Throughout the WHO European Region, stigma and discrimination are barriers that people living with mental health conditions face in nearly every aspect of their lives. These barriers hinder many from getting or keeping a job, getting an education, and even accessing health care, and often negatively affect people’s perceptions of themselves.
In Kazakhstan, innovative approaches to combat and raise awareness of stigma and discrimination are bearing fruit, largely due to the persistent work of the National Scientific Centre of Kazakhstan, with its 2 dedicated Mental Health Centers founded by the Ministry of Health in Kazakhstan, in cooperation with WHO and partners.
“It’s not only [public] stigma that is an issue in our country,” explains Dr Nikolay Negay, Mental Health Consultant at the WHO Country Office in Kazakhstan and former Director of the Research Center for Mental Health. “People suffering from ill mental health tend to self-stigmatize, creating double barriers for themselves. But luckily, we’re slowly starting to change this trend.”
“A diagnosis worse than the disease”
In 2014, the first national suicide prevention programme in Kazakhstan, carried out by the Research Center for Mental Health of Kazakhstan, the Ministry of Health and the Ministry of Education with the technical support of the United Nations Children's Fund (UNICEF), found that even family members would hesitate to help a person with a mental health condition – even one at risk of suicide – simply for fear of stigmatization. People often feared the diagnosis more than the condition itself.
“Families often encouraged self-isolation and cutting off social ties,” says Nikolay. “People with a high risk of suicidal behaviour and their caregivers tended to categorically refuse any help from a mental health specialist. We also faced a situation where caregivers would write complaints about mental health specialists wanting to make persons mentally ill.”
In these cases, the fear of stigma could be life-threatening. “We had several cases where we weren’t allowed to assist or treat, and a patient would die by suicide,” Nikolay explains. “For me, as a specialist and one of the mental health service heads at that time, it was a revelation of the huge issue we faced, and a tragedy. We decided it was absolutely crucial to start work on destigmatization. Improving mental health and fighting stigma became my calling.”
Changing attitudes and raising awareness
With technical support from UNICEF, destigmatization became one of the biggest components of the suicide prevention programme. At the beginning of the project in 2015, more than 11% of patients at high risk of suicide refused any professional help. A year later, that number had decreased to 5%; in 2017, it was only 1%.
At the same time, 2017 saw the advent of several new initiatives to improve mental health services in Kazakhstan.
- Psychiatric services were transformed into mental health services, including the inclusion of mental health services into primary health care. This ensured that people could access all services in one place.
- The country introduced new legislation on mental health, including an updated national health code. The new code helped ensure that people wouldn’t lose their legal right to make their own decisions, simply because they were living with a mental health condition. In 2021 alone, 18 patients regained their legal autonomy.
- Programmes were created to reduce self-stigmatization and stigmatization of patients and their relatives.
- New activities — often outside the health system — emerged, such as protected houses, places where a person with a mental health condition can receive legal education, skills training and help in readjusting to society.
Assessing these measures is a complex challenge
“Visible results of these activities will only be seen in the future,” he says. “We’re not at the finish line yet in Kazakhstan, but I think we have already come a long way. As part of WHO’s Pan-European Mental Health Coalition, we have an active working group transcending all levels of work in the areas of improving mental health and decreasing stigma and discrimination. This is a big step forward.”
Nikolay recalls 2 service users who were living in a closed, protected facility under guardianship, having lost their legal autonomy. Through comprehensive care, including the right treatment, both have had their rights reinstated and have been reintegrated into society.
“This was such a landmark success, showcasing how a person deemed unfit in the eyes of society can be helped and treated,” Nikolay shares. “One of them now works as a waiter and the other in a computer shop. Both have left the closed facility where they used to live; they have their own homes and lives, and for me it was simply a success I will never forget, proving that it can be done.”
The WHO European Programme of Work 2020–2025 places a strong emphasis on mental health through the Pan-European Mental Health Coalition – a network of individuals and organizations, including people living with mental health conditions, non-governmental organizations, governmental representatives, academics and more. The Coalition, in which Nikolay is a member, is working to scale up destigmatization efforts throughout the WHO European Region as one of its priority areas.
World Mental Health Day, which falls on 10 October every year, is observed throughout the world, aiming to raise awareness of everyone’s right to mental health and well-being.