Potentialities and challenges of digital health in psychiatry in Kashmir, India

Abstract

Telepsychiatry has been recommended as a cost-effective strategy to meet the high unmet need for mental health services to the remote and areas with conflict. The current COVID-19 pandemic along with lockdown measures to prevent the spread of the disease has worsened the mental health status of the Kashmiri population.

Since the inception, the people of Kashmir have been exposed to enduring conflict, war, and political instability that take a huge toll on the mental health and well-being. About 45% (1.8 million) of the Kashmiri population is suffering from some sort of psychological distress.¹ However, health-seeking behaviors have been seriously affected by curfews, lockdowns, and communication black-outs due to recent political turbulence.² Additionally, Kashmir is vulnerable to several types of disasters particularly earthquakes, landslides, floods, and avalanches due to its geographical characteristics. Moreover, the current COVID-19 pandemic along with lockdown measures to prevent the spread of the disease has worsened the mental health status of the Kashmiri population.

Telepsychiatry has been recommended as a cost-effective strategy to meet the high unmet need for mental health services to the remote and areas with conflict.³ The establishment of telepsychiatry could have an immense impact on the mental health system of Kashmir as there is a shortage of mental health professionals. There are around 41 psychiatrists and 12 clinical psychologists for a Kashmiri population of 12.5 million (2011 census).⁴ Following nationwide lockdown due to the COVID-19 pandemic, the number of patients at psychiatry outpatient departments (OPDs) has reduced in the government hospitals while OPDs at private hospitals were closed. The Indian Psychiatric Society released a position statement on 30 March 2020, advocating the use of available technology to ‘reach the unreached in the form of online consultation with the psychiatrist.⁵ It also asked to refill with an old prescription or through online prescriptions till the crisis is over. The timely release of the Telemedicine Practice Guidelines by the Government has motivated care providers in India to deliver much-needed medical evaluation, diagnosis, and triage remotely during the current COVID-19 crisis.⁶ Many clinicians and patients in Kashmir are now realizing the full potential of telehealth tools, as they are forced to utilize them to connect in a time when in-person and face-to-face visits are impossible. One of the major benefits of tele-mental health services is the possibility of remote assessment (triage) and the provision of care by the health service providers especially during times of disasters. Rapid virtualization has shown that clinicians, patients, and systems can quickly adapt to telepsychiatry, though not without challenges and lessons learned. The regulatory and system changes brought by the COVID-19 crisis present the opportunity for the field to gather lessons learned to strategically shape the post–COVID-19 telepsychiatry services in Kashmir.

However, in Kashmir, the implication of telepsychiatry is challenging due to the second generation (2 G) mobile network, frequent communication blackouts, lack of infrastructure, poor digital literacy, and absence of a functioning community mental health team. Instituting the telepsychiatry in Kashmir will need assistance from government authorities, international agencies (World Health Organization, United Nations International Children’s Emergency Fund), non-governmental organizations, and all other stakeholders. The adequate fund is an extremely important prerequisite for the telepsychiatric services followed by the well-designed modification of existing services such as clinics is warranted. Effective and culture-specific strategies to improve digital literacy and further research are recommended. Telehealth is an underutilized and underestimated mode of treatment in Kashmir and may play a vital role in providing mental health services in Kashmir.