Journal of Psychology and Clinical Psychiatry

Case Report Open Access

Mental health and youth of kashmir

Volume 7 Issue 3 - 2017

Sayed Aqeel,1 Mohammad Muzaffar Khan,2

Shekhar Saxena,3 Saleem ur Rehman4
Case report 1
Consultant Psychiatrist Lincolnshire partnership NHS
Foundation Trust, UK
This report is being written in the context of current political 2
Consultant Psychologist and Director Police Deaddiction
turmoil in Kashmir and the impact it had on the mental health of the services Kashmir, India
Youth of Kashmir. To begin with let us define what Mental health 3
Director WHO Mental health and Substance Abuse
means. Director Health Services Kashmir, India
4

According to WHO Mental health is a state of well being in which Correspondence: Sayed Aqeel, Consultant Psychiatrist
an individual realizes his or her own abilities, can cope with the Lincolnshire partnership NHS Foundation Trust, UK,
Email
normal stresses of life , can work productively and is able to make
contribution to his or her community. In this positive sense mental Received: February 10, 2017 | Published: February 17, 2017
health is the foundation for individual well being and the effective
functioning of a community.
It becomes a disability if it has long term effect on normal day
to day activity which is something an individual does regularly in a
normal day.

A person whose state of mental health as defined above is disturbed We need to work on all four objectives in our state as well if we
needs help to restore the equilibrium which can be achieved by help want to improve service delivery in the mental health field for our
from family , friends or professional help. population suffering from political turmoil for the past two decades
which had significant impact on the mental health of our population
Before explaining the role of professionals it is important to
especially our youth who have lived and grown in the environment
evaluate the services available in the field of mental health.
of turmoil.
According to WHO only 1% of the global workforce works in
mental health and the median public expenditure on mental health per The action plan relies on six cross cutting principles
person is 2$ in low and middle income countries compared to 50$ in and approaches
High income countries.
1. Universal health coverages…. Regardless of age, sex,
Similarly there are only 5 mental health beds per 100,000 socioeconomic status, race ,ethnicity or sexual orientation and
population in low and middle income countries compared to 50 following the principle of equity persons with mental disorders
mental health beds per 100,000 population. should be able to access without the risk of improverishing
themselves, essential health and social services that enable them
Only 2/3 WHO Member states have a stand alone policy or plan
to achieve recovery and the highest attainable standard of health.
for mental health and only ½ WHO Member states have a stand alone
MENTAL HEALTH LAW. However these policies are often not fully 2. Human Rights… Mental health strategies, actions and
in line with international human rights covenants and implementation interventions for treatment , prevention and promotion must be
is weak. compliant with the Convention of the Rights of Persons with
In view of the scarcity of resources in our settings it is important Disabilities and other international and regional human rights
that much work needs to be done in the field of promotion and instruments.
prevention.
3. Evidence based practice. Mental Health strategies and
WHO has recommended various programme in the field of interventions for treatment, prevention and promotion need to
promotion and prevention and which we need to adopt and work on be based on scientific evidence and best practice taking cultural
in our settings which includes mental health awareness/anti stigma considerations into account.
campaign, maternal mental health promotion, school based mental
health promotion, parental/family mental health promotion, violence 4. Life course approach. Policies plans and services for mental
prevention (women, child abuse), workplace mental health promotion health need to take account of health and social needs at all stages
and suicide prevention. of the life course, including infancy, childhood, adolescence,
adulthood and older age.
In order to improve service delivery in the field of mental health
WHO in 2013 launched the comprehensive Mental Health Action 5. Multisectoral approach. A comprehensive and coordinated
plan 2013-2020 with four main objectives of Strengthening leadership response for mental health requires partnership with multiple
and governance for mental health. Providing comprehensive mental public sectors such as health, education, employment, judicial,
health and social care services in community settings. Implementing housing, social and other relevant sectors as well as the private
strategies to promote and prevent mental health. Strengthening sector as appropriate to the country situation
information systems, evidence and research.

Submit Manuscript | http://medcraveonline.com J Psychol Clin Psychiatry. 2017;7(3):14‒12. 1

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6. Empowerment of persons with mental disorders and psychosocial Similarly data from the survey done on participants of mhGAP
disabilities. Persons with mental disorders and psychosocial which included professionals from various fields including doctors,
disabilities should e empowered and involved in mental health nurses, psychologists, teachers, social workers, police personals,
advocacy, policy, planning, legislation, service provision, lawyers and other professionals reported that in the past one month
monitoring, research and evaluation. majority of the cases of mental health they had contact with were new
patients and majority were having symptoms suggestive of depression
Following the launch of action plan all International Collaborative
and anxiety.
partners were invited to the mhGAP forum in Geneva to share their
expertise and submit recommendations in order to successfully Similarly during the three month monitoring and evaluation
implement the Global Mental Health Action Plan and I had the phase of mhGAP in District Ganderbal more than 80 percent patients
opportunity to attend the forum at the invitation of WHO Director with mental illness were having symptoms suggestive of depression
Mental Health Dr Shekhar Saxena. followed by PTSD.
Following the recommendation it was agreed that more stress The patients were identified by both BUMS and Allopathic doctors
should be laid on improving mental health rather than focussing and were successfully treated, provided counselling or referred to
specifically on mental disorders. psychiatrist or secondary care services highlighting the effectiveness
of community training under mhGAP.
Spirituality should be considered as an important dimension in the
concept of recovery Similarly the results of the survey conducted by MSF in 2015
the results of which were presented by me both at mhGAP Forum in
Emphasis was laid on transcultural issues e.g recognition of
Geneva in the WHO assembly as well at International Humantarian
depression and potential value of other cultural models.
Congress in Berlin co-hosted by MSF Germany and Red Cross
With regards to the above principles and recommendations the Germany at the request of MSF Kashmir division showed that from
major limitations in service provision in our state included. 5600 households selected from more than 400 villages in 10 districts
1.8 million adults (45% of the adult population ) are experiencing
Treatment Gap in universal access to mental health services symptoms of mental distress with 41% exhibiting symptoms of
Gaps are even larger with regard to preventive, promotive mental probable depression 26% probable anxiety and 19% probable PTSD.
health program as well as rehabilitation services. The study also revealed that those with lower education outcome
We are too slow in realizing the basic human rights of people with were more likely to have mental distress and individuals with
mental illness. secondary and tertiary education were shown to have significant
decreased risk of showing signs of mental distress.
At the government level their was poor inter ministerial
coordination. Rehabilitation is the responsibility of Ministry of Social The results indicated that on average an adult in the Kashmir
Justice and Empowerment where as Mental health is the responsibility valley has witnessed or experienced 7.7 traumatic events during his/
of MOHFW. her lifetime. Exposure to multiple traumatic events was positively
associated with all three mental disorders. There was a dose response
Many persons with mental illness, especially those with chronic relationship between traumatic events experienced or witnessed and
mental illness require a combination of medical treatment and the development of symptoms of depression anxiety and PTSD. There
rehabilitation to facilitate recovery. This will be Applicable to Those was an upward trend in the proportion of all three disorders in districts
Who Have Suffered Permanent Injuries during Current Political reporting greater number of traumatic events in the population.
Turmoil.
The most reported problems of daily life faced by adults living in
The lack of seamless provision of health and rehabilitation services the valley were financial issues, poor health and unemployment.
can be partly attributed to this separation of responsibilities towards
health and rehabilitation and the lack of intersectoral coordination in The main coping strategies adopted by Kashmiri adults were
the delivery of these services. praying, talking to family member of friend and keeping busy.

Poor inter departmental coordination at the state level. In view of the significant treatment gap between service need and
service delivery majority of the population sought help both from
Department of psychiatry in GMC comes under the Directorate faith healers and professionals.
of Medical Education and the Primary Health Centres are under the
Directorate of Health Services. As recommended by WHO about the importance of spirituality as
an important dimension of recovery as well as the recommendation by
The lack of effective coordination between these two directorates Professor Sue Bailey ex president of the Royal College of Psychiatrists
impacts negatively on developing and implementing mental health London to engage faith healers in service delivery during my meeting
services in the community. with her to get approval for the mhGAP project there is clear evidence
The below data highlights the need for effective and improved that faith healers can and play a significant part in providing support
delivery of services in the field of mental health. and informal counselling in significant number of patients with
mental health problems but at the same time there is need for them to
Data with regards to number of patients treated in the Government recognise that more severe cases need active psychiatric intervention
Psychiatry Disease Hospital revealed that in 1985 only few thousand in addition to the support provided by the faith healers.
people visited Government Psychiatry Disease Hospital where as in
2012 the number had increased to more than one lakh highlighting There is need for professionals and faith healers to work in
the need to reduce the workload and establish effective mental health collaboration rather competing with each other in providing services
services in the community. to the vast majority of people suffering from mental illness in the
valley.

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438
 Copyright:
Mental health and youth of kashmir ©2017 Aqeel et al. 3

Majority of the population did not understand the western The project proposal is awaiting go ahead both from the Govt
concept of structured counselling and relied mostly on biomedical Psychiatric disease hospital and Directorate of Health Services
model for treatment of mental illness. The evidence for the bio Kashmir and will contribute significantly to providing support to
medical model was corroborated by the fact that 11% of Kashmiri those at risk of suicide or those who had attempted suicide. mhGAP
adults were taking benzodiazepines. The report highlighted people’s Trainers from Royal College of Psychiatrists London in House Boat in
desire for decentralisation as well as need for improved employment 2014 and looking forward to invitation from Kashmir for establishing
opportunities and business and skill development as necessary for CRISIS TEAM as part of Memorandum of Understanding.
improved mental health.
Feed back by trainers
Following the survey a meeting was coordinated by MSF which
was chaired by Principal Medical College Srinagar and was attended Thanks to the vision and excellent organizing skills of Dr. Aqeel
by experts and representatives of Psychiatry Disease hospital, and Dr Muzaffar this was a truly extraordinary and intense learning
Department of Psychology University of Kashmir, department of experience for both the participants as well as the trainers. The
sociology university of Kashmir, police deaddiction services and state mhGAP training is well designed, easy to teach and learn from and
coordinator of the mhGAP team. very applicable. As one participant commented for her the course has
been an “eye-opener” and I think the same can be said for some of the
The expert panel stressed the need and importance of European trainers. Becoming aware how much can be done with little
decentralisation, training of people at grass root level in the community means and how much need and enthusiasm exists here to improve the
and the necessity of establishing a crisis team in all districts of lives of those with mental illness was at times a humbling experience.
Kashmir. The panel also stressed the importance of research especially Thank You!”
in areas related to suicide and child and adolescent mental health and
the need to work on improving prevention and promotion strategies Enormous efforts had gone into [this mhGAP initiative in
with regards to mental health. Kashmir], this I know for sure, as I am trying to setup 2 mhGap
trainings in India, without much success so far”-Dr Mina Bobdey, a
The need for crisis team in all districts of Kashmir was also mhGAP Trainer in Kashmir1
highlighted during my meeting with Director Health services Kashmir
Dr Saleem ur Rehman. As part of MOU signed between the Royal The WHO launched its first suicide report in the WHO assembly
college of Psychiatrists London and Health and Medical Education in 2015 and all the international collaboraters were invited to attend
Department of Jammu and Kashmir to improve mental health services the WHO assembly and I also had an opportunity to be invited discuss
in Kashmir a project proposal was submitted by me to Royal College and review the findings of the WHO suicide report.
of Psychiatrists London and WHO which was accepted both by With regards to Suicide in May 2013, the sixty sixth World Health
the Royal College of Psychiatrists London and WHO Geneva .The Assembly dopted the first ever Mental Health Action Plan of the
project proposal was discussed by me in the mhGAP forum at WHO WHO. Suicide prevention was an integral part of the plan with the
assembly in Geneva. goal of reducing the suicide in countries by 10% by 2020.
The project proposal highlighted the need to train the psychiatrists There is no single explaination of why people die by suicide.
as trainers for establishing crisis team in the community which will However many suicides happen impulsively and in such circumstances,
be followed by invitation to psychiatric trainers to UK where they easy access to a means of suicide –such as pesticides or firearms-can
will have an opportunity to get an insight into working of the crisis make the difference as to whether a person lives or dies.
team in UK as well interact with team members which will help in
establishing effective crisis team in various districts of the valley. Social, psychological, cultural and other factors can interact to
lead a person to suicidal behaviour, but the stigma attached to mental
The aim of the team will be early identification of patients in disorders and suicide means that many people are unable to seek help.
crisis, provide treatment and support , refer to tertiary care where Despite the evidence that many deaths are preventable suicide is too
needed ,follow up suicide attempt cases for support and treatment and often a low priority for government and policy holders.
contribute data towards the research.
We should all aim at prioritizing suicide prevention on the global
The team will be led by psychiatrist where available in each public health and public policy agendas and to raise awareness of
district of Kashmir. It is worth mentioning that I am responsible for suicide as a public health issue.
leading the crisis and community team in Lincolnshire Partnership
NHS foundation Trust in UK. With regards to WHO data on suicide an estimated 800,000 suicide
deaths occurred worldwide in 2012 representing an annual global age
standardized suicide rate of 11.4 per 100,000 population (15 for males
and 8 for females). However since suicide is a sensitive issue and
even illegal in some countries.it is very likely that it is under reported.
In countries with good vital registration data, suicide may often be
misclassified as an accident or another cause of death. Registering
a suicide is a complicated procedure involving several different
authorities often including law enforcement and in countries without
reliable registration of deaths, suicides simply die uncounted.
In richer countries three times as many men die of suicide than
women do, but in low and middle income countries the male female
ratio is much lower at 1.5 men to women. Globally suicides account
for 50%of all violent deaths in men and 71% in women. With regards

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438
 Copyright:
Mental health and youth of kashmir ©2017 Aqeel et al. 4

to age suicide rates are highest in persons aged 70 years or over for reports come from Europe and North America with a mere 1.3% from
both men and women in almost all regions of the world. In some developing countries.
countries suicide rate is highest among the young and globally suicide
In a presentation at the Humantarian congress in Berlin which I
is the second leading cause of death in 15-29year old. The ingestion of
attended data by WHO was shown which showed that no reliable data
pesticide, hanging and firearms are among the most common methods
is available from J and K compared to rest of India which makes it
of suicide globally, but many other methods are used with the choice
more important to conduct reliable studies on suicide in our state.
of method often varying according to population group.
In one study conducted by department of sociology university of
For every suicide there are many more people who attempt suicide
Kashmir showed that only 48% percent showed signs of depression
every year. Significantly a prior suicide attempt is the most important
before committing suicide compared to 52% who did not.
risk factor for suicide in general population. For both suicide and
suicide attempts improved availability and quality of data from vital Similarly only 9% had signs of mental illness compared to 91%
registration, hospital based systems and surveys are required for who did not shows that other factors besides mental illness contributed
effective suicide prevention. to the cause of suicide.
Restricting access to the means of suicide is a key element of Similarly 21% had drug related problems compared to 69% who
suicide prevention methods. did not showing that there was not significant correlation between
drug misuse and suicide in Kashmir.
With regards to data from india
In order to formulate strategies to deal with the suicide in our valley
More than one lakh lives are lost every year due to suicide, the an one day interactive session was held on world suicide prevention
suicide rate has increased from 7.9 to 10.3 per 100000. There is a wide day in 2015 which was organised by Dr Mohammad Muzaffar Khan
variation across the country with southern states of kerala, Karnataka, with support from Help foundation.
Tamil Nadu have a suicide rate of >15 while the northern states of
Punjab, bihar and j and k the suicide rate is around 3 per 100000.This The session was attended by NGOs like Unicef, Action Aid,
variable has been stable for the past 20years. No reliable study has CRDP, Borderless world foundation, HPVT, Drud deaddiction centre,
been done to estimate the impact of political turmoil on the suicide SOS children childline 1098 besides advocates, myself as consultant
rates in Kashmir which is all the more important for formulating psychiatrist, Media personal and Religious scholars.
effective preventive and treatment strategies. The forum made the following recommendation.
The majority of suicides (37.8%) in India were by those below To put efforts in drafting an authentic research base in order to
the age of 30years. The fact that 71% of suicides in Inida are by carry out studies and intervention in the same area.
persons below the age of 44years imposes a huge social, emotional
and economical burden on the society. The near equal suicide rates in To promote advocacy for suicide prevention with Govt bodies
young men and women denote that more Indian women die of suicide particular police department at par with the standards set by
than their western counterpart. Poisoning 36.6%, hanging 32.1% and International community.
self immolation (7.9%) were the common methods used to commit
Building up strong network with Mental Health institutions to
suicide. Two large epidemiological verbal autopsy studies in rural
deal with the issue of suicide and its cause and effect relationship at
Tamil nadu reveal that the annual suicide rate is six to nine times the
individual and institution level.
official rate. If these figures are extrapolated it suggests that there are
at least half a million suicide in India every year. It is estimated that Implement the modalities and strategies at the basic school level.
one in 60 person in our country are affected by suicide. It includes both
those who have attempted suicide and those who have been affected Incorporation of the various life skills at elementary level to
by the suicide of a close family or friend. Thus suicide is a major supplement the prevention strategies regarding suicide.
public and mental health problem which demands urgent action. Ensure the follow up of suicidal attempted cases after being
Although suicide is deeply personal and individual act, suicidal reported and dealt with the relevant medical intervention.
behaviour is determined by a number of individual and social Considering and revisiting the legal aspects of suicide and its
factors .Ever since Esquirol wrote “all those who committed suicide implications.
are insane” and Durkheim proposed that suicide was an outcome
of social/societal situations the debate of individual vulnerability Sensitizing the communities and civil society to deal with the issue
versus social stressors in the causation of suicide has divided our of suicide at the grass root level.
thoughts on suicide. Suicide is best understood as a multidimensional, Another important strategy needed to reduce impulsive suicides
multifactorial malaise. Suicide is perceived as a social problem in and use of pesticides was presented by Dr Vijay Lakshmi in the WHO
our country and hence mental disorder is given equal conceptual assembly on the launch of first suicide report.
status with family conflicts, social maladjustmenst etc. According to
the official data the reason for suicide is not known in about 43% of Dr Lakshmi had recommended to Govt of Tamilnadu to introduce
suicides while illness and family problems contribute to about 44% special supplementary exams for 10th and 12th classes so that students
of suicides. who have failed in only three subjects were able to resit the exam after
3months thus saving them the year and their career.
Mental disorder occupy a premier positon in the matrix of causation
of suicide. Majority of studies note that around 90% of those who die Another innovation introduced was the establishment of pesticide
by suicide have a mental disorder. The number of published reports banks in panchayat where people stored their pesticides and not at
specifically studying the psychiatric diagnosis of people who die home thus reducing easy access to pesticides especially in case of
by suicide has been relatively small. The majority (82.2%) of such impulsive overdoses and suicides.

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438
 Copyright:
Mental health and youth of kashmir ©2017 Aqeel et al. 5

Following my discussion at forum with Dr Vijay Lakshmi, Dr To summarize the interventions as recommended for restoration of
Lakshmi reported that both these measures have significantly led to mental health and rehabilitation we need to focus on.
reduction of suicides in young boys and girls.
Health promotion
Another important maladaptive coping strategy that people use
is to use illicit drugs. Recent data from Police Deaddiction Centre Health promotion interventions are provided to increase awareness
provided by Director Police deaddiction centre and state coordinator of the mental health needs of the children and increase community
for mhGAP revealed that in the past four months from June 2016, resilience. These includes.
171 patients with substance abuse were rehabilitated at the drug A. Peer support Groups.
deaddiction centre in Srinagar according to data released by DIG
police. Of the 336 patients seen this year 38 were admitted and 93 B. Community sensitization.
were on waiting list due to lack of infrastructure and doctors. The C. Psychoeducation.
centre had 15 bed capacity and the unit was working on improving
the capacity to 30 to cater for the increasing demand for treatment and Prevention
rehabilitation.
Prevention activities which target subgroups of children with
Last year 1383 patients were seen at the Srinagar centre of whom psychosocial distress and include
713 were confirmed as victims of substance abuse, 400 of multiple
Detection using brief context sensitive screener in schools
substance abuse, 108 cannabis, 58 of opium, 37 of volatile solvents,
27 alcohol and 17 of benzodiazepines. The average stay of patients at Structured group intervention to address the symptoms of distress
deaddiction centre was 21days. The total number of patients seen in and strengthen protective factors
the opd since 2008 was 13972 of which 1266 were admitted.
Treatment
The above data emphasises the need to develop effective services
to help the young population who are resorting to illicit substance Children with severe mental health problems should
misuse as a maladaptive coping strategy to deal with the problems receive treatment as necessary which may include.
which could be enhanced or complicated by the political turmoil. Individual counselling.

As we are aware that mental illness+stigma+ lesser treatment Parental support.

facility+financial crisis+socio-political disturbances makes it a Referral to a psychiatrist.
complex phenomena.
They should be helped to use their natural coping mechanism to
People in conflict zones live in constant fear, adults are strained regain a sense of control which can include.
and mostly unavailable for normal contact and child rearing.
a. Get enough rest.
Damage to and destruction of home and community, destruction
of normal life and no structured days for children has a significant b. Eat as regularly as possible and drink water.
impact of psychosocial development of the young population.
c. Talk and spend time with family and friends.
Boys less than 18 get involved in the process which are in conflict
with law. d. Discuss problems with someone they trust.
When minors enter the legal process it may be in conflict with e. Relax, walk, pray and play.
convention on the rights of children.
f. Exercise.
In war and conflict the mentally vulnerable children are therefore
g. Avoid alcohol or drugs, caffein, nicotine
even more at risk due to heightened confusion and fear.
h. Attend to personal hygiene.
What can be done at Least?
One the major stumbling blocks for people to seek help is stigma
We need to ensure schools are open and safe.
associated with mental health studies have revealed that 42% of
Emergency psycho social support exists. people with a mental illness face stigma and discrimination at least
once a month. 58% of sufferers say the stigma and discrimination is
Effective monitoring mechanism to stop all forms of child abuse as damaging to deal with than the illness itself and 63% of adults
and ensure rights of children. know someone with a mental health problems besides stigma some
Adequate mental health facility other factors that stop people from seeking help include could
not afford cost believe could handle problems without treatment
Availability of services at grass root level and staff trained to detect Did not know where to go for services
mental health issues at the earliest.
Did not had time
Most importantly
Treatment would not help
Parents, teachers, police and social workers should be aware that
more extreme difficult, pre delinquent /delinquent behaviours require Did not feel the need for treatment
not punishment but psychosocial and even psychiatric help. Might cause neighbours/community to have negative opinion
If possible we must find alternatives to locking up manageable Did not want others to find out
youngesters as it is a very serious violation of there human dignity.
Might have negative effect on job.

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438
 Copyright:
Mental health and youth of kashmir ©2017 Aqeel et al. 6

Fear of being committed/having to take medicine b. People so upset that they can’t care for themselves or their
children
Concerned about confidentiality.
c. People who may hurt themselves
Besides helping themselves it is important to help others which
can give satisfaction and sense and purpose in life. d. People who may hurt or endanger the lives of others.
WHO has recommended Psychological First Aid Training and Why PFA
we conducted the first such training in Kashmir last month attended
by more than 40 participants from various local, national and People do better over the long term if they Feel safe, connected
International organisations. to others, calm and hopeful. Have access to social, physical and
emotional support. Regain a sense of control by being able to help
The report was presented by myself to the WHO assembly in themselves.
Geneva as this years theme was Psychological First Aid. The report
has been validated by WHO and is available on WHO website for People may have very different reactions to an event. The
people to use all over the globe. particulars of the event, such as the degree of violence or the element
of surprise may also shape victim’s reactions. Traumatic events shake
It is strongly recommended that most young people should get the foundations of a person’s life. Certain traumatic experiences, such
trained in PFA and I am going to summarise briefly the principles of as extremely early experiences of abuse, may interfere with or even
the PFA. prevent a person from developing a solid sense of self.
What is PFA Emotional makeup, personal history, social relationships, previous
coping strategies, age at the time of the trauma, and the availability
Humane supportive and practical assistance to fellow human
of support before, during, and following the traumatic experience-all
beings who recently suffered exposure to serious stressors and
these factors help to shape the meaning of the event for the victim.
involves:
The particular ways in which people are affected by stressful
1. Non intrusive practical care and support.
events can differ widely. This reflects the normal differences among
2. Assessing needs and concerns people.

3. Helping people to address basic needs

4. Listening but not pressuring people to talk
5. Comforting people and helping them feel calm
6. Helping people connect to information,services and social support
7. Protecting people from further harm

What PFA is Not

i. It is not something only professionals can do
ii. It is not professional counselling
iii. It is not psychological debriefing that is no detailed discussion of
the distressing event
iv. It is not asking people to analyse what happened or put time
events in order PFA action principles
v. Although PFA involves being available to listen to peoples stories Learn about the crisis event.
it is not pressuring people to tell you their feelings or reactions Prepare Learn about available services and supports.
to an event. Learn about safety and security concerns.
Observe for safety.
Who may benefit from PFA Look Observe for people with obvious urgent basic needs.
1. Very distressed people who are being exposed to violence. Observe for people with severe distress reactions.
Make contact with people who may need support?
2. Can be provided to adults and children. Listen Ask about people’s needs and concerns.
Listen to people and help them feel calm.
3. Not everyone who experiences a crisis event will need or want
Help people address basic needs and access services
PFA.
Help people cope with problems
Link
4. We should not force help on those who don’t want it, but make Give information
ourselves available and easily accessible to those who may want Connect people with loved ones and social support
support.
We all should aim at building our resilience
Who Needs More Advanced Support than PFA Alone
There are many definitions and understandings of resilience.
a. People with serious life threatening injuries IFRC’s definition of resilience is “the ability of individuals,

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438
 Copyright:
Mental health and youth of kashmir ©2017 Aqeel et al. 7

communities, organizations or countries exposed to disasters and Message from theWorld Health Organization:soliciting
crises and underlying vulnerabilities to anticipate, reduce the impact your interest in a new mental health campaign
of, cope with, and recover from the effects of shocks and stresses
without compromising their long-term prospects” (IFRC, 2015). I am contacting you to solicit your interest in engaging with us at
the World Health Organization (WHO) on an exciting new campaign
And finally we should aim for positive health as defined below to improve understanding of and support for a condition that affects a
with each individual having his own ways to achieve it with varying staggering 350 million people around the world – depression.
support.
Depression is the leading cause of disability worldwide. In
Although definitions vary, positive mental health is generally seen addition, as many of you will have heard during the recent World
as including: Bank-WHO co-hosted event “Out of the shadows: making mental
a. Emotion (affect/feeling), health a global development priority”, when considered with anxiety,
depression costs the global economy US$1 trillion a year. At worst,
b. Cognition (perception, thinking, reasoning) depression can lead to suicide.
c. Social functioning (relations with others and society) This is why the focus of World Health Day 2017 will be depression,
together with its causes and consequences.
d. Coherence (sense of meaning and purpose in life).
World Health Day is celebrated on 7 April every year to mark the
I would dedicate the world disability day on 3rd December in
anniversary of the founding of WHO in 1948. A different theme is
Kashmir to those injured in current political turmoil and ensure we
selected every year. World Health Day will complement efforts for
all work together as a family to help them rehabilitate them into the
World Mental Health Day, held on 10 October every year.
community as best as possible.
The purpose of this is to determine your interest in engaging with
I hope this report will be helpful in improving and developing
us as we move forward with planning.
services and support for the youth of Kashmir.
We look forward to hearing from you.
Dedicated to the People of Kashmir.
Sincerely, Shekhar Saxena
Dr Sayed Aqeel Hussain MRCPsych (UK)
Director
Consultant Psychiatrist Lincolnshire partnership NHS Foundation
Trust UK Department of Mental Health and Substance Abuse
Incharge Crisis resolution team World Health Organization
Master Trainer for mhGAP and PFA on behalf of WHO. Link of WHO site on mhGAP Kashmir.
International Coordinator for mhGAP. Email: sayedaqeel@gmail. http://mhinnovation.net/innovations/mhgap-implementation-
com kashmir#.VTs5LtKqqko
Copy To mhgap intervention guide [Clicks:50949times]. [mhgap
1. Hon’ble Chief Minster Ms Mehbooba Mufti evidence resource centre [Clicks:25981times]... mhgap kashmir
[Clicks:110434times]. Some statistics about mhGAP on line
2. Hon’ble Deputy Chief Minister Dr Nirmal Kumar Singh
3. Hon’ble Minister for Health and Medical Education Mr Bali
Bhagat
4. Hon,ble Minister for Revenue Relief and Rehabilitation Syed
Basharat Ahmad Bukhari
5. Hon’ble Minister for Information Technology, Technical
Education & Youth Services
6. & Sports Mr Imran Raza Ansari
7. Hon’ble Minister for Education Mr Naeem Akhtar
8. Hon’ble Minister for Social welfare ARI & Training Science and
Technology Mr Sajad Gani Lone
9. Hon’ble Minister for finance Culture Labour & Employment Mr
Haseeb A Drabu
Representing the Institute of Psychiatry at the WHO Assembly
mhGAP Kashmir Being Nominated as the Most Popular Innovation
By WHO
mhGAP Kashmir Being Nominated as Role Model mhGAP Project
In Who Assembly On Oct 10 2016 For Implementation of mhGAP
Projects Across 90 Countries Around The World.

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438
 Copyright:
Mental health and youth of kashmir ©2017 Aqeel et al. 8

Famous Disability Chair outside United Nations Unit in Geneva

With Theme That Even Though Even If There Is Disability a
Person Is Still A Human Being And Entitled To All Rights Respect
And Dignity
Message from Secretary General United Nations on World
Disability Day

The Photo Is The Kashmiri Lattice Window With Women Praying

Behind It Representing The People of Kashmir Praying For The
Success Of The Project.
Painting By Masood Hussain Renowned Artist of Kashmir.
With Dr Shekhar Saxena Director Who Mental Health, Dr Khalid
Saeed Incharge Who Mediterranean Including Iraq, Syria, Yemen, International Day of Persons with Disabilities 3 December
And All Middle East Countries, Dr Tarun Dua Incharge Research
And Action On Mental And Brain Disorders In Who Headquarters On “We mark this year’s International Day of Persons with Disabilities
October 10 2016 On World Mental Health Day in the wake of the adoption of the ambitious 2030 Agenda for

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438
 Copyright:
Mental health and youth of kashmir ©2017 Aqeel et al. 9

Sustainable Development. This global blueprint for action summons Conflicts of interest
us to “leave no one behind”.” Secretary-General Ban Ki-moon.
Author declares there are no conflicts of interest.
Acknowledgments
Funding
None.
None.

Citation: Aqeel S, Khan MM, Saxena S, et al. Mental health and youth of kashmir. J Psychol Clin Psychiatry. 2017;7(3):11‒12. DOI: 10.15406/jpcpy.2017.07.00438