SRINAGAR, India – Areeba* tucks a strip of tiny blue pills into the back of her mathematics textbook before heading to class. It’s become second nature.

“Half when I can’t sleep. One if I can’t walk,” says the 22-year-old university student, her voice calm, as if describing a cold remedy. “I don’t really want to take them, but it’s the only way to get through the day.”

Across Kashmir, India’s northernmost and politically volatile region, young people are self-medicating to cope with anxiety, sleeplessness and depression. The strains of decades-long conflict, repeated lockdowns, and recent flare-ups–including a drone strike and extended power blackouts during cross-border tensions in May–have left many struggling to find mental health care.

While India’s National Mental Health Mission has expanded services across several states, Kashmir remains critically underserved. With limited access to therapists, trained counsellors or psychiatrists, antidepressants, sedatives and illicit narcotics have become people’s primary coping mechanisms and are often obtained without prescription or follow-up.

Panic attack in the dark

Zubair Iqbal, a 20-year-old undergraduate in Sopore, recalls the night of 9 May vividly: “It was around 9pm. I had packed my bag for a flight to Delhi the next morning. “But because of the tension with Pakistan, it got cancelled. My mother came and said, ‘Zubair, come downstairs – we’ll eat in the blackout’.”

Iqbal was puzzled when the power went out, then heard what felt like “a thousand thunderstrikes.”

“My brother said it was just thunder, but I knew it wasn’t. It was a drone attack.”

He collapsed inside the house. “My legs were shaking. I couldn’t see properly. My heart was racing. I thought I was dying.”

The next day, he asked his father if he could see a doctor.

“My father said, ‘We won’t travel 40 kilometres to Srinagar for this. It’s nothing–you were just scared. Let’s go to the peer sahib (faith healer).’ I wanted to cry.”

Instead, Iqbal looked online for the name of an antidepressant, then went to a local pharmacy and bought it over the counter.

Hidden in plain sight

A clinical psychologist in downtown Srinagar, who requested anonymity because of workplace restrictions, says Zubair’s experience is typical.

“Because of the conflict and some of the highest unemployment rates in India – female unemployment here is 53.6% – symptoms of trauma are normalized,” she says.

She sees over 100 patients a day, many adolescents.

“Every other teenager between 15 and 18 reports some mental health concern. Many fear the schools will close again if the war escalates. Others worry their parents will lose their jobs. But very few actually seek therapy.”

Her observations reflect existing data. A 2015 survey by humanitarian group Médecins Sans Frontières (MSF) found that 1.8 million adults in Kashmir’s valley – about 45% of the population – experienced significant mental distress. Almost one in five people showed symptoms of post-traumatic stress disorder. Meanwhile, 41% of women and 26% of men showed symptoms consistent with depression, according to the study.

According to government Census figures from 2011, there were just 41 psychiatrists for the entire Jammu and Kashmir region, home to 12.5 million people. 

Mental health experts believe that the number has barely doubled in the past 14 years, leaving much of the population without access to specialized care.

‘We were just trying to survive’

Kubra Aziz, 24, lives in Uri, a village just 3km from the Line of Control, the heavily militarized border with Pakistan. She fled with her family to Baramulla during recent shelling in May.

“We left at night,” she recalls. “My cousin, who has a history of mental illness, began hyperventilating.”

They took shelter in a local college, where Kubra says her cousin screamed all night.

“The next morning, I took her to the district hospital, but the psychiatrist was on leave.”

That, she says, is routine: “Even when there’s a doctor, they may have 1000 patients. They’re overwhelmed. Misdiagnoses are common.”

In the absence of therapy, many Kashmiris turn to pills and substances – prescribed or not.

“Most people either buy psychiatric medication from pharmacies or turn to charas, tobacco, or anything that numbs the brain,” Kubra says.

One young man, Nadeem*, left Kashmir for Saudi Arabia three years ago.

“I was unemployed and addicted to hash. My family thought leaving Kashmir would help,” he says.

He quit drugs after moving abroad, but returned home recently amid renewed violence.

“The stress is back. I’m trying to hold on. But I don’t know how long I’ll last.”

A 2022 report from Kashmir’s only government-run drug de-addiction centre showed a 2,660% increase in patients since 2016. Doctors say most patients are not recreational drug users, but they are self-medicating trauma.

“I plan to leave again,” Nadeem says. “People from age 10 to 40 are trapped in addiction. Just look at the schoolkids.”

No therapists in schools

Aman Bhat, a 17-year-old high school junior in Budgam district, says his missionary-run school has no mental health services.

“We don’t have a counsellor,” Bhat says. “If someone is anxious or depressed, there’s no one to talk to. Mental health is something we don’t even have words for here. We say, ‘My heart feels heavy.’ That’s it.”

Many of his classmates chew tobacco to manage stress. “What else can they do?”

In villages, Bhat notes, “We don’t have real hospitals like other parts of India. What do we have?”

Learning from Gujarat

Despite the scale of Kashmir’s mental health crisis, the region lacks community-based support models proven successful elsewhere in India, such as the Atmiyata program, which means “shared compassion” in Marathi.

Atmiyata was launched in Mehsana district of Gujarat in 2017 which comprises of 645 villages. Atmiyata Mitras – trained community volunteers – identify people in distress and provide up to six sessions of basic, evidence-based counselling in homes or local temples.

Volunteers use smartphones to screen culturally relevant films about unemployment, alcoholism, domestic violence, and other root causes of mental distress – issues that are difficult to talk about.

When symptoms exceed what a volunteer can handle, Mitras guide patients through India’s District Mental Health Programme, even accompanying them to clinics.

Because mental health and poverty are often intertwined, Mitras also help families apply for disability pensions, job schemes and social benefits.

What Kashmir needs now

“If the recent trauma in Kashmir has taught us anything, it’s that medication alone is not the answer,” says Dr Sameena Qadri, a South Asia-based public health psychiatrist. 

“Antidepressants and sedatives offer short-term relief. But without therapy, follow-up care and social support, the root causes remain untouched.”

This conversation is urgent as global leaders prepare for the UN High-Level Meeting (HLM) on Non-Communicable Diseases (NCDs) and Mental Health on 25 September. The meeting aims to ensure that 150 million more people worldwide gain access to affordable mental health care by 2030.

The HLM zero draft includes the target of 80% of public primary health care (PHC) facilities having essential mental health medicines and technologies available by 2030.

“These targets sound ambitious,” Qadri says. “But they must be grounded in places like Kashmir, where the mental health crisis is visible in pharmacies, schools and homes.”

She advocates for a multi-tiered, district-wide care system, with trained community volunteers delivering support and referring severe cases. She also calls for mobile mental health clinics and tele-psychiatry.

“School-based counselling is essential, especially in conflict zones. Children grow up with trauma and no outlet. Without care, we risk losing a generation.

“These aren’t luxuries,” she says. “They’re urgent needs.”

Call for global partnerships

“We need partnerships between governments, civil society and global health organizations to scale community care. The most vulnerable can’t wait for a perfect system. They need access now,” Qadri urges.

“Mental health is not a luxury. It’s dignity. You can’t talk about peace or sustainable development while millions suffer in silence.”

Kubra agrees: “We always talk about peace. But how can there be peace when people are breaking inside, and no one hears them?”

Until models like Atmiyata are adapted to Kashmir and scaled, young Kashmiris will continue to medicate their distress in silence – behind schoolbooks, in back-alley pharmacies and bedrooms darkened by blackout curtains, both literal and emotional.

*Not their real names.

Image Credits: MSF, Arshdeep Singh.