by Dr Insha Rauf
Dr Hoch’s vision of a general hospital psychiatry unit has materialised at SMHS, in a three-storey building that houses general psychiatry outpatients, de-addiction services, inpatient wards, a child psychiatry unit, an auditorium, and a digital classroom.
One of the earliest references to the present Institute of Mental Health and Neurosciences in Kashmir is found in The Valley of Kashmir by Walter R Lawrence. In his account of 1892-93, he wrote that 146 patients, described then as lunatics, were treated at the asylum connected with the Srinagar gaol, now the central jail. He noted that this was not an asylum in the English sense but a place where medicinal treatment was offered for insomnia and attacks of intense excitement.
In 1969, Dr Erna Martha Hoch, a Swiss psychiatrist who lived in India from 1956 to 1988, was appointed professor and head of the Department of Psychiatry at Government Medical College, Srinagar. Alongside this role, she became superintendent of the Mental Asylum, which at that time came under the medical college and was renamed the Government Psychiatric Diseases Hospital, Srinagar.
More than a decade earlier, in 1957-58, the gaol extension for the mentally ill had been handed to the health department, which constructed a new building. Dr Hoch is widely regarded as the architect of modern psychiatry in Kashmir. She set up a psychiatry polyclinic at the hospital and at SMHS Hospital, open six days a week. Her focus was general hospital psychiatry, where she had five beds and two outpatient rooms. She argued that most mental health conditions could be identified and treated within general hospitals, an idea that is now accepted as standard practice.
Her work at the hospital centred on improving care and protecting the human rights of patients. She promoted the biopsychosocial model of disease and applied it to strengthen psychiatric services. Patients in the closed wards of the hospital benefited from her insistence on humane treatment. Dr Hoch left the hospital in 1980, although she remained in Kashmir until 1988.
In 1994, disaster struck when the hospital was destroyed in a fire described as accidental or mysterious. Within hours, the psychiatric facility of Kashmir was reduced to ruins, leaving only outpatient services and admissions for chronic care in makeshift wards. The hospital functioned in this compromised form until 2000, and the loss of infrastructure severely limited the treatment of mental illness.
In the late 2000s, Médecins Sans Frontières Holland began work in mental health in Kashmir. Advocacy for rebuilding the burnt facility became part of their mission. They established a counselling centre on the premises and reconstructed a ward. The government also began reconstruction, including a new outpatient department.
Although a postgraduate course in psychiatry had been launched in 1983, recognition from the Medical Council of India was delayed due to political turmoil. It was only in 2006 that MCI inspected the department at GMC Srinagar, recognised one psychiatry unit, and permitted two MD seats.
In 2007, the hospital received assistance under the National Mental Health Programme to upgrade facilities. Funds were used to refurbish wards and establish a general hospital psychiatry unit at SMHS Hospital. A year later, the government of India sought proposals to upgrade psychiatric hospitals into centres of excellence. Following detailed presentations and assessments, the Psychiatric Diseases Hospital was granted centre of excellence status in September 2009. Thirty crore rupees were allocated to establish the Institute of Mental Health and Neurosciences Kashmir, which marked a turning point in the region’s psychiatric infrastructure.
The institute now has a bed strength of 160 at two sites, Badamwari and SMHS. Dr Hoch’s vision of a general hospital psychiatry unit has materialised at SMHS, in a three-storey building that houses general psychiatry outpatients, de-addiction services, inpatient wards, a child psychiatry unit, an auditorium, and a digital classroom.
The main IMHANS complex at Badamwari contains wards, a modern electroconvulsive therapy suite, a 3 Tesla functional MRI facility, an auditorium, and a library. The campus also accommodates long-stay patients and provides hostels for postgraduate students, registrars, consultants, and staff.
The institute runs outpatient services in general psychiatry, addiction treatment, and clinical psychology at Badamwari, and general psychiatry, de-addiction, and child psychiatry clinics at SMHS. It also offers 24-hour emergency services at Badamwari.
Inpatient care covers general psychiatry, addiction and dual diagnosis, de-addiction at SMHS, and long-stay patient services. Facilities include MRI, modified electroconvulsive therapy, a ketamine clinic, psychotherapies, neuropsychological testing, psychometry, EEG, and laboratory services in haematology and biochemistry.
IMHANS runs recognised postgraduate and professional courses. These include twelve annual MD seats in psychiatry, eight MPhil seats in clinical psychology, and five MSc seats in psychiatric nursing in collaboration with SKIMS Soura. The institute also trains undergraduate nursing students from across the Valley and Pir Panjal, MA psychology students, and MSW students.
Services in development include inpatient child psychiatry, geriatric psychiatry, long-term rehabilitative care, and advanced brain stimulation techniques such as deep TMS, rTMS, and tDCS. Proposed teaching courses include DM Addiction Medicine, DM Child Psychiatry, and a diploma in addiction counselling.
(The writer is an Assistant Professor in the Department of Psychiatry. Views are personal.)
