Access to adolescent care not uniform across India: Dr Prabha Chandra

Interview/ Dr Prabha Chandra, director, NIMHANS

Q/ India has one of the world’s largest adolescent populations. Do we have adequate data to understand the true burden of mental health disorders among teenagers?

A/ Children and adolescents represent a vulnerable demographic, with global estimates indicating that 1 in 7 live with a diagnosable mental disorder. In India, the National Mental Health Survey (NMHS) reports a 7.3 per cent prevalence of mental disorders among youth aged 13–17. [But] detailed, granular information regarding the burden of mental health disorders, especially among teenagers in rural regions, needs to be further assessed. The NMHS-2 shall be taking steps to address the same by having adolescents as a dedicated population for the survey and will also involve children (7–12 years, using parental reporting).

Q/ Teen suicide remains a major public health concern. What does current evidence tell us about key risk factors?

A/ A large number of factors play a role, both independently and in tandem—mental health problems, along with negative childhood experiences, broken families and fractured relationships, academic stressors, violence, social and lifestyle factors, economic distress, relationship factors and other demographic vulnerabilities. In India, the National Crime Records Bureau collects suicide-related data, and nearly 8 per cent of all suicides are by students. In fact, 18 years to 30 years is the most vulnerable group when it comes to suicide. The most common reasons for suicide, as per the Accidental Deaths and Suicides in India report of 2024, are failed relationships, failing examinations, family issues and illnesses.

While multiple attempts are being made to reduce the number of lives lost due to suicide, many gaps continue to persist. These include a lack of awareness about mental health among adolescents, especially limited knowledge regarding readily [and freely] available mental health resources like Tele MANAS. Help-seeking in this group is further limited by stigma, a lack of support and the rat race that our youth are often sucked into.

The only way of tackling this is through large awareness drives, dedicated suicide prevention strategies for the youth and an action plan at different levels of care to ensure that the youth know where to turn to and from whom to seek help. The government of India has taken a lot of remedial measures in this regard, such as the National Suicide Prevention Strategy, the printing of the Tele MANAS number in textbooks, proactive display of helpline numbers and some state governments even reaching out to students during exam periods to check on their wellbeing. Though these are baby steps in tackling the issue at large, they definitely are a starting point to bring about sustainable change.

Q/ Despite increasing awareness, treatment gaps remain high. What are the biggest structural barriers?

A/ The biggest structural barriers that continue to prevent Indians from seeking or receiving health care, leading to a treatment gap of 70 per cent to 92 per cent (as per the NMHS), are diverse and intersecting. Deficits in human resources [are] one of the most significant and challenging [barriers]. India has a psychiatrist-to-population ratio below the WHO-recommended minimum. As of 2019, it was 0.75 per lakh population as opposed to the 3 that was recommended. Further compounding matters is the uneven distribution of available resources, with most of the psychiatrists concentrated in urban areas. These factors, along with high out-of-pocket expenditure, lack of knowledge about mental health, illness and support, along with the stigma around mental health care, contribute to the high treatment gap.

We are increasingly seeing adolescents and young adults seeking help more openly, as compared to older adults, in part because social media and digital platforms have made mental health conversations more visible and acceptable. Older adults still hesitate to seek help, fearing stigma or worrying about burdening their families. Awareness and accessibility to mental health care are not uniform across India. Individuals from rural backgrounds, marginalised communities, lower socioeconomic groups and socially disadvantaged populations often face greater barriers in accessing mental health care despite being more vulnerable to stressors and adversity. Since awareness itself has an important role to play in improving help-seeking behaviours, which can further impact mental health outcomes, creating awareness becomes our responsibility. I would say this responsibility is not limited to mental health professionals alone, but must be undertaken at several levels meticulously and continually in a country like India.

Q/ Stigma remains a challenge.

A/ Stigma continues to be one of the biggest obstacles for service providers as well as the people who are struggling with mental illness. Progressive efforts have been made to reduce the stigma, but it continues to persist and presents as a challenge despite the same. Isolated awareness campaigns have not proven to be as effective as they were envisioned to drive behavioural change or increase service utilisation. Rather, strategies that utilise a combination of intra-personal, inter-personal and community-level interventions are effective. NIMHANS has been involved in the development of several such programmes. I believe that we have made significant progress in strengthening mental health care systems over the years. Initiatives such as the District Mental Health Programme, Tele MANAS services and state-level programmes like Karnataka’s Manochaitanya and the Taluk Mental Health Programme have improved access to care. Many of these were undertaken at state and district levels, but Tele MANAS is India’s flagship digital mental health initiative, which has received more than 3 million calls since its inception, showing both increasing awareness and growing need for mental health support. The expansion of community-based services and tele-mental health platforms to bridge the treatment gap in India is an encouraging development. There is still a long way to go. Because of such diverse needs, our mental health system has to have the capability to mould itself to cater to the unique needs of our population. There is no ‘one size fits all’ approach with mental health.

Q/ How can mental health services be better integrated into primary health care so that support is available closer to communities?

A/ India has established a multi-tiered public mental health framework by overhauling its legal system with the Mental Healthcare Act 2017, which decriminalised suicide attempts and turned care into a statutory right, alongside launching its first National Suicide Prevention Strategy to cut mortality rates by 10 per cent by 2030. At the grassroots level, the country has decentralised care by scaling the District Mental Health Programme across 767 districts and embedding a Mental, Neurological, and Substance Use (MNS) screening package into over 1.81 lakh primary Ayushman Arogya Mandirs. To bridge the geographic gap, India deployed Tele MANAS, while concurrently launching school-based safety nets like the UMMEED guidelines and the School Health & Wellness Programme to train teachers as frontline emotional gatekeepers. India also has a unique ‘Dawa-Dua’ model of health care in mental health, as relatives may take patients to faith healers instead of psychiatrists. By training faith healers in mental health resources and developing appropriate referral mechanisms to care, we can work with the families while also being respectful of their choices. Further, to directly equip low-income family caregivers who cannot afford professional fees, this ecosystem actively utilises the Kutumb Samvardhan initiative and community-based psychoeducation programmes to upskill families into active care partners. Training relatives to recognise ‘idioms of distress’ (such as tracking somatic complaints like chronic tension or body aches) and implementing home-based behavioural stabilisation strategies can effectively transform the home into a supportive, non-punitive extension of the primary health care network.

Q/ What are NIMHANS’s upcoming projects, especially ones that address teen mental health?

A/ NIMHANS is actively driving a structural shift in public mental health through upcoming projects like the National Mental Health Survey 2.0. [The survey] establishes a National Well-Being Index and fills critical data gaps by mapping child and adolescent psychiatric metrics across India. Alongside, [we are] mentoring the rollout of the new NIMHANS-2 in north India to promote regional equity.

For teen and adolescent mental health specifically, the institution is scaling targeted initiatives including YASHAS, which tracks and provides structured follow-up care for youth under 24 admitted to general hospitals after self-harm attempts, a multi-state ICMR-funded Student Implementation Research Study to embed suicide prevention models on campuses, and new teen-centric wellness and digital detox toolkits adapted from its SHUT clinic. These are further reinforced by the ongoing expansion of SAMVAD, which trains community frameworks to provide trauma-informed psychiatric care for highly vulnerable children within institutional and protective welfare systems.