Treated but not recognised: Why mental illness remains an invisible disability in Kashmir

Srinagar: Every day, hundreds of patients pass through the gates of the Institute of Mental Health and Neurosciences (IMHANS) in Srinagar, the only tertiary psychiatric care facility in Kashmir.

Many return month after month, struggling with conditions that have stripped them of the ability to study, work or live independently. Yet despite years of treatment, most are never formally recognised as persons with disabilities.

IMHANS treated around two lakh patients in a single year, according to data cited by doctors at the institute, underscoring the extraordinary scale of psychological distress in a region shaped by decades of conflict, political uncertainty, repeated violence and economic disruption.

“As the only tertiary-level psychiatric hospital in the region, IMHANS catered to around two lakh patients in 2024,” Dr Yasir Rather, Professor of Psychiatry at IMHANS, told DH. “This number itself reflects the growing demand for mental health care.”

Treatment, however, does not automatically translate into recognition — particularly when it comes to mental illness and psychosocial conditions as disability.

Disability on paper, denial in practice

India’s Rights of Persons with Disabilities (RPwD) Act, 2016 recognises mental illness and psychosocial conditions as disabilities if they substantially impair daily functioning. In principle, this entitles affected individuals to disability certificates, pensions, employment reservations and educational support.

In Kashmir, however, mental disability remains among the least recognised and least certified categories.

Psychiatrists say conditions such as post-traumatic stress disorder (PTSD), chronic depression, bipolar disorder and severe anxiety disorders frequently become long-term and disabling.

“Patients drop out of education, lose jobs and withdraw socially, becoming dependent on family members. Yet certification boards often view psychiatric illness as temporary or curable, even when symptoms persist for years,” said Dr Arshid Hussain, a noted psychiatrist and professor at IMHANS, Srinagar

A peer-reviewed study published in the Journal of Family Medicine and Primary Care found that over 11% of adults in Kashmir suffer from a diagnosable mental disorder, significantly higher than national averages. Mental health professionals caution that the true prevalence is likely much higher due to stigma and underreporting.

Despite this burden, disability rights activists say the RPwD Act remains largely unimplemented on the ground.

While the Act was extended to J&K in 2019 and its rules were framed in 2021, provisions related to accessibility, job reservations, inclusive education and welfare mechanisms have seen little progress. Public institutions continue to fail basic accessibility norms, and persons with disabilities struggle to access their legally guaranteed rights.

Conflict and chronic psychological injury

Mental disability in Kashmir cannot be separated from the region’s prolonged exposure to violence and instability.

A 2015 survey by Médecins Sans Frontières (Doctors Without Borders) found that nearly 45% of adults in the Valley showed symptoms of mental distress, while around 19% met diagnostic criteria for PTSD — among the highest rates recorded in any conflict-affected population.

“These findings show extremely high levels of mental health problems among adults in Kashmir,” MSF said while releasing the survey, directly linking the crisis to prolonged exposure to violence and insecurity.

MSF, which has provided mental health services in Kashmir for years, has emphasised that trauma here is cumulative rather than episodic.

Life without recognition or support

The absence of disability recognition has severe consequences. Without certification, people with serious mental illness are excluded from job reservations and welfare schemes. Families shoulder the burden of lifelong care — medication costs, supervision and lost income — often with no institutional support.

Doctors warn that parents of persons with severe mental illness live with constant anxiety about the future, fearing what will happen when they are no longer able to provide care. Women face additional stigma, with mental illness frequently concealed due to fears of marital breakdown or social exclusion, delaying treatment until impairment becomes profound.

Former Commissioner for Persons with Disabilities in Jammu and Kashmir Iqbal Lone has repeatedly stressed the need for stronger institutional engagement. He has said the Union Territory must involve academia and researchers to effectively address the complex challenges faced by persons with disabilities, particularly those with invisible and psychosocial impairments.