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Recommendations for Mental 

Health Reforms in Uzbekistan: A 

Policy Report 

 

 

Akmal Alikhan Aliev1*, Tatiana 

Taylor Salisbury1 
 
1Centre for Global Mental Health, Health 
Service and Population Research 
Department, Institute of Psychiatry, 
Psychology and Neuroscience, King’s 
College London, London, UK 
 
*Corresponding Author 

 

Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2020.513   |   http://cajgh.pitt.edu 

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Abstract 

Introduction: There are large differences in the development of mental health systems of the West and the countries of the former 

Eastern Bloc. The latter is characterized by a more biological approach to mental health and reliance on psychiatric hospitals. In 

2018, Uzbekistan authorities showed interest in reforming mental health care of the country. The policy report provides an overview 

of progress towards the provision of community mental health (CMH) care across Eastern Europe and recommendations for this 

transition within Uzbekistan. 

Methods: A literature search on mental health care in Uzbekistan was conducted to understand its strengths and weaknesses. 

Progress towards the provision of CMH care across Eastern Europe was assessed using data on the number of psychiatric beds and 

availability of mental health services in community settings reported within the published literature. Countries identified as making 

the greatest progress towards CMH care were reviewed in detail to better understand the process of reform assets and barriers.  

Results: Mental health care in Uzbekistan is highly institutionalized, underfunded and understaffed. Social care services are poorly 

developed. However, current leadership has kindled the promise of mental health reform. Georgia, Lithuania and Poland have made 

the most progress in terms of CMH care availability. However, due to various obstacles such as dual financial burden, high stigma 

and lack of political will, their programs lack social integration and/or uniform availability and underfunding along with scarcity 

of mental health specialists are common. On the other hand, research and evaluation, involvement of service users into service 

planning and cooperation with donors facilitated reform implementation. 

Conclusion: Uzbekistan may develop into a modern mental health system and avoid the setbacks encountered by other countries 

in the region, through careful financial planning, stigma reduction, improving mental health literacy, human resources strategic 

development and civil society engagement. 

Keywords: Deinstitutionalization; Policy Report; Uzbekistan  

Recommendations for Mental Health 

Reforms in Uzbekistan: A Policy 

Report 

 

 

Akmal Alikhan Aliev1, Tatiana Taylor 

Salisbury1 

 
1Centre for Global Mental Health, Health 

Service and Population Research 

Department, Institute of Psychiatry, 

Psychology and Neuroscience, King’s College 

London, London, UK 

Research 

The reform of mental health care in Eastern 

Europe (i.e. the 23 countries of the United Nations 

Eastern European Group1) has not been as swift as in 

Western Europe. In the West, mental health care reform 

began in earnest in the mid-20th century with closures of 

mental asylums and psychiatric hospitals in response to 

financial, treatment and societal shifts2,3 which resulted 

in major policy shifts favoring community-based mental 

health care and deinstitutionalization4. Community 

mental health (CMH) is based on the principle that 

treatment is provided in the least confined environment 

and aimed at rehabilitating the person for returning to the 

society5. The process of downsizing psychiatric hospitals 

while expanding mental health services within the 

community is known as deinstitutionalization6. 

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While deinstitutionalization was commonplace 

across Western Europe during the end of the 20th century, 

a more biological approach to mental health held across 

Eastern Europe (EE) supported the institutionalization of 

mental health care in the region7.  Although progress 

towards deinstitutionalization in Europe varies 

significantly from country to country8, across EE it is 

generally hampered by insufficient numbers of mental 

health professionals, a significant reliance on inpatient 

care and a lack of funding9. 

Uzbekistan, a middle-income country in Central 

Asia with a population of 32.4 million people10, gained 

independence after the collapse of Soviet Union and has 

experienced a long period of stagnation with mental 

health services concentrated primarily in old 

overcrowded psychiatric institutions with poor sanitary 

conditions11. Recently the country has shown signs of 

openness for wide-ranging reforms, including in mental 

health. A revised psychiatric care law is planned to be 

issued in the near future with a focus on human rights. 

The presidential decree on mental health published in 

2018 aimed at reducing the treatment gap, improving the 

quality of care in hospitals and increasing the psychiatric 

workforce12. However, the country’s new mental health 

policy does not include a commitment to developing 

CMH care, which could contribute to bridging the health 

gap between Uzbekistan and Western Europe13. 

The aim of this paper is to provide evidence-

based recommendations for the reform of the 

Uzbekistan’s mental health care. This policy report 

provides (1) a description of the current mental health 

system in Uzbekistan, and (2) a discussion of reforms in 

mental health systems of EE countries. Based on these 

findings, recommendations for deinstitutionalization in 

Uzbekistan are proposed. 

 

Methods 

Review of Uzbekistan’s mental health system 

A literature search on the Uzbekistan’s mental 

health system published between 1991 (year of 

Uzbekistan’s independence) and April 2019 was 

conducted across four databases (Medline, Embase, 

PsychINFO and Web of Science). The search strategy 

(appendix) was based on a previous review of mental 

health systems in EE14.  

Literature on the epidemiology of severe mental 

disorders (ICD-10 diagnosis: F20–F22, F24, F25, F28–

F31, F32.3, and F33.3), available mental health services 

and staff, policy and legislation, financing of mental 

health care, stigma and service users’ involvement was 

included. Severe mental disorders were selected due to 

their high socio-economic burden15. The inclusion 

criteria were extended to include opinion papers, reports 

and editorials. All literature published in English or 

Russian languages were included. Clinical, biological, 

psychometric research papers, case studies, conference 

abstracts were excluded. After title and abstract 

screening, studies that did not meet inclusion criteria 

were excluded as not relevant and the rest were screened 

for full-text. Identified studies were complemented with 

World Health Organization (WHO) reports (e.g. Health 

Systems in Transition, WHO-AIMS and Mental Health 

Atlas). State websites (e.g. lex.uz and minzdrav.uz) were 

used to obtain documents on mental health law, legal acts 

and presidential decrees concerning mental health. Data 

from included articles were coded and extracted 

according to topics mentioned above. A narrative 

synthesis was used to summarize the information. 

The impact of mental health reforms on 

deinstitutionalization in Eastern Europe 

Mental health care transition from institutes to 

CMH in EE was evaluated through psychiatric beds 

reduction and availability of community services. Mental 

Health Atlas16–19 was used for psychiatric beds change 

calculation and availability of community mental health 

services was analyzed through 23 country profiles in the 

Lancet’s review of mental health systems in EE20. 

Georgia, Lithuania and Poland were identified as 

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countries which had achieved the most progress in the 

transition to CMH in EE for their significant inpatient 

bed reduction and commitment to scale-up community 

services. Details with tables on the process of 

identification of these three countries can be found in the 

appendix.  

Selected countries were then further examined 

by literature referenced in the corresponding country 

profiles in the Lancet review14. Key milestones in the 

development of mental health policies and systems were 

extracted for each of the identified countries as a 

particular focus on the factors that contributed to reform 

and CMH and challenges experienced. Activities, 

milestones and barriers common across identified 

countries were explored. Triangulation of information 

identified through the literature review was used to 

develop a set of recommendations for mental health 

reform in Uzbekistan. 

 

Results 

Mental health care in Uzbekistan 

One hundred and forty unique records were 

identified through the search strategy (Figure 1). 

Following title and abstract screening, eight full-text 

articles were reviewed. Two articles did not meet 

inclusion criteria and one article could not be found. An 

additional three legislation and policy documents and 

three national reports were included.

Figure 1. Screening and selection of articles 

 

 

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Uzbekistan adopted its first mental health law, 

On Psychiatric Care, in the year 2000, which ensures the 

rights of people with mental disorders and outlines 

involuntary hospitalization procedures21. In July 2018, a 

draft of the amended law was published for public 

consultation. This included more thorough regulation of 

involuntary hospitalization, including court appeal 

process and state supervision over the activities of 

psychiatric care provision22. A national mental health 

policy and plan, which focused on shifting services from 

hospitals to the community was also introduced in 2000. 

However, it was not accompanied by an increase in 

funding and remains largely unenacted23. A number of 

legal acts were published in 2013-2014. These aimed to 

improve psychiatric provision through incentivizing 

mental health workers and ameliorating patient quality of 

life24. 

The proportion of mental health expenditure has 

varied and declined since independence. The latest 

available data from 2012 reports 2.1% of the total health 

budget is spent on mental health25. Additional funds have 

been allocated to mental health care since 2013 by the 

Ministry of Finance together with loans and grants from 

foreign states for the reconstruction of psychiatric 

facilities and purchase of medical equipment12,25. 

Before independence, primary care was 

neglected in favor of secondary and tertiary care 

provision26. This was and still is particularly true for 

mental health. Most (89%) of the mental health budget is 

spent on psychiatric hospitals while integration of mental 

health into primary care remains poor23,27. Outpatient 

care is provided by 22 psychiatric dispensaries located 

across the country, including day treatment in some 

regions28. 

Although psychiatric hospitals continue to 

receive the majority of the mental health budget, the 

number of beds in mental hospitals and psychiatric 

dispensaries has declined nearly two-fold since 199128. 

However, the associated savings from reduced bed 

numbers were not reallocated to create community-based 

services but, instead, diverted to other health care 

concerns28. Today, the number of beds in psychiatric 

hospitals is 26 per 100,000 population but it does not 

fully reflect the institutionalization of people with mental 

disorders in Uzbekistan. An additional 890 beds are 

located in forensic inpatient departments and 6,500 beds 

for people with mental disabilities across 20 social care 

homes26. In addition, tens of thousands of children with 

special education needs are placed in more than 200 

special boarding schools in the country25. It is not clear 

whether reduction of psychiatric beds is associated with 

transinstitutionalization of people from hospitals to other 

institutions since information on these facilities is not 

publicly available. 

Due to the stigmatization of the field of 

psychiatry, relatively low salaries and poor working 

conditions, the number of psychiatrists working in 

Uzbekistan has declined nearly two-fold since 1991 to 

2.8 per 100,000 population25. However, the country 

retains a high number of psychiatric nurses, with nine per 

100,000. Social workers and psychologists are not 

integrated into the health system. There are only 0.08 

psychologists per 100,000 population and no social 

workers or occupational therapists involved in mental 

health care17. To address the lack of human resources for 

mental health, the 2018 presidential decree identified 

increasing access to psychiatric care as a priority and 

promotes the inclusion of social workers within the 

mental health care system12. Quotas for postgraduate 

studies and medical residencies in psychiatry have 

increased in each medical school and scholarships are 

now provided. 

Stigma associated with mental disorders within 

the country has been related to a decrease in help-seeking 

from medical professionals and greater demand for 

traditional healers26,29. Mundt et al.11 suggest this finding 

is partly a result of the integration of Muslim spiritual and 

Russian biological traditions in Uzbekistan’s psychiatry. 

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Mental health care development in Georgia, Lithuania 

and Poland 

Apart from showing tangible commitment to the 

provision of mental health in the community by 

developing services integrated into state health system, 

Georgia, Lithuania and Poland have substantially 

downsized inpatient capacities and provide the best 

examples of CMH care in the region. In Lithuania and 

Poland, a number of consecutive policy documents 

developed in the 1990’s onwards set the direction of a 

new mental health policy30,31. New community services 

began as a result, but these were sporadic and largely 

unavailable. New strategies in 2007, in Lithuania, and in 

2010, in Poland, supported the development of networks 

of nation-wide CMH centers to provide care for those 

who would have previously been cared for in hospitals. 

Unfortunately, they never provided an appropriate 

quality of care, largely lacking psychosocial 

elements20,32. Reform failure can be explained by low 

prioritization of mental health among policy-makers, 

which led to the underfinancing of reform programs31,33. 

The inability to ensure appropriate resourcing of CMH 

care was experienced in both countries. Poland was 

unable to address financial challenges during reform. 

New community services were poorly integrated and 

found themselves in competition with hospitals where the 

majority of funds were still allocated and used for their 

renovation. Reforms also lacked sufficient monitoring 

mechanisms to assess the efficacy and quality of 

implementation activities. Low prioritization of mental 

health in Georgia and Lithuania was partly associated 

with prevalent societal stigma towards mental illness, 

which discourages policy-makers from implementing 

plans to make services for people with mental disorders 

closer to communities33. 

Another barrier for new community services to 

operate is significant lack of qualified staff that could 

deliver psychosocial services20,32,34. Under financial 

assistance from EU Funds Lithuania built a network of 

community facilities but faced with absence of specialists 

who could deliver quality psychosocial help, instead 

treatment remained pharmacological. Reform 

implementation is also aggravated by bureaucratic 

challenges of interagency cooperation between different 

government structures like Ministry of Health and 

Ministry of Social Welfare that are both responsible for 

new program implementation20. 

Georgia, which was devastated by civil war in 

the early 1990’s, presents a slightly different case of 

mental health care development. After change of 

government in 2004, a window of opportunity for 

reforms was opened35. It took several years of 

preparatory work to provide policymakers with evidence 

on poor quality of psychiatric care available within the 

country and cost-effectiveness of psychosocial 

interventions prior to adoption of the mental health 

reform in 201035,36. Investment for mental health 

gradually increased and plans and programs were 

supported by foreign experts. Deinstitutionalization 

within the country was comprehensive including not only 

establishment of services in the community such as crisis 

teams and residential facilities (this is referred by 

Georgian experts as a “real” deinstitutionalization, 

emphasizing that the process is not just about the 

reduction of psychiatric beds), but also investing into 

capacity building and education20,35. Modern psychiatric 

literature was translated into the Georgian language and 

treatment guidelines were updated. Mental health 

workers received evidence-based training and a mental 

health research center was established. Georgian national 

NGOs were directly involved in mental health reform by 

piloting psychosocial interventions that were later scaled-

up to the state level and participating in development of 

policy and legislation as stakeholders. Despite significant 

investment into CMH care, the reforms did not affect the 

psychiatric hospitals, which still consume most of the 

mental health budget (69% in 2014) and remain in poor 

condition with treatment being purely pharmacological37, 

emphasizing, again, importance of addressing dual 

financial burden during reform implementation. Table 1 

presents a summary of the findings in three countries.

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 Poland Lithuania Georgia 

Strong and weak 

characteristics of 

CMH 

• Day clinics 

• Centers for mental health 

• Substantial reduction (40%) of beds in 

psychiatric hospitals 

• Availability and organization of services is 

very poor 

• 115 Multidisciplinary mental health teams in 

primary care clinics 

• 40 Day-care centers opened 

• Substantial reduction (40%) of beds in 

psychiatric hospitals 

• Multidisciplinary teams are not utilized for 

people with SMI 

• Drug treatment prevails over the psychosocial 

treatment 

• Lack of social workers and psychologists in 

the teams 

• One of the largest psychiatric hospitals closed 

and beds relocated into general hospitals  

• New residential facilities opened in a number 

of towns 

• Crises teams started functioning across 

country 

• Mental health education reformed 

• Inpatient care deteriorated and treatment 

became more aggressive in order to discharge 

patients quickly to comply with new rules. 

Policy and/or plans 

and their outcomes in 

terms of access to 

community care 

Mental Health Protection Act (1994) 

Mental Health Programme(1994) 

   -Access to psychiatric care worsened 

National Programme on Mental Health 2011-

2015 

   -Care mostly provided in 51 large psychiatric 

hospitals with unsatisfactory conditions 

   -Centers for mental health do not meet criteria 

of the Programme 

State Programme on the Prevention of Mental 

Disorders 1999-2009 

Mental Health Strategy (2007) 

   -Investments took place into hospital and 

pharmaceutical care 

   -Deinstitutionalization and destigmatization 

targets were not prioritized 

   -Community care remained underfunded 

National Health Care Strategy 2011-2015 

The National Strategy and Action Plan for 2015-

2020 

   -Care mostly relies on psychiatric hospitals 

with unsatisfactory conditions 

Key facilitating 

factors 

• User organizations participate in policy 

formulating and organization of psychiatric care 

•  EU Structural Funds assisted in opening new 

day-care centers 

• State funding for mental health substantially 

increased after 2004 

• New funding model (2008) 

• Evidence of positive outcomes of CMH 

provided to policy-makers 

• Civil society involvement  is substantial 

• International donors financial support 

Key Obstacles • Major health reform that changed financial 

scheme of health care and diluted responsibility 

of mental health policy 

• Lack of funding 

• Inadequate funding of community services 

• Shortage of mental health staff 

• No mechanisms to assess efficacy and quality 

of implementation were in place 

• Lack of political will 

• Economic constrains 

• Stigma among general population 

• Passive user movement 

• Shortage of mental health staff 

• Lack of funding 

 

• Lack of state funding 

• Shortage of mental health staff 

Table 1. Community mental health development in Poland, Lithuania, and Georgia 

  

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Discussion 

Most countries in EE have made failed attempts 

to introduce nation-wide CMH care.  Most patients 

continue to be treated in psychiatric hospitals despite 

adoption of mental health policies and implementation 

plans focused on deinstitutionalization. Commitments to 

reform mental health care remain primarily on paper. 

Path dependency and historical institutionalism theories 

help to explain these phenomena38. For policymakers it is 

extremely difficult for a radically different approach such 

as CMH care to be introduced, when the previous system 

had been developing for decades with different priorities 

and political meaning7. Petrea suggests that it is likely 

that availability of often ambitious plans and policies 

might be merely symbolic gestures to comply with 

international norms with little intention of enforcing 

them39. Significant societal mental health stigma, 

insufficient funding and scarce human resources make 

further challenges the reform process. 

Mental health care in Uzbekistan shares many 

of the same characteristics as other EE countries at the 

start of their mental health reforms. While each country’s 

attempts at deinstitutionalization have resulted in mixed 

outcomes, their experiences provide valuable 

information on the reasons why they failed to radically 

change the system despite ambitious plans and steady 

reduction of psychiatric beds. 

Based on the experience of other countries in the 

region and the history of mental health care within 

Uzbekistan, we recommend the following actions to 

increase the success of continuing mental health reform: 

1. Embed financial planning for reform 

implementation. Lack of funding is the primary 

obstacle every country faces when CMH care is 

attempted. Uzbekistan’s average allocation of 

the health budget to mental health is 

considerably lower than in EE, which is itself 

twice lower than in Western Europe9. Lack of 

investment in mental health services during the 

1990s led to the deterioration psychiatric 

hospitals and much of the current funding is 

spent on their maintenance, leaving little for 

CMH to develop. Based on the experiences of 

Georgia, Lithuania, Poland and Uzbekistan, as 

well as the global experience of 

deinstitutionalization, it is vital that adequate 

funds are made available to support mental 

health care in the community and psychiatric 

hospitals at the beginning of reforms with the 

majority of financial allocations shifting to 

community-based care as its coverage and 

treatment capabilities increase and reliance on 

psychiatric hospitals decreases. One can expect 

that after substantial economic reforms in the 

country and market liberalization10, Uzbekistan 

will have more financial capacity to increase 

expenditure on mental health care in the near 

future. Collaboration with international donors 

will also likely increase, which as in the cases of 

Georgia and Lithuania, will play an important 

role in scaling-up CMH services. However, it is 

important that increases in funding are 

thoughtfully spent in line with best evidence and 

existing resources. A review of the local 

context, strengths, needs and capacities of 

Uzbekistan should precede the planning and 

implementation of any reforms40. Financial 

planning will also address the dual financial 

burden of funding the old and new systems 

during the transitional period. 

2. Address knowledge gap and increase 

research capacity to assess reforms. There is a 

significant gap in research on the impact of 

mental health reform across EE14. It is a 

particular problem for Uzbekistan as our study 

has highlighted the substantial lack of published 

literature on Uzbekistan’s mental health care 

within international journals. A mental health 

research body, which does not exist currently in 

Uzbekistan, should be established to obtain 

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local evidence to support implementation plans 

and disseminate implementation outcomes. A 

standardized data collection system should be in 

place to assist policymaking and advocacy. 

Failing to introduce robust assessment 

mechanisms and lack of prioritization 

contributed to the failure of Lithuanian reforms. 

This issue, however, was addressed in Georgia, 

where extensive training and educational 

support was made available for local 

professionals to challenge the old psychiatric 

model and an entire research center was 

established to support reforms and their 

implementation. Collaboration with 

international institutions will be crucial to the 

introduction of contemporary approaches to 

scientific research and strengthening of research 

capacity within the country. 

3. Reduce stigma associated with mental 

health. High stigma towards mental illness is 

prevalent among general population and policy-

makers across EE and is related to a long period 

of institutionalization of mental health7. In 

Lithuania, the authorities, although aware of 

deinstitutionalization policy and the notion of 

liberalization of mental health, were unwilling 

to introduce changes because of their concerns 

about losing the voters33. To avoid this in 

Uzbekistan, the overriding institutional culture 

should be challenged by national anti-stigma 

campaigns along with or prior to shifting care to 

community. Such campaigns based on local 

educational initiatives aiming at replacing 

myths and stereotypes together with mass-

media advertising have reported positive 

outcomes both in increasing public knowledge 

on mental illness and in diminishing 

experienced discrimination reported by people 

with mental disorders in England, Japan, New 

Zealand, Egypt and Brazil41. 

4. Create favorable conditions for civil society 

groups to evolve and take part in development 

of mental health agenda as an equal 

stakeholder. If civil society, which is comprised 

of charities, NGOs, service user associations 

and other groups united by the same goal, is not 

considered as a competent stakeholder, mental 

health care reforms are not likely to progress42. 

This is a particular problem for Uzbekistan, 

where our study was unable to identify a single 

NGO working in the field of mental health. In 

contrast, civil society in EE is active and raises 

concerns about mental health system on the 

political level. The lack of visibility of civil 

society groups within Uzbekistan may be partly 

due to excessively bureaucratic and opaque 

politics with little openness and trancparency43. 

These shortcomings have contributed to the 

suppression of civil initiatives and limited 

international aid involvement in healthcare44,45. 

The current Uzbekistan government, which has 

demonstrated openness to new ideas and 

reform, should start with creating favorable 

conditions for NGOs to evolve and international 

aid organizations to work in the country. 

Furthermore, civil society should be accepted as 

an equal stakeholder by the government to 

improve national mental health outcomes46. 

5. Improve the country’s human resources for 

mental health. Scarcity of mental health 

professionals is a global challenge. No 

strategies used by the studied countries were 

identified to tackle this issue. Significant efforts 

are needed in health workforce policy, 

education and financing to address the problem 

of labor migration and stigma among medical 

community to prevent the shortage to worsen47. 

In other low and middle-income countries, 

strategies including task-shifting and integration 

of mental health care with general health care 

already proved to be effective to compensate 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.513 | http://cajgh.pitt.edu 

 

 

limited human resources47. Uzbekistan has 

addressed this issue by investing into 

psychiatric education and introducing new 

specialties such as social worker and 

occupational therapist. To capitalize further on 

the government’s actions, Uzbekistan should 

define where these specialists will be based and 

in what form they will operate (e.g. 

multidisciplinary teams, primary care) and 

develop national training plans. Given 

Uzbekistan’s cultural context, engaging 

traditional healers in mental health care 

delivery48 is another strategy to address this 

issue. 

This study was initiated in light of increasing 

attention towards mental health care in Uzbekistan and 

drew on knowledge transfer from experience of other 

countries in the similar political context. Based on 

revealed obstacles and facilitators during reforms in three 

countries a set of recommendation was developed for 

Uzbekistan’s policymakers. To the best of our 

knowledge, no such work has been conducted before. 

It was not possible to evaluate the quality of 

policies and community services. Countries were chosen 

on the basis of the reported availability of mental health 

policies and access to community services, but not 

necessarily having a quality care. This is a major subject 

to study further in the future. 

Mental Health Atlas was used as a primary 

evidence for the assessment of a country’s psychiatric 

hospital capacities because it is the most complete source 

of information on national mental health systems 

currently available. Because of different approaches to 

collect data in different years and a large number of 

missing data, change only in psychiatric beds in 

psychiatric and general hospitals was analyzed to assess 

progress towards CMH. This could potentially impact the 

results as beds in community settings such as in 

residential facilities were not taken into account. 

Since the initial analysis for this study was 

conducted, country profiles for the WHO MHA 2017 

have been made available. There are no significant 

deviations from the data obtained from previous years’ 

reports, except for Estonia, which reduced psychiatric 

bed capacity by ten-fold and increased the number of 

beds in general hospitals by 2.8 per 100,000 since 2005. 

Future studies should evaluate Estonia’s mental health 

policies and CMH services and their success. 

Uzbekistan is standing on the same path of 

mental health system development with other EE 

countries. The country was closed from external 

influence and had never introduced community care 

before. Today, when it is on the verge of reforms, it is 

very likely that Uzbekistan will experience the same 

obstacles that other countries faced with: low 

prioritization of mental health and persistent shortage of 

finances, resistance to change from medical community 

and general population, knowledge gap, lack of mental 

health and social care staff, passive civil society – these 

are all barriers that hinder development of community 

care in EE. With the change of political power, a window 

of opportunity in Uzbekistan was opened, where reforms 

started to take place and it is important to address these 

issues now to avoid challenges other countries had to 

experience. Through the creation of a financial plan, 

reducing the local mental health knowledge gap, tackling 

stigma associated with mental disorders, supporting civil 

society and increasing the numbers of mental health 

professionals, we believe Uzbekistan can give itself the 

best chance to find success through 

deinstitutionalization. 

 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

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Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.513 | http://cajgh.pitt.edu 

 

 

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