A/HRC/41/34/Add.1 provided certain health-care services, although only through informal payments that are more costly. 54. Children with disabilities are another group in a vulnerable situation. According to the most recently available data provided by the Ministry of Labour and Social Development, there were 29,000 registered children with disabilities in 2017.21 However, this number only includes those children who have been registered by the Ministry as eligible for monthly social benefits, and not the “invisible” children with developmental disabilities. All children with disabilities, whether registered by the Ministry or not, have poor access to quality care services that meet their needs. The current care system in Kyrgyzstan continues to focus on the medical model of disability, which rarely provides for appropriate support at a young age through early identification and targeted family support measures, putting children with disabilities at a significant risk of exclusion and discrimination. 55. Many children and adults in vulnerable situations live in residential institutions, which continue to exist in Kyrgyzstan under the management of different ministries. The Ministry of Health manages institutions for children under the age of 3 and their parents, the Ministry of Education and Science is in charge of institutions for orphaned children and adolescents, and the Ministry of Labour and Social Development is responsible for institutions for persons with disabilities, both children and adults, and institutions for older persons, in coordination with local governments. It has annually increased its expenditure on the institutions under its responsibility. 22 56. Increased funding for institutions managed by the social sector should not be aimed at expanding the institutional care of children and adults with disabilities and in other vulnerable situations. Although more funding may be needed to improve the conditions and quality of life for those who are already living in institutions, allocating increased funding to institutional care would also suggest that this type of care is the priority over communitybased alternatives. This practice in the social sector is contrary to the progress made by the health sector, which has prioritized family medicine centres. Kyrgyzstan should continue to move away from dependency on costly and ineffective institutional care in the health, social and education sectors, and should increasingly invest in community-based alternatives. III. Mental health 57. Health-care services in Kyrgyzstan are still based on a narrow and outdated biomedical model, which is why health insurance coverage includes mainly biomedical interventions. It is important to recall that, globally, modern health care has incorporated new priorities with a holistic approach, such as mental health services for children and adults with disabilities, services for older persons, medical and psychosocial rehabilitation and palliative care. Kyrgyzstan should modify its health-care system so that resources are used not only for medication and hospital treatment, but also for other types of healthrelated intervention, which may not necessarily be only biomedical. This is particularly important when planning and developing policies and services to address mental health, an area increasingly becoming a global priority. 58. The Special Rapporteur visited a pilot outpatient mental health centre in Jalal-Abad that provides mental health services in compliance with WHO recommendations. It is a promising initiative based on a modern approach to health care and will, it is hoped, become part of the national strategy. Similar initiatives should be replicated throughout the country, and funded and supported by the Government to allow for their sustainable integration into the general health-care system. 59. If the right to mental health is to be fully realized, strategic changes must be made to the entire system. Primary care should take mental health as seriously as it does physical 21 22 See www.unicef.org/kyrgyzstan/children-kyrgyzstan. OECD, 2018 Development Pathways, p. 135. 11