For India's Families Caring for the Mentally Ill, an App Was Never Going to Be Enough
By Arunima Rajan
Dr Jyoti Kapoor is a psychiatrist at Maarga Mind Care. Kapoor tells Arunima Rajan that our healthcare system does not address recovery and focuses only on managing symptoms of mental illness.
India's treatment gap sits between 70 and 92% depending on the condition. In your experience, how often does a patient reach clinical stability but still fall through the system before reaching real recovery? What does that gap look like on the ground?
The problem facing India in terms of mental health is not merely the treatment gap of 70%–92% discussed by WHO and the NMHS, but also a recovery gap. In practical medicine, a substantial number of patients manage to achieve symptom stabilisation, but still fail to resume normal functioning or employment, or maintain relationships or independence. This is what the gap is all about - the "gray zone" that can be seen quite frequently in conditions such as schizophrenia or bipolar disorder.
In real life, those are people who do not relapse anymore, but are far from being healthy, usually dependent on their family, having cognitive and social deficits, and prone to relapse. It appears that our system does not address recovery, and focuses only on managing the symptoms.
AI-driven tools are increasingly positioned as front-door entry points to mental health care. At what point in a patient's journey, if at all, do these sorts of tools have a legitimate role?
These types of AI technologies do have a valid place within the treatment continuum as an initial point of contact for screening, psychoeducation, and managing mild-to-moderate cases of psychological distress, especially within a health care system where up to 70%-92% do not receive appropriate care as highlighted by the World Health Organization and the National Mental Health Survey. There certainly comes a time where AI-powered solutions are no longer effective due to the presence of suicidal thoughts, psychoses, impaired functioning, and other complexities where only clinician intervention will suffice. The benefits provided by these solutions are mainly seen among low-risk patients. Therefore, their use must come before transitioning the client into clinician-led care through a stepped-care process.
Research shows that AI chatbots demonstrate small-to-moderate effects on depression and anxiety and are effective or useful for low-to-moderate issues, but Maarga treats complex psychiatric conditions, including schizophrenia, bipolar, and PTSD. Where precisely is the clinical floor at the point at which a chatbot or digital tool must hand over to a psychiatrist who decides that? Is the Indian system currently equipped to manage their transition?
While there seems to be merit to using AI chatbots in the case of moderate mental health issues, the clinical threshold gets crossed in severe, risky, and/or complex scenarios that involve suicidality, psychosis, manic states, marked functional impairment, or even disorders like schizophrenia, bipolar disorders, or post-traumatic stress disorder.
At such a point, digital means should transfer these cases to the care of clinicians and psychiatrists, which will help provide specialised, patient-centered care along with multiple forms of intervention that algorithms simply cannot provide at present.
Ideally, this process should depend on pre-defined risk evaluation processes that form a part of the software itself. However, this may also depend on the clinical perspective.
Unfortunately, the Indian context still lacks such an integrated framework, making it difficult for any such process to flow seamlessly from one level to another.
Hospital CXOs across India have not yet formally answered what their institutional role is when a patient's first contact with the mental health system is tech rather than a clinician. If digital tools become the primary response system or the primary triage layer in India, what does it mean for hospitals like Maarga? Does it increase your patient volume, change the complexity of who arrives at your door, based on your personal experience?
Since these devices will become the initial contact point in increasing numbers, they are beginning to change how hospitals like Maarga Mind Care operate. Instead of acting as the main entrance points, hospitals are starting to play the role of second and third-level care providers. In doing so, they may be expected to see an increase in the number of patients.
However, this would come together with an increase in the severity of conditions. Research shows that there is a chance of seeing less patients coming in with minor symptoms but more with severe conditions that could have been diagnosed earlier or not triaged properly, meaning that by the time of arrival at the hospital, their situation becomes much more complicated.
Is mental health tech in India genuinely increasing access to care, or is it filling a gap for people who already had access, while those who truly cannot remain invisible?
Though there has been an increase in access through mental health technology, the distribution has been uneven; it mainly reaches people who are technically savvy and knowledgeable enough. Studies have shown that those suffering from mental disorders find it hard to interact with such technology due to cognitive problems, poor self-awareness, and lack of technology accessibility.
In cases of severe conditions like schizophrenia and bipolar disorders, patients need in-person visits to mental health practitioners in India, where families act as the primary care providers followed by medical intervention from clinicians.
Thus, technology can only offer aid at the initial stage; the rest of the process still requires physical interventions.
Your program, the Integrative Day Care Program, uses a proprietary cognitive-motor-sensory CMS integration model combining therapy with music, yoga, expressive arts, and a structured routine. This is explicitly relational care. What has your clinical team observed that this is something that tech cannot replicate? It is not exactly a criticism of tech, but it is a way of showing that there is value in in-person psychiatric care.
The phenomenon that our team notices repeatedly is that recovery, particularly for complex psychiatric disorders, involves deep connections with others and within one’s body; this is a process that is difficult to reproduce with the current level of technological development. In integrated treatment, the healing occurs through processes such as joint presence, nonverbal communication, and co-regulation which extend beyond mere symptom monitoring.
Studies show that the strength of the therapeutic alliance in terms of trust, attunement, and affective engagement predicts outcomes. Day treatment centers combine routine structure, music, yoga, and creative expression to provide an embodied experience that restores motivation, social rhythm, and self-identity.
These are not techniques; these are relational experiences. Technology can help patients get easier access and earlier treatment; however, the process of recovery requires being seen and heard by others.
How does a digital-first or app-based mental health ecosystem account for, or fail to account for, the family unit in the Indian psychiatric recovery?
In India, the process of mental illness recovery is strongly centered on the family unit. Patients, especially those within the so-called 'recovery gap', may be physically healthy, yet require intensive familial assistance to function normally. Although digital technology may provide psychoeducational information, it is built around the individual and does not consider caregiver strain, family interaction dynamics, or even the modes of communication between members.
These are significant shortcomings. Evidence suggests that family participation increases the chances of successful therapy and relapse prevention, especially in complex conditions such as schizophrenia and bipolar disorders. However, digital systems do not provide opportunities for collective comprehension or guided participation from family units.
Conversely, face-to-face interaction provides practitioners with direct means to monitor, engage, and help families, ultimately decreasing strain and improving communication.
For the hospital CXOs making decisions about the digital health investments and mental health infrastructure, what is the one thing that the hospital system must do right now that it is not doing?
What hospital organizations should definitely achieve right now is creating an integrated stepped-care pathway encompassing primary care, use of technology, and psychiatric specialists. Nowadays, there is no integration: patients are being referred from applications to general practitioners to hospitals without any coordinated approach.
Organizations like Indian Psychiatric Society and World Health Organization advocate for integrating mental health interventions into primary care and promoting task-sharing. This means that healthcare providers should be trained to conduct basic mental health assessments; use of applications is encouraged as a means of screening and tracking symptoms while clinical judgment will be preserved by mental health professionals.
It can be assumed that such disintegration causes not only delays and inappropriate referrals but also untreated mental disorders among the Indian population.
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