As the overcrowded Lohardaga-Ranchi train departed from the Akashi station, a sudden disturbance unfolded. A group of individuals, comprising both men and women, gathered around a woman in her mid-thirties who was seated across from me, absorbed in her phone. Moments later, she was in tears.
The companions of this woman, Aanumati, clarified that they were returning from an 'Ojha,' a traditional healer, as she was undergoing treatment for a condition known as 'Aatma Sudhi,' or spiritual purification. Aanumati, the youngest of three sisters, lost her mother when she was merely three years old. Her father, at 84, works as a daily wage labourer. Following her marriage, her husband lost his job as a salesman at a local shop and migrated to Gujarat, only visiting home once in the past years. Aanumati has completed her 12th-grade education and is now a mother of two, serving as the primary breadwinner for her family by collecting fish from local fishermen to sell in the market. However, the ongoing drought has significantly decreased fish availability, complicating her efforts to sustain her family. In the last few days, her neighbours heard sounds from her house, so they took her for treatment.
Regrettably, Aanumati’s situation is not an isolated case. Mental health issues are frequently overlooked in rural India, where the predominant focus remains on physical health and the burden of diseases. Yet, as we delve into the complexities of rural living, it becomes increasingly apparent that mental health demands urgent attention. According to 'The State of Rural Healthcare-2024,' a report published by the Development Intelligence Unit (DiU), a staggering 45 per cent of individuals regularly experience anxiety and worry, greatly impacting their mental well-being. The report indicates that mental health issues are particularly prevalent among older populations; however, around 40 per cent of younger individuals also report experiencing frequent stress and anxiety, which is a significant concern. This data highlights that mental health disorders do not discriminate based on gender; they equally impact both men and women, emphasising the immediate need for effective interventions in these underrepresented regions.
Anxiety transcends age boundaries, affecting not only adults but also children and the elderly in rural communities. Children and teenagers face increasing pressures from academics, social dynamics, and family expectations, which led many to experience severe stress. This overwhelming anxiety can impede their academic performance and personal development. Conversely, adults wrestle with job insecurity, financial difficulties, and societal pressures that exacerbate their anxiety. Older adults, often isolated with limited access to healthcare, also confront anxiety stemming from health concerns and loneliness. These pervasive issues underscore the necessity of recognising mental health as a crucial aspect of overall well-being in rural contexts and the various factors—from social changes to environmental conditions—that contribute to the ongoing mental health crisis.
In response to the escalating burden of mental health disorders, the Government of India has launched several initiatives aimed at addressing these challenges. Acknowledging the need for comprehensive mental health care, various programs have been instituted at both the national and state levels. The National Mental Health Programme (NMHP), established in 1982, serves as the foundation for tackling mental health challenges in India. Over the years, the NMHP has evolved to incorporate the District Mental Health Programme (DMHP), which seeks to deliver mental health services at the district level, integrating these services into primary healthcare to enhance accessibility and training for healthcare professionals, particularly in rural areas.
The Mental Healthcare Act of 2017 marked a significant advancement in safeguarding the rights of individuals with mental illnesses. It ensures access to mental healthcare for all citizens and underscores the availability of affordable services in government facilities. This legislation also decriminalized suicide and established patient rights, including informed consent and the ability to formulate advance directives for treatment. In acknowledgment of the mental health consequences arising from academic pressure and the COVID-19 pandemic, the Ministry of Education introduced the Manodarpan initiative in 2020, offering psychological support for students, teachers, and parents through counselling services, online resources, and webinars.
In addition, the Central Board of Secondary Education (CBSE) and the National Council of Educational Research and Training (NCERT) have implemented mental health awareness programs in schools, equipping educators to identify and address mental health challenges among students. The KIRAN helpline, a national support service provided by the Ministry of Social Justice and Empowerment, offers early assistance for mental health issues in multiple languages, addressing emotional distress, substance abuse, and other psychological problems. Furthermore, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) now includes mental health services, integrating mental well-being into the broader primary healthcare framework to serve underserved populations. Tele-Manas, a tele-mental health service within the NMHP, provides essential first-line intervention and referral services through a toll-free number.
Despite these initiatives, addressing mental health in rural India remains a formidable challenge. Stigma surrounding mental illness, insufficient access to professional care, and deep-rooted cultural beliefs hinder progress. With approximately 0.75 psychiatrists for every 100,000 individuals—far below the recommended three—there exists a pressing need for a more robust mental health workforce. Additionally, social stigma and a lack of awareness often deter individuals from seeking treatment, while inadequate infrastructure and high costs present further barriers.
Rural regions, in particular, suffer from a lack of mental health resources due to widespread illiteracy, poverty, and misconceptions about mental illness, which frequently lead communities to depend on religious or superstitious remedies rather than scientific treatment methods. Within these contexts, mental health issues may be mistakenly attributed to divine punishment or curses, fostering reliance on non-evidence-based remedies.
To effectively combat the ongoing mental health crisis in rural India, there is an urgent requirement for continued efforts and innovative strategies that engage communities in their mental health journeys. Current models of mental health program delivery can be disjointed, burdening individuals rather than addressing the broader socioeconomic and cultural factors that influence mental health. It is essential to leverage the strong familial and community ties to foster a supportive network for those contending with mental health challenges, promoting a health system that is both accessible and responsive to individual needs.
An optimal approach would emphasise 'Neighborhoods of Care'—an ecosystem that prioritises individuals and families while integrating community resources with healthcare systems. Recognising the interconnectedness of individuals, organisations, and resources is vital for effective mental health management, alongside fostering supportive networks and accessible service platforms. Addressing social determinants of health, such as poor living conditions, lack of clean water, and inadequate sanitation, is also critical. Combining governmental schemes with community-based initiatives will enhance the quality of life while optimising available resources.
By actively tackling stigma, improving accessibility, enhancing service quality, shifting towards community-centric care, safeguarding human rights, and integrating mental health into mainstream healthcare systems, India can make substantial progress in addressing mental health challenges. This comprehensive approach could pave the way for a healthier, more inclusive future for rural communities grappling with mental health issues.
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