Psychiatric disorders have a deep impact, globally accounting for 12% of all disability adjusted life years (DALYs), and 31% of all years lived with a disability. [WHO 2001] In Europe alone, they account for 20% of all disability adjusted life years, and 43% of all years lived with a disability. Globally, they include 3 of the top 20 causes of disease burden in the general population, (unipolar depressive disorders, self inflicted injuries and alcohol use disorders), and six in the 15-44 age group, (additionally schizophrenia, bipolar depressive disorder and panic disorder). Furthermore the incidence of age related cognitive disorders in the next two decades is expected to increase markedly, and the proportion of DALYs attributed to mental health disorders are expected to increase to 15% by 2020. Poor mental health also has a significant impact on other aspects of health. The level of co-morbidities and (non suicide related) mortality in people with mental illness has been observed to be significantly higher than those in the general population. In addition to the burden on overall individual health, mental health disorders generate substantial costs not only to health and social care services but also to many other sectors of the economy, including notably criminal justice. The social impact is also profound. The stigmatization and social exclusion of those with mental health disorders, can affect all aspects of an individual’s life limiting their access to employment and housing, hampering social relationships and reducing self esteem
Family relationships may suffer; relatives may have little choice but to provide substantial amounts of informal care, much of which is not valued in economic burden studies. Mental disorders that occur in childhood can also have a significant impact on educational attainment; depression has been shown to be correlated with poor school grades.  Those with untreated common childhood mental disorders may experience higher rates of unemployment, poorer relationships, and greater contact with the criminal justice system in adult life.
The impact on employment and productivity is substantial, e.g. one UK study estimated that depression alone accounted for a third of absenteeism from work. . In another recent study it was estimated that 86% of the total costs of bi-polar disorder (£2 billion in total) were attributable to lost productivity.  In the United States costs of lost productivity attributable to mental illness were estimated to be $76 billion in 1990. Those with mental health disorders may drift into poverty and are at greater risk of becoming homeless. The mentally ill may also be subjected to human rights violations, through inappropriate use of compulsory detention and involuntary treatment.
Kashmir has experienced one of the worst conflicts of modern times. Lifetime prevalence of major depression, substance use disorder and trauma related disorders are at an all time high. The economic costs of this huge mental health burden are tremendous. Annualized work loss due to mental health issues in Kashmir due to absenteeism and presentism is predictably huge. In lower socioeconomic class the costs are more alarming. Mental health problems lead to economic depression which in turn lead to inadequate treatment or no treatment which leads to perpetual and vicious circle leading to social drift hampering employment, relationship, and resulting in many other severe social problems. In urban areas the problem is compounded by lack of social networking leading to further social exclusion and stigmatization. There are no income tax benefits for most of mental health problems even though WHO recognizes them as costliest diseases. Insurance doesn’t cover any mental health problem.NGOs and social groups don’t provide any long-term treatment benefits in the form of drugs, investigations etc to mentally ill except for some initiatives by Action Aid. This is more serious because mental health problems in Kashmir are afflicting young productive age group furthering the economic burden. Because of substance use and other mental health problem the indirect costs on criminal justice are also increased. Because of somatization the indirect costs on existing health system are too difficult to understand and estimate but everybody in Kashmir hospitals know that maximum unwanted procedures - diagnostic and therapeutic- . Subjects are people with mental health problems and with privatization the costs are even higher and sometimes cruel. Substance use and suicide seem to be to be consequences of hidden mental health morbidity in the community and are consuming our young.
Kashmir lost calm long back. One of the nightmares we are living with is that our children are at increased risk of developing a substance related problems. When there was Opioids boom in whole subcontinent we were aloof as society except for few aberrations in tourist related areas and socially accepted charas takias. We had beliefs and values which would guard us against Opioids epidemic. No more can I repeat this optimism as Opioids abuse along with other medicinal abuse has gone deep inside Kashmiri society, I know of some far off rural areas where you don't see transport plying, but you do see Opioids  not only inflicting damage on the minds and souls of youth who consume it but breaking families and neighbor hoods and societies and in the process causing irreparable damage to culture. Families after families are drifting into blind hole of poverty and alas we are watching thinking  that my children, my siblings can’t do it, not understanding that when flood breaks river banks then it does not obey laws it moves to destroy everything in its way and does not even spare mosques and  temples.
Let's not be concerned only about our own selves. Let's show the concern for one and all.

(Dr. Arshad Hussain is a noted psychiatrist of the valley)

Lastupdate on : Sat, 8 Oct 2011 21:30:00 Makkah time
Lastupdate on : Sat, 8 Oct 2011 18:30:00 GMT
Lastupdate on : Sun, 9 Oct 2011 00:00:00 IST