uzbekistan. Hum Organ. Published online 1999:240–250.

Swarbrick M. Expertise from Experience: Mental Health Recovery and Wellness. In Eds. Graham, G., Thornicroft, G., Szmukler, G. Mueser, KT., & Drake, RE. Oxford Textbook of Community Mental Health. Oxford Univresity Press. In: ; 2011.

Kakuma R, Minas H, Dal Poz MR. 10 Strategies for Strengthening Human Resources for Mental Health. Glob Ment Health Princ Pract. Published online 2013:104.

Nortje G, Oladeji B, Gureje O, Seedat S. Effectiveness of traditional healers in treating mental disorders: a systematic review. Lancet Psychiatry. 2016;3(2):154–170.