Premier mental health programme fails to take off in Kashmir

A centrally-sponsored mental health programme meant to improve access to diagnostic and treatment services has failed to take off in Kashmir even as various studies have established the high incidence of mental health issues here.

In 2016, the centrally sponsored district mental health program (DMHP) was launched in four districts of Kashmir viz. Pulwama, Kulgam, Bandipora and Ganderbal, by directorate of health services Kashmir.

The program was meant to improve access to diagnostic and treatment services for psychiatric disorders by providing a team of experts as well as infrastructure at district hospitals. However, three years on, except for district hospital Pulwama, the program has remained confined to OPD services only.

Consultant psychiatrist at district hospital (DH) PulwamaDr Majid Shafi, said the lack of manpower in these centres was a major impediment in making them functional. “The psychiatrist is paid less than a resident under Kashmir DMHP. How is that supposed to work?” he asked.

This apathy towards mental health can be gauged from the fact that while newly established Government Medical Colleges (GMC) of Anantnag and Baramulla have a department of psychiatry, the affiliated hospitals have no provision for improved mental health services.

At DH Baramulla, the psychiatry department is restricted to a small shared room that functions both as OPD and counseling room. At DH Anantnag, affiliated to GMC Anantnag, the scenario is no different. A single chair OPD is all that functions in the name of psychiatry at the hospital, a health official said.

In the past different studies have talked about the severity of mental health illness in Kashmir. As per a 2016 study by Medecins Sans Frontier (MSF), as much as 45 percent of Kashmir’s population “was experiencing symptoms of mental distress, with 41 percent exhibiting probable depression”.

A year later, Action Aid India, in collaboration with Institute of Mental Health and Neurosciences of Government Medical College Srinagar, released findings of an extensive study about prevalence of mental health illnesses in Kashmir’s 10 districts.

The study revealed that  in Kashmir “12.3 percent of people had witnessed traumatic events in their families in terms of losing a family member, having a member disappeared, detained, tortured or disabled due to conflict related reasons”. Expectantly, a significantly higher proportion among these, about 24.3% had developed some kind of mental health disorder. In general population, the prevalence was much lower and stood at just 9.4%.

The mental health experts rue that adequate attention has not been paid to addressing this mental health illnesses in Kashmir. As a result, diagnostic and treatment services have remained centralized to Srinagar’s tertiary care hospitals, thus posing hurdles in access and treatment seeking.

“Mental health cannot be addressed by a centralized service only and there is a dire need to improve awareness as well as outreach in this area,” said a senior psychiatrist at GMC Srinagar. He added that although the GMC alone produced as many as eight psychiatrists every year, there was no infrastructure available in peripheries where these experts could render their services.

DrTajammulHussain, Assistant Professor Psychiatry at GMC Baramulla said that location of a psychiatry facility was a major factor in treatment seeking. “I have patients who cannot afford to travel and then get admitted far away from their homes in Srinagar,” he said adding that such patients usually give up on treatment as travelling to the GMC’s mental health facilities was too hard on their pockets.

Director health services Kashmir, DrKunzes Dolma agreed that DMHP had not taken off, thus reducing the ambit of mental health facilities in Kashmir. She said that her department was cognizant of the magnitude of mental health issues in Kashmir and improving the infrastructure and manpower in district hospitals for psychiatry was the “need of the hour”.

“We have submitted a proposal to Government seeking extension of DMHP to all districts. We hope it will be approved soon,” she said.