CROSS ROADS
Armed conflicts have a serious impact upon social determinants of mental health and well-being such as family relations, community networks, access to healthcare, education, housing, water and sanitation. The presence of armed conflict has a harmful effect on the mental health of people by destroying the social fabric of the society and affecting people’s livelihoods, often leading to unemployment and poverty.
As a result, individuals need to adjust to highly anxiety-triggering situations. In children and adolescents this has particularly damaging effects since it takes place within a developmental context and thus potentially disrupts the normal developmental course of the individual, later on affecting his/hers adult functioning. Thus, mistrust in others and lack of confidence in being able to exert agency in one’s life could have long-lasting implications.
Usually individuals are unlikely to be exposed to traumatic stressors at any given time, however in the case of Jammu & Kashmir, as per the extensive Kashmir Mental Health Survey Report conducted by Médecins Sans Frontières, on average, an adult in Kashmir has witnessed 7.7 traumatic events in the course of her/his life.
The reported traumatic experiences include terrorist attacks, explosions, assault with a weapon, crackdowns/raids, kidnappings, imprisonment, interrogation, torture, enforced disappearances, violent death of someone known, sexual assault and physical assault. In addition to that, apart from the direct victims of these traumatic events, emergency service workers such as medical personnel, police and fire fighters are also repeatedly exposed to traumatic stressors, such as accidents, killings, bomb blasts, grenade attacks, mine blasts and suicide squads.
Furthermore, as an inevitable counter-terrorism measure, the prevalence of security personnel results in the militarization of society. As a result, society develops feelings of intimidation, which ultimately undermines normal interaction and community life. That coupled with the high youth unemployment rates, the fractured and uncertain economy and the breakdown of social-support systems gives rise to stressors which negatively impact the livelihood and wellbeing of the population.
Therefore, it does not come as a surprise that large sections of the Kashmiri society suffer from various mental illnesses and disorders.
Numerous studies have pointed out the causal link between armed conflict and mental health issues and associated dysfunctions. Apart from the psychological problems incurred, persistent dysfunctions are related to decreased productivity, poor nutritional, health and educational outcomes and curtailed ability to take part in development efforts. As a result, the adverse impact of mental health disorders in conflict-affected communities could be a major constraint in societal reconstruction and development efforts.
While under normal circumstances only 1-3% of the general population experiences any type of psychiatric disorder, in the case of Jammu & Kashmir, nearly 2.5 million adults in the Kashmir Valley are suffering from symptoms of mental health distress, with 41% exhibiting signs of depression, 26% signs of anxiety and 19% signs of Post-Traumatic Stress Disorder (PTSD), with residents from the districts of Baramulla and Budgam exhibiting the highest rates for all three. These districts have also been considered hotbeds of terrorism and it was recorded that the number of people attending psychiatric hospitals rose from 1,700 in 1989 to 100,000 in 2017.
Given the social stigma attached to frequenting mental health institutions in Kashmir, not only is this number alarming, but very likely also higher in reality due to underreporting. Doctors in the region estimate that no more than 10% of the population who are in need of psychiatric help actually visits the designated institutions.
A highly underexplored aspect stemming from the devotion cult towards militancy established in Kashmir is the misuse of young girls by terrorists. Relying on their hero-worshipping acquired status, militants attract young women, oftentimes maintaining affairs with multiple ones at a time, subsequently leaving them, either by choice or upon their death, which results in their marginalization considering the highly conservative nature of the Kashmiri society where sexual relations before marriage are frowned upon and deemed sinful.
The phenomenon remains very hushed up, due to the cultural and social stigma placed on it, alongside with the negative repercussions for one’s family honour. Moreover, segments of the community who support these militants further protect their image by denying these realities not for the sake of the girls’ reputation, but the militants’ esteem.
Such cases of sexual violence and harassment are unfortunately a common reality in the region of Kashmir. Given the taboo nature of this topic including rape, and the reluctance on behalf of victims to report either due to feelings of shame or fears of judgment on behalf of the community, unfortunately the number of cases of sexual violence is most likely much higher.
The effects of sexual assault on women’s mental health have been extensively studied and according to scholars, survivors of sexual abuse develop a range of psychological issues ranging from PTSD, anxiety, depression, suicidal tendencies, alcohol dependency and illicit substance abuse. When it comes to the latter, drug addiction has become one of the fastest growing problems in Jammu & Kashmir and is particularly rampant among young females.
In this regard, the European Foundation for South Asian Studies – Srinagar Branch (EFSAS – www.efsas.org) conducted field research in the Kashmir Valley. During the study, multiple-choice questionnaires were designed and distributed among the local population in the Kashmir Valley in order to assess the living situation of members of the community, their sense of marginalization/social inclusion and opinions on the ongoing conflict. The survey received 401 answers which were subsequently analysed. The questionnaires were distributed both online and offline.
Almost up to 40% of all participants argued that they do not believe that there are others who want to listen to their problems or help them out, as well as lacking someone to consult for advice or help. These statistics imply a lack of support structure in the community, which could further lead to feelings of marginalization.
43.1% argued that they feel left alone with their problems, while 41.8% stated that they feel hopeless. Both answers exhibit symptoms in the respondents of possible depressive states, which is imperative to address.
39.1% of the respondents argued that they know others who have resorted to substance abuse due to feelings of social exclusion or discrimination (40.9%). Unfortunately, the type of drug was not specified, which would have been important in regards to recognizing trends in licit and illicit consumption; nevertheless, the high number is alarming signifying the utilization of drugs as a coping mechanism to feelings of social ostracization.
While it is well acknowledged that people impacted by ongoing conflict are more vulnerable to psychological distress, this does not always translate into improved access to mental health care and therapy. This is also the case in Jammu & Kashmir, where experts have identified numerous barriers to adequate treatment including lack of awareness of psychiatric services, travel time, cost and distance to services, poor physical infrastructure, lack of understanding around the western ‘counselling’ or ‘talk therapy’ models, deficiency in mental health professionals adequately trained (especially in the understanding of somatization as an indicator of psychopathology), over-reliance on spiritual/religious healers and absence of community awareness programs.
As a result, the present reality exhibits the unmet and urgent need of ameliorating and expanding the mental health services in Jammu & Kashmir, raising awareness about the different conditions exhibited as well as reducing the stigma of seeking treatment.
As summarized by various reports and scholars, specific recommendations on those lines would include, (1) Creating more jobs for specialists in mental health facilities at all levels of healthcare, (2) Establish training for personnel at these mental health facilities to strengthen their competencies, (3) Sensitize policymakers and advocate for the development of suitable job selection criteria and the establishment of appropriate positions based on the specialization necessary, (4) Encourage and establish incentives for mental healthcare staff working in rural areas (5) Develop a crisis team and a dedicated helpline for Rescue and Rehabilitation, providing services such as transport, shelter etc. for all mentally ill individuals, (6) Develop models for catering to individuals who lack caretakers like orphans, (7) Ensure access to mental healthcare in inaccessible rural areas through audiovisual technology, (8) Formulate guidelines for the setting up of drug de-addiction centres alongside with rehabilitative measures for substance abusers (9) Encourage the Education System (schools, universities etc.) on raising awareness on the topics of mental health and substance abuse, (10) Make it mandatory for all schools to have a counsellor and a special needs teacher as part of schools and universities mental health programs (11) Make it mandatory to have a counsellor, psychiatrist and psychologist working at state emergency service institutions such as the police department, fire department and others, (12) Sensitize authorities and policy makers regarding mental health issues.
Civil society organizations should further launch different community awareness programs, which familiarize the general public with the spectrum of mental health issues, acquire a gendered approach by recognizing the needs of women and men, as well as promoting the normalization of seeking treatment for the purposes of reducing the stigma attached to mental illnesses.
EFSAS’ current study has exhibited and described this phenomenon using as a case study the Union Territory of Jammu & Kashmir, focusing predominantly on the Kashmir Valley. While this is easily explainable with the fact that the Valley has in many ways become the epicentre of ongoing conflict and brewing terrorism, further research must focus also on the regions of Jammu, Ladakh as well as Pakistan Occupied Jammu & Kashmir and Pakistan Occupied Gilgit Baltistan.
The effects of terrorism are multifold – loss of life, physical destruction and economic damages are unfortunately a grim reality, yet those who live to mourn their ravaged homeland are also the ones who oftentimes relive the trauma and develop psychopathological responses to what have happened. It is imperative not to forget their struggle and adopt effective and considerate approaches to assist them in their daily lives.
(The Author is the Director of the European Foundation for South Asian Studies (EFSAS) and can be reached at [email protected])
