More than half a century ago, the World Health Organization declared that there is no health without mental health. The message was widely accepted. The systemic changes it demanded have too often failed to follow.
India has invested heavily in expanding hospital capacity, reducing maternal & child mortality, and combating infectious diseases. Yet one of the country's fastest-growing public health challenges continues to unfold quietly inside homes, schools and workplaces, far from clinical settings and public attention. Mental illness is no longer a marginal concern. It is a development challenge, an economic challenge, and, above all, a human one.
The numbers bear this out with uncomfortable precision. The National Mental Health Survey estimates that nearly one in seven Indians live with a mental disorder at any given time, and the treatment gap remains among the widest of any major health condition. A recent state-specific study in Haryana found that approximately 18% of rural adults and 23% of urban adults report symptoms of common mental disorders, depression, anxiety, stress-related and substance-use conditions. In both settings, the treatment gap runs close to 85%. Most people who need care simply never receive it.
In rural areas, the burden is compounded by agricultural stress and indebtedness, low socioeconomic status, chronic physical illness, and a psychiatrist density of roughly 0.03 per lakh population. Pan India, where services exist at all, are usually confined to the district level. In urban centres, the pressures are different but no lighter work pressure, academic and career stress among the young, screen time, nuclear families and social isolation against a psychiatrist availability of approximately 0.5 per lakh: better than rural areas, but still far short of what the need demands.
Two scenarios, two different sets of stressors, but one common verdict: our mental health system was built for yesterday's challenges, not today's realities. For decades, mental health services in India were built around specialists working in tertiary institutions. That model remains essential for severe psychiatric illness, but it cannot, by itself, meet the scale of today's demand. Expecting every person experiencing anxiety, depression or emotional distress to travel to a medical college or district hospital is neither practical nor equitable. The challenge, therefore, is not merely to expand specialist services but to redesign care around where people actually live. A nuanced focus on our youth is especially important, recognising that their mental health needs range from navigating everyday emotional and social pressures to identifying emerging mental health concerns early and ensuring timely access to appropriate support. Mental healthcare of the future will be built in communities rather than confined to institutions. This vision is now shaping Haryana's approach.
Over the past few years, the District Mental Health Programme has expanded across all districts, integrating psychiatric consultation, counselling and essential medicines within the public health system. Community health centres and primary-level facilities are being strengthened so that early identification, counselling and follow-up become part of everyday healthcare rather than a specialised intervention reserved for a few. Block and PHC-level mental health support, services across medical colleges and major hospitals, and a growing network of trained counsellors and community mental health workers are together meant to make one thing true: seeking help early should no longer require travelling far or waiting long.
But infrastructure alone cannot close a gap this wide. India faces a severe shortage of psychiatrists, clinical psychologists, psychiatric social workers and psychiatric nurses, and building enough specialist institutions will take years the state does not have the luxury of waiting out. Haryana has instead adopted the task-sharing model recommended globally: training medical officers, ASHA and ANM workers, teachers, police personnel and volunteers to recognise common mental disorders, assess suicide risk, provide initial support, and refer complex cases onwards. This does not replace psychiatrists. It frees them to focus on advanced care while common conditions are managed early and closer to home.
Perhaps the most important lesson from mental health research is that intervention must begin much earlier than adulthood. Nearly half of all mental illnesses take root before adolescence; by the time individuals reach their twenties, many disorders have already become entrenched. This makes schools not merely places of education but critical sites of prevention, which is why school and college counselling services, exam-stress support, and life-skills and resilience-building programmes are now treated as core public health infrastructure, not peripheral welfare.
Haryana is taking mental health support directly into schools where timely intervention can make the greatest difference to a child’s well-being, confidence and future. The state has a robust public health network comprising 23 District Civil Hospitals, 50 Sub-Divisional Hospitals and 122 Community Health Centres (CHCs), giving a total of 195 healthcare institutions across the state. Alongside this network are 3,214 secondary and senior secondary schools, creating an average linkage of nearly 17 schools with each healthcare institution.
This extensive network provides Haryana with a practical, scalable and sustainable framework for integrating school mental health services into the existing public health system. Through regular outreach from CHCs and other healthcare institutions, counsellors and medical officers can work closely with schools to promote mental well-being, identify concerns at an early stage, provide counselling, facilitate timely referrals and ensure continued follow-up. In this way, Haryana can build a system where mental health support is not limited to hospitals—it reaches children where they learn, grow and spend some of the most formative years of their lives.
What Haryana is doing differently is that we have merged 470 health department counsellors from different programmes, be it HIV, Mental health, Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), or the de-addiction programme, who regularly visit government schools to help students cope with stress, anxiety and emotional difficulties. They also identify children who may have learning difficulties or developmental conditions such as intellectual disability so they can receive timely assessment and the support they need. Using the existing platform of RBSK, these children are enrolled on the Rashtriya Bal Swasthya Karyakram (RBSK) 2.0 digital platform with ABHA Ids, which enables systematic follow-up, referral to appropriate specialists, and continued monitoring to ensure they receive the healthcare, rehabilitation and educational support they need. By linking schools with nearby CHCs and the RBSK 2.0 platform, Haryana is moving beyond treating illness to recognising problems early and giving every child the best opportunity to learn, grow and reach their full potential.
Technology has also begun to bridge barriers that geography alone could not overcome. Tele-MANAS now provides 24×7 tele-mental health services, crisis counselling, psychological support and follow-up care, reaching rural and remote communities without requiring travel. A confidential phone call has reduced the barriers of distance, cost and stigma that so often keep people from seeking timely care, and similar approaches are now being extended to prisons and other populations that have traditionally remained underserved.
The service's own numbers tell a story of quiet but sustained demand. Tele-MANAS has received a cumulative 17,660 calls since its inception on 10th October 2022; 92.4% of them were initiated directly by beneficiaries, a strong signal of public awareness and trust in the helpline. Most callers, 82%, fall between 18 and 45, underscoring how squarely this crisis sits among the young and the working-age population. Sadness and depression-related concerns account for over a third of all calls, followed by stress linked to exams, work and relationships. Anxiety, substance use and sleep disturbances round out the leading complaints, together making up more than 80% of contacts. A smaller share involve psychotic symptoms or suicidal ideation, which are rarer but demanding urgent, coordinated responses, and a reminder that Tele-MANAS is as much a gateway into the wider mental healthcare system as it is a service in itself.
Mental health also intersects with one of Haryana's most pressing social concerns: substance use, affecting 3.1% of rural and 4.6% of urban adults. Addiction cannot be addressed through law enforcement alone; sustainable recovery requires counselling, long-term treatment, rehabilitation and continued psychosocial support, which is why de-addiction services are being strengthened alongside, not apart from, mainstream mental healthcare.
Stigma still silences families before it silences symptoms. Rural areas remain a challenge. Rehabilitation services need deeper investment, and mental healthcare financing remains modest against the true scale of need. Above all, society must learn to extend to mental illness the same compassion and urgency it already extends to physical illness.
This is why Haryana's Vision 2030 sets out a five-year roadmap building on these foundations: a state-of-the-art Integrated De-addiction Centre at SIMH Rohtak, new 50-bedded de-addiction centres in Ambala, Gurugram and Fatehabad, and expanded treatment across medical colleges, sub-district hospitals and CHCs. It includes District Crisis Intervention Teams and expanded Tele-MANAS Tier-II services for those at risk of suicide or severe distress; halfway homes and community-based rehabilitation for sustainable recovery; a statewide strategy to identify and reintegrate homeless persons with severe mental illness; workplace mental health programmes and stigma-reduction campaigns; and phased expansion of Opioid Assisted Treatment across Primary Health Centres, beginning with border districts where the burden is greatest.
The measure of progress will not be the number of hospitals built or counsellors appointed. It will be whether young people seek help without fear. Whether families recognise distress early instead of after the crisis. Whether communities choose to support recovery over discrimination. And whether every citizen, regardless of geography or income, can access care with dignity intact.
Haryana's Vision 2030 frames this as a mentally healthy state for every citizen, every family, and every community. As India works toward Viksit Bharat by 2047, mental health must move from the margins of public policy to its centre because economic growth, demographic dividend and social progress cannot be sustained if psychological wellbeing is left behind. A mentally healthier society is not merely a healthcare aspiration; it is a precondition for an inclusive, productive and resilient India. And as Haryana's experience suggests, that transformation begins not in specialised institutions alone, but in schools, primary health centres, communities and homes wherever people actually live their everyday lives.
About the Author: Dr. Sumita Misra is an IAS officer currently serving as Additional Chief Secretary, Health & Family Welfare Department, Government of Haryana. A seasoned administrator and acclaimed author, her work weaves together public policy expertise, administrative leadership, and literary expression.
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