• Universal health coverage is about ensuring all people can get quality health services, where and when they need them, without suffering financial hardship.
• No one should have to choose between good health and other life necessities.
• The World Health Organization (WHO) defined human health in its broader sense in its 1948 constitution as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Over 800 million people (almost 12 percent of the world’s population) spend at least 10 percent of their household budgets on health expenses for themselves, a sick child or other family member. They incur so-called “catastrophic expenditures”. Now this is a huge number.
Mental health forms very important criteria of being healthy. Now if we look at even older surveys of mental health in Kashmir, picture is not encouraging. About 16 qualified psychologists and 25 Psychiatrists for population of 5 million in Kashmir. Jammu region faces the same problem, particularly border districts of Rajouri where patients first have to travel, then stay in Jammu to meet a qualified psychiatrist. It remains to be seen when international organizations working in Jammu Kashmir will set up counseling centers in border areas of state, where population is prone to disorders like PTSD, Anxiety ,disorders which arise due to frequent shelling at LOC. Its interesting that very little or nothing is known of Psychiatric ailments in Ladakh. Although work of IMHANS [Psychiatric Hospital, Rainawari], JVC, SMHS is exemplary but they still cannot cope with epidemic of psychiatric ailments in Kashmir. Its painful but pertinent to mention that for whole of Kashmir, only one Drug De-addiction Centre caters to needs of patients on scientific basis which is situated at Batmaloo, Srinagar. According to UN report there are about 50 thousand drug abusers in Kashmir out of which 4 thousand are females. Females are addicted mainly to multiple doses of pain killers, anti spasmodic medicine and sleeping pills given by local chemists. For females there is no separate de-addiction centre in whole of JK state. Suicides also have become common in state especially in Kashmir, but unfortunately there is no suicide prevention helpline in Kashmir which could work 24/7 to help high risk groups of patients having suicidal ideations or attempted suicides previously. A survey by MSF says 45 % of population in Kashmir faced trauma in their life, to tackle this type of hurricane that has hit us, we need to take urgent steps. Its sad to notice that some parents oppose when their children ask them for a frank conversation with mental health doctors or counselors. Sometimes disease starts in childhood or teenage, and treatment is sought when patient is in late twenties, thus complicating the required treatment. Stress can affect any one children, teenagers, young, old, men and women. Following guidelines will go a long way in removing stigma of going to Psychiatrists and bringing awareness about mental health diseases.
Mohalla clinics where even doctors or counselors with experience in psychiatry can evaluate patients of psychiatric ailments and refer them if necessary. For mild form of depression or anxiety , medicine is not necessary, by having such type of mohalla clinics saves precious time of patients can and unnecessary rush to psychiatric hospitals can be reduced. Time is important as far as jobs of patients are concerned, usually one day is spent in going to any government psychiatric facility, with high rate of unemployment this is one of the reasons people with psychiatric ailments do not visit hospitals.
We must understand that no government in world can do everything, but people who care for Kashmir or Jammu can help set up such centers whose annual budget will not be more than 2 lakhs yearly. Our respected ministers also can take the lead by spending money from their CDF for this noble cause.
Most of the patients do not know about major signs of Depression, Anxiety or Psychotic ailments.
Its important that all school and college teachers get trained in recognizing symptoms of common psychiatric disorders. Unfortunately when most of educational institutions are approached for this training ,they say things like “Our syllabus is not completed, this training on psychiatric ailments will give a bad name to our educational institutions “. Educational institutions are places where intellectuals are working, so these kinds of answers are highly disappointing.
Providing spaces where children, youth, women can discuss emotional problems of their life, with doctors, counselors or senior citizens. It will be again good if civil society takes initiative. Many of mental health problems arise, as due to rabid urbanization and being becoming more materialistic, even family members have no time to listen to problems faced by our children, family members or neighbors. They cannot vent their feelings, hence creating unnecessary blocks in our thinking and finally paving way for many mental health ailments. Whenever anyone is diagnosed with any severe psychiatric ailment, family members instead of concentrating on recovery of patient, are anxious when will the concerned psychiatrist stop medicine. We never hasten to do this if somebody is diagnosed with thyroid problems or high blood pressure.
Like others health facilities, mental health facilities need to be provided at all places, that’s what this year’s theme of UNIVERSAL HEALTH COVERAGE talks about. Otherwise we do celebrate WORLD HEALTH DAYs in posh hospitals rather than doing something on ground level.
I hope this year government, civil society, doctors working in community psychiatry develop a consensus for working on regular basis in a planned manner to improve mental health scenario in Kashmir.