Year : 2021 | Volume
: 30 | Issue : 2 | Page : 361--363
Development of mental health services in Kashmir
Sheikh Shoib1, S M Yasir Arafat2, Sheikh Mohd Saleem3,
1 Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, Jammu and Kashmir, India
2 Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
3 Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Rainawari, Srinagar - 190 003, Jammu and Kashmir
|How to cite this article:|
Shoib S, Arafat S M, Saleem SM. Development of mental health services in Kashmir.Ind Psychiatry J 2021;30:361-363
|How to cite this URL:|
Shoib S, Arafat S M, Saleem SM. Development of mental health services in Kashmir. Ind Psychiatry J [serial online] 2021 [cited 2022 Jan 25 ];30:361-363
Available from: https://www.industrialpsychiatry.org/text.asp?2021/30/2/361/325647
Kashmir has a geographical area of 15,948 square km which is commonly referred to as Heaven on earth. Being located in the northern region of India, it is famous for its magnificent beauty. It is divided into 10 districts and mainly into three territories like south Kashmir, north Kashmir, and central Kashmir. The population of the state has a mixed ethnic, cultural, and religious background with Kashmiris being the predominant ethnic group, followed by Sikhs, Pandith's, small minority of Hindus as well. Mental health in Kashmir has always been a subject of attention as there are a lot of socio-political considerations. Mental health disorders are on the rise since the past 30 years of insurgency. Jammu Kashmir has a population of around 12.5 million according to the 2011 census of India. One study identified that 45% of Kashmir's adult population (1.8 million) were suffering from some form of mental distress.
Development Of Mental Health Services In Kashmir
The history of the development of psychiatric services dates back to 1880 when the asylum was started in the Prison Department. Subsequently, it was taken by the Health Department in 1950 which was associated with Government Medical College, Srinagar, in 1971. It was headed by Swiss psychiatrist Professor, Erna Martha Hoch at that time. It was later up-gradation as the Institute of Mental Health and Neurosciences. Formal mental health services were first started at the mental institutions, which were later decentralized to the general hospital and primary health care settings. Currently, there are about 41 psychiatrists, who are mostly affiliated with teaching hospitals in two cities of Jammu. The mental health services in Kashmir are primarily limited to two hospitals in Srinagar (GMC, Srinagar, and SKIMS hospital), even though the National Mental Health Plan and the district mental health program were started in many districts of Kashmir.
The psychiatric department has started in two medical colleges Anantnag and Baramulla that provide mental health services in respective areas. There are 140 indoor beds in 10 districts of Kashmir and the outpatient's services are being provided by 12 psychologists, and one social worker., Deaddiction services are primarily provided by Drug De-addiction Centre (DOC) at SMHS Srinagar.
Mental health services in Kashmir are arranged according to hierarchy organizations, through which resources are allocated from central to peripheral levels. The government acts as the funder and provider of all public services. The mental health expenditure by the Union Government is <0.5% of its total health budget. The Ministry of Health and Family Welfare is the authority responsible for health and mental health services. Resources are distributed to the states through the state health societies and subsequently to the district health societies. There are separate governances to hospital and primary care services ‒ hospital services being under the Directorate of Health Services, Kashmir and Health, and Health and Medical Education Department, respectively. Henceforth, primary mental health services that were introduced later than the hospital services have become separately governed under the private sector. Social services for the mentally ill people are provided through the employment of medical social welfare officers, especially by the local Nongovernmental Organizations (NGOs) which is small and focused on acute needs rather than long-term care. Engagement in involving them in mental health care is at a preliminary stage. The involvement of private organizations in the delivery of mental health care has been small, largely due to the prohibition through the old stigma associated with mental health issues. These are in the form of private specialist services and local NGOs. Several NGOs, which involved professionals, consumers, and careers, have been established decades ago. Interestingly, there has been a significant rise in the efforts in mental health advocacy by individuals and groups of consumers using social media as a platform. Efforts to form coalitions at the national level and to involve as many stakeholders in the national planning of services delivery have just been revived recently. Mutual collaboration with services from other governmental agencies (NGOs), and from private and NGOs, are potential outlets for mental health service delivery in future.
Specialized Education And Training In Mental Health
At the postgraduation (PG) level, MD psychiatry was started in GMC, Srinagar in 1983, and gradually seats were increased from one to eight. Similarly, the Diplomate of National Board (DNB) psychiatry was started in SKIMS Medical College, Bemina, and later MD psychiatry was started there. There are currently 3 MD seats in the college. The specialized degree in MPhil in clinical psychology was started by a Government Psychiatric Hospital and was recognized as MPhil clinical psychology by UGC. Further, PG in psychiatric nursing (MSc in psychiatric nursing) was started in 2012–2013. There are no courses in psychiatric social works available in universities. At the undergraduate level, psychiatry subjects have been induced in the curriculum of MBBS. The MBBS students get posting in the psychiatric department for learning and gain skills in psychiatry. The interns are posted for 2 weeks in psychiatry to get well acquaintance of knowledge regarding mental health.
Milestones Of Development Of Psychiatric Services In Kashmir
1880: The Prison Department established mental asylum1950: Health Department took over the charge of mental asylum1971: Government Medical College, Srinagar and became an associated hospital1971: Professor, Erna Martha Hoch Swiss psychiatrist headed the Government Psychiatric Hospital1983: MD psychiatry started in GMC, Srinagar1999-Psychiatric Department of SKIMS Medical College started2009: Hospital was upgraded to Institute of Mental Health and Neurosciences2018: Newly storeyed hospital building located on the bank was made functional2018: clinical psychology course in GMC, Srinagar was started.2010–2013 - The new hospital building at IMHANS, Rainawari has been constructed under the National Mental Health Program under which the Government. Psychiatric Diseases Hospital, Srinagar was upgraded to Center of Excellence2013/2014: DNB Psychiatry started in SKIMS, Bemina2014: JK psychiatry society formed2019: SKIMS Gets MCI Recognition for 2 MD psychiatry seatsJuly 2008; District Mental Health Programme (DMHP) implemented in Srinagar, Kupwara, Baramulla, Budgam, Anantnag, Pulwama, Kulgam, Leh, Shopian2013: DMHP was implemented in Ganderbal2014: DMHP implemented in Bandipora.June 26, 2014 - witnessed the inauguration of the valley's first specialized DOC at SMHS Srinagar2016–2017: Funds received for DMHP for 04 districts (Bandipora, Kulgam, Ganderbal, Pulwama) during2019-Department of Psychiatry Services in GMC, Anantnag2019-Department of Psychiatry Services in GMC, Baramulla2019-Draft policy for drug addiction2020: GMC, Antanag gets nod to start deaddiction outpatient department services.
Mental health services in Kashmir are still largely based on those inside mental institutions. Efforts have been made to expand services beyond the mental hospitals through decentralization to move services to the general hospitals for many years, and the incorporation of mental health care into the primary health programs. Services currently available in the system can be categorized into three levels ‒ the mental hospitals, the general hospitals, and the primary health centers, as well as specialist services. Being in a state of conflict with limited resources, the main focus had been providing services to the people seeking treatment in those settings. However, there is a need to provide coordinated comprehensive mental health care to cater to the different groups of people with different levels of mental health needs through within and from outside the health organization. These would include adequate mental health promotion and mental illness prevention activities, services for early detection, and treatment of common mental illnesses, and services that provide adequate treatment and aftercare for people with serious mental illnesses. For this purpose, to look at the needs of the population for mental health services is important so that services would be more needs-led and fair.
|1||Médecins Sans Frontières (MSF), the University of Kashmir, Institute of Mental Health and Neurosciences (IMHANS). Muntazar: Kashmir Mental Health Survey Report; 2015.|
|2||Wittchen HU, Faravelli C, Barbui C, Komaki G, Healy D, Painuly N, et al. IFP News Section. Psychotherapy Psychosom 2004;73:263-5.|
|3||Shoib S, Yasir Arafat SM. Mental health in Kashmir: Conflict to COVID-19. Public Health 2020;187:65-6.|
|4||Malla A, Margoob M, Iyer S, Joober R, Lal S, Thara R, et al. A model of mental health care involving trained lay health workers for treatment of major mental disorders among youth in a conflict-ridden, low-middle income environment: Part I Adaptation and implementation. Can J Psychiatry 2019;64:621-9.|
|5||Garg K, Kumar CN, Chandra PS. Number of psychiatrists in India: Baby steps forward, but a long way to go. Indian J Psychiatry 2019;61:104-5.|
|6||Goel DS, Agarwal SP, Ichhpujani RL, Shrivastava S. Mental Health 2003: The Indian scene. In: Agarwal SP, Goel DS, Ichhpujani RL. Salhan RN. Shrivastava S, editors. Mental Health: An Indian Perspective, 1946–2003. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare; 2004. p. 3-24.|
|7||Wadoo O, Shah AJ. Psychiatry in conflict zone–Try in conflict zone–Challenges in Kashmir. JPPS 2009;6:14-6.|