Mental Health In India: Why Policy Reform Must Focus On Empathy

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India’s public health successes like polio, maternal mortality and COVID-19 have followed a similar arc–from a visible threat, to a coordinated response, and measurable reduction. Yet, mental health does not fit this trajectory. Unlike other health emergencies, it does not announce itself with a sudden outbreak, but with quiet signals such as dropping out of school, unexplained fatigue, declining productivity, and suicides relegated to the margins of newspapers. And so, for decades, we have under-invested, under-counted and under-responded to it.

India currently loses about 2,433 years per 100,000 people due to mental illness, measured in Disability-Adjusted Life Years (DALYs), which combine years lived with disability and years lost to early death. With only 56,600 psychiatric beds, 9,000 psychiatrists, and a per capita government spend of just Rs 7.46 on mental hospitals, we are fundamentally unprepared. Such a health system, which is activated only after someone falls severely ill, is inadequate and structurally impossible. In our recent paper, ‘Mental Health in India: The Pathway to Zero’, we used simulation modelling to examine what it would take to meet the population’s mental health needs through treatment alone. To meet the current need, we require nearly 800,000 psychiatric beds, 500,000 psychiatrists, and Rs 20,000 per person annually. By 2040, with the mental health burden projected to rise by 30 per cent, the requirements swell up to over 1,100,000 psychiatric beds, 700,000 psychiatrists and Rs 40,000 per person annually.

These gaps are unbridgeable. No health system can be expected to scale over 20 times its infrastructure, 80 times its workforce, and 5000 times its budget in 15 years. To meet the mental health needs of our population, India must shift from a late-stage, treatment-heavy approach to one that prioritises prevention, early intervention and population-level support.

Mental health develops over time, deeply shaped by early experiences and reinforced or disrupted across a lifespan. It begins at birth with caregiver interactions laying the foundation for emotional development. Epidemiological data consistently show that 50 per cent of all mental illnesses set in by age 14, and 75 per cent set in by age 24. This is the most crucial development window where identity formation and emotional regulation are in active flux. Global evidence increasingly confirms that the earlier we intervene, the more likely we are to influence lifelong trajectories across income, health and overall well-being.

Biological predisposition can increase vulnerability to mental illness. Conditions such as schizophrenia, bipolar disorder and ADHD exhibit high heritability, especially among individuals with a close family history. Yet, genes are not destiny. As our paper shows, targeted interventions like responsive caregiving, early stimulation and structured support can meaningfully reduce lifetime risk, even among high-risk children. Children exposed to trauma, such as neglect, violence, or parental substance use, face sharply elevated risks. Adverse Childhood Experiences (ACEs) are among the most well-established predictors of later mental illness. Children with four or more ACEs are up to 12 times more likely to attempt suicide and may lose as many as 20 years of life expectancy. This is comparable to a person living with severe, untreated schizophrenia.

Scientific evidence makes clear that these are not abstract probabilities, but early signals, pointing to preventable pathways when addressed from the very beginning.

Prevention Begins at Home, School and Community

In our review of over 300 global interventions, we identified a first set of 16 programmes with strong evidence, high feasibility and immediate scalability through India’s existing systems. These interventions do not require reinventing the wheel. They build on programmes we already have in anganwadis, schools, apprenticeship schemes and community health policies. These programmes focus on strengthening three foundations—early resilience, structural protection and supportive environments.

Early resilience programmes focus on the children in the setting of their caregivers, teachers and employers. They aim to promote the development of non-cognitive skills that shape how young people respond to stress, including traits like emotional regulation, self-esteem and pro-social behaviour.

Structured, nurturing daycare offers a safe space for young children, especially in homes affected by violence or mental illness. It also reduces maternal depression and household stress. Coaching caregivers in responsive parenting and play-based learning in the home environment has long-term effects on cognitive, emotional and behavioural development.

Programmes such as ‘Girls Arise!’ that teach adolescent girls how to negotiate within restrictive social norms show improvements in mental health, school attendance and agency. The Good Behaviour Game (GBG) is a classroom-based strategy that teaches emotional regulation and cooperative behaviour. Studies show that children exposed to the GBG have lower rates of substance use, violence and suicidal ideation well into adulthood. For adolescents, short-term exposure to structured work such as internships reduces anxiety and feelings of aimlessness. Especially in contexts of high youth unemployment, such programmes can build identity, agency and future orientation.

Structural Protection: Reducing Exposure to Harm

Economic insecurity and social exclusion are major drivers of poor mental health. For young people, the lack of jobs or education disrupts identity and increases anxiety. Women face added risks from limited autonomy and unsafe work. Marginalised communities—Dalits, Adivasis, LGBTQIA+ individuals, and women—often experience lifelong discrimination, worsening stress and limiting care. And yet, we do not need to solve every dimension of inequality to make meaningful progress. Programmes that offer structure, build identity and create safer, more inclusive environments have already shown promise in restoring agency and improving mental well-being.

One of the few large-scale programmes with documented impact on mental health, the National Rural Employment Guarantee Scheme (NREGS), has been associated with a 12 per cent reduction in depression in rural households. Basic economic certainty and its dignity-based framing reduce exposure to stress.

Urban design interventions such as play streets, safe alleys and green areas create environments that reduce stress and promote social interaction, especially in dense, low-income neighbourhoods.

Anti-bullying programmes are needed in schools, colleges and workplaces. KiVa, an evidence-based school programme from Finland, has shown measurable reductions in bullying and anxiety. Its success lies in changing group norms, not just disciplining individuals. Equipping teachers to recognise and respond to trauma can transform school environments. Such approaches reduce punitive discipline, improve peer relationships and support kids living with chronic adversity.

Gender-transformative interventions such as ‘Unite for a Better Life’ that address intimate partner violence also lead to improvements in women’s mental health and self-worth.

Supportive Environments: Inclusion Across the Life Course

Mental health is shaped both by what happens to us as well as the systems we are embedded in. This means prevention is not limited to childhood. For older adults, social isolation and loss of identity can be profound stressors. Programmes such as ‘Experience Corps’, which engage older adults in community service, show improvements in cognitive function, mood and purpose.

To test the effects of scaled prevention, we developed a simulation model. Using India’s current mental health burden of 2,443 DALYs per 100,000 people, we projected the long-term impact of implementing 16 high-impact programmes across the prevention pathway and six across the recovery pathway. Our findings show that these interventions could reduce the national burden to just 600 DALYs per 100,000 by 2040—a 75 per cent decline. Notably, nearly 70 per cent of this impact comes from preventive programmes rooted in early childhood, education, workplaces, and communities.

To close the gap further, from 600 to zero, we identified 39 additional interventions targeting more complex conditions and harder-to-reach populations. These include structural supports like universal housing and universal basic income, precision tools like digital therapy and genetic risk profiling, and identity-based supports like trauma care. These interventions are not all system-ready and requires more research and policy reform. But together, they chart a path toward a mental health system that is scalable and inclusive.

Prevention is Not the Absence of Care

A prevention-first strategy does not mean turning away from those already in distress, but rather expanding the existing care ecosystem. It allows us to intervene earlier, reduce the number of people who fall through the cracks, and ease the pressure on an already overstretched health system. It creates room for our limited psychiatric capacity to be used where it is most urgently needed, while also equipping caregivers and frontline workers with tools that are effective, scalable, and grounded in evidence.

This does not mean recovery is any less important. We still need strong clinical protocols, collaborative care models, and long-term community-based services for people living with severe mental illness. But we do not need to wait for a system to respond only after a crisis.

To deliver prevention at scale, we must invest in the architecture that can sustain it. We propose the creation of three national institutions that together reimagine mental health as a shared public responsibility. The first is a Sentinel Network for Mental Health, a real-time surveillance system that combines clinical indicators with digital signals, such as search trends and social media patterns, to track emerging distress and misinformation. The second is a Centre for Public Mental Health, a policy and design initiative tasked with embedding mental health into upstream systems such as employment, urban planning, and education. The third is a Centre for Mental Health Treatment and Recovery, focused on developing collaborative care protocols, training non-specialist providers, and scaling recovery solutions that reach people where they live. Together, these centres move mental health out of the margins and into the mainstream, connecting care to the context and prevention to practice.

In our paper, “zero” is not a claim that distress can be eliminated. It is a design principle to reimagine the mental health system to start earlier, act faster, and reach further. It calls for shifting from crisis response to upstream prevention, from narrow clinical pathways to broader structural support. Our simulation shows that we can reduce the burden by 75 per cent using interventions that already exist through programmes embedded in homes, schools, streets, and workplaces. For the remaining gap, we need to build precision tools, invest in harder-to-reach populations, and design systems that are supportive and inclusive. Mental health policy must move beyond treatment to include prevention at every level. We need to act now because the longer we wait, the harder and costlier the journey becomes.

Nachiket Mor is a Visiting Scientist at the Banyan Academy of Leadership in Mental Health & a Visiting Prof. at the Indian School of Business

Iti Bhargava is a mental health researcher based in Bangalore

In its August 21 issue, Every Day I Pray For Love, Outlook collaborated with The Banyan India to take a hard look at the community and care provided to those with mental health disorders in India. From the inmates in mental health facilities across India—Ranchi to Lucknow—to the mental health impact of conflict journalism, to the chronic stress caused by the caste system, our reporters and columnists shed light on and questioned the stigma weighing down the vulnerable communities where mental health disorders are prevalent. This copy appeared in print as Prescription: Empathy.