Working towards addressing the gap in mental health by ‘mending minds to rebuild lives’.
He was tired of it all – the everyday struggles of making ends meet, of living in constant fear of foreign armed forces, of the incessant bickering of his so-called ‘family’. Life had reached a stage where everything seemed pointless. Now, just one thought circled his mind over and over again – ‘end it all’. He felt so alone…Would anyone ever understand his inner strife? Was there anyone who could help?
Last month, Médecins Sans Frontières (MSF) released a report of the first comprehensive mental health survey of Kashmir. The study was conducted by MSF along with Kashmir University’s Department of Psychology and the Institute of Mental Health and Neurosciences (IMHANS) between October and December 2015 in 399 villages. It has revealed that nearly 1.8 million adults or 45% of adults in Kashmir suffer from mental distress and a majority of people have experienced or witnessed conflict-related trauma. Nearly 1 in 5 adults in the Kashmir Valley lives with significant PTSD symptoms, representing 7,71,000 individuals, with 2,48,000 (6%) meeting the diagnostic criteria for PTSD.
It just takes reading the daily newspaper to see validation for the MSF study. In the past year, almost every week there has been news about someone having ended their life. A valley rife with talent and one that has achieved so much despite the odds, these cases of suicide are deeply disturbing. Unfortunately, with a healthcare system that lacks resources and is already overburdened, mental health cases often do not receive much attention or support. In an environment of tremendous need but meager supply, non-governmental and other private organizations have to come up to fill the critical void.
‘Healing Kashmir’ (HK) is one such organization that believes societies can never achieve their full potential if psychological illnesses are not addressed. Headquartered in Baghat Burzalla, Srinagar, HK is working towards addressing the gap in mental health by ‘mending minds to rebuild lives’.
Healing Kashmir: From Idea to Implementation
“You could say that the most lasting damage of war is to the mind. In the case of the disputed Kashmir Valley, more than twenty-five years of fighting has caused inordinate long-term mental damage to a high percentage of the population” (Healing Kashmir).
Healing Kashmir was launched in 2009 as a non-Governmental organization registered in India and the United Kingdom. The team consists of a carefully selected group of Kashmiri men and women from various backgrounds. The HK therapists have lived through the conflict and thus have a far deeper understanding of those they treat than any outsider could. A senior Mental Health Therapist at HK who has been with the organization since it first started shares that “all of the staff at HK have a either a bachelor’s or master’s degree in psychology. They receive an intensive 1 year of training and an ongoing training every three months. Staff is trained on various topics including how to conduct therapy sessions, Reiki therapy, existential therapy, and the psychology of happiness. Training and supervision of cases is provided by consultant psychologists”.
With a team of 22 employees, HK operates as a three-tier system:
A) ‘Kashmir Life Line’ Mental Health Helpline: The HK helpline offers completely anonymous and confidential counselling. The toll-free number 1800-180-7020 is managed by a team of professionally trained therapists from Sunday through Thursday. Alternatively, individuals can also chat with a therapist online through the website www.kashmirlifeline.org. The therapists make callers comfortable with sharing their problems and provide motivation and education. The next step for for people to be able to have face-to-face conversation at either the main clinic or at one of their outreach centers. The helpline is faced with a range of cases like relationship issues, peer pressure, self-harming behavior, suicidal ideation and so on. If an individual has suicidal ideation, HK staff use a strict protocol and either try to get the caller to pass the phone to a member of their family, or they try to get the caller to come to the clinic. The focus is on using non-pharmacological approaches to address various disorders and to empower patients to understand what is wrong with them so they become able to doctor themselves.
B) Outreach Counseling Centers: Staff from HK visit area hospitals in Anantnag, Baramulla, Shopian, Kangan, Pulwama, and Char-e-Shareef every week to provide free one-on-one sessions to provide counselling and psychotherapy. Additionally, people are also seen by therapists at the main HK office in Burzalla, Srinagar. Recently, services have also been added at SMHS Hospital Srinagar in the AYUSH Unit. Two therapists see patients every Tuesday from 1030 am – 4 pm at SMHS. Cases typically consist of symptoms relating to Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, with the majority of people falling in the age range of 18-25 years. One of the common conditions seen by HK is the somatization of mental illness. Somatization is the physical manifestation of psychiatric disorder. The most common manifestation in Kashmir is back pain. Every client has a minimum of a weekly session, at times 2-3 per week. Therapy goes on for as long as it is needed.
C) Awareness Programs: Staff at HK also provide extensive training for Integrated Child Development Services or ICDS workers and hospital staff. In addition, awareness programs are also held at area universities and colleges. These sessions cover topics of relevance to students such as peer pressure and examination anxiety. Awareness programs for ICDS workers include education about basic mental health, various disorders, how to identify people who have these conditions and referral resources available.
The trauma helpline model created for Kashmir is based on one of the most successful models in the world known as ‘The Samaritans’ founded in the UK in the 1950s. The main ethos of the model is listening. Justine Hardy – a trauma psychologist, journalist and author from the United Kingdom and founder of Healing Kashmir elaborated on this concept stating, “Everyone is usually always told what to do. We wanted to turn that around. When people are in psychological pain they want to be able to tell their story, they want to be heard and listened to, and so listening is the first level. So if someone is brave enough or has enough presence of mind to call us, we triage it, try to normalize the situation and start to examine the problem that lies behind it. For some people the phone works for them, but we want them to come to the clinic as face-to-face can be life-changing for people. So, we have created a homey environment and we are trying to get away from the idea of the doctor as an authority figure so that the person feels that the therapist is a support system, an ally. “
Milestones and Future Goals
HK has seen a slow and steady growth over the years. In 2011, the helpline took in 1500 calls. By 2015, this number had more than doubled to over 4000 calls in the year. In 2015, they ran 25 awareness programs, conducted ongoing training with over 1000 Aganwadi workers, and saw approximately 1300 patients for individual counselling sessions.
“The gradual breakdown of the stigma associated with mental illness is one of our biggest accomplishments”, shares Justine. When asked about her most memorable case, a senior Mental Health Therapist shared the story of a female patient who came to HK complaining of sleeplessness. The patient had been on medications for several years due to anxiety disorder. “We started therapy with her and after some time we went to the doctor with her. Because of the extensive therapy she received, for the first time she was able to be firm with the doctor about not wanting to continue taking medication. She is now doing very well and has referred more patients to us”. The work of HK has spread by word of mouth throughout the valley.
So, what is in store for the future? Justine and her team isn’t one to rest on their laurels. “We will continue to do what we are doing but push quite hard not to over expand. We are looking right now at creating a program aimed at young men who slipped through the cracks and are feeling marginalized. We are looking at what the best way to do it by helping people to learn about basic mental health so that they know how to look after themselves and their own minds in healthier way– ways that allow them to build their self-respect.” The team plans to expand the reach and awareness of the helpline and work towards removing the stigma associated with mental health.
The author is the Director of Innovise Healthcare LLP, a healthcare consultancy offering expert guidance to improve healthcare operations. She has a Masters in Health Administration from the University of North Florida (USA) & previously managed a healthcare facility in Florida for 3 years.