Breaking the silence: Mental health in Kashmir

“When we first started working here, people were suspicious,” says Taheem Jafar, a community mental health worker with MSF. “They would ask, ‘Why are you here? What do you want from us?’ Now they recognize our work.”

“Remember, we’re not here to diagnose or label,” says Sabreena Hassan, an MSF health promotion supervisor. “We’re here to listen, educate, and connect people with services if they need them.”

Taheem and her colleague Rayees Ahmed Mir approach a house where an elderly man is sitting on the porch. Taheem tells the man about the free mental health services MSF provides.

“What exactly do you mean by ‘mental health’?” asks the man, gesturing at them to come and sit. 

This is a question Rayees and Taheem have answered countless times.

“Just as our bodies can get sick, our minds can also experience difficulties, especially after stressful events,” Taheem explains. “Feelings of sadness that don’t go away, trouble sleeping, constant worry—these are all signs that someone might need support.”

As Taheem shares more about MSF’s services with the man, she emphasizes that they’re free and confidential. “Whatever is discussed remains between the person and their counselor. No one else needs to know.”

Meeting people where they are

MSF community health workers Zainab-U-Nisa and Mudasir Ahmad Lone are invited inside a woman’s home in Bomai, Baramulla, where teams walk through difficult terrain to conduct outreach activities. The living room is simple but spotlessly clean, with cushions arranged on the floor around a low table.

“Three years ago, I wouldn’t have even opened my door,” the woman confides to Zainab. “My husband was always angry, startling at the smallest sounds. I didn’t know what to do.”

Zainab listens attentively, watching for signs of possible secondary trauma—nervous hand movements, quick glances toward the window at each passing sound. “You’re not alone in this experience. Many families in Kashmir face similar challenges. Would you be interested in learning some techniques that might help both you and your husband?”

Zainab explains how stress affects the body and mind, demonstrating a simple breathing exercise. Then she provides information about MSF’s counseling services, explaining how the woman’s husband could benefit from professional support.

“Some people think seeking help for mental health means you’re weak,” Zainab says. “But it’s actually a sign of strength—like going to a doctor when you have a physical illness.”

A midday community session

By midday, the team in Baramulla district converges at the house of a local community member, where 15 women have gathered. Some have brought their young children, who play quietly in a corner with toys provided by the center’s staff. Rayees and Taheem start the session by asking the women what they know about mental health. Initially, the responses are hesitant.

“It’s when someone behaves strangely,” one woman suggests.

“It’s a punishment for sins,” says another.

Taheem acknowledges each response without judgment. “These are common beliefs,” she says. “Let me share what medical science tells us about mental health.”

Using plain language and cultural references, she explains how the brain functions, how stress affects it, and how common conditions like anxiety and depression manifest. Rayees also uses visual aids—pictures and diagrams—to help explain complex concepts.

“If someone has diabetes, we don’t blame them or call it a punishment,” she points out. “Mental health conditions are similar—they are medical issues that can be addressed with proper support.”

The session becomes more interactive as women begin sharing experiences—sleep disturbances, persistent sadness, physical symptoms like headaches and digestive problems that doctors couldn’t explain. Rayees and Taheem validate these experiences while providing information about coping strategies and available services.

“What if my husband doesn’t want me to seek help?” one woman asks quietly.

“We’ve found that involving respected community figures—like religious leaders or teachers—can sometimes help family members understand the importance of mental health care,” says Rayees. “We can also provide family education sessions where everyone learns together.”

By the end of the two-hour session, several women express interest in follow-up consultations. The team arranges appointments at the primary health care center, working around the women’s household responsibilities to ensure they can attend.

After a quick lunch break, the team meets with local social workers in a small community hall. These government-appointed community health workers are vital partners in reaching more people, especially in remote areas.

“Before we started working with MSF, we didn’t know how to respond when we encountered mental health issues during our home visits,” says one social worker with eight years of experience. “Now we can identify warning signs and know where to refer people.”

“Remember, your relationship with families gives you a unique opportunity to reduce stigma,” Mudasir tells the local social workers. “When you normalize talking about mental health, it gives others permission to do the same.”

The collaboration extends beyond the community social workers. “We conduct regular meetings with village heads, religious leaders, teachers, and even local pharmacists,” says Sabreena. “In the beginning, some faith healers saw us as competition, but over time, many have become partners. Now they often refer people to us when they recognize signs of mental health conditions.”

This multi-layered approach has been crucial in creating a more supportive environment for people seeking help. As one social worker notes, “Now when I suggest someone might benefit from counseling, families are much more receptive than they were three years ago.”

Staying motivated through stories of change

During a brief tea break, the team shares success stories that keep them motivated despite the challenges of their work.

Mudasir recounts the story of a woman whose husband died, leaving her alone with six children. “When we first met her, she was barely functioning. Her two oldest daughters had to drop out of school to care for the younger ones, and they were showing signs of trauma themselves. The family was isolated—relatives had helped initially but eventually returned to their own lives.”

The team provided counseling to the mother and children, initially meeting them in their home because they were reluctant to visit the clinic. “It took time and patience,” Mudasir explains. “We had to build trust gradually. The mother feared judgment from the community if people knew they were receiving mental health support.”

After several months of consistent support, changes became evident. “The mother started functioning better, and with our help, she connected with an NGO that provided financial assistance. Her daughters returned to school, and one is now preparing for medical college entrance exams.”

The most significant outcome, according to Mudasir, is that this woman now actively refers others to MSF’s services. “She’s become an advocate in her community. When she sees someone struggling, she tells them, ‘I know a place that can help.’”

Zainab shares another story about an adolescent who hadn’t left his house for six years due to severe depression: “When he first came to our clinic, he wouldn’t make eye contact or speak. After six counseling sessions, we saw remarkable changes. Now he has a job and interacts confidently with others. His parents say it’s like having their son back.”

These stories represent the tangible impact of MSF’s mental health program, which has been operating in Kashmir since 2001, providing free, high-quality, and confidential services across Kashmir valley.

Reflecting on another day’s work

By 4 p.m., the team returns to their respective primary health care centers to document their day’s activities. Each member carefully records who they met, what they observed, and any referrals made. This documentation is crucial for tracking progress and identifying patterns in the community.

“We create both qualitative and quantitative data,” explains Zainab. “This helps us understand if our strategies are working and where we need to adapt.”

The day concludes with a team reflection session. Each member shares challenges they encountered and successful moments they experienced. This practice helps them process the emotional weight of their work and learn from each other’s approaches.

“Listening to people’s suffering can take a toll on us,” acknowledges Taheem. “We practice professional boundaries—reminding ourselves that these stories are part of our job, not our personal burden. But we also support each other and seek help from our counselors for other stress management techniques when needed.”

For self-care, team members have developed various strategies. Zainab enjoys cooking and spending quality time with her child.

Taheem practices her faith and tends to her garden. Some team members like to read books and some engage in agricultural activities on their family’s land.

“These practices help us recharge so we can return the next day with renewed energy,” says Rayees.

Creating lasting impact

As 5 p.m. approaches and the team prepares to leave, their conversation turns to the broader impact of their work over the years.

“When we started, mental health was completely misunderstood in our communities,” reflects Firdaus Bashir, MSF community mental health worker in Baramulla. “People either didn’t recognize it as a health issue or viewed it as a personal weakness or spiritual problem. Now we’re seeing a gradual shift in perception.”

This shift is evident in multiple ways: increased self-referrals to the clinic, community members openly discussing mental health issues during sessions, and even former patients becoming advocates for mental health awareness.

“One of the most significant changes,” notes Firdaus, “is that people are beginning to understand that mental health conditions are treatable. This gives hope, especially in a region where conflict and uncertainty have been constants for decades.”

The team’s work is part of MSF’s long-term commitment to supporting mental health in Kashmir. Despite challenges—constraints, deep-rooted stigma, limited resources—MSF has maintained consistent services, adapting approaches to meet evolving needs.

“Before joining MSF, I couldn’t understand people’s feelings and emotions,” reflects Taheem as the team disbands for the day. “Now my vision has changed. I see mental health as integral to overall well-being, and I’ve learned that with the right support, people have remarkable capacity for resilience and recovery.”

As the sun sets behind the mountains, casting long shadows across the valley, the team members head home, carrying with them the stories they’ve heard, the connections they’ve made, and the knowledge that their presence in these communities is slowly breaking silence and building pathways to healing.

Through their daily work—door by door, conversation by conversation, session by session—MSF’s mental health workers are changing the narrative around mental health in Kashmir, bringing professional care to those who need it most and demonstrating that even in the most challenging contexts, healing is possible.