Med Student Mental Health Plan Needs More Than Guidelines: NIMHANS Researchers

India’s plan to address mental health among medical students is an important step, but experts warn that its success will depend on what happens beyond the guidelines — who will fund it, implement it and monitor it.

Researchers from Bengaluru’s National Institute of Mental Health and Neuro Sciences (NIMHANS) have flagged gaps in manpower, funding, timelines, accountability and monitoring that could leave the recommendations on paper unless medical colleges are given the resources and responsibility to implement them.

The concern comes against a worrying backdrop. A nationwide survey of more than 37,000 medical students and faculty found that 27.8% of undergraduate medical students reported a diagnosed mental health condition, while 16.2% reported suicidal thoughts. Among postgraduate students, 15.3% reported a diagnosed mental health condition and 31.23% reported suicidal thoughts.

In an article published in the Indian Journal of Medical Research, NIMHANS psychiatrists Dr Sai Chaitanya Reddy, Dr Manik Inder Singh Sethi and Dr Priyanka Singhal have questioned whether counselling services, mentor-mentee systems, crisis support and duty-hour reforms can work without adequate people, money, clear timelines and institutional accountability.

For a student struggling with depression, anxiety or suicidal thoughts, the problem may therefore be more than finding a counsellor. It could be the fear of being judged, losing accommodation, being labelled “unfit” or not knowing whom to approach safely.

These numbers suggest that distress is not confined to a small group of students who may simply need to “adjust” to medical college.

Independent studies have also reported worrying levels of suicidal behaviour. A 2022 study of 531 medical students in north India found that 19.6% met the study’s threshold for suicidal behaviour. Lifetime suicidal ideation was reported by 20.3%, suicidal plans by 10.3% and suicide attempts by 2.3%; one-year suicidal ideation was 33%. Depression and dissatisfaction with academic performance were among the strongest associated factors.

Another study of undergraduate medical students in western India found a 9% prevalence of suicidal ideation in the preceding two weeks. Academic stress, family-related stress, abuse and relationship-related problems were among the factors associated with suicidal thoughts.

More recently, a 2025 study covering 1,102 undergraduate medical students across Kerala found that 33.7% reported suicidal ideation at some point in their lives, while 15.2% reported recent suicidal ideation. Academic stress, parental pressure over career choices and feelings of discrimination by peers and teachers were among the factors associated with suicidal ideation.

The crisis has also surfaced repeatedly in individual cases.

The 2019 suicide of Dr Payal Tadvi, a postgraduate student at Mumbai’s BYL Nair Hospital, brought allegations of caste-based harassment and ragging into sharp public focus. Her death triggered a wider debate about discrimination and the vulnerability of junior doctors within medical institutions.

In 2026, the death of a first-year postgraduate student at Government Medical College, Surat, again brought allegations of harassment by seniors under scrutiny, with police registering a case after the student’s death.

A decade-long analysis of publicly reported suicides among Indian medical students, residents and physicians found 358 deaths between 2010 and 2019, including 125 medical students and 105 residents.

The NIMHANS researchers cautioned that the figure was based on publicly available reports and therefore could not be considered a complete national count. Academic stress was the most commonly reported reason among medical students, while harassment featured prominently among residents. Only 13% of those reported in the study had sought psychiatric help before their deaths.

For the NIMHANS researchers, therefore, the task force recommendations need to move quickly from broad principles to an operational plan.

The task force has proposed counselling services, awareness programmes, faculty “gatekeeper” training, mentor-mentee systems, crisis intervention mechanisms, regulation of duty hours and stronger institutional support.

But who will provide the counselling? Who will train faculty? Who will monitor duty hours? And what happens when a medical college simply does not have enough doctors, counsellors or money?

The NIMHANS team has suggested a phased approach, with immediate measures within six months, near-term interventions over six to 18 months and broader systemic reforms over 18 to 36 months.

Some measures could begin almost immediately — displaying Tele-MANAS information, introducing gatekeeper training and ensuring regular mentor-mentee interactions. Recruitment of counsellors and creation of mental health and wellbeing committees could follow, while longer-term reforms would have to address staffing, duty hours, funding and national monitoring.

One of the most sensitive concerns raised by the researchers is what happens when a student discloses mental health difficulties.

In some institutions, they fear, students may be asked to leave the campus or hostel rather than being assessed and supported. That can send a dangerous message: do not tell us that you are struggling.

The NIMHANS experts stress that having a mental health condition does not automatically make a student unfit to become a doctor.

Dr Singhal said a student should be assessed properly, particularly where clinical competence may be affected.

“Where a condition affects clinical competence, a proper fitness-to-practise assessment is necessary because patient safety cannot be compromised,” she said.

But that assessment should come after evaluation and treatment — not as an automatic consequence of seeking help.

This distinction is crucial. A student undergoing treatment for depression or anxiety may still be able to study, attend classes and practise medicine safely with appropriate support and monitoring.

Excessive working hours remain another major concern.

The task force has recommended regulating duty hours, but the NIMHANS researchers warn that simply putting a ceiling on working hours will not solve the problem if hospitals do not have enough manpower.

“If staffing levels remain unchanged, reducing hours for one group could merely shift workloads to another or create gaps in patient services,” said Dr Sethi.

The researchers have therefore suggested standardised duty rosters, trainee self-reporting and periodic audits.

That means colleges should be able to demonstrate how many hours residents actually work, rather than merely having a written duty-hour policy.

The issue also extends to faculty. Doctors who become teachers may be excellent clinicians but may receive little formal training in teaching, assessment or recognising mental health problems in students.

The NIMHANS team has suggested mandatory training for new postgraduate doctors entering teaching roles.

Faculty wellbeing also cannot be ignored. An exhausted teacher may find it difficult to recognise distress in a student or respond patiently when a student needs help.

Digital mental health services can make it easier for students to seek help anonymously, particularly when they fear approaching someone within their own institution.

But the NIMHANS researchers caution against treating a helpline as a complete mental health system.

“Tele-MANAS may provide an important entry point for students who hesitate to approach someone within their institution, but students with ongoing difficulties may require repeated assessment, academic accommodation, mentoring and follow-up.”

What they meant was that a phone number can open the door, but someone still has to walk the student through it.

When asked to comment, Dr Manish Jangra, founder of the Federation of All India Medical Association (FAIMA), said the Association agrees with the NIMHANS researchers' concerns.

He said the task force’s recommendations were an important step but would have little impact unless they translated into measurable and accountable action in every medical college and teaching hospital.

Dr Jangra said that the FAIMA has called for confidential counselling, trained faculty mentors, crisis intervention and an environment where seeking help does not create fear of academic punishment, stigma or loss of accommodation.

It also agreed that seeking mental health support should not automatically be treated as evidence that a student is unfit to pursue medicine.

At the same time, FAIMA has supported individual fitness-to-practise assessments where patient safety or clinical competence is genuinely affected.

On duty hours, Jangra said reforms must go hand in hand with adequate staffing.

“Simply prescribing maximum working hours without increasing manpower could push the workload on to other residents and faculty or affect patient care,” FAIMA said.

The association has also called for transparent rosters, attendance systems, self-reporting and periodic audits.

Importantly, FAIMA wants medical students and residents to have a voice in how the reforms are implemented.

Policies about their mental health, it said, should not be designed without listening to those who experience the system every day. “Student and resident representatives should therefore be part of institutional mental health and wellbeing committees.”

However, mental health cannot be added to the medical education system as another circular or committee. “It has to become part of the way medical education itself is run," summed up Jangra.