A Deep-Rooted Crisis

The psychiatric health of the people of Jammu and Kashmir presents a very complex issue that is deeply influenced by decades of conflict, socio-economic challenges, and inadequate access to mental health services. This region, scarred by its long-standing political instability and violence, is a unique case in which mental health problems cannot be wholly conceptualized as individual conditions but are integrally connected to the general socio-political milieu. Numerous studies point out how these factors weigh heavily on the population’s psyche, including the 2015 Kashmir Mental Health Survey by Médecins Sans Frontières (MSF). It also reports, “An estimated 1.8 million adults, approximately 45% of the population in Kashmir Valley, present symptoms of mental distress; 41% have probable depression, 26% probable anxiety, and 19% probable PTSD” (MSF South Asia).

These findings are part of a bigger and more deeply entrenched mental health crisis driven by traumatic experiences, daily stress, and lack of access to mental health care. The ongoing conflict has exposed countless individuals to trauma, including violence, the loss of loved ones, and forced displacement. An adult, on average, has experienced 7.7 traumatic events in the region, which is greatly related to higher rates of depression, anxiety, and PTSD. Such repeated exposure to trauma has led to massive feelings of fear, hopelessness, and uncertainty that have deeply affected the uniform mental health in Jammu and Kashmir among all demographic spectrums.

Conflict in Jammu and Kashmir has produced instability and insecurity as part of life. This chronic condition has torn apart structures of the community, stretched social support systems beyond their limits, and built up a climate of chronic stress and anxiety. All these mental health burdens have been compounded by the socio-economic instability accompanying this conflict. These factors are coupled with families experiencing financial difficulties, unemployment, and an inability to meet basic needs, exacerbating the stress and anxiety of living in such an environment.

Besides, this region’s health infrastructure is poor, and there is a large gap in service delivery. Jammu and Kashmir face an acute shortage of mental health professionals, with only 41 psychiatrists serving the more than 12.5 million population, against which the Kashmir Law & Justice Project reported an alarming shortage in 2015. This is further exacerbated by the hard geography and perpetual state of conflict that predisposes the region to get hard-to-deliver and non-accessible mental health care. Consequently, many people with mental illnesses do not receive the treatment they need, while those who seek help face long waiting lists and often have limited options. Probably one of the biggest barriers to battling the psychiatric health crisis in Jammu and Kashmir is the social stigma associated with mental health.

Mostly, mental health has just been known but discussed very little in many communities, and people with conditions such as depression or anxiety tend not to seek help from professionals because they fear social labelling that may subsequently lead to discrimination. This is more powerful in rural areas where poor understanding of mental health beyond some deep-rooted beliefs blocks people from getting the care they deserve. These social obstacles account for the reason studies show that almost 90% of the people at risk do not seek any treatment. Some of the other reasons include expenditure on mental health care spending constitutes a small percentage, usually less than 1% of the general budget on health and, secondly, the lack of policies in public health regarding mental health care pushes it to the back-burner with the prevalence of other glaringly obvious health problems.

Mental health services are often located in urban areas, which makes access to needed care difficult for individuals living in more remote or rural areas. Cultural and religious contexts influence attitudes toward mental health in Jammu and Kashmir. A majority of the population in this region is Muslim, with marked influences of religious beliefs on almost every aspect of daily life.

Spiritual resilience can thus be a potent method of coping with the concomitant psychological consequence of conflict and stress. Resilience would therefore be encouraged to use faith, spiritual activities such as prayer, and community support, and be instilled with hope. Local religious and cultural concerns should be considered for mental health interventional programs to be more acceptable and effective. Mental health workers also need to be involved in creating awareness and reducing stigma, along with religious and community leaders, for people to come forward for help without the fear of being judged.

Research studies carried out in Jammu and Kashmir over and over again emphasize the need for a multi-dimensional way to tackle the mental health crisis. This approach embodies increasing the availability of mental health professionals, integrating mental health care into primary health care centres, and developing community-based interventions that are culturally sensitive and specific to the population’s needs. Promoting education and awareness to decrease stigma and encourage help-seeking is also integral to this approach. Community-based interventions in mental health provided in non-clinical settings like schools and community centres are particularly effective in reducing barriers to care. For example, programs that offer peer support for mental health education and that train community leaders in basic mental health first aid help to bridge the gap between formal mental health services and those in need.

Accordingly, eminent personalities and thought leaders have shared the importance of mental health, voicing the same seriousness taken over the condition of people suffering from it in conflicted situations like that in Jammu and Kashmir. Nelson Mandela once said, “There is no health without mental health,” underlining that mental health is integral to any health. On a related note, the Dalai Lama himself has pointed out that compassion, resilience, and emotional strength mark the urgency and importance of all citizens in conflict-affected areas. These views strengthen the argument that mental health is no less important than physical health in areas where constant conflicts and upheavals in socioeconomic conditions have made people feel ostensibly distressed and insecure.

Any strategy aimed at addressing the psychiatric health crisis in Jammu and Kashmir should adopt a holistic approach and integrate mental health care with primary healthcare, apart from simply expanding access to mental health services. Of essence is the formulation of culturally adapted interventions that decrease stigma and enhance help-seeking behaviour. These include community interplays, religious leadership, and stakeholder sensitization through which adequate consciousness can be ensured on the issues, and a non-critical atmosphere is maintained for mentally ill persons.

The region also urgently needs policy-level interventions to redo its priorities related to mental health care and provide adequate resources. Promotion, prevention, and early intervention of mental health through a public health approach can make a crucial difference in decreasing the burden of distress and promoting the general well-being of the population. The international community, including humanitarian organizations and those concerned with global mental health, can play a key role in supporting such initiatives.

These organizations will bridge the shortfalls in mental health services through technical assistance, funding, and advocacy. The construction of a comprehensive and integrated mental health care system responsive to the special needs of Jammu and Kashmir citizens can only be achieved with collaboration among local health authorities, NGOs, and community-based groups.

The psychiatric health of the citizens in Jammu and Kashmir is an intricate, multi-dimensional issue that needs immediate and sustained attention. The high prevalence of mental disorders, together with inadequate mental health services and pervasive social stigma, poses a significant public health challenge. Therefore, this calls for urgent effort on the part of government organs and other stakeholders like health professionals, community leaders, and international agencies. Besides, through collaborative thinking, formulation, and implementation of effective mental health strategies, it is quite conceivable to help people in Jammu and Kashmir have better quality lives and contribute to the bigger aim of peace and stability within the region.

Community support and sensitivity toward culture must supplement any holistic approach aimed at improving the psychiatric health of people in Jammu and Kashmir. Service expansion, integration of mental health care into primary healthcare, and supportive community environment development are key methods through which the burden of mental distress can be reduced, and the quality of life improved among residents of this troubled region. It is such work that will bring change into people’s lives and, furthermore, peace and stability relevant to the entire region of Jammu and Kashmir will be positively affected, enhancing the resiliency of all. Focusing on ways of promoting mental health and reducing causes of distress at their roots, there is an attempt to build a healthy, resilient society that can thrive irrespective of continued challenges.

By: Aatira Akram