The psychiatric cost of conflict

The impact on mental health of people living in conflict zones is well established. According to a recent report of United Nations, one-in-five suffer mental health condition in conflict zones. Around 22 percent of those affected suffer depression, anxiety or post-traumatic stress disorder, according to an analysis of 129 studies published in the reputed medical journal ‘The Lancet’. Contrary to the past studies which seemed to underestimate the magnitude of mental health conditions in conflict-hit areas, the revised estimates show increased rates of severe, moderate and mild mental health issues.

The study is believed to be more comprehensive, using data from 39 countries published between 1980 and August 2017. It categorizes cases as mild, moderate or severe while excluding natural disasters and public health emergencies like virus outbreaks. In a conflict-ridden place like Kashmir, many issues go unnoticed till they assume grave propositions. The armed conflict has also spurred mental disorders, prompting authorities to count the number of persons having mental illnesses in Census 2011.

Some non-governmental organizations like Médecins Sans Frontières/Doctors Without Borders (MSF) have been doing their bit to help the people suffering from mental disorders in Kashmir. A comprehensive mental health survey conducted by MSF in 2015 revealed that nearly 1.8 million adults (45 percent of the population) in Kashmir valley show symptoms of significant mental distress. As per the research, 41 percent of people exhibited symptoms of probable depression, 26 percent showed symptoms of probable anxiety and 19 percent showed symptoms of probable Post-Traumatic Stress Disorder (PTSD).

The research done in collaboration with the Department of Psychology, Kashmir University and the Institute of Mental Health and Neuroscience (IMHANS) provided an insight into the level of mental distress in the ten districts of Kashmir Valley. The MSF study pointed out “clear gap” in accessibility to mental health services at district level. “The main barrier to seeking treatment included lack of awareness of available mental health services. Other commonly mentioned obstacles included distance, travel time, and associated costs necessary to reach health services,” the MSF website quoted principal researcher Dr Tambri Housen as saying. The research also stressed on the urgent need to develop a “comprehensive, integrated and decentralized” mental health programme in the valley aiming at both prevention and treatment. The MSF report recommended decentralization and expansion of mental healthcare services besides increased public sensitisation.

PTSD is often used synonymously with conflict related mental disorders. Washington Post carried an interesting report on “How doctors discovered PTSD”. PTSD was designated as a defined disorder in 1980. The term is used to refer to cluster of symptoms in people in the wake of a traumatic experience in conflict zones including hyper-vigilance, hyper-arousal, emotional numbing, flashbacks and hallucinations of the traumatic event. Psychiatric impairments are accompanied by feelings of fear and helplessness.

Back home, we get to hear lengthy speeches about the problems faced by physically disabled and the schemes meant for their welfare on occasions like World Disability Day. Such functions also witness token gestures of giving prosthetic limbs, wheel chairs or cheques to some disabled persons. While their inclusion in the census enumeration was expected to benefit the physically challenged persons and those with mental illnesses, we need concrete measures to alleviate their sufferings. For instance, it can introduce Mental Health Schemes to improve the psychological condition of people in the valley. We keep hearing about efforts for improving health sector. Let’s also work for the betterment of persons suffering from mental disorders. The MSF recommendations should help shape the government response.

Even the Lancet study reiterates the need for sustained psychosocial support in conflict areas. In the words of the study author Mark van Ommeren, who works in WHO’s Department of Mental Health and Substance Abuse, “despite their tragic consequences, when the political will exists, emergencies can be catalysts for building quality, sustainable mental health services that continue to help people in the long-term”. Just like the 2016 MSF report, the latest UN estimates provide valuable inputs of the prevalence of mental health conditions in areas of conflict. We often discuss the physical casualties of the conflict. The fact is the psychiatric cost is also too huge to be ignored.