How Kashmir’s Shortage of Psychiatrists Leaves Patients Misdiagnosed
- Irfan Amin Malik
- 11 minutes ago
- 5 min read
In the villages and towns of Indian-administered Kashmir, mental illness often arrives disguised as something else.
People complain of racing heartbeats, chest pain, breathlessness, dizziness, stomach discomfort, and fear. Many spend months, and sometimes years, visiting hospitals convinced they are suffering from heart disease or another physical illness.
They undergo repeated tests, collect folders full of prescriptions, and move from one doctor to another in search of answers. What many eventually discover is that the illness they have been treating is not cardiac or gastrointestinal at all. It is anxiety, depression, trauma, or another mental health condition that remained undiagnosed because specialist care was unavailable.
As a journalist, I have spent years reporting from Kashmir, a region where mental distress has become one of the most significant yet least discussed public health challenges.
In district and sub-district hospitals, crowded psychiatric wards, and remote mountain villages, I encountered people whose journey to a diagnosis was often longer and more painful than the treatment itself.
Their stories reveal how the dearth of psychiatrists, combined with geography, political violence, and stigma, continues to shape mental healthcare across the region.
A Flutter, Then Fear
As dusk settles over Kuchmullah, a village of orchards and rice fields in Kashmir, some 44 kilometres from the capital city of Srinagar, Sameena Akhtar (name changed) begins to worry.
The 45-year-old has come to recognise the feeling. It starts with a flutter in her chest before her heart begins racing uncontrollably. Breathing becomes difficult. Sometimes she feels as though she is about to collapse.
Wrong Diagnosis
For nearly two years, Sameena believed she had a serious heart condition. Repeated visits to the nearby sub-district hospital brought electrocardiograms, medicines, and reassurances that nothing appeared seriously wrong. Yet the attacks kept returning.
“My heart would beat so fast that I thought I was suffering from a serious cardiac problem,” she says. “I would become breathless and restless. Sometimes I thought I would die. The doctors kept telling me my heart was normal, but I knew something was wrong. I spent years moving from one doctor to another before somebody finally explained what was happening to me.”
The answer came only after she travelled 44 kilometres to the capital city, Srinagar, and consulted a psychiatrist. The diagnosis was anxiety disorder.
For Sameena, the discovery brought relief. It also brought frustration. Years had passed before anyone identified what she was experiencing. During that time, her husband, who works in a flour mill on a modest salary, spent thousands of rupees on consultations, medicines, tests, and travel. The family was searching for an illness they believed was affecting her heart, while the real problem remained untreated.
No Specialist in Sight
Every day, patients arrive at hilly sub-district hospital Tral complaining of racing heartbeats, insomnia, chest discomfort, unexplained fear, dizziness, and anxiety. Few suspect they are suffering from a mental health condition. Most arrive believing they have a cardiac or neurological problem.
Yet there is no psychiatrist posted at the hospital, despite serving around 150,000 people.
Most patients are seen by general physicians who do what they can with the resources available. ECGs are ordered, medicines are prescribed, and symptoms are managed. While the treatment may provide temporary relief, the underlying condition frequently remains undiagnosed.
Dr Junaid Ahmad, a Bachelor of Unani Medicine and Surgery physician posted at the hospital, says the shortage of specialists has forced doctors to take on responsibilities far beyond their training. “Such is the dearth of doctors in government hospitals that BUMS doctors are asked to handle outpatient departments and manage the rush of patients irrespective of the disease,” he says.
“We see patients with all kinds of complaints and the rush increases every evening. Many come with symptoms that later turn out to be related to anxiety or depression.”
Staggering Shortfall
Dr Majid Shafi, a leading consultant psychiatrist in Srinagar and Nodal Officer for Mental Health and Addiction Treatment under the Directorate of Health Services Kashmir, puts the shortfall plainly. "There is a clear shortage of psychiatrists in Kashmir. As per WHO guidelines, one psychiatrist should be available for every 100,000 people. What we have instead is one specialist for half a million people."
He estimates the region needs at least 140 psychiatrists. It has around 40 to 50. That gap is made worse by a fact the national figures alone do not capture: Kashmir's mental health burden is four times higher than the national average.
A 2015 study found that 45% of the population in J&K was experiencing immense psychological distress. Studies estimate that nearly 45% of adults show signs of mental distress, depression affects 41%, anxiety disorders 26%, and PTSD 19%.
Childhood mental health disorders affect up to 27% of children between eight and fourteen. Figures presented before the J&K Assembly this year confirmed that eleven districts are operating without a single psychiatrist.
Roads Close, Patients Wait
In Poonch, a mountainous and border district near the Line of Control, specialist mental healthcare is virtually absent. Zareena Banoo, 43 (name changed), struggled with severe anxiety and insomnia for years, repeatedly told by doctors that anaemia was the cause. In August 2023, she made the 170-kilometre journey to Srinagar with her son.
"Doctors kept telling me it was because of weakness and low blood levels. I took the medicines, but my condition did not improve."
A psychiatrist identified the problem almost immediately. Today medication helps, but she must return every two months. During winter, the Mughal Road connecting Poonch to the Kashmir Valley closes due to snow. "Sometimes my anxiety becomes worse and I want to consult the doctor, but travelling is not possible. Then I have to wait until the roads reopen."
Fifty kilometres away in Pulwama, Kasim Jan, a 50-year-old tribal woman living in a tent with her family and livestock, has had severe anxiety for eight years. "Every time we migrate with our livestock, some animals die, the stress becomes unbearable, and my blood pressure rises. I have never found a psychiatrist who could help me.”
200,000 Visits, One Facility
For those who reach Srinagar, there is IMHANS, the Institute of Mental Health and Neurosciences, a 140-bed facility that recorded nearly 200,000 patient visits in 2025.
Inside the jam-packed hospital, the families arrive carrying years of unanswered questions, having already spent months being treated for conditions they never had.
At JLNM Hospital in Srinagar’s Rainawari, Dr Majid Shafi sees 120 patients from morning to evening. "One doctor cannot handle a huge clinic for hours together. The patient does not get adequate time, and that compromises quality care." His prescription is direct: one psychiatrist at every sub-district hospital, at minimum.
Dr. Shafi estimates that 90% of mental health patients in Kashmir are currently being seen by neurologists and cardiologists rather than psychiatrists. Without a psychiatrist, each condition is treated as whatever it most closely resembles.
The government has expanded access through Tele-MANAS, a 24-hour mental health helpline launched in 2022. It has helped primarily women experiencing anxiety, stress, and concerns about drug addiction. For more information, you can read my previous article here. However, mental health experts have cautioned that, while it is helpful, technology cannot replace psychiatrists and counsellors working on the ground.
This article has been sponsored by the Psychiatry Research Trust, who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.
