Gulshan (name changed), 30, has been coming to Srinagar's Sri Maharaja Hari Singh (SMHS) hospital to get treated for Deliberate Self Harm (DSH), an act when a one tries to harm oneself to attract attention. She is married to a police official and lives in a small village in Shopian district, a militant-infested area of south Kashmir. At SMHS, Kashmir's leading psychiatrist, Dr Arshad Hussain, is responsible for her care.
Seated in his small, crowded OPD, Dr Hussain explains that DSH is "a cry for help". He attends to Gulshan, who tremblingly whispers that she fears for her husband's life. Yet, she refuses to respond to queries about an overdose of sleeping pills she took.
Many such cases of DSH, suicides and para-suicides (a serious attempt to end one's life) are now reported in Kashmir. In fact, a journalist in Kashmir recently revealed that out of the 50 or so news messages he receives from a news agency every day, at least 10 are about suicides, largely attempted by women.
The 1,000-bed SMHS hospital; Srinagar's psychiatry-only hospital in Rainawari; and some private clinics have been handling a large number of cases of depression, trauma, post-traumatic syndrome disorder (PTSD) and schizophrenia since the last decade. However, suicide still is a relatively new phenomenon. "Our records reveal that while the lifetime prevalence of major depression is touching 20 per cent, substance use abuse is 17 per cent and PTSD 17 per cent. For the last three years, a daily average of 3.5 persons report for suicide, para-suicide and DSH at the OPD of SMHS hospital," Dr Hussain says.
He adds, "While most of the suicides are committed by males in the age group of 25 to 34, women report four times more for para-suicide and seven times more for DSH."
Police records and sociological studies, too, indicate that the number of attempted suicides by young girls and women is more than that of the men, particularly in the rural areas. In Pulwama and Anantnag districts in south Kashmir, there have been more than 35 suicides since January this year; 20 of them were committed by women.
In north Kashmir's Kupwara and Baramulla districts, nearly half of the 40-plus reported cases of suicide were committed by women. Most of them ended their lives by consuming substances such as organ phosphorus, or drugs such as Benzodiazepines and Tricyclic anti-depressants. These are easily available to them over the counter, as most are invariably being treated for depression or other mental disorders. Other suicide methods are immolation and slitting of the throat - particularly common amongst schizophrenics and those suffering from severe melancholic depression.
According to Dr Hussain, while all types of suicidal behaviours are common in the 25-34 age group, DSH is the most common amongst females, with 63 per cent of such women falling in the age group of 19-24 years. Domestic violence, poverty, changing lifestyles, unemployment and conflict-related violence are the major reasons for women taking such drastic steps as they have no outlet for expressing their trauma and pain.
Even as doctors and sociologist undertake social research studies to ascertain the factors behind the increasing number of suicides in the Valley, Dr Hussain feels that in order to develop and design specific suicide prevention programmes, there is a need to focus on cases of para-suicide and DSH. "Para-suicide and DSH are the greatest indicators of eventual suicide, and thus warrant public health measures," he says.
The alarming increase in suicides has evoked a response from concerned social leaders. Mufti Mohammad Bashir-ud-din, Mufti-e-Azam of Jammu and Kashmir State and Chairman of Religious Affairs issued a 'fatwa' (religious edict) on suicides in July, declaring the act un-Islamic. "Suicide is prohibited in Islam and we never had this problem in Kashmir," said the Mufti. "We have to sensitise society and rediscover Kashmir's spiritual wisdom to counter this growing phenomenon."
Besides religious leaders taking an initiative, there are also a few community outreach programmes conducted by NGOs such as Medicine Sans Frontiers, Action Aid, Women in Security and Conflict Management (WISCOMP) and Voluntary Health Association of India (VHAI). "I thought of a psycho-social intervention because in the prevailing situation - complete breakdown of civil machinery, traditional culture and the community support system - people, in general, and women, in particular, feel insecure and vulnerable. They need someone they can trust and speak to about their distress, despair, hopelessness and fear," says Ezabir Ali, a member of WISCOMP and a volunteer with VHAI.
With the support of WISCOMP, Ali has trained a group of 30 health workers to
provide counselling. They are called 'barefoot counsellors' because they go
door-to-door and reach out to women in villages. "Women also come to our Samanbal centre at village Zoohama (Badgam district) for counselling. We have integrated general health with mental health services to avoid stigmatisation and make it easier for the women to seek help," explains Ali.
Shahzada, 45, a health worker who is associated with the centre at Zoohama, adds, "We have helped hundreds of women suffering from stress, trauma and tension, who come to us for counselling. Sustained intervention helps in healing."
Most of the women that visit them have domestic problems; but there have been times when women who have lost a close relative feel suicidal, Shahzada notes. Their strategy is to try and involve the patient's close family members and channel them towards taking up some kind of activity or reading of the Koran.
Haseena, a health worker from a remote village in District Pulwama, reveals that they don't have trained doctors in the villages. "Our door-to door counselling has helped lot of women break their silence and share their grievances."
While appreciative of such efforts, Dr Hussain feels that the alarming situation demands urgent intervention by the state government. "The government must take concrete policy decisions regarding upgrading and providing mental health infrastructure and integrating it with general health and asylum in hospitals," he said at a recent meeting called by WISCOMP. "In the prevailing situation, the government has to make mental health its top priority."