Gulnar’s story of mental rehabilitation and recovery

Gulnar Sagiyeva went through a difficult journey – following a mental health crisis, she was deprived of legal capacity and spent 10 years in a specialized long-term psychiatric care institution. This story is based on her recollections.

“I was born and raised in an ordinary large family in Kazakhstan. I graduated from high school, medical school, and received an education as a nurse. I worked at the research centre, in an intensive care unit for newborns, for 10 years. I was one of the best specialists there. I was acknowledged for my contributions to the development of national health care and was considered for the Florence Nightingale Medal for the achievements in my work. Unfortunately, I didn’t get to enjoy these accolades.” 

Around 20 years ago, Gulnar’s family contacted a psychiatric team to help her manage her worsening mental health symptoms. She was hospitalized several times that year. Eventually, she was no longer expected to make her own legal decisions.

“When I realized what had happened, I felt hopeless; powerless. I went through so much heartache and misunderstanding, but despite the situation, I always tried to be active, helping people using the knowledge and experience I had gained in the medical field. There were times when I found the courage to give advice to nurses, encouraging them to also become psychologists when a patient has a relapse, to try to understand rather than ignore their perspective. To take their side and try to calm them down.” 

Road to recovery

While hospitalized, Gulnar remained active. An expert knitter, she began to teach other patients the craft. She also played an active role in organizing concerts and staging dances. Her work prompted the management of the long-term care facility to start additional leisure clubs; they also opened occupational therapy rooms, bringing in therapists and cultural organizers to provide their services to users. 

“However, it was all behind closed doors, as if from another world,” she reflects. “We felt that we were different. I do not know if it is right, but at that moment I saw no point in doing anything. I only understood that it was useless to try to reach out. I felt alone.”

Then, in 2015, Gulnar participated in a social project called “Training Cafe”, employing people with mental health issues. Besides Gulnar, other recipients of social services got permanent jobs at the cafe as cooks, waiters or bartenders. The project has since garnered widespread attention from the people of Kazakhstan. 

“Six months later, I was asked to manage the dumpling production unit. In 2017, we received a building to open a new cafe by the same name. Later that year, the project ‘Centre for independent living of people with mental disorders’ was launched. The purpose of the centre was to enable patients to live in a regular apartment under the supervision of social workers, while getting a job, thereby offering the patients greater socialization opportunities. All these projects were launched thanks to Kazakh psychoanalyst Dr Anna Kudiyarova and support from the local government. This project gave me the opportunity to feel like I’m a part of society, which of course had a positive impact on my recovery.”  

Thanks to the work of local human rights activists, who also joined this process, Gulnar regained her legal capacity. Now she works at the Centre of the Psychoanalytic Association as an assistant to the Head.

“I am glad that I can now earn money again and work towards my personal goals, but in the future, I would like to try my hand at other things, like marketing or working in a private clinic, such as a dental clinic. I think I can do well as a receptionist, communicating with clients or patients.”

She continues, “Overall, all I need is to be a part of society to communicate and achieve my goals.”

Transforming mental health services

Gulnar’s story shows that stigma and discriminatory attitudes and directives can adversely impact mental health and hinder people’s recovery. Investing in mental health can greatly reduce suffering and improve quality of life, social functioning and life expectancy for people with mental health conditions. On 10 October 2024, WHO/Europe released the Mosaic toolkit to end stigma and discrimination in mental health. The toolkit is designed for anyone who wants to be involved in anti-stigma work, aimed at demystifying the process of reducing stigma and discrimination.

WHO has been supporting countries in transforming mental health services to adopt a person-centred, community- and rights-based approach. Supporting the development and implementation of inclusive policies that prioritize community-based mental health care helps to ensure that people receive comprehensive, accessible, and compassionate support in their local communities. 

One of WHO’s tools for promoting transformation of services is the global QualityRights initiative, designed to improve the quality of care in mental health and related services, and to promote the rights of people with psychosocial, intellectual and cognitive disabilities. QualityRights works at the ground level to directly change attitudes and practices, as well as through policy to create sustainable change. The initiative has developed and now deploys a diverse range of training materials, toolkits, technical support and practical guidance to support a human rights and recovery approach to mental health, in accordance with the United Nations Convention on the Rights of Persons with Disabilities and other international human rights standards.