Psychologists say crackdown has led to a rise in people seeking help for anxiety, stress and other issues

It had been six weeks since Syed Ruhi, 19, saw her boyfriend, Ashfaq Ahmad, 25. They last met in his shop in the bustling town market in Pulwama. The atmosphere was tense: extra troops had just been deployed to Kashmir, and everyone suspected something might be about to happen.

Three days later, Ruhi awoke to find that her home, Kashmir, had changed. The Indian government announced it was stripping the territory of its special status and dividing the state of Jammu and Kashmir in two. Millions of residents were placed under an unprecedented communications blackout. Ruhi was no longer able to use her mobile phone, landline or internet. For some, even cable TV services were cut.

Q&A About this series Show Hide Mental illness is universal, affecting hundreds of millions of people around the world. No country is spared, and when it comes to treatments, every country is a developing country. Causes are legion: stress, shock, grief, trauma (particularly if sustained in childhood). Naturally, conflict of any kind will generate many of these causative factors and increase the risk of mental illness in the population. Study after study has proven this to be true. This mini-series, part of the Guardian's global mental health project in 2019, hears from the people directly affected.

Photograph: Aaref Watad/AFP

As the days passed, thousands of people were reportedly detained as part of the clampdown, with some taken to prisons elsewhere in India. It is not known how many have been released.

Ruhi worried constantly about whether Ahmad was OK. After becoming increasingly distressed, she visited the district hospital’s psychiatry clinic. Inside, patients sitting on wooden benches awaited their turn to consult the only psychiatric doctor.

Abdul Hamid, a clinical psychologist, said there had been an increase in patients experiencing anxiety, stress, post-traumatic stress disorder, and heart ailments. Several patients said they were living in fear “of army raids, tortures and arrests”.

People who had previously learned to manage their mental health conditions were now experiencing a relapse, he added.

Ruhi is one of them.

After two years of treatment for her mental illness, Ruhi felt she had recovered and stopped taking medication. But the uncertainty and tension appear to have revived the illness. “When someone says that the situation is not normal outside I feel mentally unwell,” she said.

The doctor prescribed medicines. And by a stroke of luck, Ruhi found a second source of comfort at the hospital – she saw Ahmad there.

Every day more than 170 patients visit the four-room psychiatry clinic – the only one serving the Shopian and Pulwama districts of south Kashmir. It is likely that far greater numbers need treatment, but many patients cannot reach the hospital because there is no public transport.

Facebook Twitter Pinterest People sit in the waiting room at the Pulwama mental health clinic. Photograph: Bhat Burhan/The Guardian

Patients from the district hospital are often referred to the psychiatry clinic of the Shri Maharaja Hari Singh (SMHS) hospital in Srinagar, where patients have been attending in higher numbers in the last few weeks.

Mustafa Ahmad, 22, is among those seeking treatment. It is one year since he last visited the clinic in Srinagar, and he had successfully discontinued his medication. But the clampdown sparked a relapse of his insomnia and anxiety.

Ahmad would normally wake at 7am and go to the gym before working from 10am till 6pm. “Now, I can’t sleep until 2am,” he said. “I sleep during daytime because there is nothing to do. [The] gym is also shut.”

He has been taking sleeping pills for the last seven weeks and is having nightmares. “I fear getting arrested, then what will happen to my family? Or if I am hit by bullets or a teargas shell. I didn’t expect [the clampdown] to be so long and uncertain.”

According to a 2015 survey by Médecins Sans Frontières, nearly 1.8 million adults in Kashmir – 45% of the population – have shown symptoms of mental distress. More than 41% of the population showed signs of depression, 26% signs of anxiety and 19% showed probable symptoms of post-traumatic stress disorder.

Dr Aijaz Ahmad Khan, a clinical psychologist at the SMHS mental clinic, believes the situation is getting worse. “A week after August 5, we saw a change in the patients. We started having patients who had psychological disturbances. It is increasing since then,” he said. “There is emotional numbness and it is increasing.”

He said at least 10% of patients have complaints directly related to the clampdown. A year ago, about 70 to 80 patients visited the Srinagar clinic, but Khan said it was now seeing 130 to 150 a day.

The fragile situation in Kashmir has severely affected women, who have fewer opportunities to venture outside. Romana, 22, from Pulwama, said she was suffering paranoia.

“I was feeling sick while at home,” said Romana, a computer studies student. “If a person wants to go somewhere, you can’t. People are panicked, so am I … I feel scared.”

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Romana’s prescription says her situation has escalated “due to the curfew”.

Zoya Mir, a clinical psychology student at the Institute of Mental Health and Neurosciences in Srinagar, is worried about the future.

“We have become resilient to pain, feelings, and emotions,” said Mir, who has experienced panic attacks. “There will be a point where it will be beyond repair.”

People do not communicate with their families or each other because there is nothing positive to say, added Mir. Even if there was, mobile and internet services remain suspended for millions. Landlines, though apparently restored, are unreliable.

As the shadows in the hospital grew longer, Ruhi and Ahmad decided to drive back home together. “In the car, we will decide our next meeting,” said Ruhi. “We will meet again now, soon.”

Some names have been changed