Kashmir has witnessed much violence and conflict, especially over the past two-and-a-half decades. Tens of thousands of people have lost their lives due to the conflict; thousands more have simply disappeared, and many others have faced torture and injury. People have lost their jobs and livelihoods, and exposure to violence remains high in the Valley — most have seen cross-fires, raids, sexual assault, forced labour, arrests, torture, maltreatment, disappearances, killings.
It is widely recognised in Kashmir that the prevalence of mental health issues has significantly increased since the conflict began. This is based on random observations, OPD records and very limited research conducted on some of the very vulnerable groups and/or in healthcare institutions.
One of the widely quoted data is based on OPD records of the number of people who were undergoing treatment at the State Psychiatric Disease Hospital, Srinagar, in 1985 (taken as baseline) and the number of patients now. These records show that the number, which was 775 in 1985 (at the SPDH, then the lone hospital in Kashmir where psychiatric services were unavailable), increased to 1,30,000 in 2015 (in two state hospitals including the State SMHS Hospital and State Psychiatric Hospital in Srinagar, both affiliated with GMC Srinagar) (Nissa, 2015).
In the State Psychiatric Hospital alone, 75,000 patients were treated at the OPD in 2015. This certainly indicates a steep increase in numbers of patients who sought psychiatric services. Of course, this doesn't take into account factors such as affordability of treatment being a major issue, the high level of stigma around mental illness, and general awareness about mental health awareness being low. Therefore, several instances of mental illness (in the earlier years) would have gone unreported.
On the other hand, in 2015, not only at the two state hospitals (SMHS Hospital and State Psychiatric Hospital in Srinagar), psychiatric services are also available in all major district hospitals, and most of these psychiatrists also provide services at their private clinics. Those who visit private clinics (and this is a significant number) go unreported. Because of these reasons, the comparison of OPD records between 1985 and 2015 has major loopholes.
However, the increase in mental illness in the Valley remains a fact, which is also corroborated with research findings from other, smaller studies. As conflict has been prevalent throughout Kashmir, affecting all districts, any estimate of mental illness warrants a community-based prevalence study. In this context, a study titled 'Mental Health Illness in the Valley: A Community-Based Prevalence Study of Mental Health Issues in Kashmir' by the Psychiatric Hospital, Srinagar, is significant. It is the first community-based study in Kashmir which uses scientific methods and rigorous process of data collection led by experienced people in the field.
In that spirit, it is important that the state of Jammu and Kashmir has conceived a comprehensive community mental health programme comprising promotive, preventive and curative dimensions of treatment to address mental health issues of people, both immediate and long-term, in ways which will help promote mental well-being, reduce stigma, address physical health needs, create mass awareness, provide home-based counselling, facilitate psychiatric treatment from public hospitals. Other aspects such as organising child clubs, building vocational skills and sustainable livelihoods, linking people with government entitlements and to create an environment where those who are affected by conflict can meet to share experiences to focus on starting life afresh, also need to be built in.
Text courtesy: Mental Health Illness in the Valley: A Community-Based Prevalence Study of Mental Health Issues in Kashmir by Psychiatric Hospital Srinagar.
Photos by Javeed Shah.
Doctors' working table at Srinagar's Shri Maharaja Hari Singh Hospital (SMHS).