‘11.3 percent of adult population suffers from mental illness in the valley, higher than the Indian national average of 7.3 percent’
This prolonged armed conflict has taken a heavy toll on human lives, psycho-social and economic wellbeing. The killing and disappearances of thousands of people have resulted into new marginalized groups of widow headed households, orphans, elderly without any support, disabled and has also accentuated the marginalization of already marginalized like labour and landless class. The macro data also indicates that J&K lags behind in many of the development indicators as compared with India as a whole including literacy rate, roads, per capita incomes, agriculture, employment opportunities, etc.
The conflict has resulted into many structural constraints and has created many barriers that shape the access of people to employment, livelihood and essential services. In this socio-economic and political context, many more have become victims of mental trauma, stress, anxiety, depression and many other mental health disorders. This has been a debate and a widely recognised fact in Kashmir that the prevalence of mental health issues have significantly increased since conflict began. By relying on observations of OPD records and limited research conducted on some of the very vulnerable groups and those in health care institutions, a steep increase in numbers of patients who sought psychiatric services is reported. But these estimates suffer from many loopholes to demonstrate anything near to actual estimates.
As the conflict has been prevalent throughout Kashmir, affecting all districts, any estimate on the prevalence warranted a community based scientific study. The present study was carried out to estimate the prevalence of mental illness in the valley, and therefore, achieves significance for its being first community led study to determine the prevalence of mental health disorders in Kashmir. The study surveyed 4000 people across two districts of Kashmir. It was carried using scientific methods and rigorous process of data collection led by experienced people in the field and guided by those who have decadal-long experience as practitioners and teachers in the field of mental health in Kashmir. A sample of people who were identified suffering from mental illness during the field study was cross-verified by the psychiatrists to check the reliability and validity of the data. This is the first scientific study which has looked at prevalence of active and untreated morbidity of mental health disorders and can be considered fairly representative for whole population of Kashmir but with some limitations. Unlike many other higher-end estimates on the prevalence of mental health issues in Kashmir, this study indicates that 11.3% of adult population suffers from mental illness in the valley. This prevalence is significantly higher than the Indian national average of 7.3% (Ganguli, 2000).
The study finds that the prevalence of mental health disorders was more in females (12.9%) than males (8.4%). It was also more among those who were not educated (12.7%) than those who had attained education up to high school (12.8%) or higher levels of education (8.7%). The prevalence was also significantly higher among those who were either divorced or separated or widowed (14.7%) than those who were married (12.1%) or never married (8.7%). The prevalence of mental health disorders also showed a clear class gradient, higher among those who were poor than those who were better off. 13% of those who reported to have no land holdings at all suffered from some mental illness, while as 11.5% of respondents who had 1 to 8 Kanals of land (1 acre) had mental illness. In contrast, a significantly lower proportion of 9.1% of those who had more than 8 Kanals of land had any mental illness. This was corroborated by findings across ration-card-type categories with significantly higher presence of mental health disorders among AAY ration card holders (16.3%) than BPL (10.8%) and APL ration card holders (10.2%).
Importantly, the study indicated very clearly the impact of conflict on mental health, and one of the reasons for a higher prevalence of mental illness in Kashmir. A total of 494 respondents 42 (12.3%) had witnessed conflict induced traumatic events in their families (in terms of anyone in the family killed/disappeared/detained/tortured/disabled due to conflict related reasons), and among them a significantly higher proportion of about 24.3% had developed a mental health disorder. This was much lower among those who reported not having being exposed to such events in their families, and was just 9.4%. These findings about higher prevalence of psychiatric morbidity in persons with trauma exposure are in accordance with research from other conflict ridden areas. As per WHO estimates, 10% of the people who experience traumatic events will have serious mental health problems and another 10% will develop behaviour that will hinder their ability to function effectively, in the situations of armed conflicts (WHO, 2001).
Although the prevalence of 11.3% mental health disorders in the population represents an abnormally serious situation, what was also surprising was that the treatment gap was very high? Only 12.6% of the people with mental illness sought help from health services and only 6.4% of those who had mental illness had consulted a psychiatrist. The reasons for this low treatment levels may be because of very high stigmatization of these illnesses in the society, very low awareness about illness as well as about treatment, and inaccessible treatment at the community level, as most mental health services available in Kashmir are located in urban areas.
Excerpted from the report titled “Mental Health Illness in the Valley” recently released on World Health Day at the Government Medical College, Srinagar