Closing the mental health treatment gap in Central Asia

WHO

Countries in central Asia, including Kazakhstan, Kyrgyzstan, Turkmenistan and Uzbekistan are embarking on fundamental mental health system reforms to improve the treatment of mental health conditions for their population. This marks a major a shift in attitude and treatment of mental health conditions in this part of the WHO European Region.

Responding to high levels of self-harm, suicide and substance abuse

Over 100 million people in the European Region are suffering from some form of mental illness, and in the Region’s richest countries only about 30% are receiving the medical attention they require. In the poorest countries, the numbers drop to less than 5%.

“Virtually all of us know someone who has had a mental health problem, but at the same time, so few people get the help they need,” said Professor Sir Graham Thornicroft, King’s College London, who was attending the WHO European High-level Conference on Noncommunicable Diseases in Ashgabat, Turkmenistan.

Central Asia has relatively high levels of self-harm, suicide and substance abuse, but systems of care rely heavily on specialized services based in traditional hospital or institutional settings.

Many people with mental health problems choose not to engage or to maintain contact with services because they feel stigmatized and discriminated against. Negative treatment and care experiences can be another factor contributing to the delay for many people in seeking care.

Accordingly, mental health policies and programmes need to combine structural reform of services with a focus on quality, ensuring the delivery of safe, effective and acceptable treatments by a competent workforce.

Mental Health Gap Action Programme: making care more accessible

For many years, WHO has been trying to shift the balance of care away from institutional and hospital-based care settings to a more community-based model that is more accessible and less stigmatized through its flagship Mental Health Gap Action Programme (mhGAP). mhGAP is designed to make care more accessible for people with a range of mental, neurological and substance use disorders, with services available close to where people live to support this vision. WHO has produced the mhGAP Intervention Guide, a clinical tool for use by non-specialists in everyday clinical practice.

“We have been delighted to receive a series of requests within the last year from central Asian countries for mhGAP training and programme implementation, and have been able to respond through a succession of national planning, adaption and capacity-building workshops, the latest of which is taking place this week in Almaty, Kazakhstan. This signifies a really encouraging change of attitude and heart by governments across the subregion,” said Dr Dan Chisholm, Programme Manager for Mental Health at WHO/Europe.

The mhGAP programme asserts that with proper care, psychosocial assistance and medication, tens of millions of people could be treated for a range of mental disorders, including depression and schizophrenia, and also prevented from death by suicide, so that they can lead healthy lives – even in areas where resources are scarce.

“Countries in eastern Europe and central Asia have a growing number of primary care physicians, and the idea is that primary health providers should be the first line of defence for mental illness in order to help reduce the mental health gap in treatment,” said Dr Nino Makhashvili, Head of the Mental Health Resource Centre at Ilia State University in Tbilisi, Georgia and a WHO consultant providing hands-on training and support to the countries.

Other opportunities for more integrated planning and programming include mental health awareness and literacy programmes in schools and workplaces, which are designed to make it easier for people to make informed medical decisions.

“The main focus of mental health throughout parts of eastern Europe and central Asia has for a long time been based on overburdened psychological support and pharmacological therapy. But this is changing and greater emphasis is being placed on primary care and community-based services,” said Dr Makhashvili.

Adopting a holistic approach to mental health with other noncommunicable diseases

As highlighted during the recent WHO European High-level Conference on Noncommunicable Diseases, a high degree of comorbidity exists between mental health conditions, such as depression, and other noncommunicable diseases (NCDs), including cardiovascular disease, diabetes and alcohol-use disorders.

“Primary health care nurses and doctors have to keep in mind that if they are talking with someone with an NCD, that person is also more likely to be depressed. If we consider all of the people who have a mental illness, such people on average die 10 years younger than the rest of the population. When it comes to people with severe mental illness, such as psychosis or bipolar disorder, they sometimes die 20 years earlier,” said Professor Thornicroft.

Since mental health conditions and NCDs place similar demands on health workers and health systems, an integrated approach to organizing care and managing these conditions is needed to improve efficiency.

“We now have practical tools, so it’s time for countries to invest and to implement better mental health care,” said Professor Thornicroft.