- Kerala, often hailed for its social development model, is facing the double-edged consequences of its demographic success.
- Kerala’s mental health challenges are starkly reflected in its suicide statistics
- Mental health issues in Kerala are not limited to the elderly.
Anoop, a small-time businessman from Ernakulam, once led a contented life with his wife, children, and an elderly mother-in-law. Known for his active involvement in village sports and community activities, Anoop’s life took a difficult turn when his mother-in-law, in her 70s, began displaying signs of memory loss and erratic behaviour. With no one to care for her during the day and fearing for her safety, Anoop was left with no choice but to confine her to a room. His work suffered, his social life collapsed, and the family’s financial health deteriorated.
Anoop’s story is not an isolated case—it mirrors a growing and urgent social and public health challenge in Kerala: the mental wellbeing of the elderly.
Kerala, often hailed for its social development model, is facing the double-edged consequences of its demographic success. According to the Population Projection for India and States (2011-2036), 16 per cent of the state’s population is over the age of 60—the highest in the country. Compounding the problem is Kerala’s Total Fertility Rate (TFR), which stands at 1.8 (NFHS 2019-21), well below the replacement level. This means that while the number of the elderly is steadily rising, the pool of young people available to care for them is shrinking.
This demographic inversion creates a situation where the ageing individuals are increasingly left alone, without adequate family or community support.
A 2018 study titled “Prevalence of Dementia in an Urban Population, Kerala-India” revealed that 34 out of every 1,000 elderly persons in Kerala suffer from dementia. National estimates put this figure at 7.4 per cent among adults aged 60 and above. Experts warn that these numbers are just the tip of the iceberg.
“Depression and social withdrawal are often dismissed as normal signs of ageing,” says Jino Joy, consultant geriatrician at the Medical Trust Hospital, Kochi. “But these are symptoms of geriatric mental illness. Without intervention, these conditions worsen and become a social crisis,” he says.
This was exactly the experience of Dinesh Kumar, a schoolteacher in Kannur, whose 75-year-old father―who was already diabetic and hypertensive―gradually slipped into isolation. “He stopped speaking, barely responded, and slowly forgot our names and faces,” recalls Dinesh. Routine medical visits failed to address the underlying issue until it was too late.
Along with demographic changes, a key factor in the crisis is the migration of youth to European countries and the US. As younger generations leave for better opportunities, parents and grandparents are left behind. According to Jino Oomen, visiting faculty at the International Institute of Migration and Development, the “social cost of migration is extremely high in Kerala”, especially in the southern districts.
“The 2018 floods exposed how vulnerable our elderly are when they live alone,” says Oomen. “We need a serious academic study of the mental health implications of migration and urgent policy responses,” he adds.
Encouragingly, some local initiatives are stepping in where traditional systems have failed. The Active Ageing Centre, started by Jose Jolly Pyanadath, is said to be the first of its kind in India. It offers non-pharmacological therapies like art, theatre, and group interaction sessions for elderly individuals with dementia and other cognitive challenges.
“While dementia cannot be reversed, structured engagement helps patients and carers live more meaningfully,” says Pyanadath. “We’ve seen remarkable improvements through interactive theatre workshops and regular community gatherings,” he adds.
Joy also echoes the need for community-centric infrastructure: “Panchayat-level elderly activity centres and shared living spaces can create social safety nets. This is no longer a job just for doctors—society as a whole must adapt to the changing social reality.”
Mental health issues in Kerala are not limited to the elderly. The National Mental Health Survey (2015-16) found that 11.36 per cent of the population suffers from various mental disorders. Children and adolescents are increasingly affected, with the pandemic and digital overexposure accelerating the trend.
“Children today are living adult lives,” says C. J. John, a senior psychiatrist. “Addiction to mobile phones, outdated teaching methods, lack of socialisation, and poor parenting have created a perfect storm. Lack of financial discipline and consumerist culture are forcing people into a debt trap. Mental health issues due to the debt trap are on the rise in the state. Changes in family relationships are another major contributing factor to mental health morbidity,” adds John.
A schoolteacher from Kannur district, on the condition of anonymity, agrees: “After COVID-19, we have seen a spike in attention issues, aggression, and emotional isolation. Though many of the schools have counsellors, most students don’t approach them because of stigma.”
Kerala’s mental health challenges are starkly reflected in its suicide statistics. According to the National Crime Records Bureau (NCRB), suicide deaths in the state rose from 8,500 in 2020 to 10,162 in 2022. Alarmingly, the Global Burden of Disease Report (2016) listed suicide among the top causes for death in the 15-39 age group in the state.
“The problem is we always focus only on immediate triggers like a breakup or financial loss—when a suicide happens,” says Smitha Ramadas, a professor of psychiatry at the Government Medical College, Kottayam. “But the ‘biopsychosocial’ context—personal history, emotional trauma and social pressure—must be studied for meaningful intervention.”
She recommends integrating life skills education into the curriculum to foster emotional resilience, critical thinking, and interpersonal skills among young people.
Kerala has made significant advances in healthcare and boasts of one of the best mental health infrastructures in India, with a dedicated state policy since 2003 and mental health programmes in every district. Yet, the challenges today are more complex, driven by ageing, migration, substance use, digital over-dependency, and family breakdowns.
Experts agree that a holistic and cross-sectoral approach is the need of the hour. Mental health can no longer be seen as the sole responsibility of doctors or psychiatrists. It must become a public concern, integrated into our schools, communities, workplaces, and policy frameworks.
As Kerala transitions into a super-aged society, building a supportive, inclusive, and mentally resilient ecosystem will be its urgent public health imperative.
