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We aimed to map evidence on the development of mental health care in Central Asia after 1991. We conducted a scoping review complemented by an expert review. We searched five databases for peer-reviewed journal articles and conducted grey literature searching. The reference lists of included articles were screened for additional relevant publications. We included 53 articles (Kazakhstan: 13, Kyrgyzstan: 14, Tajikistan: 10, Uzbekistan: 9, Turkmenistan: 2, Multinational: 5). Only 9 were published in internationally recognised journals. In the 1990’s mental health services collapsed following a sharp decline in funding, and historically popular folk services re-emerged as an alternative. Currently, modernised mental health policies exist but remain largely unimplemented due to lack of investment and low prioritisation by governments. Psychiatric treatment is still concentrated in hospitals, and community-based and psycho-social services are almost entirely unavailable. Stigma is reportedly high throughout the region, psychiatric myths are widespread, and societal awareness of human rights is low. With the exception of Kyrgyzstan, user involvement is virtually absent. After many years of stagnation, however, political interest in mental health is beginning to show, along with some promising service developments. There is a substantial knowledge gap in the region. Informed decision-making and collaboration with stakeholders is necessary to facilitate future reform implementation.

Designing and implementing long-term management strategies for chronic biological invasions is amongst the most vexing ecological research problems. Two key challenges to resolving this problem are: (a) integrating science-based and values-based (e.g. spiritual, cultural, economic and ethical) knowledge sources and (b) developing durable knowledge generation and curation platforms to co-ordinate long-term research efforts. We begin by identifying knowledge sources (stakeholder values, forecasts of invader spread and impacts, management technologies and operational logistics) to guide the high-level actions (governance framework design, selection of ethical management technologies, definition of long-term objectives, design of management strategies and operational plans implementing strategies) required for management of chronic invasions. We use exotic conifer invasions in New Zealand as an example. Next, we propose a transdisciplinary knowledge ecology framework where each knowledge source is represented by a separate knowledge generation and curation platform (i.e. knowledge ecosystem) and linked through high-level actions. We detail the structure and function of a single knowledge ecosystem (forecasting spread and impacts), and document two case studies to illustrate how knowledge ecosystems might (a) increase participation of individual researchers within long-term research efforts, and (b) facilitate inclusion of non-researchers in developing a common knowledge base. Finally, we propose a set of guidelines for combining science-based and values-based reasoning in decision-making via localised governance structures. We suggest that viewing knowledge ecologies as an integrated collection of distinct knowledge ecosystems offers a promising approach for identifying, generating, curating and integrating the knowledge sources needed to improve management of chronic biological invasions.

Background There is a large “treatment gap” for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression. Methods Data were analysed from a two round cross-sectional community survey conducted in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors using univariable regression. Results 86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p Conclusions These findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential role of marriage in facilitating treatment-seeking.