A first of its kind community-based Prevalence Study of mental health issues in Kashmir has revealed “alarming levels of mental health disorders” in the population of Kashmir. The report is the first community-led study to determine the prevalence of mental health disorders in Kashmir. Based on scientific methods and rigorous data collection, led by experienced psychiatrists and researchers in the field, the 54-page report titled Mental Health Illness in the Valley was recently released at the Government Medical College (Srinagar) to mark World Health Day, themed 'Depression - Let's talk'. The study reveals a psychiatric morbidity of 11.3 percent among respondents from Kashmir who are suffering from mental health disorders, which is significantly higher than the Indian national average of 7.3 percent.
Undertaken by the Institute of Mental Health and Neurosciences (IMHANS) in Kashmir and commissioned by Action Aid Association with the support of Directorate General for Humanitarian Aid and Civil Protection (ECHO), the study was principally led by valley’s noted psychiatrist Dr. Arshad Hussain and other psychiatrists including Dr. Mansoor Ahmad Dar, Dr. Majid Shafi Shah , Dr. Fazl-e-Roub, Dr. Inaam-ul-Haq, Showkat Ahmad Ganaie and Fouzia Panjabi.
About 4000 people were surveyed for the study across two districts of Kashmir. “This is the first scientific study which has looked at the prevalence of active and untreated morbidity of mental health disorders and can be considered fairly representative of the whole population of Kashmir,” the report says in its conclusion.
The study reveals a high treatment gap of about “88 percent with only 6.4 percent of suffering population having received treatment by a qualified mental health professional (from a psychiatrist).” The study also shows that out of those who suffered any mental illness, 333 (12.9%) were females and 119 (8.4%) were males. As per the study, persons with traumatic/conflict exposure had a significantly higher morbidity with almost 24 percent of them suffering from mental health disorders.
Listing mental health as one of the worst casualties of conflict in Kashmir, the report says mental illnesses not only lead to direct sufferings of the people “but its economic burden is tremendous, in terms of work days lost and investments to be made into the treatment.”
“Inability of people to access treatment further leads to a perpetual and vicious circle of socio-economic drift hampering employment, relationships, and many other severe social problems,” the report reveals. “This is more serious in Kashmir because mental health problems are affecting a younger age-group.”
“Given the alarming levels of mental health disorders in the Valley, it is important that the Government initiates some of the comprehensive, community based and sustainable measures to address mental health illness without any further delay,” valley’s noted psychiatrist Prof. Mushtaq Ahmad Margoob and Ex-HoD of IMHANS-Kashmir, writes in the foreword of the study. “Additionally, the situation also demands the involvement of many NGOs to increase awareness, improve access to services, help people to access food and livelihood entitlements, undertake advocacy, provide counselling, etc.”
Dr Arshad Hussain says most of the people who suffer from mental illnesses never come to the hospitals for treatment. “So the people we treat in the hospitals show only the tip of the iceberg when it comes to the state of mental illness in Kashmir,” he says. “We have also found more than 90 percent of people who have had traumatic experiences suffer from traumatic stress, and they are not mild traumas as most of them are severe traumas which further worsens their mental health.”
Dr Arshad also points out another recent and worrying trend about mental health illnesses in Kashmir that has come out of their study. “More and more young people in Kashmir are suffering from depression. Classically it was earlier found in middle age and higher age groups, not in young age groups, but now we are observing that much younger population in Kashmir has developed mental illness which is worrying,” he says.
He says the traditional systems of healing in Kashmir are also witnessing a decline which does not auger well for those suffering from mental health illnesses. “The traditional system of beliefs is also breaking up and in the absence of these traditional healing systems you need to have alternate systems of healing like counseling, terminal hospital care,” he says.
Dr. Majid Shafi, another psychiatrist who was part of the team of researchers, says the treatment gap in Kashmir is alarming. “Only 12.6 percent cases of mental disorders in the community have any access to any form of treatment,” he says.
The study has also revealed that in Kashmir, which had one of the lowest suicide rates in whole of India at 0.5 per one lakh population, the medical records now show that “in past few years Kashmir has seen a spurt of suicides, para–suicides and deliberate self-harm.”
“The increase in incidence of para-suicides and deliberate self-harm are much more alarming, and are predictors of eventual suicide,” the study cautions, adding that this rate of active suicidality itself is an indication of the seriousness of the problem.
“As is well known that the National Crime Records Bureau (NCRB) data and also the medical records suffer from gross under reporting, this study (being rigorous and community led) may indicate relatively more reliable levels of suicidality,” the report says, adding that “1.8 percent of respondents among a sample of 4000 would mean that almost 1775 persons per lakh population would have active suicidality in Kashmir and much more among those who have any mental illness.”
The results of the study also reveal that the prevalence of mental health disorders is much higher in Kashmir among women (12.9%) than men (8.4%). “This is corroborated by findings of many research studies globally and in Kashmir, which have found women being more vulnerable to mental illness,” the reports adds. “The same results are also corroborated from Action Aid’s community mental health programme which has shown that almost 60-65 percent people who suffer from mental health disorders are women.”
The study also notes that a prolonged armed conflict in Kashmir from the last two and half decades has taken a heavy toll on socio-economic and psychological well-being of the people. “The long drawn conflict has affected people widely and in a number of ways,” the study notes. “But the exposure to conflict, level of impact, and sensitivity of the exposure vary, and impact psychological health accordingly.”
The study found that out of total of 494 respondents (12.3%) had witnessed traumatic events in their families, and among them a significantly higher proportion of about 24.3 percent had developed mental health disorders. “This is an important finding about the impact of conflict induced traumatic events on the mental health of people in Kashmir,” the study notes.
The study has also pointed at minimal access to treatment given the poor state of mental health services in the Valley. The report calls for several mental health interventions to address higher levels of mental illness in Kashmir. “Building on the existing local structures and strengths, the state of J&K must start a community based mental healthcare programme integrated into the primary health care,” the report recommends at the end.“These findings should sound the alarm to initiate processes to address mental health issues with urgency.”