Care and Community

Mental Health Services in the Kyrgyz Republic

A Country Report

Picture by kind permission of Gennadiy Klementiev, Bishkek

June 2005
Olga & Andriy Vasylchenko

© InterMinds
PO Box 23121, Edinburgh EH6 4YL Scotland
Tel. 00 44 131 467 0117
Email: InterMindsPK@aol.com

Scottish Charity Number SC 025132

 CONTENTS

Acknowledgements 3
Introduction 4

PART 1
MENTAL HEALTH SERVICES IN KYRGYZSTAN

Overview 7
Non Governmental Organisations in Mental Health
International Organisations 10
National and Local Organisations 11
Human Rights in Psychiatric Facilities
Monitoring by YHRG and MHS 13
Monitoring by MDAC 14
Visiting the Institutions
Republican Mental Health Centre 16
Ward 12 of the RMHC 17
Chym-Korgon Mental Hospital 18
Iskra Social Care Institution 19

PART 2
KYRGYZSTAN TODAY

Geography 22
History 23
The People 25
Culture 26
Politics and Society 27
The Economy 28
2
CONCLUSIONS
A Potential Role for InterMinds 32

ANNEXES
Schedule of Visits and Meetings 34
Persons and Organisations 36
Excerpt from “Law of Kyrgyz Republic: On psychiatric care and
guaranteeing the rights of persons receiving such care” (1999) 38
Information for the Collegium Meeting
“On State of the Mental Health Service” (Excerpt) 40
Materials of the 13th Local Policy Forum 42
Joint Press Release by the Mental Disability Advocacy Centre
and Kyrgyz NGO “Mental Health and Society” of 16 February 2005 43
Principal References 45

3
 ACKNOWLEDGEMENTS

Many people and organisations have contributed to this report in a variety of ways. We
owe our deepest thanks to Burul Makenbaeva and all colleagues from Mental Health
and Society: Without their comprehensive introduction to mental health problems in
Kyrgyzstan our visit would hardly have achieved its aims. We wish to express our
gratitude to the Ministry of Health of Kyrgyzstan, who gave us better understanding of
the national picture. Thanks also go to the Republican Mental Health Centre, Chym-
Korgon mental health hospital, Iskra social care institution, and all the other
organisations we visited in Kyrgyzstan.
We owe our profound thanks to all people directly involved in mental health services
whom we had a chance to meet and whose knowledge and experiences we had the
privilege to share.
In writing this report we also gathered information from a wide range of written sources
and are grateful to all the authors of books, reports and articles on Kyrgyzstan to which
we had access. The principal sources of information are listed at the end of the report.

4
 INTRODUCTION

InterMinds is a Scottish mental health charity working internationally in partnership with

local organisations to help people with mental health problems live ordinary lives within
communities where human and social rights are respected. Peter Kampman, the
Director of InterMinds, was the head of our mission in Kyrgyzstan. It was of great benefit
that we had a chance to learn from Peter’s abundant international experience in mental
health and to discuss with him our impressions straight away as they were being
shaped. The main purpose of InterMinds’ visit was to find out the opportunities and
limitations within the Kyrgyz mental health situation in order to develop, in close
collaboration with our Kyrgyz partner NGO1 Mental Health and Society, a preliminary
vision of priorities for a potential IBPP2 project.
Kyrgyzstan is a lively and constantly developing society in which the role of NGOs
should not be underestimated. Erkinbek Kasybekov, the head of the Kyrgyz branch of
the NGO Counterpart International. states:"[In Kyrgyzstan] it’s already maybe 10 years
of intensive NGO development and we see now very well advanced NGOs dealing with
very sophisticated works”.
NGOs provide a space for civil initiatives to be pursued and a forum for discussions, as
well as enabling projects that would otherwise not be supported by state organisations.
NGOs may challenge state organisations by monitoring their policies, disseminating
information and encouraging political participation. Many NGOs in the country are
united in the coalition ‘For Democracy and Civil Society’ – an organisation that
consistently stands up for civic rights and freedom of speech during election campaigns.
Our visit to Kyrgyzstan took place at the beginning of 2005, only a few days after the
‘orange’ revolution in Ukraine. Since then Kyrgyzstan has itself been undergoing
upheaval, following strong demand from the people and resulting in the departure of the
president. It is a time of turmoil but we have been encouraged that social actions are
being taken for the sake of the oppressed and vulnerable. We are keen to offer our
professional skills to help the new undertakings of our Kyrgyz colleagues who work for
the good of people with mental health problems.
Everything is interrelated in human society and the way vulnerable people are treated in
a particular community reflects the general political and social situation. If we want to
contribute as professionals to improving a particular aspect of human life, such as life
for people with mental health problems, we will succeed better if we take into account
and build on our knowledge of the opportunities as well as the limitations of the political
and cultural context in which people live. A large part of this report therefore describes
the background to present day Kyrgyzstan, including geography, history, economy and
culture as well as the current political developments.
The report will focus optimistically on the opportunities now available, while not
minimising the significant and major problems that exist for people with mental health
problems. A Chinese traveller-monk who visited Kyrgyzstan in the seventh century was
amazed not only by “tall peaks which reach to the very sky” but also by “dragons which
molest uninvited guests” (we were leased to have been invited in!). There remain many

1
Non-Governmental Organisation
2
European Commission Institutions Building Partnership Programme
5
paradoxes in this society. A post-Soviet authoritarian rule has co-existed with a sense of
nomadic freedom in people’s bearings and gestures. Almost total corruption and
enormous administrative control in governmental establishments has lived in relative
harmony with a developed civil society and mature political opposition. The not
uncommon practice of torture in mental health institutions occurs nevertheless within a
system that could allow some patients in institutions to complain to an independent
NGO.
In summary, we can to a great extent share the amazement of the Chinese monk who
had the privilege of contemplating the stunning beauty of mountains through a fiery
dragon breath. Perhaps the most important result of our visit is that, unexpectedly and
irrevocably, we have fallen in love with Kyrgyzstan. We cannot help being amazed by its
nature and culture, and we cannot be indifferent to the life of the Kyrgyz people.

6
PART I

MENTAL HEALTH SERVICES IN KYRGYZSTAN

7
 OVERVIEW

Mental health services are provided in 3 mental healthcare facilities, including 2 mental
health centers (republican center with two affiliates and Osh oblast center), as well as
republican mental hospital in v. Kyzyl-Jar, by 9 psychiatric departments in public health
hospitals and 55 psychiatric units at the primary care level (in Family medicine
centers).1
The health care system in the Kyrgyz Republic, including mental health services, is
currently under transition towards decentralisation with the need to meet an ever-
increasing demand. As part of the attempt to reform the mental health system in 1999
the government passed the Psychiatric Care Law and in 2000 a national strategy was
launched, Mental Health of the Population of the Kyrgyz Republic in 2001-2010. Both
the law and the programme anticipate a shift from institution-based mental health care
to more local community-based care, with an emphasis on bringing mental health care
to individuals in their local communities. Due to lack of funding, implementation of the
programme has been suspended.
The position of the Kyrgyz Ministry of Health is that, ideally, the Kyrgyz mental health
system should function on three levels:

• Primary care at the rayon (district) level by general practitioners;

• lntermediate care facilities staffed with psychiatrists at the oblast

(province/region) level; and

• Tertiary long-term care at the national level in the Republican Mental Health
Centre (RMHC) in Bishkek.
In practice, psychiatric facilities operating at district and regional levels are
administratively part of general medical hospitals and funded through them, thus having
fewer resources than facilities funded directly by the national government. Many mental
health patients do not receive proper psychiatric help at either the rayon or oblast level,
thus causing the RMHC to become in effect a ‘primary’ rather than ‘tertiary’ level facility.
Only just over half of all patients in the psychiatric hospitals are suffering from severe
mental disorders (including learning disability), which implies that a significant number
have less severe conditions, such as neurotic difficulties or have no mental illness at all.
In most other countries such people would receive treatment outside hospital. Delays in
discharge have transformed mental hospitals into long-term asylums, where two thirds
of patients don’t need hospital treatment. This applies especially to people with learning
disability, most of whom can live in the community with support.
There are serious deficiencies in the organisation and delivery of non-hospital care. In
some family medicine centres, there are physicians in mental care units who are not
specialised in psychiatry. They often lack basic knowledge about mental illness, so that
mental health patients are often referred directly on to the RMHC or another large
mental hospital.
The Mental Disability Advocacy Centre concluded in its review ‘Mental Health Law of
the Kyrgyz Republic and its Implementation’:
1
This information is dated by January 2004.
8
“In general the current mental health care system in the Kyrgyz Republic remains
antiquated, based on large institutions and overly centralised. The attempts to bring
about change have been met with strong resistance. Additional barriers are posed by
inadequate funding, lack of trained mental health professionals to provide the necessary
community-based mental health care, particularly in rural areas, and the lack of private
pay psychiatrists.”

Table 1. Prevalence of Mental Disorder in 2002/2003

2002 2003

No. of people with mental disorder 57,882 55,630

No. per 100,000 population 1,161.2 1,110.1

Table 2. Firstly Admitted People with Mental Disorder (per 100,000 population)
2000 132.2
2001 136.3
2002 141.6
2003 147.4

Table 3. Patient Diagnoses

2002 2003
Percentage of patients with
schizophrenia 19.5% 19.6%
Percentage of patients with
learning disability 45.0% 46.0%
Percentage of patients with non-
mental disorders 8.4% 10.2%

Table 4. Proportion of Children and Teenagers among Patients Suffering from

Mental Disorders

2002 2003
Percentage of adult patients 81.6 82.2
Percentage of children 11.8 10.9
Percentage of teenagers 6.6 6.9

9
Table 5. Work of Inpatient Psychiatric Institutions

2001 2002 2003

Total number of beds 2,572 2,406 2,398

Average length of stay (days) 86.1 92.0 82
Average bed rotation
(patients per year) 3.6 3.3 3.5
Amount of patients treated 9,263 8,043 8,514

Table 6. Staff of Inpatient Psychiatric Institutions

2001 2002 2003

Psychiatrists 148 143 144

Psychotherapists 10 8 7
Medical psychologists 2 3 4

In the development of the Kyrgyz mental health services, there are two opposed
tendencies. On the one hand, mental health morbidity is growing. The Table 2 shows
this clearly, while a certain decrease in morbidity from 2002 to 2003 shown in the Table
1 may be explained only by incidental factors (most likely, increase of mortality or/and
change of registration methods). On the other hand, the total number of beds in
psychiatric institutions is being reduced. However, such a decrease happens not as a
part of certain plan of de-institutionalisation (as it is the case in many European
countries), but as a result of a lack of resources. Unfortunately but understandably, no
outpatient alternative to institutional care is being proposed.

10
 NON-GOVERNMENTAL ORGANISATIONS IN MENTAL HEALTH

International Organisations
Since 1992, Kyrgyzstan has been a member of the World Health Organization (WHO).
The objective of WHO is the attainment by all peoples of the highest possible level of
health. Health, as defined in the WHO Constitution, is a state of complete physical,
mental and social wellbeing and not merely the absence of disease or infirmity. A
specialised agency of the United Nations with 191 Member States, WHO promotes
technical co-operation for health among nations, carries out programmes to control and
eradicate diseases and strives to improve the quality of human life. WHO was
established in 1948, with its headquarters in Geneva, Switzerland.
WHO has four main functions:

• To give world-wide guidance in the field of health

• To set global standards for health

• To co-operate with governments in strengthening national health programmes

• To develop and transfer appropriate health technology, information and standards

Based on an agreement between the Government of the Kyrgyz Republic and the WHO
Regional Office for Europe, approved by the Governments of other Central Asian
Republics, the WHO Information Centre for health for Central Asian Republics was set
up in Bishkek in 1993 and the WHO Liaison Office was established the following year.
In 1996, the government adopted the MANAS1 National Health Care Reform Program,
which was developed with considerable support from WHO. This was constituted as a
10-year program of comprehensive reform of the organisation, financing and content of
the health system. The broad aim was to adjust the system to the economic realities of
a transitional and post-transitional country and to replace certain outmoded practices
inherited from the Soviet Union with modern, evidence-based practices. It also aims to
shift from the highly specialised Soviet model to a system based and led by primary
care.
The reform in mental health stated in the national programme Mental Health of the
Population of the Kyrgyz Republic in 2001-2010 is a natural continuation of this policy.
The Mental Disability Advocacy Centre (MDAC) is an international non-governmental
organisation based in Budapest, which promotes and protects the human rights of people
with mental health problems and intellectual disabilities across Central and Eastern Europe
and Central Asia. MDAC works to improve the quality of life for people with mental
disabilities through litigation, research and international advocacy. It promotes public
policies that respect human rights and foster community integration. MDAC has
participatory status at the Council of Europe and is a co-operating organisation of the
International Helsinki Federation for Human Rights.
In Kyrgyzstan, MDAC monitors the state of mental health law and its implementation,
and works with the Kyrgyz government, advocating for the rights of people with mental
1
Named after the important historical Kyrgyz epic
11
disabilities. A key recommendation in MDAC’s 2004 report on human rights and
psychiatry in Kyrgyzstan was to establish an independent advocacy service for patients
at the Republican Centre. MDAC works with the Kyrgyz NGO Mental Health and
Society for the support and development of such an advocacy service, which has
existed since November 2004.
Other international organisations that have been involved in mental health work locally are:
Geneva Initiative in Psychiatry, Hamlet Trust, OSCE1 in Bishkek, Freedom House,
and the Soros-Kyrgyzstan Foundation. All these bodies are partners of Mental Health
and Society.

National and Local Organisations

The public association Mental Health and Society (MHS), founded in 2000, is a
national not-for-profit, non-governmental organisation. Its objective is to help protect
human rights and freedoms, especially the rights of people with mental disorders,
learning disabilities and psychosocial problems. In its activities, MHS adheres to the
principles of pluralism and equal opportunities and promotes the involvement of mental
health service users in taking decisions about their life and medical treatment and
influencing the conditions of institutional care and mental health policy and reform.
The main goals are:

• To integrate mental health services, to ensure optimal care for users, to provide
education to the public about mental illness to reduce stigma

• To provide information to users, families, health professionals and community

members about mental illness so that treatment and prevention may be improved

• To provide programmes that will enable users to become involved in developing the
ability to become active participants in supporting one another and in decision
making about their own care and about mental health policies

• To promote the humanisation of psychiatric care

• To counteract the violence that affects the mental health of the citizens

• To promote the integration of people with mental disorders into society

• To support stable family life, social cohesion and human development

• To promote the improvement of Kyrgyz Mental Health Law

The main activities are:

• Legal support for people suffering from mental health problems

• Monitoring human rights in psychiatric institutions

• Promotion of self-help groups, including training in group work skills

1
Organization for Security and Co-operation in Europe
12
• Working with the media to raise public awareness about mental health problems

• Exerting influence over government’s policy in mental health

Mental Health and Society collaborates, in attaining its objectives, with the Ministry of
Health of the Kyrgyz Republic, the Office of the Ombudsman of the Kyrgyz Republic,
and with a wide range of NGOs and individuals – professionals in mental health.

Youth Human Rights Group (YHRG) is a not-for-profit NGO founded in 1995. The
objective of the organisation is the protection and affirmation of human rights. The main
priorities are:

• Promotion of the rights of children

• Legal reform as regards juvenal law

• Observance of human rights in custodial institutions of different types

• Effective use of international mechanisms of human rights protection

• Raising public awareness about human rights

Special importance is given to collaboration with other organisations. A crucial activity is
the monitoring of compliance with human rights in state boarding schools and
psychiatric institutions, as well as for particular vulnerable groups like child refugees.
Another important organisation on the mental health scene is the Kyrgyz Psychiatric
Association (KPA). The President of the Association is Professor Valery Solozhenkin,
Head of the Chair of Clinical Psychology and Psychiatry at the Kyrgyz State Medical
Academy and the Chief Psychiatrist at the Ministry of Health of the Kyrgyz Republic.
KPA promotes self-help initiatives by users of mental health services, their relatives and
professionals and it is currently establishing a users’ organisation. Professor
Solozhenkin, while supporting in principle the monitoring/advocacy activities of MSH,
YHRG and MDAC, criticises these organisations for what he calls “moral maximalism”
and stresses the need to create a “respectful, constructive dialogue” between human
rights activists on the one hand and psychiatrists and other professionals working in
psychiatric institutions on the other hand. KPA intends to promote a wider co-operation
between different NGOs in mental health, and works for the creation of an effective
dialogue between all sides of the mental health scene in order to balance human rights
issues with other facets of productive work for the benefit of people with mental health
problems.
There are a number of other organisations working for mental health development in the
country: Family and Society, Act in Support of the Family, Solomon’s Rays (Osh),
and others. There is also a national system of centres for children with autism and
learning disabilities where qualified professionals work.

13
 HUMAN RIGHTS IN PSYCHIATRIC FACILITIES

Monitoring by YHRG and MHS

In 2000 the Youth Human Rights Group conducted monitoring of human rights and
maintenance conditions in a number of psychiatric institutions in the Kyrgyz Republic.
As a result of this monitoring, a number of serious problems were discovered. In general
the situation of patients in psychiatric institutions was characterised as unfavourable.
The majority of legal requirements were not complied with and many employees and
patients were ignorant of the law. In order to improve the situation, recommendations
were suggested based on the following principles:

• De-institutionalisation of services

• Development of the autonomy of patients

• Protection from exploitation

• Prevention from abuse in psychiatry

• Judicial control over forced admission

• Active involvement of patients in their treatment

• Ensuring the patients’ access to information

• More effective financing of institutions

The second and third stages of human rights monitoring in psychiatric facilities in 2003
and 2004 were carried out again by Mental Health and Society and Youth Human
Rights Group. The monitoring was focused on the observance of human rights in the
RMHC (second stage) and in the Chym-Korgon branch, now Chym-Korgon Republican
Mental Hospital (third stage). As a result, the monitoring organisations elaborated
further their claims and recommendations about the observance of human rights in
psychiatric institutions. In particular, it was concluded that, in spite of some initial
improvements, the right to access of information was not being followed. Numerous
violations of patients’ rights were reported, such as rights about giving consent to
treatment, the provision of information related to existing disorders, goals and methods
of treatment, anticipated duration of treatment, possible side effects of administered
medication and involvement in the care plan development, etc.
To achieve a greater observance of human rights, the following measures were
proposed:

• Improving professional qualification of doctors

• Introducing education on mental health and related law for the staff of psychiatric
facilities

• Introducing such education also for people with mental health problems, their friends
and relatives

14
• Creating an independent service for the protection of the patients’ rights

• Creating alternative forms of care in the community

• Distributing resources according to real needs of institutions

• Facilitating access to appropriate medication for people with mental health problems

• Facilitating access to treatment of non-mental diseases for people with mental health
problems

• Promoting self-help groups for relatives of people with mental health problems

• Strengthening control of the work of psychiatric institutions

Monitoring by MDAC
In 2003, the Mental Disability Advocacy Centre (MDAC), at the request of the Office of
the President of the Kyrgyz Republic, conducted an examination of the extent to
which the mental health law and practice in Kyrgyz Republic complies with
international standards and then gave recommendations to the Kyrgyz
government. In a report of 2004, MDAC analysed the system of mental health
care in the Kyrgyz Republic against the international standard set out in 1991 in
the United Nations General Assembly Resolution 46/119 ‘Principles for the
Protection of Persons with Mental Illness and the Improvement of Mental Health
Care. In particular, serious violations of basic human rights were reported:
failures in providing patients with adequate food, medicine, and general medical
care plus sexual exploitation of female patients. MDAC In order to resolve this,
proposed the following measures:

• Developing an independent service to protect the human rights of psychiatric in-

patients

• Providing training to mental health clinicians, hospital staff, lawyers, and judges
regarding the Kyrgyz mental health law, with a particular focus on the specific
provisions of the involuntary treatment procedures

• Providing training for judges, lawyers, and clinicians regarding the legal
requirements for forensic mental health assessments

• Implementing formal monitoring by an independent, qualified NGO with expertise in

the area of mental health law – or by a group of similarly qualified NGOs, working
collaboratively – regarding the implementation of the involuntary mental health
treatment procedures

• Ensuring sufficient funding to implement mental health law and the 2001-2010
National Programme, and to implement involuntary commitment legal procedures of
the 1999 Psychiatric Care Law

• Providing training to individuals with mental disabilities and their family about legal
rights, how to obtain assistance with patients’ rights violations, and self-advocacy
skills

15
Since the publication of MDAC report, certain steps have been taken towards the
implementation of its recommendations. Since November 2004, Mental Health and
Society has been operating an advocacy service with the support of MDAC, on the base
of funding by the Open Society Institute. As part of the service, there are now complaint
boxes in each ward of the Republican Center where patients can anonymously deposit
grievances. Lawyers in the advocacy center and former users of mental health services
are working together to resolve the complaints, which thus far include complaints about
lack of food, involuntary detention and lack of information about diagnosis and
treatment.
On February 16, 2005, the Ombudsman of the Kyrgyz Republic, Mr. T. Bakir Uulu,
signed a Memorandum with Mental Health and Society and MDAC, in which he pledged
to work with Mental Health and Society and MDAC to support the further development
of the advocacy service. The Memorandum also encourages the government to
improve implementation of the 1999 Kyrgyz Law on Psychiatric Care, and goes on to
emphasize the importance of human rights protection for people in Kyrgyz psychiatric
institutions.

16
 VISITING THE INSTITUTIONS

Republican Mental Health Centre

The Republican Mental Health Centre (RMHC) is the main mental healthcare facility in
the Kyrgyz Republic. It is located in Bishkek, the capital, in vast green territory close to
transport communications. The wards are located in brick buildings built in 1956,
designed specially as a mental health clinic.
RMHC consists of 12 wards:

• 1, 7 & 9 – male wards for acute patients;

• 2, 8 & 10 – female wards for acute patients;

• 3 – mixed ward of open type for individuals with non-psychotic (‘psychosomatic’)

disorders

• 4 –day care ward of open type;

• 5 – adult outpatient department;

• 6 – children outpatient department;

• 11 – ward for military examination;

• 12 – male ward located separately, in Novo-Pavlovka village

RMHC is a clinical facility for the Kyrgyz State Medical Academy and Medical
Department of the Kyrgyz–Russian Slavic University. The staff and patients of RMHC
benefit from a close association with the Kyrgyz Institute of Psychiatry and Neurology,
headed by Dr. Valery Solozhenkin, Chief Psychiatrist for the Ministry of Health of the
Kyrgyz Republic. This university-affiliated institute provides professional training and
certification to students of psychiatry.
The average number of patients served today is 800.
The representatives of InterMinds were given an opportunity to talk to the doctors of the
hospital during their regular meeting. There was clear interest in collaboration, both from
the administration and from the doctors themselves. The staff of the rehabilitation ward
and the children’s ward showed a particular interest. We met with these two groups of
psychiatrists separately and heard a demand for a training programme about new forms
of work with clients in the community. Both these groups of professionals work with
clients’ families and are interested in getting to know more about similar experiences
from professionals in other countries.
Due to the efforts of NGOs, first of all Mental Health and Society, a user-oriented advice
centre, Infocentre, was opened in RMHC, in ward 5. Patients of the hospital and other
people with mental disabilities can get professional advice regarding the observance of
their rights as well as information and other support to help resolve their problems. As
well as this support, a self-help group is based in the Infocentre. The group meets
regularly in a warm and light room that is a good communication space for people who,
in many cases, have lost contact with families and friends. Through the common efforts

17
of staff and users of the Infocentre a few celebrations have been organised and the first
user newspaper has been published.
The most discussed problem in the self-help group is the lack of employment
opportunities and the related impossibility of leaving the hospital and settling in the
outside world. As far as we know, this self-help group for users is unique to Bishkek.
Groups for relatives meet in the rehabilitation ward with the support of the staff. Out of
the hospital, in the community, there are no groups at all for users or their relatives.

Ward 12 of the RMHC

Ward № 12 is a male ward located on the outskirts of Bishkek, in Novo-Pavlovka village
and it is currently in the process of transition. The YHRG 2000 Monitoring report
described the situation in the ward as “more disastrous” than in the other departments
of the RMHC. Absence of telephone communications and transport is a problem. Also
there is a great lack of staff and stealing by the local population takes place (the
provision of a guard is not envisaged). The buildings are in overall disrepair.
Temperatures are low because of lack of coal for the stoves and due to a bad heating
system carbon monoxide seeps into rooms. The walls are painted dark, there are slots
of up to two centimetres in walls, and the floor in the dining facility is made of cement.
The MDAC 2004 report (that describes the situation in mid-2003) described the
shortage of food and clothing in Ward 12. “Many of the patients stated that they were
always hungry and that in the winter they were very cold. Staff members stated that, for
the most part, patients survive on a few crusts of bread and water.” The electrical
system worked only intermittently. A coal stove provided the only heat for the ward.
Many of the windows were broken. “Water for bathing and drinking has to be carried
from a rusted pump in the yard”. The single toilet, at the time of MDAC’s visit, was
overflowing with human waste and could not be used. Several of the patients had no
mattresses and so had to lie directly on their iron bedsteads. Bed linens and blankets
were in short supply. The patients’ clothing was threadbare. Patient rooms were
crowded with beds, allowing for little room for movement and no privacy.”
Resulting from the efforts of human rights activists, the administration of RMHC became
aware of the problems at ward 12 and decided to transfer the patients kept in the ward
into the main part of the Centre in Bishkek. In practice, however, some patients who
preferred to stay in ward 12 were allowed to do so. A mini-ward with only 8 patients and
a home-like atmosphere was what we saw when we visited Novo-Pavlovka in 2004, a
considerable improvement.
Indeed the attitude of the clients of this ward toward their problems differed
advantageously from the spirit that prevailed in all other institutions we saw in the
country. An oven is being stoked at the building, but it is warm only in one room where
all eight patients live. “To live” (zhit’) is the only verb that the patients use referring to
their stay in the ward. Zhekshen Aralbaev, the doctor of the ward who works mainly in
the main RMHC premises and comes to Novo-Pavlovka once a week, told us that all
those patients who had moved to Bishkek now wished to come back to ward 12. The
inhabitants of the ward cook and keep things in order themselves. They can go out from
the ward and come back if they wish. They maintain good relations with neighbours. A
nurse comes every day and helps the patients to organise their daily life. When we
spoke to the clients, the talk was about plans to renovate the building, to plant flowers in
spring, to bring in order their lives after stay in the hospital. The patients proudly keep a
18
little library that mostly consists of religious literature. The territory of the ward embraces
not only the main building and a few household constructions, but a large yard: that is
vacant ground that could be transformed into a garden.
Despite this very little, if anything has been improved in the physical environment in the
ward since the period of MDAC monitoring. The situation with heat and electricity is
practically the same. Water still has to be carried from a pump. However, the quality of
life of those who live in the ward after the majority have moved away has been visibly
increased. Why?
The quality of life can be understood in different ways. Food, heat, clothing and
medicines are very important indeed. But for many people with mental health problems
self-dependency, freedom, and life in the community are more significant than safe
predictability and artificial comfort. Both good material conditions and a good social
environment that allows autonomy and self-respect are essential.

Chym-Korgon Hospital
The psychiatric hospital in Chym-Korgon village is located 85 km away from the capital.
The hospital serves the whole of the Kyrgyz Republic and also the southern oblasts of
Kazakhstan. The YHRG 2000 Monitoring Report stresses the long length of patients’
stay as a specific feature of the institution. The reason for this is the remoteness of the
hospital and also that some patients have lost their identification documents, have no
family or cannot afford staying at the RMHC in Bishkek (as this requires fees for
maintenance and treatment). The hospital is comprised of 12 wards including a ward for
TB patients, a ward for forensic examination of patients being in forced treatment, a
gerontology ward and rehabilitation wards. The hospital is meant for 850 beds but only
400 were used when we visited.
Staff wages in Chym-Korgon hospital vary from 400 soms ($10) to 1,200 soms ($30)
monthly, with the biggest salaries being those for psychiatrists. Director Ghanybek
Azhibekov told us that there is a high level of staff fluidity due to the low wages. Daily
maintenance of a patient is 30 soms ($0.75) although the maintenance of TB patients is
somewhat larger, 40 soms ($1). This includes food (25 and 35 soms respectively), and
medicines (5 soms). The annual budget of the hospital amounts to 15 million soms
($375,000).
Chym-Korgon Hospital is remote, located at the foot of the mountains (at least such is
an impression, for mountains dominate over the landscape) and it naturally evokes
idyllic associations. What can be as healing for a human soul as pastoral life close to
nature? However, the institution has not escaped ill fame. A few clients who talked to us
mentioned that whoever happened to come to Chym-Korgon will never get out of the
custodial system of psychiatric services (psikhushka).
Director Ghanybek Azhibekov invited us (we had come together with colleagues from
Mental Health and Society) to his office, answered patiently to all our sharp questions,
gave us an opportunity to see all the wards and to talk to the staff and clients. During
our visit to the wards, a senior member of staff accompanied us all the time and literally
saw us to the gates. We interpreted this as a sign of hospitality and respect. This
member of staff was in her forties or fifties and lives in a nearby village. Her salary in the
hospital is about $12. The lady says that most young people in the village have gone
abroad in search for their fortune, while she is not daring to move off. Life is hard at

19
home, but at least she has a job here. This job is something she knows quite well, and
all changes are frightening, after all. Better stability than uncertainty.
We saw two wards renovated by the staff and clients themselves (materials were
provided by sponsors) and it was very warm because sponsors had provided new
radiators in every room. Clients now have the opportunity to see their relatives in special
meeting rooms, so step by step, the conditions are becoming better in all the wards. Yet
there is very little connection of the clients with the outside world and there is no
opportunity for out-of-hospital care. The more clients remain in the hospital, the more
the medical staff are paid, so there is a perverse incentive to keep people in hospital
and admit new patients.
We saw a desolate ward that a year or two ago had been reported to sponsors as fully
renovated, funded by the Central Asian Bank. There were modern double-glazed
windows (so called evropaket, “europackage”) bought from the most expensive window-
producer in the country (maybe someone’s relative?) and a luxuriously tiled floor in the
entrance hall. But there were no inside doors, not even door-frames, no plastering, no
floor. No electricity. No finish, in every sense of the word. A photographer who works
with Mental Health and Society took photos showing cobwebs and construction rubbish
in the foreground. MHS is monitoring this situation carefully and highlighting it through
the mass media as well as letting the authorities know about power abuses in mental
health institutions etc.
A power abuse story monitored by MHS is related to the ‘subsidiary farm’ (podkhoz) of
Chym-Korgon hospital. There were all sorts of bad rumours about the farm. It was the
base of a separate hospital ward providing “vocational therapy” for patients but known
as a “labour colony”; numerous violations of human rights have been committed there
and the exploitation of patients was tolerated. These problems are very well reflected in
the MHS and YHRG 2003 report, and in the MDAC 2004 report. To quote the latter: “At
the ‘Labour Colony’ patients are required to do work such as growing vegetables and
other crops, as well as other types of labour, when residing at the hospital. Although
these patients spend all day, almost every day doing work to benefit the hospital, they
receive no payment.”
Due to the efforts of human rights activists, the labour colony was closed. However
some patients were interested in having the opportunity of part-time work in the farm.
MHS supports the efforts of the newly appointed Director of the farm, Zhenishbek
Esezhaliev, in organising a social enterprise that will be able (such is the intention) to
combine the part time employment of patients while respecting their human rights in
providing the hospital with agricultural production.
In the meantime, some livestock is kept on the farm, but MHS discovered that much
more livestock was present than the hospital officially holds. We witnessed how this fact
was testified by the representatives of MSH, and a relevant formal statement was drawn
up.

Iskra Social Care Institution

In Russian, the name of this kind of institution is Internat dlia psikhokhronikov, that is, “a
hostel for chronically ill mental patients.” Such hostels, typical in all post-Soviet
countries, are designed for people with mental health problems who have lost their
families or cannot live in the family for other reasons. The Internat is meant for 150

20
beds; at the time of our visit a few of them are free. There is an annual budget of 3
million soms ($75,000) and the average daily maintenance fee is 30,7 soms ($0.75) per
person. Relatives rarely visit the inhabitants of the Internat, as most people who live
here have come from remote parts of the country. It is a state policy to move clients far
away from their communities and quite often the relatives’ desires go along with this
policy.
The institution is situated on the outskirts of Iskra village, which provides an opportunity
for eight to ten men living in the Internat to find modest jobs in the village. The salary is
food rather than money, but this gives a chance for otherwise isolated and marginalised
people to go outside the institution and have a feeling of normal human life. The clients
of the Internat are men aged from 16 to 70.
Only twelve clients receive pensions, so very few inhabitants have cash in their private
possession. All others are fully dependent on the Internat maintenance, which
absolutely ties people to the institution and leaves no chance of moving away. All the
people who receive pensions have been admitted recently and this minimal financial
stability has been achieved due to the current Chief Psychiatrist of the Internat, her
predecessors never paid attention to the social problems of patients. She has a
background in paediatrics and is free from some negative professional attitudes found in
certificated psychiatrists. She tries to resolve their social problems and wins their
respect. It goes without saying that no social worker is provided for this, or for any other
mental health institution in Kyrgyzstan.
Building renovation is underway and some clients live four persons in a room that is
relatively warm. However the first floor has not been renovated yet and is in a worse
condition. People live eight in a room there. The inhabitants of the institution have only
one entertainment: to watch TV. Most books from hospital library are puffed away for
rolled cigarettes.
There is a room in the basement where clients can have their hair cut and one of the
residents’ works as a hairdresser. He is happy to have this job. The hairdresser is
young, and was transferred to the institution from an orphan boarding school. He still
has friends in the outside ‘large’ world and is one of a few inhabitants of the Internat
who wishes to move away, believing that one day he will find a job beyond the
boundaries of the institution.
The Internat has its own bakery, and equipment for cooking macaroni was being
installed when we visited. The refectory is quite large, but people eat in two shifts. The
midday meal (obed) is the central daily event. People start gathering in the refectory
beforehand, and do not hurry to break up afterwards. The refectory has two entrances:
one connects it to the residential building, another one is external. The area outdoors
around the external entrance is open to a little Internat garden. This is a place where
clients talk to each other and smoke after the meal. Occasionally, ladies from the junior
staff talk to them, as if it was a habitual gathering of people in a village. The talk is vivid
but short: it is quite cold in January, in spite of sunny weather. Ladies go aside soon and
start talking about their families. Men finish their cigarettes, and huddle up. They have
only one opportunity left, to come back to the building and the area outside the refectory
becomes empty.
Only giant mountain peaks, covered by snow, still stay in the garden. As usual, they
seem much closer than they really are. A permanent feature of Kyrgyz life, these same
mountains are seen from the windows of every mental health institution in the country.
Unlike living beings who come and go, mountains are always a part of the landscape.
21
PART 2

KYRGYZSTAN TODAY1

1
Information contained in Part 2 is borrowed from a number of sources quoted at the end of the report, in
the section “Principal References”, subsections “Part I” and “Internet Resources”. We express our special
gratitude to R. Stewart and S. Weldon, the authors of the excellent book “Kyrgyzstan” (2002), and to the
authors of International Crisis Group Asia papers N°25 (2003) and N°81 (2004).
22
 GEOGRAPHY

Kyrgyzstan has a population of just over 5 million1 people, the same as Scotland, in a
land covering approximately 198,500 square kilometres, about the size of Great Britain.
It is a mountainous country in the Tien Shan and Pamir systems, with an average
altitude of 2,750 metres. About a third of the country is perennially covered with snow
and glaciers and many lakes and fast-flowing rivers drain from mountains. Deep valleys
cut dramatically through majestic Alps, with flat areas only in northern and eastern
valleys. The domination of the Tien Shan, ‘Mountains of Heaven’, gives to Kyrgyzstan
its unique character as the ‘jewel’ of Central Asia. The climate varies from polar in high
Tien Shan to subtropical in Ferranti Valley on the southwest, but in most places the
summers are hot and dry while the winters are cold, with temperatures ranging from 2°C
in January to 18° C in July.
The country is bordered by Kazakhstan in the north and north-west, Uzbekistan in the
south-west, Tajikistan in the south and China in the south-east. This geographical
position has historically made Kyrgyzstan a gateway to the west for warriors as well as
traders. The major cities are Bishkek (the capital), Osh, Dzhalal-Abad, Tokmak and
Przhevalsk.
Kyrgyzstan has a large variety of flora and fauna and is particularly rich in medicinal
herbs. However, many industries use highly poisonous substances without proper
storage sites. Radioactive pollution related to uranium dumps, contamination by DDT,
water and soil pollution with increasing soil salinity, overgrazing of grasslands,
degradation of forests and the extinction of animal and plant species are part of a long
list of major environmental problems. The government has recently developed a
National Biodiversity Strategy to start addressing this.
Ecological and social issues are correlated today more than ever. Preserving the fragile
environmental balance is appreciated as a task of similar value and complexity as
ensuring a balanced system of social justice in human society.

1
July 2004

23
 HISTORY

The presence of human society in what is modern Kyrgyzstan began about 200,000 to
300,000 years ago. The first written records of a Kyrgyz civilisation appear in Chinese
chronicles beginning about 2000 B.C. If there has been anything permanent in a long
line of emerging and dying great khanates and empires since that time, it is probably the
Silk Route, a trade road throughout the Kyrgyz valleys, connecting a range of
civilisations from Beijing to Rome. A titanic exchange between cultures, religions and
traditions has thus contributed to the genesis of Kyrgyz people from the very beginning.
The modern nation of Kyrgyzstan is based on a civilisation of nomadic tribes who
moved across the eastern and northern sections of Central Asia. They mixed with other
tribes and peoples who have influenced the current character of the Kyrgyz people. The
first Kyrgyz state, the Kyrgyz Khanate, existed from the sixth until the thirteenth century
AD and established intensive commercial contacts with China, Tibet, Central Asia and
Persia.
The invasion of Mongols into Central Asia in the fourteenth century devastated the
territory of Kyrgyzstan, costing its people their independence and their written language.
For the next 200 years, the Kyrgyz remained under the Golden Horde (Mongols) and
the Oriot and Jumgar khanates that succeeded that regime. Freedom was regained in
1510, but the Kyrgyz tribes were then overrun by the Kalmyks in the seventeenth
century, the Manchus in the mid-eighteenth century and in the early nineteenth century
by the Uzbeks. The Kyrgyz began efforts to gain protection from more powerful
neighbouring states in 1758, when some tribes sent emissaries to China. A similar
mission went to the Russian Empire in 1785.
In 1876 Russian troops defeated the Kokand Khanate and occupied northern
Kyrgyzstan. Within five years, all Kyrgyzstan had become part of the Russian Empire,
and the Kyrgyz people slowly began to integrate themselves into the economic and
political life of Russia. In the last decades of the nineteenth century increasing numbers
of Russian, Ukrainian and German settlers moved into the northern part of present-day
Kyrgyzstan. The negative effects of the Russian Empire's repressive policies became
clear. Land confiscation, large taxes, forced labour, and price policies all targeted the
indigenous population and raised discontent and regional tension. The great rebellion of
1916, which rushed through Central Asia, gave expression to widespread resentment
against the injustices of the Russian Empire.
The nomadic Kyrgyz resisted conscription into the tsarist army in 1916 and fought the
establishment of Bolshevik control from 1917 to 1921. As a result of war and
devastation there was a famine in 1921–22 in which over 500,000 Kyrgyz died. The
area was formed into the Kara-Kirghiz Autonomous Region within the Russian Soviet
Federated Socialist Republic in 1924, becoming an autonomous republic in 1926 and a
constituent republic in 1936.
In 1990, Askar Akaev, president of the republic’s Academy of Sciences and a non-
Communist, was elected president by the legislature. After fighting off an attempted
coup in 1991, the government declared Kyrgyzstan independent of the Soviet Union.
Kyrgyzstan proclaimed its independence from the Soviet Union on 31 August 1991 and
on 21 December 1991; Kyrgyzstan joined the Commonwealth of Independent States.
The country joined the UN and the IMF in 1992 and adopted a radical economic
program after voters endorsed market reforms in a referendum held in 1994. In 1996

24
referendum voters overwhelmingly endorsed proposed constitutional changes that
enhanced the power of the president. Representatives of the country along with those of
Russia, China, Kazakhstan, and Tajikistan signed a non-aggression agreement in April
1996.
In 1997, Russian border control was extended as authorities in Kyrgyzstan grew
increasingly concerned about the growth of the illegal narcotics trade in the country.
Another concern has been that since 1999, several groups of radical Islamic gunmen,
believed to be from Uzbekistan or Tajikistan, have led raids and kidnappings from
camps in Kyrgyzstan's mountains.

25
 THE PEOPLE

Kyrgyzstan is a multi-national society comprising at least 23 national groups. The ethnic

majority are the Kyrgyz who form 64.9% of the population. Minorities include Uzbeks
(13.8%), Russians (12.5%), Dungans (1.1%), Ukrainians (1%), Uygurs (1%) and other
(5.7%). The main religions are Muslim (75%) and Russian Orthodox (20%).
A major problem following independence has been large-scale migration. In particular,
considerable numbers of minority populations have returned to the countries of their
ancestors’ origin. According to UNDP statistics, between 1991 and 1998 the Russian
population reduced by 273,000 and the German population by 61,000. In general,
during the same period one seventh of the population of Kyrgyzstan moved into, out of
or around the country. Migration can be explained mainly due to economic motives,
although some inter-ethnic tensions have been reported by independent observers.
Following independence in 1991, Kyrgyz was established as the state language. In
practice Russian remained dominant and most commonly used in government and
official business, although Russians and other minorities were faced with the need to
learn Kyrgyz. A Kyrgyz language exam was established in 2000 for presidential
candidates and in 2001 the Parliament made Russian a second state language, on an
equal footing with Kyrgyz.

26
 CULTURE

The tightest geographical and historic description of Kyrgyzstan is the one given by The
World Factbook: “A Central Asian country of incredible natural beauty and proud
nomadic traditions.” The emphasis on nomadic traditions might seem to be an
exaggeration, but it is not. One of the most striking features of modern Kyrgyz culture is
that its core values have survived the enforced century-long transition from nomadic to
settled life.
One of these values consists in the central role of tribal and regional lineage for Kyrgyz
identity and society. Today there are some 30 Kyrgyz tribes (sanjira). They are grouped
into two main regional blocks, the northerners (Tagai), who include the tribes of the
central plateau and the Kyrgyz living in Kazakhstan; and the southerners (Ich Kylyk),
who include the Kyrgyz of Tajikistan and China. Tribes of the central plateau are also
often considered to be a ‘third force’. This tribal division has a clear influence on Kyrgyz
politics and cannot be underestimated as an important societal factor relevant to mental
health issues
Tribal connections are a natural extension of traditional family ties and an extraordinary
respect is given to the family in the Kyrgyz society. Many traditional practices related to
family life have survived through Soviet times: dowries are still given, and even bride
prices are occasionally paid in spite of the fact that bride price was considered to be a
crime against the Soviet state. A traditional hierarchy of family roles, fastened together
with respect for elders is imbued in children and constitutes the real ground of Kyrgyz
societal life, as opposed to officially declared policies such as communist ideology in the
Soviet times. Traditional society consisted of villages (ails); each ail was a kind of
extended family and comprised one man (the chief), and his unmarried daughters and
the families of his married sons. At the head of a group of ails was an elder called bi, or
manap. The competence of a bi concerned the general welfare of the group; he made
decisions for the good of his community with a help of a council of advisers (aksakals),
elder men from the ails of his community. Neither the bis, nor the aksakals, were
elected, instead their authority came from their age and wisdom.
In accordance with the Kyrgyz tradition, one of the advantages of being nomadic lies in
the privilege of the ail to move away and join another group of tribes if the bi’s rule is
unwise. A 19th-century scholar stated that the Kyrgyz “had neither princes nor nobles;
the elders… were not chosen by any kind of election, but owed their position entirely to
their personal influence.” Thus love of freedom is a peculiarity of Kyrgyz nomadic
culture. Among nomads, the power of clan leaders is much stronger than that of any
appointed governor. Similarly, the impact of the natural world on personal identity is
much stronger than that of any sort of fixed state system. Kyrgyz folklore, music and
handicraft perfectly reflect this nomadic attitude to nature.
Any system of care for people with mental disabilities must take account of such cultural
issues.

27
 POLITICS AND SOCIETY

Kyrgyzstan has managed to retain at least some of the liberalism that marked it in the
early 1990s. The Kyrgyz government has succeeded in showing itself more progressive
in terms of economic reform and liberalisation than other neighbouring countries. It has
been particularly good in presenting itself to international community as a democratic,
reforming partner in an otherwise difficult region. But high-level corruption and poor
governance have inhibited economic growth. As a result, many ambitious plans
announced at international gatherings have not turned into reality
Increasingly the political system came to be dominated by a small group around
President Akaev and the opposition was sidelined and independent media came under
pressure. In 2000, President Askar Akaev easily won re-election with nearly 75% of the
vote, but the election was marred by allegations of fraud, diminishing Kyrgyzstan’s claim
to be the centrepiece of Central Asian democracy.
In 2001, Kyrgyzstan permitted troops from the US and seven other nations to be
stationed in the country in support of efforts to fight against the Taliban and al-Qaeda in
neighbouring Afghanistan. In 2002, construction of a large US airbase began outside of
Bishkek. In February 2003, a controversial referendum expanded Akaev's powers, and
in June Parliament granted him lifelong immunity from prosecution.
Akaev did achieve much, particularly in laying the foundation for economic reform and
ensuring political stability. The constitution commits the Kyrgyz government to a
democratic, secular society with freedom of worship and expression and uncensored
press, but the sincerity of the government’s commitment to this over the last few years
was seriously put in doubt.
Kyrgyzstan faced the difficult question of how to achieve political transition peacefully
and without losing the gains of the past decade. In March 2005 protests against the
results of the February election forced the resignation of the government and Akaev left
the country. A new government was formed. At the moment, there are signs of growing
stability. Many people pin their hopes on the presidential elections which are expected
on the 10th of July, 2005. People believe that Kyrgyzstan is destined for a democratic
and prosperous future.

28
 THE ECONOMY

The Kyrgyz people have traditionally excelled in wood carving, carpet weaving, and
jewellery-making. In agriculture Kyrgyzstan has rich pasturage for goats, sheep, cattle,
and horses. Over 80% of the cultivated area is irrigated and cotton, potatoes, sugar
beets, tobacco, vegetables, fruit and grapes are grown. Grain crops are cultivated in the
non-irrigated areas. Kyrgyzstan has deposits of antimony, gold, molybdenum, tin, coal,
tungsten, mercury, uranium, petroleum, and natural gas. Industries include food
processing, sugar refining, non-ferrous metallurgy, and the manufacture of agricultural
machinery, textiles, building materials, appliances, furniture, and electric motors. The
negative impact on the environment of these industries has already been mentioned.
The leading exports are cotton, wool, meat, tobacco, metals (particularly gold, mercury,
uranium, and steel), hydropower, and machinery; chief imports are grain, lumber,
industrial products, ferrous metals, and fuel. The main trading partners currently are
other former Soviet republics and China. In 1998, Kyrgyzstan became the first former
Soviet republic to join the World Trade Organisation.
Despite all its problems, Kyrgyzstan makes some slow moves forward. Privatisation of
agriculture was initially a disaster in many areas, as farmers sold their cattle for money
rather than invest for the future. But now in some areas private agriculture is beginning
to pick up. In 2002 agricultural exports were up 30 per cent, and new schemes for
farmers in southern Kyrgyzstan led to possible exports of fruits, vegetables and flowers
to Russia, Europe and elsewhere. Most of these schemes are still a long way from
fruition, but at least tobacco and cotton are now exported privately.
Some evidence of modest economic progress can be seen from the official data of the
Kyrgyz National Statistical Committee presented below.

Table 7. Main indicators of social and economic development of the

Kyrgyz Republic in 1998-2002 (in % to the previous year)

1998 1999 2000 2001 2002

Gross domestic product 102.1 103.7 105.4 105.3 100.0
Gross capital formation 15.4 18.0 20.0 18.0 17.6
Gross savings -8.2 1.2 14.4 16.8 17.4
Industrial products 105.3 95.7 106.0 105.4 89.1
Gross output of products and
services of agriculture, hunting and
forestry. 102.9 108.2 102.6 107.3 103.1
Capital investments 64.6 121.5 137.3 85.5 90.4
Passengers carried by all types of
transport 114.5 95.7 111.4 100.8 92.7
Annual average of employed in
economy, thsd. people 1704.9 1764.3 1768.4 1787.0 1807.1
Average wage, soms 840.6 1049.9 1227.0 1455.1 1684.4
Number of unemployed, thsd. people 106.4 136.8 144.3 152.1 169.5
Including officially registered
unemployed people 55.9 54.7 58.3 60.5 60.2
29
Exports of goods and services 597.9 527.5 572.7 560.6 636.5
Imports of goods and services 931.4 705.4 655.7 565.1 697.6
Som’s rate to dollar (for the end of
the period) 29.38 45.43 48.30 47.72 46.09
External debt 1480.3 1647.4 1703.8 1677.7 1784.6
Minimum consumer budget per
capita ,soms 799.3 1097.1 1205.31 1316.45 1404.78
Poverty level, in % 54.9 55.3 52.0 47.6 44.4
Among them extreme poverty 23.0 23.3 17.8 13.5 13.8

Table 8. Main indicators of social and economic development of the

Kyrgyz Republic in 2004 (million Soms)

Actual Jan-Dec 2004 Reference

as a data: Jan-Dec
percentage of 2003 as a % of
Jan-Dec 2003 Jan-Dec 2002
Gross Domestic Product
(preliminary estimation) 5413.5 105.5 105.5
Industrial Production Volume
(works, services) – Total 4580.1 101.6 102.7
Mining 73.8 102.0 94.1
Manufacturing 3221.5 99.0 105.0
Energy, gas and water
production and distribution 1284.8 106.9 97.5
Agriculture, hunting and forestry
gross output 1826.5 101.1 100.0
Agricultural Production Output by
all holding categories, thsd. tons:
Cattle and poultry for slaughter
(live weight) 24.8 100.2 100.1
Raw milk 60.3 102.3 98.0
Eggs, mln. pieces 16.1 113.2 120.0
Fixed assets investments
(investments) accounting all
financial sources 152.7 95.7 84.1
Gross construction output 153.8 108.2 101.9
Consumer Price Index 103.6 105.7
- as of December 2004 101.3
Officially registered unemployed,
thsd. Persons 58.4 101.3 95.6
Nominal average monthly wage
per employee, Soms 2202.9 114.7 117.6
Export, mln. USD 718.8 123.6 119.8
Import, mln. USD 941.0 131.3 122.2

30
Our overview of recent economic development in Kyrgyzstan can be summed up by a
quotation from ICG paper “Central Asia: A Last Chance for Change” (2003): “President
Askar Akaev has managed to achieve the most liberal political and economic
atmosphere in the region, but fine words do not always translate into good practice. …
Some economic reforms have been made, but much more could be achieved if a
serious effort was undertaken to tackle corruption at all levels and if the presidential
family and friends restricted their appetites to control the most lucrative sectors.”
“Kyrgyzstan's society has become more mature since independence but its government
more authoritarian,” suggests an International Crisis Group Report on political transition
in Kyrgyzstan. The Kyrgyz regime of this day can be best described as a kind of soft
authoritarianism: a semblance of democratic politics with some independent media and
opposition representation in parliament remains, partly due to particular aspects of Kyrgyz
political culture – nomadic tradition and lack of authoritarian political customs – and partly
to decisions taken in the early 1990s to forge a political system based largely on pluralism
and tolerance.

31
CONCLUSIONS

32
 A POTENTIAL ROLE FOR INTERMINDS

There is considerable need to develop community mental health services in Kyrgyzstan.

The representatives of InterMinds discussed with Mental Health and Society the
opportunities for common projects. Four directions of work for the improvement of the
mental health situation in Kyrgyzstan were proposed.
1. Creation of new and support for existing groups that work on mental health problems
out of hospital, involving users in the work of these organisations, and supporting
user initiatives in creating independent self-help groups. As a result of this work, a
network of mental health organisations working in the community can be created.
2. Elaboration and implementation of a training programme for relatives of people with
mental health problems. In the organisation of this programme, a range of NGOs
such as Act in Support of the Family, Family and Society etc. should be involved.
Knowledge about the needs of users of mental health services, their relatives and
professionals, systematically carried out by Mental Health and Society, should be
accumulated.
3. Training professionals in methods of out-of-hospital work through workshops on
community care for psychiatrists, psychologists and social workers.
4. Transformation of ward 12 at RCMH into a community based service for people with
mental health problems. Users can be involved in the renovation work of the building
and surrounding land. Such a community based service can serve different
purposes: provide out-of-hospital accommodation for users, be a placement for a
daily community centre with a range of leisure and training programmes, etc. This
would require co-ordination between InterMinds, Mental Health and Society, the
administration of RCMH and the Ministry of Health.
The final selection of the directions of InterMinds’ and MHS joint project is subject to
further consultations between the two organisations.

33
ANNEXES

34
 SCHEDULE OF VISITS AND MEETINGS
(Participants from the part of InterMinds are shown in brackets)

2005, January 11, Monday

11.00: Acquaintance with Public Association “Mental Health and Society”
Conversation with the members of the Association (Olga, Andriy)
January 12, Tuesday
8.30: Official introduction to the staff of the Republican Mental Health Centre
(Olga, Andriy)
9.00: Visit to the Information Centre at RMHC (Olga, Andriy)
11.00: Meeting at Freedom House with Stuart Kahn, Programme Director
(Olga, Andriy)
16.00: Meeting at the OSCE Centre in Bishkek with Christian Knust, Human
Dimension Officer, and the staff of the (Peter, Olga, Andriy)
January 13, Wednesday
11.30: Visit to Iskra Social Care Institution (Peter, Olga, Andriy)
Interviewing Kylychbek Akhmatov, Director
Interviewing staff and patients
14.00: Visit to the Chym-Korgon Psychiatric Hospital (Peter, Olga, Andriy)
Interviewing Ghanybek Azhibekov, Director
Interviewing staff and patients
January 14, Thursday
11.00: Meeting with users’ self-help group at the RMHC Information Centre
(Olga, Andriy)
Interviewing users
14.30: Meeting with the staff of RMHC (Peter, Olga)
Interviewing staff and patients
16.30: Visit to the Ministry of Health of the Kyrgyz Republic (Peter, Olga)
Interviewing Dinara Sagynbaeva and Gulmira Ibraeva

35
January 15, Friday
10.00: Meeting with Zhenishbek Esezhaliev, Director of Chym-Korgon Farm
(Peter, Olga, Andriy)
11.00: Meeting with Keneshbek Usenov, Head of Bishkek City Centre of
Psychiatric Help (Peter, Olga, Andriy)
11.30: Meeting with Kanchaiym Tokusheva, NGO “Act in Support of Family”
(Peter, Olga)
12.20: Visit to the Ward 12 of RMHC (Peter, Olga, Andriy)
Interviewing Zhekshen Aralbaev, Head of the Ward 12
Interviewing staff and patients
15.00: Meeting with Public Association “Mental Health and Society”
(Peter, Olga, Andriy)
Elaborating a plan of common actions
16.00: Meeting with the activists of the Kyrgyz Psychiatric Association
(Peter, Olga, Andriy)
Interviewing Victoria Malobekova, Lilia Panteleeva and Mikhail Popkov
17.30: Meeting with Larisa Lee, journalist, newspaper “MSN” (Peter, Olga, Andriy)

36
 PERSONS AND ORGANISATIONS
(In chronological order of meetings)

Burul Makenbaeva, Director of NGO “Mental Health and Society”

Members of the Public Association “Mental Health and Society”: Kanchaiym Tokusheva,
Keneshbek Usenov, Aigul Kyzalakova, Svetlana Akhmatova, Azeema Ibraeva, Chinara
Ismailova, Salkynaj Akaeva, Bermet Tolubaeva, Almaz Kalbaev, Almaz Bekbaev,
Andrey Danilchenko, Nurbek Toktakunov
Keneshbek Usenov, Head of Bishkek City Centre of Psychiatric Help
Psychiatrists at RMHC
Aigul Kyzalakova, Andrey Danilchenko, Information Centre at RMHC
Stuart Kahn, Programme Director, Freedom House
Christian Knust, Human Dimension Officer, the OSCE Centre in Bishkek
Staff at the OSCE Centre in Bishkek
Larisa Lee, Journalist, newspaper “MSN”
Kylychbek Akhmatov, Director of Iskra Social Care Institution
Staff and patients at Iskra Social Care Institution
Ghanybek Azhibekov, Director of Chym-Korgon Psychiatric Hospital
Staff and patients at Chym-Korgon Psychiatric Hospital
Zhenishbek Esezhaliev, Director of Chym-Korgon Farm
Toktayim Umetalieva, President of the NGO Association
Users’ self-help group at RMHC
Dinara Sagynbaeva, Gulmira Ibraeva, Ministry of Health of the Kyrgyz Republic
Kanchaiym Tokusheva, NGO “Act in Support of Family”
Zhekshen Aralbaev, Head of the Ward 12 of RMHC
Staff and patients at the Ward 12 of RMHC
Victoria Malobekova, Kyrgyz Psychiatrist Association
Lilia Panteleeva, Mikhail Popkov, Kyrgyz Psychiatrist Association and NGO “Family and
Society”
Nazgul Turdubekova, Youth Human Rights Group
Uulkan Itikulova, Children Psychiatrist at RMHC
Juliana Chigaeva, Children Psychiatrist at RMHC
37
Yelena Dolgikh, Psychoteurapist, Centre for Children with Autism and Learning
Disabilities, Bishkek
Zhanyl Alyshkulova, Speech Therapist, Centre for Children with Autism and Learning
Disabilities, Bishkek
Marina Zemlianykh, Co-ordinator, Centre for Children with Autism and Learning
Disabilities, Bishkek
Nazgul Mirzamatova, Children Psychiatrist at RMHC

38
 EXCERPT FROM THE LAW OF KYRGYZ REPUBLIC
On Psychiatric Care and Guaranteeing Rights of Persons Receiving Such
Care (1999)

“Article 5. Rights of persons having mental disorders.

1. Persons having mental disorders have all the rights and freedom provided by the
Constitution of the Kyrgyz Republic. Limitations of rights and freedom related to
psychiatric care are permitted only in cases provided by the legislation of the Kyrgyz
Republic.
2. All persons having mental disorders and receiving psychiatric care have rights for:

• respectful and humane treatment excluding humiliation of human dignity;

• receiving information about their rights, the nature of mental disorders and treatment
methods applied in a comprehensible manner and taking into account their medical
condition;

• psychiatric care in conditions limiting their freedom to the least possible extent and if
possible at home;

• to be kept in in-patient psychiatric institutions only for a period necessary for

examination and treatment;

• all kinds of care (including resorts) based on medical indications in the absence of
contraindications;

• psychiatric care in conditions satisfying basic sanitary-hygiene requirements;

• prior permission or rejection at any stage regarding usage as objects of experiments

of medical means and methods, scientific research of training process,
photo/video/film recording;

• invitation of any specialist participating in the provision of psychiatric care to engage

in activities of medical committee regarding matters specified in the present Law;

• assistance of a lawyer, legal representative or other persons in accordance with

procedures set by the legislation of the Kyrgyz Republic.”
“Article 16. Types of psychiatric care and social protection guaranteed by the state.
1. The State guarantees:

• emergency psychiatric care;

• consultative-diagnostic, treatment, preventive and rehabilitation care in out-patient

and in-patient institutions;

• all types of psychiatric assessment, identification of temporary inability to work;

• social and legal assistance and support in finding employment for person having
mental disorders;

39
• guardianship issues;

• consultations on legal matters and other kinds of legal assistance in psychiatric and
psycho-neurological institutions;

• provision of social assistance for the disabled and elderly having mental disorders as
well as provision of care;

• training of disabled and minors having mental disorders;

• psychiatric care during disasters and emergencies.

2. For the provision of psychiatric care and social protection for persons having mental
disorders, the State:

• establishes all kinds of institutions providing out-patient and in-patient care, if

possible near the residence of the patients;

• organises mainstream and vocational education for minors having mental disorders;

• creates special production enterprises for work therapy, vocational training and
employment for persons having mental disorders, including the disabled as well as
special production shops or sections with simple working conditions for such
persons;

• receives complete and efficient information regarding the availability of vacancies

from employment agencies;

• establishes obligatory quotas for various enterprises, institutions and organizations

to employ persons having mental disorders;

• applies methods of economic stimulation for enterprises, institutions and

organisations accepting persons having mental disorders;

• creates dormitories for persons having mental disorders who have lost their social
connections;

• takes other measures necessary for the social support of persons having mental
disorders.
3. Provisions of all types of psychiatric care and social protection for persons having
mental disorders, is implemented by central and local government agencies in
accordance with their competencies determined by the legislation of the Kyrgyz
Republic.”
“Article 17. Funding of psychiatric care.
Funding of institutions and persons providing psychiatric care is implemented from the
state budget, the fund of compulsory medical insurance and other sources not forbidden
by the legislation of the Kyrgyz Republic in amounts necessary for the guaranteed level
and high quality of psychiatric care.”

40
 INFORMATION FOR THE COLLEGIUM MEETING (Excerpt)
On State of the Mental Health Service in Osh, Jalal-Abad, and Batken
Oblasts and on Activity of Republican Mental Health Center as
Organizational and Methodological Center of the Service
(Translation was provided by Mental Health and Society)
Lethality in psychiatric hospitals remains at the level 1-1,4 (in 2002 it became 1,4),
however, it was founded that death rate was persistently underestimated in the affiliate
of the №1 RMHC starting from 1997, what impacted the general country indicator. So,
for example, in 2002, instead of 146 died patients only 61 (41,8%) was reported, in
2001- instead of 142 cases - 55 (38,7%) was recorded, in 2000, instead of 75- 45 (60%)
patients, etc. And besides, there was a wide practice of burials without autopsy (in
2002- 66,7%.) or there were cases of discharging patients as alive, and receiving
signatures of their families for receiving corpse (5 cases). There are no patients’ dying
descriptions, courses of death are not mentioned in epicrisis, appropriate health care is
not provided in case of a patient’s state deterioration, diagnosis very often are corrected
on cover pages of patients’ files. In 8 patient records, of patients died in 2001, there is
no mentioning of burial or handing in the body to its relatives. Since1997 up to 2002 -
24 corpses were sent to the department of operative surgery of the Kyrgyz Medical
Academy in 2002, but results of autopsy are mentioned only in 2 case histories.
Therefore, the share of autopsies in 2001 was 2,1% (3 ), in 2002 – it was 28,2% (40 ).
Analysis of 43 autopsies, made in 2001-2002 showed that in 35 cases (81,4%) the
course for death was intoxication of the body as a result of tuberculosis, in 5 cases
(11,6%) – ischemic heart disease and in 4 other cases – there were some other
courses. For the period from 1997 up to 2002, the affiliate №1 of the RMHC handed
over 157 unclaimed corpses and 33 died people in hospital-house for chronic mentally
ill patients in a village Iskra to the department of operating surgery and topographical
anatomy. During supervision, it was founded that in 16 cases died people were
registered as discharged, but in fact, their corpses were handed into the plastination
center of the Kyrgyz State Medical Academy. There are no death certificates for those
146 died people in the affiliate №1 of the RMHC and 33 died people in hospital-house
for chronically mentally ill patients in a village Iskra, and in accordance to statistics
these patients are alive, as their deaths were not registered in special registration
agency.
Since 28.08.02 director of the hospital-house for chronic mentally ill patients Akmatov
and chief doctor of the affiliate №1 of the RMHC Mamyrbayeva B.К. made an
agreement (№ 02/255 dated 4.09.02.), where the administration of the hospital-house
for chronic mentally ill patients is committed to pay the affiliate 350 soms per each
buried corpse and promise to deliver it to mortuary for burying in hospital cemetery.
However, breaking their own agreement, the affiliate №1 of the RMHC sent 33 corpses
to the operative surgery departments, and none of documents registered receipt of the
money agreed in amount 11 thousands 550 soms. In Osh oblast center, there were 4
cases of death in 2003 and 12 cases of death in the Republican mental health hospital
in a village Kyzyl-Jar, and in no cases the autopsy was made, and the course of death
was not founded.
Unjustified delays of patients in hospitals have actually transformed large mental
hospitals into long-term asylums, where 2/3 of all patients don’t need any treatment in
hospitals. During check-up, no one patient with acute psychotic symptomology,
requiring supervision, and active and intensive treatment in hospitals was found (Isfana,
Batken, Kyzyl-Kiya, Mailuu-Suu, affiliate №1 RMHC). SO in RPH in Kyzyl-Jar the

41
patient stayed with one purpose – “observation” in the following departments: № 1-14,
3% of patients, № 4-35,9%, №5-11, 8%, № 10-8,1% of patients. Departments in №№ 7
and 11, where mentally ill patients ha TB as well, more than 90% of all patients don’t
receive anti-psychotic treatment and can be discharged based on their psychotic
conditions. In the affiliate №2 of the RMHC more than a half out of 45 patients didn’t
received any treatment, so, in fact they stayed their in regime of “asylum”.
There are serious deficiencies in organization of rehabilitation process. In major part of
large mental hospitals, rehabilitation departments were created, but they don’t function
as they should, for example in rehabilitation department of Osh oblast mental health
center patients instead of working or doing different rehabilitation activities, stay all
morning in fenced space designed for walking. The same thing is happening in psycho-
narcological departments in RMHC affiliates in the following towns: Isfana, Batken,
Kyzyl-Kiya, Mailuu-Suu. Newly created rehabilitation departments are simply having a
name for it, but they are not equipped with necessary equipment, don’t have trained
specialists and don’t have well developed technologies for rehabilitation process.
Hospitals don’t have conditions for labor rehabilitation of patients, sewing workshops
are not operating and don’t have trained specialists (RPH in Kyzyl-Jar, RMHC affiliate
in Chym-Korgon), there are no lawyers, social workers, labor instructors, social
assistant service in hospitals, who would work for providing links with social security
agencies and assist in patients’ adaptation.
Absence of approved rules for involving patients into labor, brings to casual involvement
of patients to different works, very often connected with hard physical load, and
compensation for this work is not regulated (except sewing workshops), what is
stipulated by our legislation. Involvement of patients for work in private homestead
lands in Kyzyl-Jar was indirectly confirmed by orders, issued by hospital administration
on 1999 – 2002 saying that “some cases were detected, when heads of departments
send patients to private works and one of the points says that “it is prohibited for all
heads of departments and chief nurses to send patients for private works in the village”
(orders, dated 21.04., 1999 №19; 7.03.2001; and 30.06.2003г. №17). Office of public
Prosecutor of Kemin rayon has confirmed the cases of using patients for working in
private gardens or other private works for doctors in the RMHC affiliate №1. So head of
the Department Talipova R. has permanently used a patient К.В. for her domestic
works, and patients C.C., the former taxi-driver was in fact making repair works of
director’s Adjibekov hospital car, patients from labor rehabilitation department don’t
receive any compensation for their work.
Therefore, despite the implemented work for improvement of the mental health service,
the speed of its reforming and quality of provision mental care in the country remain
poor. A number of mental disorders and related disunities keep on growing, alternative
forma of care are not introduced, there is no real efforts to extend psychotherapeutic
and children mental health services, day-time hospitals, mental health service is not
really close to population, small crisis departments in territorial hospitals are not
created, there is not proper interaction with family doctors for early detection of mental
pathology, in particular its “mild” forms, there are numerous violations of patients’ rights,
when mental care is provided, the Kyrgyz Republic Law “On Psychiatric Care and
Guarantees of Citizens Right when It is Provided”. Mental health service does not make
any efforts to decentralize the service, to break up large mental health center into
smaller units and integrate them into the general network of healthcare facilities;
organization of non-hospital rehabilitation for patients with hard mental disorders is
needed.

42
Head of the Department of Organization of Health Care К.B.Mambetov

43
 MATERIALS OF THE 13TH LOCAL POLICY FORUM
REGARDING MENTAL HEALTH ISSUES (Held in February 2005)
Questions
• What needs do you have?
• In what skills are you interested to be trained, in order to become able to influence
actively on mental health policy?
Responses (in the order of priority)
1st group – professionals:
• Information about mental health law, public health law

• Skills in writing project proposals

• English, computer skills

• Lobbying in local government, public health, social care system

• Training, seminars, study tours

• Literature, information
2nd group – users:
• Computer skills

• Writing project proposals

• Sharing experience with other self help groups in different countries

• Group working under the support of professionals

• Lobbying

• We need to be employed

• Training on patient’s rights

• Kyrgyz, English
3rd group – family members
• Training in mental health law and human rights

• Ability and knowledge to build relations and live together with a mentally ill person.
How to avoid conflicts

• Positive experience in other countries

• Lobbying skills

• Organisation of self help groups of family members

• Opportunities to improve the quality of mental health services provided by the state

• Information on the responsibility of state institutions, for indicating the direction of

lobbying

44
 JOINT PRESS RELEASE
BY THE MENTAL DISABILITY ADVOCACY CENTER AND KYRGYZ NGO
“MENTAL HEALTH AND SOCIETY” OF 16 FEBRUARY 2005
Kyrgyz Ombudsman Supports Human Rights Protection of People with Mental
Disabilities
16 February 2005, Bishkek and Budapest – Today, the Ombudsman of the Kyrgyz
Republic, Mr. T. Bakir uulu, signed a Memorandum with the Kyrgyz NGO “Mental Health
and Society” (MHS) and the Mental Disability Advocacy Center (MDAC), an
international legal advocacy NGO based in Budapest. The Memorandum encourages
the government to improve implementation of the 1999 Kyrgyz Law on Psychiatric Care,
and goes on to emphasize the importance of human rights protection of people in
Kyrgyz psychiatric institutions, such as the Republican Mental Health Center where
MHS operates a new independent advocacy service for patients.
The Republican Mental Health Center – a large psychiatric hospital in Bishkek was
highlighted in MDAC’s 2004 report on human rights and psychiatry in Kyrgyzstan,
“Mental Health Law of the Kyrgyz Republic and its Implementation”. A key
recommendation in this report was to establish an independent advocacy service for
patients at the Republican Center – also required by section 38 of the 1999 Kyrgyz Law
on Psychiatric Care.
Since November 2004, with funding from the Open Society Institute, the NGO “Mental
Health and Society” has been operating an advocacy service with the support of MDAC.
As part of the service, there are now complaint boxes in each ward of the Republican
Center where patients can anonymously deposit grievances. Lawyers in the advocacy
center and (ex-)users of mental health services are working together to resolve
problems noted, which thus far include complaints about lack of food, involuntary
detention and lack of information about diagnosis and treatment.
As the first independent advocacy service in a psychiatric hospital in central Asia, the
existence of the independent advocacy service is critical for the advancement of the
rights of people labeled with mental disabilities and housed in grossly inadequate
facilities in this region.
In the signed Memorandum, the Ombudsman pledges to work with NGO “Mental Health
and Society” and MDAC to support the further development of the advocacy service.
As part of a routine support trip to Bishkek last week, MDAC met with the Kyrgyz
Minister of Health who also expressed support for the advocacy service. However,
formal support of the Ministry is still under consideration. Professor Solozhenkin,
chairman of the Kyrgyz Psychiatric Association, also voiced limited support of the
advocacy service, but would like the advocacy service to be run by a greater number of
NGOs, including a “user organization” which the Association is currently establishing.
MHS and MDAC will be closely monitoring this development.
The Kyrgyz NGO “Mental Health and Society” and MDAC now encourage the Minister
of Health to demonstrate strong leadership in mental health reform and protection of
human rights by lending immediate Ministry support to the independent advocacy
center, operated by MHS.

45
Notes:
The Mental Disability Advocacy Center (MDAC) is an international non-governmental
organization that promotes and protects the human rights of people with mental health
problems and intellectual disabilities across Central and Eastern Europe and Central Asia.
MDAC works to improve the quality of life for people with mental disabilities through
litigation, research and international advocacy. MDAC has participatory status at the
Council of Europe and is a cooperating organization of the International Helsinki Federation
for Human Rights. www.mdac.info
The NGO “Mental Health and Society” a national non-governmental organization in the
Kyrgyz Republic that promotes the rights of mental health service users to have a voice
in mental health policy and reform.

46
 PRINCIPAL REFERENCES

Part I
• Stewart R., Weldon S. Kyrgyzstan. The Kyrgyz Republic: Heartland of Central Asia.
Odyssey, 2002.

• Kyrgyz State in the twentieth century. Collection of documents (in Russian).

Composed by A. Dzhumanaliev. Bishkek, 2003.

• Central Asia: A Last Chance for Change. International Crisis Group Asia Briefing
Paper N°25, 29 April 2003.

• Political Transition in Kyrgyzstan: Problems and Prospects. International Crisis

Group Asia Report N°81, 11 August 2004.

• Human Rights Watch’s Letter to President Askar Akaev of February 14, 2005.

• Appendix to Human Rights Watch’s February 14, 2005 Letter to President Askar
Akaev.

• Kyrgyz newspapers: “Slovo Kyrgyzstana”, “MSN”, “Res Publica”, “gazeta.kg”, in

January/Februay 2005.

Part II
• Highlights on health, Kyrgyzstan. WHO Report, 1999.

• Health care systems in transition, Kyrgyzstan. The European Observatory for Health
Care System Report, 2000.

• Law of Kyrgyz Republic: On psychiatric care and guaranteeing the rights of persons
receiving such care (1999).

• Monitoring of human rights in mental healthcare facilities of the Kyrgyz Republic.

Human rights and conditions of treatment in psychiatric, psychiatric-neurological and
psychiatric-narcological institutions. Report on the first stage of the monitoring.
Youth Human Rights Group. Bishkek: 2001.

• Monitoring of human rights in mental healthcare facilities of the Kyrgyz Republic.

Compliance with the rights to access to information in the Republican Mental Health
Centre: Report on the second stage of the monitoring. NGO “Mental Health and
Society” & Youth Human Rights Group. Bishkek: 2003.

• Monitoring of human rights in mental healthcare facilities of the Kyrgyz Republic.

Compliance with the rights to freedom, to appeal in court of acts of retaining patients
in the Chym-Korgon branch of the Republican Mental Health Centre: Report on the
third stage of the monitoring. NGO “Mental Health and Society” & Youth Human
Rights Group. Bishkek: 2004.

47
• Mental Health Law of the Kyrgyz Republic and its Implementation. Report. The
Mental Disability Advocacy Centre (MDAC), 2004.

• Information for the Collegiums Meeting On State of the Mental Health Service in
Osh, Jalal-Abad, and Batken Oblasts and on Activity of Republican Mental Health
Centre as Organizational and Methodological Centre of the Service. Bishkek, 2004.

• Kyrgyz Ombudsman Supports Human Rights Protection of People with Mental

Disabilities. Joint press release. By the Mental Disability Advocacy Centre and
Kyrgyz NGO “Mental Health and Society.” 16 February 2005, Bishkek & Budapest.

Internet Resources
• InterMinds Web page: http://www.interminds.org

• Mental Disability Advocacy Centre: http://www.mdac.info

• United Nations Integrated Regional Information Networks: http://www.irinnews.org

• International Crisis Group: http://www.icg.org

• Governments on the WWW Kyrgyzstan: http://www.gksoft.com/govt/en/kg.html

• National Statistical Committee of Kyrgyz Republic:

http://stat-gvc.bishkek.su/English/index.html

• The World Factbook (CIA) – Kyrgyzstan:

http://www.odci.gov/cia/publications/factbook/geos/kg.html#Intro

• Kyrgyzstan - Atlapedia Online: http://www.atlapedia.com/online/countries/kyrgyz.htm

• Kyrgyzstan. The Columbia Encyclopedia, Sixth Edition. 2001:

http://www.bartleby.com/65/ky/Kyrgyzst.html

• Kyrgyzstan at Infoplease: http://www.infoplease.com/ipa/A0107698.html

• Political Resources on the Net – Kyrgyzstan:

http://www.politicalresources.net/kyrgyzstan.htm

• Kyrgyzstan Country Studies - Federal Research Division, Library of Congress:

http://lcweb2.loc.gov/frd/cs/kgtoc.html

• The Central Eurasia Project:

http://www.eurasianet.org/departments/insight/index.shtml

48