....and Covid complicated it all
A health worker collects sample of a person for COVID-19 testing. GK photo

....and Covid complicated it all

We need to build conversations beyond lip service and encourage people in Kashmir to seek help if and when they need it

Dr Sheena Shah

shah.sheena80@gmail.com

It was the best of times, it was the worst of times, so said Dickens. While the period of pandemic is universally acknowledged to be the worst of times, it came with its set of blessings too – more family time, more leisure and flexibility in working hours. So, which side would be heavier in the bargain – the boon or the bane. Depends on who you are asking and what you are counting. Take the aspect of mental health, for example.

Many people will argue that mental health especially in Kashmir is a problem that precedes the pandemic; however, there is no denying that it is a problem that has become more myriad in nature, and widespread in extent when we add pandemic to the mix. Yet, we’ve seen that the support we all need just isn’t out there. I speak not just from general observation or testimony of experts, but as a survivor and an individual first and foremost.

For them, for us, me and for you – we must take this chance to step up the fight for mental health. That means fighting for change, for fairness, for respect and for life-changing support. The World Mental Health Day is observed on 10th October every year and offers us a reminder of this fight. This year, we need to open up conversations beyond mere lip service and encourage people in Kashmir to seek help if and when they need it. Even as the pandemic is receding at least for the time being, Kashmir sits on a precipice of mental health disintegration.

Before the pandemic, prolonged violence and siege in the Valley over the past two decades had fueled an explosive increase in various psychiatric disorders. Unremitting exposure to death, injury and deprivation has led to a weakening of the social and psychological fabric of the society – institutions like families have collapsed under the constant exposure to trauma, compounded by natural disasters like deadly earthquakes and floods. Major depressive disorders, anxiety disorders and somatization are quite pervasive.

A 2021 study, entitled ‘Prevalence of trauma among young adults exposed to stressful events of armed conflicts in South Asia: Experiences from Kashmir’, revealed that “the prevalence of trauma was 100% in both males and females”. An overwhelming majority of people reported “feeling stressed” (97.3%), while most were also affected by “fear of search operations, crackdowns or curfews” (89.2%); “witnessing a protest or being part of it” (88.3%); “a family member, relative or friend being hit with a bullet, pellet, or any other explosive” (76.5%); and “exposure to violent media portrayals” (74.3%).

Mental Health and Substance Abuse:

This widespread trauma finds manifestation in the epidemic of substance abuse that has engulfed the valley with Covid adding fuel to the fire. It leads not just to life threatening illness but brings along with it associated factors like lockdown, financial strains, familial changes, disruption in normal routine which has led to many mental health issues, and unfortunately "substance use" is one of the fallouts.

Data released by IMHANS reveal that there have been 3538 admissions since the pandemic broke out last year. Interestingly, 12 percent of OPD attendees were first-time users who took to drugs during the lockdown period. Also, 24 percent of the drug abusers had relapsed during the lockdown

During the lockdown, people witnessed financial, emotional, and other stresses where they were not able to cope. So, in some cases either as an escapism or just as a negative coping mechanism people started taking drugs

Lockdowns not only pushed more youth to drugs but also led to relapse in patients with substance use who were either on maintenance mode or were off treatment.

Data shows that a lot of overdose deaths are being reported. Therefore, the need of the hour is to establish a helpline for families of drug abusers. This is where they can be educated about overdose signs so that they can facilitate treatment for these patients.

Mental Health and Elderly

Besides physical health, the mental health of elderly patients also took a hit due to the pandemic.

Talking of mental health, in the first wave of the pandemic, the elderly persons were confined to homes. The sense of deprivation had already set in, and the second wave exacerbated it which increased the frequency of anxiety and panic attacks, depressive episodes and insomnia in them.

Besides the general anxiety and depression during lockdown, many elderly persons were suddenly thrown into maelstroms of trauma and grief.

A lot of them also prematurely lost their children or younger family members. Moreover, due to the lockdown neither they could attend funerals, nor relatives could come to comfort and console them. Since social rituals provide a means to share grief and gain support from friends and families during death, the inability to attend these rituals resulted in a greater lack of closure, adding multifold to their grief and pain.

The elderly people need easy access to home healthcare, access to essentials preferably through home delivery, and above all compassion and care from their families and state systems.

This is the right time to engage stakeholders, including elderly men and women themselves, to frame more equitable policies for a more active, empowered and productive old age.

Mental Health and Children

Everyone speaks about the mental health problems of adults, but the effect on children is often understated.

There is hardly any awareness on the need to address those of children. The increased screen time poses a great risk to children’s health, physical and mental. In the garb of online classes, they are using the time in playing games on the internet and social media interactions dominate their moods.

There are several components required for the healthy development of children that have been severely impacted in the pandemic. Physical activity is almost out of bounds, interactions with friends and new experiences from travel as well as unstructured playtime all have been shelved in the pandemic. This has affected their mood terribly as well as their ability to concentrate and learn during the online classes. Poor behaviour is frequently the result of a skill deficit in children.

That said, toddlers are facing significant social and communication delays due to social deprivation. School-age children are facing challenges in academics, and parents have to spend extra time to help them cope. Teenagers are worried about their future – whether exams will be conducted or not, whether their careers will be impacted etc. There is an increase in symptoms of stress, anxiety and depression being reported in children and adolescents. If not attended, the child could face emotional health issues in future and it can also trigger suicidal thoughts because of inadequate internal and external coping mechanisms.

According to the official figures of Child Guidance and Wellbeing Centre, Institute of Mental Health and Neurosciences, Srinagar under the MHPSS Program of UNICEF, 5400 sessions with children alone have been recorded at the centre since last year, highlighting the extent of the problem.

The theme for World Mental Health Day 2021 is “ Mental Health in an unequal world.”

Rightly so has WHO highlighted the the great divide in access to resources in todays world. Whether it is stigma, finances or inability to recognise signs for help due to lack of knowledge for the same. It reinforces the fact that what has been done so far is a lot and yet not enough.

More awareness, more knowledge, more reach to grassroots level across all sections of the society is much needed. It will need a lot of multi-layered hard-work by experts and society alike. And then maybe we will be able to make a dent in this vast ocean, that is mental health.

Dr Sheena Shah, Resident IMHANS

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