Panel 1: Illustrative quotations from seven emerging themes on mental health in the Kashmir Valley

Presentation of psychological distress su tchu har waqte mayues aasan taemis tchaeni aasan kah khushi bayei chu su alag thalag yecaan behuen beyi ne kaensi sith kath ne keh nea kah kaem ne yaecaan karun sirf dapaan bea baemha bea vucheha ne kaensi huend buuth nea bayee baemha aenigaetis be nea hasa vucheha gash te keheen ye chu aemis yaemis ye depression chu aasan. He is always sad, not happy at all, wants to sit alone, doesn’t talk, dislikes doing anything, doesn’t like to have anyone around him and wants to sit in darkness so that he will not see the light. All this happens to the person who is suffering from depression. 46-year-old female participant, Pulwama Causative factors Beyi gaye yeim haalat aezik yemaev haalaatav te oen vaariyaa keh vunkaes chuni haekaan insaan taeli aes ceer nacaan vacaan baaki cheez vunkaes chuni haekaan bache agar naebaer naeri, pareshaan che rozaan, paetii paetii chu paevaan aemis pakun khabar cha thaf ma yeyaes keh ma gachi baek cheez chu vunkaes chuni zindagi paeth barosae bae yoeri dravuus oeri yemaa vapas teith gayee zyadi yaeth saeni kasheeri manz haalat taem te oen vaariyaa dabaav. The present conditions [Socio-political conflict] have affected our life. There was a time when people used to enjoy at late hours. Today, if a child goes outside the house, parents remain tense/worried and look for him all the time as there is uncertainty and they think that he might get arrested or some other unlucky incident may happen to him. Due to uncertain conditions in Kashmir, a person does not know whether he will come back to home or not after going out of the house and this caused lot of stress/tension. . 40-year-old female participant, Pulwama Community perceptions ….yemis zaheni takleef aesi jinabali, temis tche aksar rozan insaan douryi Distance is maintained from the person who has mental illness. 55-year-old male participant, Srinagar ... Taemis bechaeris tcheni paesh yevaan theek tareeq keh... niche nazree tchis vuchaan ...That poor person is not treated well... Seen as inferior. 27-year- old female participant, Kulgam. ...mea basaan avoide tche karaan aemis yaemis ye zaheni takleef aasi ...I feel the person with the mental health problem is being avoided. 40-year-old female participant, Pulwama, Help seeking practices Pehlay peer kay pass laejatay hain aksar peer kay pass laejatay hain us kae baad doctor kay pass laejatay hain. First they are taken to a spiritual healer/peer, often taken to a peer and after that they are taken to the doctor. 27-year-old female participant, Baramulla

Tche na dapaan kah Doctor tchu tuethti, tensioni, yus tensionas wataan tchu, su tchu dawah wavah dewaan, ghacaan tche faraq, wini tchu tension tchu asaan su tchu oeruk yoeruk wanaan, temis tche wanan yi nimoen Doctoras Kum se kum gacaes faraq We say that there is a kind of ‘tensionee’ doctor who takes care of tension, he prescribes medicine and the person improves. When a person is in tension he can talk nonsense, then we tell them to take him to a doctor; at least he gets better. 45-year-old female participant, Srinagar Barriers to accessing care and treatment Jo loag gareeb hongay jis k pass koi guzaara nahin hoga vo aesay he chod daetay sonchtae hain ye apnay haal pae shayad mast hai tou rehnay dou hogaya theek tou khud he ho jaega nahin hogaya tou dekhaengay vo nahin karatay iska koi ilaj aesay b bohat loag hai.. People who are poor and cannot afford [treatment], leave such persons [persons with mental health problems] on their own, thinking that they will get better by themselves, or else we see, many people don’t even seek treatment [for such persons]. 18-year-old female participant, Baramulla Mental hospital hai lekin mental hospital pura throughout state me dou [1] he hai ya tou jammu me hai ya Srinagar me hai tou vahan pae ghareeb logun ka sources he nahi hai pohanchnae kay. There is the mental hospital but there [are] only two mental hospitals in the whole state. One is in Jammu and the other in Srinagar. To reach this place is not affordable. 60-year-old male participant, Anantnag Perceptions of the effectiveness of treatment received Eyess chhe wuchaan, bemaar chhe peeran nishh gachhan rozaan petmou paancxou, sheyou, ya dahou veryou petth. Dahou veryou patte chee tumann henzz mushkilaat badaan, tuman henzz haalat chhe waarya kharaab gachhan, patte chhe tuman ellaaj karun wariya mushkil gachhan What we see, the patients we observe they have been going to the faith healer from the last five years, six years or ten years. After ten years there problem has increased, there conditions worsens and it is very difficult to give them treatment. 20-year-old male participant, Bandipora Tum lukhh yumm aesse chhe ellaj karan chhenn paane zaana zehni sehatt kya gouv. Tuman Daktoran (khaas daktor) chhen pattah kya ellaj pazze eithenn bemaaran Karunn The doctors involved (specialist) do not know what treatment should be given to such patients.45-year-old-male participant, Kupwara Perceived mental health service needs Koi program hota har dusray teesray din yahan logun ko samjatay, Agar koi clinic he hota vo har ek ko maheenay me ek din kisi din jamah karkay kuch baat samjatay. There should be some programme every second or third day to make people aware. If there was a clinic here then it would gather and raise awareness among people. 27-year-old female participant, Anantnag.