Kerala developed a five-step preventive package that links daily lifestyle habits to mental well-being — an approach that could address a large section of stress-induced and lifestyle-related mental health problems.
Published Aug 27, 2025 | 8:00 AM ⚊ Updated Aug 27, 2025 | 8:00 AM
Representational image. (Creative Commons)
Synopsis: A new study warned that people living with mental illness die up to 15 years earlier than others, largely due to preventable diseases like diabetes and heart problems. However, Kerala’s mental health programme has already integrated lifestyle-based interventions with conventional psychiatric care.
People living with mental illness die up to 15 years earlier than others — not because of the illness itself, but largely due to preventable diseases like diabetes and heart problems, said a study by The Lancet.
The new Lancet Psychiatry report warned that bridging this deadly gap requires lifestyle-based therapies as seriously as medicines or counselling.
As Kerala prepares for the second phase of the National Mental Health Survey, experts say the state is already ahead in integrating such interventions — but the real challenge lies in delivering them on the ground.
Also Read: Kerala study reveals how poor roads affect everyday life
Exercise, diet, sleep and quitting smoking
The report has called for urgent integration of lifestyle interventions into mental health services to improve care and bridge the 15-year life expectancy gap faced by people with mental illness.
A global panel of 30 experts from 19 countries emphasised that physical activity, nutrition, sleep and smoking cessation must become central to mental health care. Published on 13 August, the report reviewed 89 lifestyle intervention trials and 18 meta-analyses, resulting in eight key recommendations and 19 action priorities.
“Lifestyle can profoundly influence both mental and physical health,” said lead author Dr Scott Teasdale, a dietitian and Senior Research Fellow at UNSW Sydney’s Discipline of Psychiatry and Mental Health and Mindgardens Neuroscience Network.
“But people with mental illness often face barriers to healthy eating, quality sleep, physical activity, and quitting smoking. These barriers worsen their mental health and contribute to preventable physical conditions,” he added.
The Commission emphasised that system-wide changes are essential, including bringing in exercise and nutrition specialists, shifting workforce attitudes and prioritising holistic care alongside medication and psychological therapy.
The report follows a 2019 Commission that highlighted how people with mental illness die 13–15 years earlier than others, largely due to preventable diseases like cardiovascular issues and diabetes.
To ensure broad applicability, the new roadmap was also reviewed by individuals with lived experience and a Global South Advisory Group, comprising 14 experts from low-income and conflict-affected regions.
India was represented in the Commission by Dr S Balasubramanian of AMAHA Healthcare, Mumbai, and Dr PS Indu, Principal of Kasaragod Government Medical College.
‘Lifestyle interventions could be a game-changer’
At a time when India’s mental health programmes largely revolve around medicines and limited psychotherapy, lifestyle interventions are emerging as a potential game-changer, said Indu, co-author of the report and co-chair of the Global South Advisory Group.
“The aspect of lifestyle interventions hasn’t received much serious thought at the national level. To move forward, wider deliberations and discussions with multiple stakeholders are essential. It can also be integrated into the District Mental Health Programme,” Indu told South First.
She noted that Kerala is better placed to implement the findings, thanks to its systematic District Mental Health Programme.
“Here, we already have mental health clinics at the primary health centre level. By integrating these with Non-Communicable Disease (NCD) clinics, we can advance the objectives. Community engagement is crucial, and nurses and doctors may need reorientation training on lifestyle-based approaches. Families, too, have a major role to play,” she added.
While the commission report highlights the role of physical activity, nutrition, smoking cessation and sleep in mental health, Indu stressed that interventions must go beyond that.
“Factors like sedentary behaviour and stress management also need attention. At the same time, we cannot ignore structural barriers such as poverty, education, housing, and systemic inequalities, which profoundly shape mental health outcomes,” she said.
‘Kerala’s five-step mindfulness package’
Meanwhile, Dr Arun B Nair, professor of psychiatry at the Government Medical College, Thiruvananthapuram, told South First that Kerala’s mental health programme has already integrated lifestyle-based interventions with conventional psychiatric care.
According to him, the state has developed a five-step preventive package that links daily lifestyle habits to mental well-being — an approach he believes could address a large section of stress-induced and lifestyle-related mental health problems.
“We started introducing lifestyle interventions into our mental health programme. Our research has looked into areas like the link between stress and Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), cortisol imbalance, and even the impact of Vitamin D deficiency on children’s mental health,” said Dr Arun.
Since there is no exclusive research cadre in psychiatry, he pointed out, such studies are carried out in between teaching and clinical duties. Yet, the team has managed to design a structured lifestyle intervention model, now being piloted across the state.
The model, as explained by Dr Arun, comprises:
Mindful breathing – A 15-minute daily relaxation technique to calm the mind.
Mindful movement – A 12-step exercise routine, gradually scaled from 50 to 150 repetitions over six weeks, done under sunlight to boost Vitamin D, improve dopamine levels, reduce cortisol, and increase blood flow to the brain.
Mindful eating – Slow, sensory-based eating practices combined with the “food plate method” that prioritises fibrous, low-carbohydrate foods to reduce the risk of cancer and lifestyle diseases.
Mindful meditation – A 20-minute daily practice to improve concentration and reduce impulsive reactions.
Sleep hygiene techniques – Structured approaches to ensure restorative sleep.
“These five steps are being used as a preventive intervention — particularly for those with a family history of mental illness or lifestyle-related problems,” Dr Arun said.
Despite the framework, the psychiatrist admitted that real-world implementation remains a hurdle.
“At the primary health centre level, a doctor may attend 100 to 150 patients in a single day. How can one doctor explain and monitor these lifestyle interventions for every patient on a one-to-one basis?” he asked.
Dr Arun stressed that behavioural changes must ideally begin at the school level, though concerns remain about burdening already overworked teachers. “The issues cited in the report are not new. We are already addressing them. The real problem lies in implementation,” he concluded.
Also Read: Kerala, ICMR launch joint research project to boost mental health of students
Second phase of National Mental Health Survey
At the same time, while discussions of the report are in progress, the state is set to launch the second phase of the National Mental Health Survey, a major initiative to assess the state’s mental health landscape.
The study is being carried out by the National Institute of Mental Health and Neurosciences (NIMHANS) on behalf of the Union Ministry of Health and Family Welfare, with the Government Medical College, Alappuzha, leading the efforts.
The state health department said the survey will provide crucial insights into the prevalence of mental health problems, their impact on families and caregivers, the economic burden, and the effectiveness of the existing mental health system. The findings will help shape better interventions and policies for Kerala.
The survey is being conducted across five districts — Alappuzha, Kottayam, Pathanamthitta, Wayanad, and Palakkad — and four major cities — Thiruvananthapuram, Thrissur, Ernakulam and Kozhikode.
An advisory committee headed by Additional Chief Secretary (Health) Dr Rajan N Khobragade will oversee the study, with support from Dr KV Viswanathan (Director of Medical Education) and Dr KJ Reena (Director, Health Department).
The research team is led by Dr Vidhu Kumar K (Psychiatry) and Dr Vishwakala VS (Community Medicine) of Government Medical College, Alappuzha, along with a panel of assistant professors from Psychiatry and Community Medicine.
Ultimately, the Lancet report underlines what Kerala has already begun to practice — that lifestyle is no longer a footnote in mental health care but a frontline therapy. The state has the blueprint, from mindfulness packages to integrated clinics, but its real test lies in translating intent into everyday care.
(Edited by Muhammed Fazil.)
