Treatment Gap for Mental Disorders Remains High, With Over 80% of People Needing Care Not Receiving It
By Arunima Rajan
In an interview with Arunima Rajan, Dr. Shaunak Ajinkya, Consultant, Psychiatrist, Kokilaben Dhirubhai Ambani Hospital, Mumbai talks about the biggest mental health trends of 2025.
How will India’s mental health story play out in 2025?
1. Digital platforms are poised to become the backbone of mental health care in India, addressing the significant gap in accessibility and professional resources. E.g.,
The National Tele Mental Health Programme (Tele-MANAS), launched in 2022, has become a flagship initiative. It is a 24/7 national helpline providing free tele-counselling and psychiatric services. By mid-2025, the program has handled over 2.38 million calls and launched a mobile app offering self-care tools and video consultations in select states.
AI-driven chatbots, virtual reality, and mobile apps are gaining traction for managing stress, anxiety, and other conditions. Wearable devices that monitor biometric data like heart rate and sleep patterns are also being integrated to provide a more holistic view of an-individual's mental and physical well-being.
There is now an increased access to mental health professionals as compared to earlier times. Digital solutions are crucial for reaching people in remote and rural areas, as well as for those who face stigma and are hesitant to seek in-person help.
Dr. Shaunak Ajinkya, Consultant, Psychiatrist, Kokilaben Dhirubhai Ambani Hospital, Mumbai
2. There also has been a shift in public perception and awareness now. Conversations around mental health are becoming more mainstream, moving from a stigmatized topic to an accepted part of overall wellness. There is a growing understanding that mental health is a legitimate health concern, leading to more open discussions in schools, workplaces, and the media. Mental well-being is increasingly viewed as an integral part of daily life, influencing consumer behaviour and leading to a demand for products and services that support both physical and emotional health.
3. The mental health of young people is a major concern in the present times. Academic pressure, social isolation, and the negative impacts of excessive social media use are contributing to a rise in anxiety and depression among youth. As a result, there is an increased focus on school-based screenings and mental health education.
4. The government is taking steps to integrate mental health into the broader healthcare system, though significant challenges remain. The Mental Healthcare Act of 2017 is a progressive piece of legislation, and efforts are being made to strengthen its implementation. Following the Mental Healthcare Act, insurers are now mandated to cover mental illnesses, making care more financially accessible. This is a significant step towards normalizing mental health treatment. The government is strengthening mental health services at the primary healthcare level by training general physicians and frontline health workers to diagnose and manage mild to moderate conditions.
5. But despite the positive developments, India's mental health landscape still faces significant hurdles.
Workforce shortage: India has a severe shortage of mental health professionals, with only a fraction of the number of psychiatrists and psychologists recommended by the WHO. This issue is particularly acute in rural areas. Thus, the treatment gap for mental disorders remains high, with over 80% of people needing care not receiving it.
Infrastructure, particularly outside of major urban centres, remains limited, which makes scaling up services difficult. The lack of robust, real-time data and research on mental health hinders effective policy-making and resource allocation.
There are reports of increasing mental health conditions in younger age groups, including self-harm and mood disorders, thus indicating a need for earlier and more effective interventions.
What is the current state of India’s mental health?
India's mental health landscape in 2025 presents a complex picture characterized by a high disease incidence and a significant treatment gap, despite growing awareness and some policy advancements.
India carries a substantial burden of mental health disorders. Estimates suggest that around 197.3 million people, or approximately 14.3% of the total population, were suffering from various mental disorders in 2017. The World Health Organization (WHO) estimates that mental and behavioural disorders account for about 12% of the global burden of diseases.
Depression and Anxiety Disorders are the most prevalent. The National Mental Health Survey (NMHS) 2015-16 survey indicated that approximately 15% of Indian adults require active intervention for mental health issues. Specifically, one in 20 Indians (or 5.25%) had experienced depression at least once in their lifetime. The prevalence of current depressive disorders was estimated at 2.68%.
Substance use disorders (including alcohol and tobacco) affecting a considerable portion of the adult population. According to National Survey on Extent and Pattern of Substance Use in India (2018-2019) conducted by the Ministry of Social Justice and Empowerment, approximately 14.6% of individuals aged 10-75 years are current users of alcohol, translating to about 16 crore people. Of these, 5.2% are estimated to have harmful or dependent alcohol use, indicating that every third alcohol user needs help. Prevalence is significantly higher among men than women. Around 3.3% of adults (18-75 years) are current users of cannabis, totalling about 2.9 crore individuals. 0.66% suffer from cannabis problems. 2.1% of adults are current users of opioids (about 1.9 crore people). Approximately 0.55% (around 60 lakh people) need help for opioid use disorders. Heroin and pharmaceutical opioids are more commonly used than opium. 1.21% of adults are current users of sedatives (i.e. about about 1.1 crore people for non-medical, non-prescription use). While less common among adults (0.58%), inhalant use is higher among children and adolescents (1.17%). Regarding other substances - Cocaine (0.11%), Amphetamine-Type Stimulants (ATS) (0.18%), and Hallucinogens (0.13%) have lower prevalence rates among adults.
Schizophrenia - Studies indicate a lifetime prevalence of schizophrenia spectrum disorders in India ranging from 1.41% to 2.5%.
Bipolar disorder - The National Mental Health Survey (NMHS) 2016 survey reported a weighted prevalence of 0.3% for current bipolar affective disorder and 0.5% for lifetime diagnosis.
Intellectual disability - A meta-analysis of studies in India estimated the pooled prevalence of intellectual disability to be 1.8%.
Autism spectrum disorders - Current estimates suggest that approximately 1% to 1.5% of children in India are on the autism spectrum.
Thus the contribution of mental disorders to the total disease burden in India (measured in Disability-Adjusted Life Years - DALYs) has nearly doubled between 1990 and 2017, increasing from 2.5% to 4.7%. Mental disorders are a leading cause of years lived with disability (YLDs) in India.
The treatment gap in India remains alarmingly high, indicating that a vast majority of individuals in need of mental health care do not receive it. Estimates for the treatment gap range widely but consistently point to a severe deficit. Some sources indicate that around 80% of individuals with mental disorders go untreated. Other figures suggest a treatment gap of 70-92% for mental health illnesses, and as high as 86% for alcohol use disorders. More recent reviews suggest a treatment gap of 84.5% for mental disorders. The contributing factors are:
Shortage of professionals: India faces a severe shortage of mental health professionals. The psychiatrist-to-patient ratio is significantly lower than global recommendations (around 0.3-0.75 per lakh population compared to the WHO recommendation of 1 per lakh, and far lower than high-income countries). The scarcity is exacerbated by the concentration of professionals in urban areas.
Stigma and lack of awareness: Social stigma associated with mental illness remains a major barrier, preventing many from seeking help.
Inadequate infrastructure: Particularly in rural and semi-urban areas, the infrastructure for mental healthcare is underdeveloped.
Financial barriers: Mental health services can be expensive, and insurance coverage, while improving, is not yet comprehensive for all.
Integration challenges: While there are efforts to integrate mental health into primary healthcare, overburdened primary health centers, lack of training for general practitioners, and limited availability of medications hinder this integration.
Low budget allocation: Despite the high burden, the budgetary allocation for mental health remains very low, often below 1% of the total health budget.
In short, India is grappling with a high and growing incidence of mental health disorders and the health system's capacity to address this is severely limited by a profound treatment gap. Efforts have been underway to bridge this gap through digital health, policy reforms, and primary healthcare integration, but these are still in their early stages and face significant systemic challenges.
Do children and adolescent get least attention in mental health?
While mental health is gaining broader attention, children and adolescents often remain a particularly vulnerable and underserved group. Calling them "orphans of the mental health sector" is probably one way to describe a reality where their specific needs are often overlooked or inadequately addressed. While the problem is being acknowledged, children and adolescents in India are still in a precarious position. Their mental health needs are significant and growing day by day, yet the systems, policies, and professional workforce dedicated to them are still tragically inadequate. The real test for India's mental health progress will be its ability to provide comprehensive, accessible, and stigma-free care for its youngest citizens.
Is data quality really bad in mental health and how does it affect the sector?
Yes, data quality is a significant and persistent problem in India's mental health sector. This poor data quality is not just a statistical inconvenience; it's a major barrier that hinders effective policy-making, resource allocation, and a true understanding of the country's mental health burden.
The probable reasons for poor data quality are:
Lack of centralized and standardized data: India lacks a comprehensive, centralized mental health registry or a standardized system for collecting data across all states and healthcare providers. The data that exists is often fragmented, collected by different government programs (like the District Mental Health Programme) and private institutions, using varying methodologies and metrics.
Underreporting and stigma: Mental illness is still heavily stigmatized In India. People are often reluctant to seek professional help or even admit to mental distress. This leads to massive underreporting of cases, as many people suffer in silence. Data collected from healthcare facilities, therefore, represents only a fraction of the actual problem.
Limited research and surveillance: There are very few large-scale, nationwide mental health surveys. The most cited and comprehensive data still comes from the National Mental Health Survey (NMHS) of 2015-16, which is now almost a decade old. While a new survey (NMHS-2) is in progress, the lack of regular, up-to-date data means policymakers are working with outdated information.
Urban-rural disparity: Most available data is from urban centers where mental health services are more established. This creates a biased picture, underestimating the true burden of mental illness in vast rural areas where most of the population resides.
Infrastructure and workforce shortage: A lack of trained mental healthcare professionals, especially in rural areas, means that mental health conditions are often misdiagnosed or not diagnosed at all. Frontline health workers may not have the training or resources to accurately identify and record cases.
Privacy concerns: The sensitive nature of mental health data raises privacy and confidentiality concerns. While the Digital Personal Data Protection (DPDP) Act of 2023 is a step forward, it still presents challenges for researchers and data collectors who need to ensure patient anonymity while gathering crucial information.
Poor data affects the sector's progress for the following reasons -
Without accurate data, policymakers cannot accurately assess the scale of the problem. This leads to resource misallocation, with funds and programs not being directed to the areas or populations most in need. For instance, if data shows a low prevalence in a particular region, it might be due to underreporting, but the government may interpret it as a low-priority area for investment.
Advocacy groups and mental health professionals need solid, current data to effectively lobby the government for increased funding and policy changes. When they have to rely on a decade-old survey or disparate regional data, their case is weakened.
Researchers in India face significant challenges due to the lack of good quality, nationally representative datasets. This hampers their ability to study disease trends, identify risk factors, and evaluate the effectiveness of interventions. As a result, India's contribution to global mental health research is relatively low, and the country relies on models and findings from other nations that may not be culturally or socio-economically relevant.
It's impossible to know if a program is working without reliable baseline data and a system to track outcomes. For example, while the Tele-MANAS program is a major step forward, without robust data collection on the types of calls, caller demographics, and outcomes, it's difficult to gauge its true impact and identify areas for improvement.
The lack of concrete, widely-publicized data on the prevalence of mental illness can contribute to the perception that it is a rare or "niche" issue, rather than a widespread public health crisis. This, in turn, makes it harder to break down the social stigma that discourages people from seeking help.
What’s your take on mental health startups ?
AI tools and mental health startups in India are rapidly emerging as a promising force to bridge the significant care gap. However, they are a double-edged sword. They offer unprecedented opportunities for access and preliminary support, but they are not a substitute for professional mental health care and come with their own set of risks.
AI chatbots and apps cannot diagnose, provide personalized treatment, or prescribe medication. They lack the nuanced understanding, empathy, and ability to build a therapeutic relationship that is essential for effective therapy. A chatbot might offer generic advice that is not suitable for a specific individual's unique situation. This can be ineffective at best, and at worst, it can be harmful. Also, excessive reliance on AI tools can lead to a delay in seeking professional care, allowing problems to deepen and become more difficult to treat as an AI tool cannot adequately handle a mental health crisis. There have been concerning international reports of chatbots failing to prevent suicide or even providing harmful advice.
There are emerging concerns about a new phenomenon where prolonged, intense interaction with AI chatbots can lead to delusions and a blurring of reality. The AI's constant validation, without human-like challenges or boundaries, can reinforce irrational beliefs. India currently lacks a centralized regulatory body to oversee mental health apps, which can lead to unverified therapeutic claims and a lack of accountability. Also, Most AI tools are not HIPAA (or equivalent Indian) compliant, and without proper regulation, user data is at risk.
Hence A.I. tools must be viewed as a complement to human care, not a replacement.
What sort of regulations do we need for mental health sector?
India has a strong legal foundation in the Mental Healthcare Act of 2017 (MHCA). It's considered one of the most progressive pieces of mental health legislation globally, focusing on human rights, the right to access care, and the decriminalization of suicide. However, a progressive law is only as good as its implementation and the regulations that support it. While the MHCA provides a broad framework, specific regulations are needed to address the evolving landscape, especially with the rise of digital health. The possible solutions are :
The Digital Personal Data Protection (DPDP) Act, 2023 is a step in the right direction, but specific rules are needed for sensitive mental health data. Regulations should mandate robust data encryption, clear consent protocols, and strict rules on how data can be used (e.g., preventing it from being sold to advertisers).
Regulations should require digital mental health tools to demonstrate clinical efficacy through evidence-based research. The government or a designated body should create a "seal of approval" or a certification process to help consumers identify safe and effective apps.
Apps and AI tools must have clear, tested, and reliable protocols for identifying and responding to users in a mental health crisis. This includes instant redirection to a national helpline like Tele-MANAS or emergency services.
Apps should be transparent about their limitations—clearly stating that they are for support and not a substitute for diagnosis or treatment from a qualified professional.
There is a critical need to regulate mental health influencers. This is a highly important area for regulation. While many influencers provide valuable content and help reduce stigma, unqualified "mental health influencers" can pose a serious public health risk. Some of the reasons are:
There is risk of misinformation and harmful advice. Some unqualified influencers promote unproven "cures" and "biohacks," that can cause significant harm and deter people from seeking legitimate medical help.
When a large number of unqualified people provide mental health advice online, it can make it difficult for the public to distinguish between a qualified professional and a content creator. This can undermine the credibility of the entire mental health profession.
Influencers can create a false sense of intimacy (a "parasocial relationship") where followers feel they know the influencer personally. This can blur the lines of a professional-client relationship and make it difficult for the follower to seek professional help from someone they don't know. While a qualified professional is bound by strict confidentiality, an influencer has no such obligation, and a follower who shares personal information might be at risk.
There could be also commercial conflicts of interest. An influencer might promote a certain product or service (like a supplement or a wellness retreat) without disclosing a financial incentive, creating a conflict of interest.
How do we regulate influencers?
Mandatory disclosure of credentials: A regulation similar to the Advertising Standards Council of India (ASCI) guidelines for "finfluencers" is needed for mental health. This would mandate that anyone offering health-related advice must clearly and prominently disclose their professional qualifications and disclaimers. The government has already started moving in this direction with new rules for wellness and health influencers to disclose their credentials.
Clear disclaimers: All mental health-related content should be required to carry a clear disclaimer stating that it is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
Collaboration with platforms: The government should work with social media companies like Instagram and YouTube to flag and remove content that is clearly misleading, dangerous, or violates ethical guidelines.
Public awareness campaigns: The government and professional bodies like the Indian Psychiatric Society should launch public awareness campaigns to educate people on how to identify a qualified mental health professional and the risks of relying on unverified online advice.
What is your take on debates about psychiatric medications?
The debate about whether psychiatric medications do more harm than good is an enduring one within the mental health community. It's a complex issue with no simple answer, as the effects of these medications can vary drastically from person to person. The "pills do more harm than good" argument is often rooted in concerns about over-prescription, long-term side effects, and the limitations of the "chemical imbalance" theory.
The arguments for medication are:
Symptom relief and functionality: For many individuals, psychiatric medications are life-changing. They can alleviate severe symptoms of conditions like schizophrenia, bipolar disorder, and severe depression, making it possible for individuals to function, hold jobs, maintain relationships, and live independently.
Acute treatment and crisis management: In acute situations, such as a psychotic episode or a severe depressive crisis, psychiatric medications can be crucial for stabilizing a patient and ensuring their safety. They can be a vital first step to allow an individual to engage in other forms of therapy.
Reducing mortality: Some studies suggest that the long-term use of certain psychiatric drugs, such as antipsychotics for schizophrenia, may be associated with a lower risk of early death. This is often linked to better management of the illness and a reduction in suicide risk.
Complementary to therapy: No reputable psychiatrist suggests that medication is a standalone solution. The consensus among professionals is that medication is most effective when used as a tool to enable therapy. By reducing the debilitating symptoms of an illness, it allows a person to participate in psychotherapy, which addresses the root causes and provides long-term coping mechanisms.
Some arguments against long-term medication are:
Side effects: Many psychiatric medications can cause significant and sometimes severe side effects, including weight gain, sexual dysfunction, emotional blunting or "numbing," cognitive impairment, and physical issues like tremors. These side effects can decrease a person's quality of life and may lead them to discontinue treatment.
Lack of robust long-term evidence based studies: A major point of criticism is that most clinical trials for psychiatric drugs, particularly antidepressants, are short-term (6-12 weeks). Critics argue that this makes long-term prescription a leap of faith.
Protracted withdrawals: Discontinuing psychiatric medications, especially after long-term use, may lead to symptoms that can often be mistaken for relapse of the original illness. This can trap patients in a cycle of continued medication.
The chemical imbalance theory: The idea that mental illness is caused by a simple chemical imbalance in the brain has been widely debated as an oversimplification of a complex issue.
In India, it is particularly relevant as the severe shortage of mental health professionals means that many patients, especially in rural areas, have limited access to anything other than medication. This can lead to a reliance on pills without the complementary psychological support. The pharmaceutical industry's marketing practices and potential conflicts of interest is also be a source of concern.
In conclusion, it's not a simple question of "good vs. bad." Psychiatric medication is a powerful tool with significant benefits and serious risks. The real issue is not the pills themselves, but how they are used. The best approach involves informed consent, where a patient and their doctor have an open discussion about the potential benefits and risks; regular reviews to assess if the medication is still necessary and effective; and, whenever possible, a holistic treatment plan that combines medication with psychotherapy and lifestyle changes.
How to strengthen India’s mental health infrastructure?
1. Workforce development and training is the most critical issue is the massive shortage of qualified mental health professionals. It may be done as follows:
Expand training capacity: Increase the number of postgraduate seats for psychiatry, clinical psychology, and psychiatric social work in medical colleges and institutions. The government's sanctioning of 25 Centres of Excellence and strengthening of 47 postgraduate departments is a positive step that needs to be accelerated.
Train general physicians and community health workers to diagnose and manage common mental illnesses like depression and anxiety. This is a core component of the DMHP, aiming to integrate mental healthcare into the primary healthcare system.
Incentivize rural service: Offer financial incentives and scholarships to mental health professionals who commit to working in underserved rural areas for a set period.
2. Leveraging technology is essential to bridge the vast geographical divide.
Strengthening Tele-MANAS: The National Tele Mental Health Programme (Tele-MANAS) is a flagship initiative. It must be expanded to cover all districts with a focus on providing quality, multilingual tele-counseling. The new mobile app should be promoted and integrated with other digital health services.
Encouraging the development and regulation of AI-based mental health solutions that can provide preliminary screenings and self-help tools, freeing up human professionals for more complex cases.
Promoting digital literacy: Conduct campaigns to increase mental health literacy and digital literacy, ensuring people in rural and remote areas can access and effectively use these online services.
3. Increasing community-based care: Moving beyond large, centralized mental hospitals is crucial for accessible, stigma-free care.
Integrating mental health programs in primary healthcare programs
Establishing community clinics: Strengthening the District Mental Health Programme (DMHP) to ensure every district has a well-functioning 10-bedded inpatient mental health facility and a strong network of satellite clinics at the community and primary health center levels.
Collaborating with non-governmental organizations (NGOs) and training community volunteers and peer counsellors to provide support and rehabilitation services. This model, based on the successful Bellary model, can be highly effective in community settings.
4. Funding: Without adequate resources and strong policy, no infrastructure plan can succeed.
Increased budgetary allocation: Despite the high burden of mental illness, the government's budget for mental health remains very low. A significant increase in funding is required for training, infrastructure development, and awareness campaigns.
Ensuring insurance coverage: While the Mental Healthcare Act, 2017 mandates insurance coverage for mental illnesses, stricter regulations are needed to ensure insurers comply and that the coverage is comprehensive and not just for hospitalization.
Implementing workplace policies: Mandating mental health policies in workplaces, including access to employee assistance programs (EAPs), mental health days, and stress management workshops. This not only supports employees but also builds a culture of wellness.
Thus, strengthening India’s mental health infrastructure requires a multi-faceted approach. The current strategy, which includes the District Mental Health Programme (DMHP) and digital initiatives, is a good start, but needs to be scaled up and integrated more effectively into the general healthcare system.
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