One night in September, a 27-year-old man was among patients waiting anxiously in the hall of a private mental health clinic in the southern Kashmir town of Anantnag.
“I have a phobia that I’m going to have a heart attack,” said the 27-year-old, who has a graduate degree in botany and wrote the Union Public Service Commission entrance exam earlier this year. .
The problems had started about four years earlier, when he was living near a training center in Greater Noida, outside Delhi, preparing for a different entrance exam. Scrolling through her Facebook account, she came across some bad news from her home: a boy from a nearby town had died of sudden cardiac arrest.
The same day, he had stomach problems. For the next two weeks, full of “anxiety and fear”, he stopped attending classes. He went home hoping to get better, but it got worse.
Three leading cardiologists assured him that he was fine. “But it wasn’t right,” the 27-year-old said. I couldn’t get this post out of my head. I wasted a year trying to find a way out.”
He managed to write his UPSC exams this year, but only got average grades. “I know I could have done better,” she said. But she hadn’t been able to concentrate on preparing for the exams.
Eventually, it was a nudge from a general practitioner at a Srinagar hospital that made her realize she might need psychiatric help. “I googled my symptoms and read about others facing similar issues,” he said.
A few more Google searches for private mental health centers near him led him to the Anantnag clinic, about 20 kilometers from his home in the Kulgam district. The Anantnag city clinic, packed with patients, was closer to home than Srinagar.
“If it had been in Srinagar, I would have had to spend the whole day traveling,” he explained.
sizing the problem
For years, the Government Hospital for Psychiatric Diseases in Srinagar was the only address for those seeking help with mental health problems. However, increased awareness of mental health has meant that more patients seek help locally, in their home districts. What is driving this phenomenon is the expansion of public and private mental health care infrastructure throughout the Kashmir Valley.
Over the last decade, government hospitals in all 10 districts of Kashmir have established mental health clinics. Districts like Baramulla, Kupwara, Kulgam and Budgam also have clinics at the sub-district level. Kashmir also has mental health clinics in three prisons, in Baramulla, Srinagar and Anantnag. Altogether, there are about 17 government-run mental health clinics in all districts. The government medical colleges at Anantnag in southern Kashmir and Baramulla in the north also have departments of psychiatry.
According to psychiatrist Arshad Hussiain, Kashmir is an outlier compared to the Indian states. “It would be a rarity in all of India for all district hospitals to have psychiatrists available in OPDs. [out patient departments],” he said.
While data on the number of private mental health clinics is not immediately available, psychiatrists believe they are a growing trend in Kashmir. But even these facilities may not be enough for Kashmir, where mental health issues are usually studied through the lens of conflict. Decades of violence have left deep scars on most Valley residents.
2004-05 to study on the prevalence of trauma had revealed that about 59% of the 1,200 people surveyed in four districts had experienced a traumatic experience. The trauma of being shot or blown up was the most common.
In 2009, a to study published by the Qassim University International Journal of Health Sciences had surveyed 2,728 people in the Kashmir Valley. It found that the prevalence of depression was highest (66.67%) in the age group 15-25 years, followed by 65.33% in the age group 26-35 years.
2015 to study, conducted by Doctors Without Borders in collaboration with the Department of Psychology, University of Kashmir and the Srinagar Institute of Mental Health and Neuroscience, surveyed all 10 districts in the Valley. It seemed to suggest a problem of an astonishing scale.
“The survey showed that almost 1.8 million adults (45% of the adult population) in the Kashmir Valley experience symptoms of mental distress, with 41% showing signs of probable depression, 26% probable anxiety and a 19% probable post-traumatic stress disorder (PTSD),” he said.
But the following year, a meeting to study by Action Aid, a non-governmental organization, and the Srinagar Institute of Mental Health and Neuroscience gave lower figures: 11.3% of the adult population in Kashmir suffered from mental illness, it concluded. This was still considerably higher than the national average of 7.3%.
getting help
What the Action Aid study also highlighted was that only 6.4% of people experiencing mental health problems had tried to get professional help. “The reasons for this low level of treatment may be due to the high stigmatization of these diseases in society, the very low awareness of the disease and treatment, and the inaccessible treatment at the community level, since most health services Mental health available in Kashmir are located in urban areas,” the study noted.
For example, a 59-year-old woman from Anantnag district’s Brakpora village, who identified herself only as Bano, spent years receiving treatment for various physical symptoms before doctors realized the problem might lie elsewhere.
After three years of being treated for back problems, Bano suddenly developed stomach problems and palpitations this January. “He couldn’t sleep and his shoulders were stiff,” his daughter explained. “We took her to a doctor who asked him to do some tests. Tests did not show any problems with his stomach or heart.”
The doctor then prescribed an antidepressant for three months, which helped. “We have a gynecologist in our family. When he saw my mother, he suggested that we see a psychiatrist,” her daughter said.
In early September, when Bano visited a psychiatrist at a clinic in the city of Anantnag, he was diagnosed with major depressive disorder. Two weeks after his first visit, he was doing relatively well. The medication had worked and he was able to sleep.
a slow change
However, mental health professionals in Kashmir say the tide is “definitely changing”.
“The increase in the number of people seeking help is due to both a rise in mental health problems and increased awareness, particularly in urban settings,” said Arshad Hussain, who led the Action Aid study in 2016.
One of the reasons driving that change, Hussain added, could be the growing number of mental health professionals in the valley. “When I started in the early 2000s, there were only three or four psychiatrists in all of Kashmir,” he said. “Today, that number is around 80 psychiatrists. Currently, we are producing eight psychiatrists per year, which will increase to 12 starting next year”.
As Mansoor Ahmad, an assistant professor of psychiatry at the Anantnag Government Medical College, explained: “Over the years, constant efforts to educate people about mental health have played an important role, but more than that, it is the development of human resources that has changed things drastically. ”
For the first three months after he joined Anantnag medical school as a psychiatrist in February 2019, Ahmad recalled, he had hardly any patients. “I decided to run a program in the hospital where I sensitized the hospital faculty about depression,” he said. “We discussed how a depressed patient presents symptoms related to cardiac, orthopedic, or gastric problems. A week after that program, I saw my non-psychiatrist colleagues referring patients to me.”
These days, Ahmad says, a group of four psychiatrists at Anantnag hospital treats 80 to 90 patients a day. “In the last 44 months, 71,000 patients have visited the hospital to seek mental health [treatment]Ahmad shared. This number, Ahmad said, reflects a “drastic change” in Kashmir. “Twenty years ago, a person in Kashmir would not think of consulting a psychiatrist,” he said.
The presence of mental health professionals alone had helped attract more patients. “If you post a psychiatrist in a remote area, he will attract patients,” Ahmad said. “Even if you don’t get patients, the least you can do is sit down with non-psychiatric doctors and sensitize them about mental health.”
The Covid Boost
Waris Zargar, who began his practice as a psychiatrist in 2018, echoed this assessment. Once or twice a week, he would drive to Kupwara in North Kashmir. But there were few patients.
“For a year, no more than five or six patients came to see me in a single day,” he said. “Today, I see between 50 and 60 patients in a single day at my clinic in Kupwara.”
It didn’t help that doctors treating physical illnesses in rural Kashmir often lacked awareness of mental health issues.
“They feel like a doctor can treat a headache while the patient may be experiencing that because of trauma or mental health issues,” he said.
While there may still be a long way to go, the Covid-19 pandemic has given an unexpected boost to awareness. Global health organizations had launched campaigns speaking out about the need to take care of mental health as millions around the world battled the devastating effects of Covid-19 and the lockdowns it entailed.
Mansoor Ahmad was very pleased with these campaigns, which greatly contributed to changing attitudes towards mental health in Kashmir.
“People started to take mental health seriously,” he said. “It’s a beautiful thing when organizations like the United Nations and the World Health Organization talk about mental health. I’m sure it will have an impact.”
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