Decades of violence in Kashmir has had an unimaginable impact on the mental health of people there. And now, COVID is compounding their problems, thereby burdening the mental health system in the state even further.
According to a study conducted by the National Center for Biotechnology Information, the change in the status of Jammu and Kashmir from a state to Union Territory after the abrogation of Article 370 in 2019, had an enduring psychological impact on the Kashmiri population. Just six months after that, the coronavirus struck India and the whole country went under a strict lockdown.
As per the study, social distancing leads to increased loneliness and the feeling of being neglected, particularly among the elderly population, which precipitated mental health issues.
The Indian Psychiatry Society found a 20 per cent increase in mental illness in India within a few weeks of lockdown starting March 25, 2020, and formulated national guidelines for telehealth services. However, people in the state have no access to such services, thanks to poor connectivity.
Severe Psychological Crisis
Doctors say that the situation has morphed into a severe psychological crisis. There has been an alarming rise in cases of depression, anxiety, and psychotic events in the Valley. Besides, there has also been a surge in suicide cases in the Valley over the last six months, and particularly during the second wave of COVID. Some reports suggest that more than 100 people committed suicide in the region during the period. Officially, 500 suicide cases have been reported at SMHS hospital in the last one year. Data compiled by National Crime Records Bureau (NCRB) records around 6,000 cases of suicide in Kashmir between 1990 and 2019
"Normally, I used to see around 20 patients a day. Now it's more than 100. This is how the impact on mental health during the last two years has been," said one of the leading psychiatrists of Kashmir valley.
"Suicides rates are growing, especially among youth. People are tired in general, but youth are more tired and closed off. Fuelled by mistrust, unemployment and general disillusionment around, suicides are becoming a leading cause of death in Kashmir," Dr Syeda Afshana, a faculty member at MERC, University of Kashmir, had cited in her column earlier this month.
Previous Studies Indicate Same
One study from 2016 found that 45 per cent of Kashmir's adult population (1.8 million) was suffering from mental distress.
"There is a high prevalence of depression (41 per cent), anxiety (26 per cent), post-traumatic stress disorder (19 per cent), and 47 per cent had experienced some sort of trauma," the study stated.
Another study found that the prevalence of childhood disorders was 22–27 per cent (for those aged between 8 and 14 years). A retrospective study on suicide recorded an increase of more than 250 per cent in the number of such attempts between 1994 and 2012. The stigma around the topic of mental health makes matters worse.
According to the 2011 census of India, Jammu Kashmir has a population of around 12.5 million, and there are about 41 psychiatrists, who are mostly affiliated at teaching hospitals in two cities of Jammu and Srinagar. Consequently, the mental health services are primarily limited to two hospitals in Srinagar (GMC Srinagar and SKIMS hospital), although the National Mental Health Plan and the District Mental Health Programme were started in many districts of Kashmir.
There are 140 indoor beds in 10 districts of Kashmir, and the outpatients' services are provided by 16 psychiatrists, 12 psychologists, and one social worker. Only five to six psychiatrists are working as consultant psychiatrists at the district level (Srinagar, Budgam, Pulwama, Anantnag, Baramulla). Much of the psychiatric care is provided by a few practitioners on a private fee-for-service basis, thus limiting access for those unable to afford it.
Need For Development Of Mental Health Services
The study pressed for the immediate need for the development of mental health services in Kashmir, accompanied by community participation, awareness programs, and mental health rehabilitation services.
"Counseling services have to be available adequately for dealing with the enduring trauma. There is also an urgent need for researchers, clinicians, and policymakers for devising policies and interventions in the context of the prevailing mental health status of the Kashmiri population," it stated.
It also suggested establishing a well-equipped telepsychiatric service system to deal with mental health problems. This approach will boost the accessibility and affordability of mental health interventions with timely diagnosis and improve the follow-up for treatment.
There is also a need to destigmatise mental health conversations in households so that more people can reach out and seek help.