October 8, 2005 brought about tremors of the mind as well

Afsana describes how the big earthquake shook the lid on social stigma associated with mental health but families need to provide support and not shun victims

(Ms. Afsana Rashid, 29, was born and raised in Srinagar and attended the Minto Circle High School. She graduated from the Government College for Women with a Bachelor's degree in science, and completed her post-graduation degree from the University of Kashmir, obtaining her Master's Degree in Mass Communication and Journalism. Ms. Rashid works as a senior journalist in the Daily Etalaat. She has received numerous world-wide recognition and awards for covering economic depravation and gender sensitive issues in Kashmiri journals, which include Sanjoy Ghose Humanitarian Award, Bhorukha Trust Media Award 2007, and the 2006-07 UNFPA-Ladli Media Award. Her work on "Impact of conflict on subsistence livelihood of marginalised communities in Kashmir and Alternatives", was recognized by Action Aid India in 2005-06. She has travelled abroad attending a workshop on "conflict Reporting" by Thomson Foundation, Cardiff, UK, and a seminar for women in conflict areas by IKV Pax Christi, Netherlands. In February 2008, she compiled a book, "Waiting for Justice: Widows and Half-widows.")

'Need for integration of psychatric services in primary health care'

Srinagar: Strongly opposing setting up of psychiatric hospitals, Director and Vice Chancellor, National Institute of Mental Health and Neuro Sciences (NIMHANS), Dr Nagaraja, has called for integration of psychiatric services into primary health services.

"It would be then easily accessible and affordable," he said.

He stressed community support backed by government adding "it would make the programme effective." He also suggested non-government organizations (NGOs) to come up with long term facilities.

When asked about conflict-psychiatric problems relationship here, he said, "It is not illness but natural reaction in abnormal proportion. There are two types of patients - those with severe mental disorder and others suffering from anxiety and depression. However, it can be more frequent here than in undisturbed areas.""If severe mental disorders can be treated early the outcome can be better. He said that in most of the psychiatric hospitals in India there is no psychiatrist and normally the medical officers run the psychiatric hospital," he added.

According to him, 90-95 patients cannot afford to go to private psychiatrist for treatment and even if they go most of them visit only once, but it requires treatment on long term basis. "In India, 110 to 120 psychiatric post graduates pass out and out of them more than 50 per cent move outside India and those who stay back generally prefer private practice," he said. He said there is severe shortage of psychiatrists in India including Kashmir. "Both shortage and mal-distribution of psychiatrists has severe effect. With present mechanism, problem can not be solved for another 50 years." He added that in the western countries the concept is to take such patients out of the family, but that can not be afforded in the Indian set-up. "Infact, it is no solution for India. Existing social support can be utilized to manage the affairs. We are not advocating a concept of growth of psychiatric hospitals. However, they can be there for the rarest cases," said Dr Nagaraja.

Reacting to social stigma attached with such patients and their lack of acceptability in a family, Dr. Nagaraja attributed it to ignorance on part of the people. "Besides," he said, "most people can not afford the tablets that are given free in the hospitals." He added the problem can be reasonably solved if the service is made available in villages. When asked about the possibility of such situation at the grass root level, he replied every state can afford it. "Simply, families need financial support," he said. When asked about his observations regarding stress related problems in the quake-ravaged areas in post earthquake scenario based on NIMHANS survey, he said the number has gone down. He attributed time factor and social support system within the community as reasons responsible for improved situation in the areas. He termed the situation arising out of October 8, 2005 earthquake as "exaggerated normal reaction" due to a natural calamity and not illness.

"It does not require medication, only small percentage needs. Basically, it is the social fabric torn into pieces, family support damaged and death of a leading person in the community. All this put people under stress." He assured regrouping of quake-victims in the community can turn the situation normal.