Despite a population of more than 1.4 billion, India has only 0.93 psychiatrists per 100,000 people, far below the World Health Organization’s recommended three per 100,000.Adnan Abidi/Reuters
India falls far below the world standard of mental health care, with millions of people lacking access to counselling. However, a telehealth program is increasingly being credited with providing that much-needed care, especially in remote areas.
Tele-MANAS is a free, 24/7 helpline offering mental-health services in more than 20 languages. With 53 operational centres across the country, the initiative is part of India’s effort to integrate such services into its broader health system.
Since its launch by the Indian government in October, 2022, Tele-MANAS has handled more than 1.8 million calls, many from impoverished states where mental-health services are scarce.
While an estimated 150 million Indians need mental-health services, only around 30 million are seeking treatment − held back by stigma, isolation, and the severe shortage of facilities and caregivers.
Despite a population of more than 1.4 billion, the country has only 0.93 psychiatrists per 100,000 people, far below the World Health Organization’s recommended three per 100,000.
Most psychiatrists are based in urban areas, and rural mental health remains severely neglected.
“In rural India, mental illnesses are wrapped in myths and superstitions. The idea that mental-health conditions are medical disorders, just like diabetes or heart disease, is not widely accepted,” said Praveen Raj, a psychiatrist at the National Institute of Mental Health and Neuro Sciences.
Dr. Raj described an encounter he had with a 58-year-old farmer who called the service. That first call, made in December, 2023, was filled with distress and anger, Dr. Raj recalled.
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Living on the fringes of his village in Raichur district in the south Indian state of Karnataka, the farmer was ostracized by his villagers, who believed his family was cursed.
His daughter’s schizophrenia, his wife’s blindness, and his own struggle with mental illness had turned them into outcasts. The stigma surrounding their condition ran deep, with villagers believing their suffering was a result of past sins or a supernatural curse that could spread to others.
One day, desperate for help, the farmer went to a local government office to apply for a disability pension. Ignored by officials, he began shouting at the people there, drawing the attention of a passerby. Seeing his distress, the individual dialed the toll-free Tele-MANAS helpline on his phone and handed it to the farmer.
“The focus of Tele-MANAS is to reach vulnerable and underserved populations who have long been overlooked,” said Naveen C. Kumar, a professor of psychiatry with NIMHANS in Bangalore. “It eliminates financial barriers, ensuring equitable access to mental-health services, regardless of socioeconomic status,” Dr. Kumar said.
For the farmer, mental health care was virtually nonexistent in the region, with the nearest general-health centre 50 kilometers away and the closest mental-health facility nearly 400 kilometers away, in Dharwad.
That single call on behalf of the farmer set in motion a year-long effort by the Tele-MANAS team to not only challenge stigma and provide the farmer with medical care but also to help reintegrate his family into their village.
“At first, he was suspicious of us,” Dr. Raj said. “He didn’t believe he had a mental-health illness. But we kept following up with him, building trust, and ensuring he received his disability pension.”
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That financial support became the turning point in the farmer’s confidence in Tele-MANAS. “Once he saw that we could actually help, he started opening up,” Dr. Raj said.
“It wasn’t just about treating the farmer’s mental health; it was about changing societal perceptions.”
Dr. Kumar said that being able to connect people to professional help with the click of a button has significantly reduced the logistical constraints on mental-health services. “We have created a system where support is immediate, responsive and patient-centric.”
Most inquiries involve common psychological issues such as anxiety, sleep disturbances and stress-related conditions. “But for some, the helpline has meant the difference between life and death,” said Dr. Raj.
Eighteen-year-old Dhyuti, a student in Kota, Rajasthan, struggled under the pressure of India’s national premedical entrance exam. Alone in her hostel room and battling suicidal thoughts, she noticed the Tele-MANAS helpline number on her coaching centre’s notice board and decided to call.
“I was overwhelmed by stress and fear of failure,” Dhyuti said. The Globe and Mail is identifying Dhyuti by her first name because of her fears of being stigmatized.
A psychologist stayed on the call with her for nearly three hours, using a non-judgmental approach to help her open up, Dr. Raj said. “She gradually shared her whereabouts, allowing us to co-ordinate an emergency intervention.”
Authorities intervened and reached out to her family in the eastern state of Jharkhand. “We remained actively involved at every step to ensure she received the support she needed,” Dr. Raj added.
As part of a broader awareness initiative, educational institutions across India have been instructed to display the Tele-MANAS helpline number on notice boards.
While the Mental Healthcare Act of 2017 guarantees access to services as a statutory right, implementation has lagged because of financial and logistical constraints, according to a statement by the Ministry of Health and Family Welfare.
As nearly 60 per cent of the population survives on less than US$3.10 per day, affordability remains a key barrier, the statement said.
With an increased investment in telehealth care and public awareness, experts say they hope reaching out for help will become as normal as seeking care for any other illnesses.
As the farmer told Dr. Raj, for the first time in years, he felt like someone was listening.