SRINAGAR: A woman, whose teenager son succumbed to pellet injuries in Kashmir this September, has been consulting clinical psychologists at a government hospital in Srinagar for over a month now.

But she is not the only one. Even though concerns were raised against the grave injuries cause by pellets, bullets and tear-smoke shells, the ordeal of many mentally distressed people went unnoticed.

Médecins Sans Frontières (MSF), in a study done before the present unrest, revealed that 45% or 1.8 million adults in Kashmir Valley showed symptoms of mental distress – including depression, anxiety and post-traumatic stress disorder.

Although experts claim to have done crisis intervention to prevent mental health problems during the unrest, a noted psychiatrist Dr Arshad Hussain said, “The seeds are sown and the real impact of the unrest will be visible only when the patients turn up for consultation after the situation normalises.”

An MSF spokesperson said people were “understandably distressed” due to the unrest. “A sudden abruption in the routine complemented with the sense of uncertainty has affected the population with people reporting suffering from fear, anxiety, sleep and concentration issues.”

Formally cured patients are returning for help, the spokesperson said.

Dr Nisar-ul-Hassan, President of the Doctors Association of Kashmir, said the present stress might lead to mental crisis soon, if left untreated. “Psychiatrists should reach out to communities and prevent mental disorders at the latent stage or the affected people will be mentally disturbed for the whole life even with medication,” he said.

However, he said the government lacked manpower for an extensive community outreach. “Seeing enormous magnitude of psychiatric ailment burden in Kashmir, our doctor-patient ratio is miniscule,” he said, adding only those patients were treated who came over taboo of getting psychiatric treatment and really sought help.

The MSF study found a “high burden of mental distress and an evident gap in service delivery,” the spokesperson said. “(There is) a need to develop a comprehensive and integrated decentralized prevention, care and treatment program in the Kashmir.”

Clinical psychologists – who treat mental disorders with therapies instead of medicine – are essential for community outreach programmes. However, there are only five of them at Kashmir’s only Psychiatric Diseases Hospital.

Clinical psychologist Dr Mudasir Hassan said there is a need for more professionals to handle the high number of patients and conduct community outreach. “Ethically we are supposed to have an hour-long counselling session for each patient, but we see nearly ten patients during six-hours at out-patient department,” he said.

He said it is necessary to reach out to people because “they may not come to psychiatric hospital due to stigma, but they will surely come to the community center.”

The psychologists, during the present unrest, could only provide psychological first aid to injured hospitalised people, mostly in Srinagar’s Shri Maharaja Hari Singh hospital. “Some of the injured were in honeymoon period – resolved towards freedom – initially, while some started having suicidal thoughts within a few days in the hospital,” Hassan said.

He said counselling is necessary at this stage to prevent serious mental disorders. “After honeymoon period, there is a downfall and they can get into depression or anxiety,” he said.

This article was first published in Hindustan Times on 22 November, 2016