Today, we live in a set-up where children & young get little space for social activities, mother-child bond is under stress & increasing social media exposure is leading to decrease in activities, taking toll on mental health’
In 2016, when Medicines Sans Frontier (MSF) and Government Medical College (GMC) Srinagar came up with first ever study on mental health in Kashmir, the toll taken by years of conflict on minds of people became more evident than ever. Even though study focused on distress rather than disorders it was evident that “huge mental health morbidity” in Kashmir was a reality. The Institute of mental health and neurosciences (IMHANS) followed with another study which showed while majority of people in conflict ridden Valley were coping and resilient, still 11.3 percent population was having mental illnesses, which was higher than national average of 7.3 percent. While affected could be of any age group, young minds, experts feel, are vulnerable and suffer consequences of violence and fluid family structures the most. Today, when organizations across world are focusing on the theme “Young People & Mental Health in a Changing World”, on international mental health day, young minds in Kashmir are on a precipice, the experts argue.
To start early
According to WHO, half of all mental illness begins by age of 14, but most cases go undetected and untreated. What is right time to start working on mental health then? Psychiatrists feel earliest interventions which can help securing healthier minds is when child is not even born. Dr Arshid Hussain, who teaches and practices psychiatry at GMC said many psychiatric illnesses can be prevented by having a good perinatal health of mothers. “I say it with conviction that if we address perinatal health, we should be able to prevent a lot of mental illnesses in future,” he said, adding factors like mother’s nutrition, safe delivery and not delaying deliveries were first steps for a child’s better mental health. Research has shown that risks in pregnancy, if not addressed, could lead to subtle brain injury affecting growing brain. “These could be very subtle but then later on it could affect intellectual abilities and give rise to cognitive issues and have even been linked to severe mental illnesses like schizophrenia,” Dr Hussain explained. For long, psychiatrists have been delving on importance of mother-child bond and its significance. The new age scenario where women are playing multiple roles limits possibility of securing that bond. Much has been talked about physical absence of mother for child in first years of growth. Although state government’s decision to increase duration of maternity leave for women in J&K was praised as a step towards better mental health of children, many women work outside government sector where the concerns still remain. “There is no provision of maternity leave in most of organizations. This is not just detrimental to health – physical and mental – of mother but also deprives child of nutritional benefits and mental health benefits of having mother’s presence,” Dr Hussain continued. Many mental health experts feel a child is separated from mother too early, inhibiting formation of a secure bond which helps a child to step into next world with confidence.
Risky digital world
Recently, an international study showed that the time a child spends in front of television, playing with mobiles and laptop affects his/her mental ability. According to research conducted at University of Pittsburgh School of Medicine, young people who invest more time on social media platforms will inevitably face issues in sleeping and are more likely to show symptoms of depression. Most dangerous effect of increasing social media exposure, Dr Hussain said, is decrease in social activities of children and young people. “With increasing urbanization, we are living in a set-up where children have no spaces for playing, mixing up with people. Even in schools, playing has been relegated to a ritual,” he said. “The definition of humans being as social animal is under challenge now. Internet and more particularly social media is definitely greatest contributor to changes in socio-cultural values.” Amid social media onslaught significance of meeting, talking, debating, discussing and learning has been relegated to a minimum. “Our being what we are as a human race is rooted in our being social. Once that ceases, we become something else,” said Dr Hussain.
Challenges to secure young minds
According to two surveys done by GMC Psychiatry department in collaboration with Action Aid India and MSF, a high percentage of people studied had witnessed traumatic event owing to conflict related reasons. Among them about 24.3 percent people studied had developed some kind of mental health disorder. It was much lower among those who had not been exposed to such events, and percentage of such people was just 9.4. Depression is the most common mental health issue faced by Kashmiris, according to both surveys and the point prevalence of depressive disorders is almost double than national average. Though Kashmir has been through natural disasters, from 2005-earthquake, snow storms and 2014-floods – factors that could add to mental health worries – Kashmiri culture seems to be very resilient to natural disasters. “In 2014 the post flood coping was tremendous in the Valley with social networking, social bonding, altruism and humour at display in every nook and corner,” Dr Hussain said, hoping this culture of resilience persists and people steer clear of vagaries of urbanisation and acculturation, often mistaken as modernization. But with changing socio-cultural norms including nuclear and urbanized families, children are faced with a new concern – the working both parents, a scenario in which children are left with no option but to spend time indoors, with gadgets. This lack of play spaces and playing culture is taking toll on young generation, with their minds developing in ways that was not the case till recent.
Schools, the first stop
Schools need to incorporate development model for elementary years, doctors have been stressing time and again. “Researches have proven that schooling, even if started later, yields same learning outcomes as starting school after age of six, for instance,” said Dr Hussain. He stressed upon need of making children learn in playful manner, in creches, play schools and formal schools. “A creche is more and more becoming preparatory schools. The stress it puts on minds of children is tremendous and could be detrimental to healthy brain development,” he cautioned. In most developed countries, a child with special needs is provided with many provisions – extra care in schools and extra opportunities in life. In Kashmir, the fact that only one school in entire region has an integrated system for children with special needs is proof of neglect by society as whole towards mental health. Although there are a few schools for children with special needs, psychiatrists feel that compartmentalization of children breeds exclusion, shame and stigma. “There has to be an inclusive system for special kids to prevent them for developing psychiatric issues,” said Dr Hussain. “A child with even a mild intellectual disability is excluded in our schools, not to speak of a child with autism or other learning disorders.”
Ignoring the needy
Population of orphans has grown manifold in conflict ridden Kashmir over the years. Traditionally, an orphan used to be taken care of by relatives but now they are shifted to orphanages which have mushroomed across the Valley where, according to doctors, these orphans are often not in best of health, physically and mentally. “I strongly wish for that system to come back where an orphan would live with uncles and grandparents. Our religion has been so vocal about taking care of orphans,” said Dr Hussain. Citing broken family system as harbinger of mental health issues, he calls for training of caretakers and vigil on children homes. Batting for a boarding school system replacing orphanages in Kashmir, Dr Hussain said it would be better safeguard to mental health of children. “The least we can do for this generation of orphaned children is to have a system of supervision for these places,” he said.
Tackling extreme step
Suicides are a reality in Kashmir as much as in other parts of world. Recognized as serious mental health problem, suicide ranks as 9th leading causes of death in developed world. Although Kashmir has lowest suicide rates in India – 0.5 per 10 lakh – over last few years, data reveals, there has been spurt in suicides, attempts to suicides and deliberate self harm. “The situation warrants public health measures to bring down mortality because of suicide. Better understanding of risk factors and magnitude of effect of known risk factors among general population is crucial to design measures about suicide prevention programs,” Dr Hussain said, adding suicide registers and prevention strategies were need of hour.
How prepared is Kashmir then to handle challenges to secure mental health of people – young and old. “We are still in infancy but we have taken birth. Mental health facilities are only going to improve from now onwards,” Dr Hussain sounded optimistic, describing IMHANS a major step in this direction. Maintaining that skilled manpower was lifeline of efficient mental healthcare delivery, he said Kashmir had a single digit number of psychiatrists in 2000. “But now, we have overcome a many hurdles in finding skilled hands.” In terms of infrastructure building new IMHANS building is ready to be inaugurated and it will have state-of-art-facilities like imaging centre, safe rooms, brain stimulation centre with recovery, family wards and most importantly rehabilitation and recovery space. “Even at SMHS hospital, integrated mental health service centre is fully functional and has besides other services, 30-bedded de-addiction centre with separate female ward and OST centre,” Dr Hussain informed, stating it was only center in J&K to have such facility. In addition to women’s mental health clinic it is already running geriatric clinic and child psychiatry clinic and will soon add UNICEF child psychiatry centre. In past two years, IMHANS has been able to increase its MCI recognized postgraduate seat-strength from one in 2000 to eight in 2018. In addition, M Phil clinical psychology not only got a stamp from rehabilitation council of India (RCI) but seats were doubled up to eight. “The result of this change is evident. We have psychiatrists in almost all districts, better psychiatrist to population ratio than any other state of India,” Dr Hussain said. However, there remains an “Achilles tendon”. The manpower to run expanding services is still inadequate at the Institute. But the GMC has hinged its hopes on new dispensation in health and medical education department led by incumbent administrative head who had “envisioned” IMHANS years ago. “We are hopeful to get the support to help us realise this dream for lakhs of people in need in Kashmir,” said Dr Hussain.