Many countries, including Kazakhstan, struggle to accept mental well-being as part of a person’s overall health. Many often view mental health disorders with suspicion, and those suffering can become outcasts from their communities and society. Changing the view of mental health in Kazakhstan is difficult, but more important than ever.
In partnership with international organizations, the government of Kazakhstan is fighting to make that change and ensure that mental health treatment is more easily available to everyone. Addressing mental health is critical to addressing poverty as each social crisis feeds and strengthens the other. An article that two psychologists published in the BJ Psych Bulletin emphasizes this connection. “We highlight how mental health problems are related directly to poverty, which in turn underlies wider health inequalities,” authors Lee Knifton and Greig Inglis say.
Imperialism and Mental Health Impacts
The way that some have addressed mental health historically is partly due to long-standing beliefs about mental health — some recognized mental health disorders as a problem in traditional religious practices, where people often attributed suffering to demons or evil spirits. There is also Kazakhstan’s experience with foreign rule. Both Imperial Russia and the Soviet Union actively worked to delegitimize traditional folk religions and healing practices, and import new forms of health care.
“The Kazakh shaman’s figure epitomized the wildness and backwardness of the native population. His healing methods were usually presented as ‘tricks’, ineffective and harmful,” one researcher, anthropologist Danuta Penkala-Gaweka, reported in the journal Central Asian Survey. These beliefs were central to Kazakh cultural identity. Ultimately, this suppression led to a backlash. Practices that some associated with former imperial powers were often regarded with suspicion. This included clinical mental health counseling and psychiatric services. In part due to the stigma, accessing services became increasingly difficult.
Difficulty in access, poorly trained practitioners and social stigma left many sufferers without treatment. Unfortunately, while it is difficult to quantify, the number of people needing support was growing. The Guardian reported the mental health impact of a falling economy, particularly on men. “Psychologists say the economic downturn has proven particularly traumatic for men who are under significant pressure to provide for their families in what is still a heavily patriarchal society,” according to the Guardian. One woman she interviewed said “Our men are embarrassed to talk about problems. While for a [Kazakh] woman the problem is avoiding being abandoned by her husband, for a man the problem is how to support his family.”
In an interview with the World Health Organization (WHO), Dr. Nikolay Negev, a mental health consultant with the organization, explains the real consequences of untreated mental health problems and stigma: “We had several cases where we weren’t allowed to assist or treat, and a patient would die by suicide.” Even those who wanted treatment had difficulty getting it. A report that the Mental Health Atlas 2020 published put the impact into real numbers. According to the United Nations, there are 18,551,428 people living in Kazakhstan. For every 100,000 citizens, there are only 24.13 mental health professionals available. Only 2.86 of those professionals specialized in treating children or adolescents. The numbers look dire, but recent developments point to a real cause for hope.
Despite their low numbers, mental health professionals in Kazakhstan are working hard at overcoming the suspicion associated with treatment. After the government partnered with UNICEF and other international organizations to create the AMHSP, or Adolescent Mental Health Promotion and Suicide Prevention Programme, there was a considerable drop in mental health problems among the youth the program reached. “[After the program was introduced, there was a] 36.1% decrease in suicidal ideation among young people, 80.6% decrease in anxiety, 56.1% decrease in depression and 65 per cent decrease in stress,” UNICEF reported in 2021.
The Kazakh government enthusiastically welcomed AMHSP’s success, which increased its funding by 25%. One report emphasized the vicious cycle here but also highlighted reasons for hope. “People are ashamed of going to a psychiatrist, counsellor [sic] or psychologist. But compared to the situation 20 years ago, we can see some changes. Most of the people who understand and want to change resort to them,” one therapist said. She did see room for continued growth, including better education for mental health professionals. “At the same time, I think, too many cases of schizophrenia are diagnosed. I meet patients with dementia regularly, and they have been diagnosed with schizophrenia.”
The fight for access to and treatment for mental health disorders is an ongoing and worldwide challenge. Kazakhstan’s success, however, is a bright light for advocates worldwide. Change can happen, and with continued support, it can flourish.
– Clara Martin