Author- Piyush Chaudhary

Mental Health Crisis in Rural India: Challenges and Policy Recommendations

Abstract

Mental health is a crucial yet often neglected aspect of healthcare, particularly in rural India. Globally, mental disorders affect approximately 10% of the population, yet 70–80% of those affected individuals do not receive proper treatment due to inadequate healthcare infrastructure, stigma, and a severe shortage of mental health professionals (National Mental Health Survey [NMHS], 2016). The rural-urban divide further exacerbates this crisis, leaving millions without the necessary support. This article explores the disparities in mental healthcare between urban and rural India, evaluates existing policies and their challenges, analyzes successful interventions, and provides evidence-based recommendations to bridge the treatment gap in rural India. 

Introduction

India is the country who lived ages into superstition where a basic mental health issue has been overlooked as some madness of cat leg or poured into ghosts. A country where the outlook of panic attacks seems like a drama. No doubt positivism and urbanization has changed phenomena but what about the context of rural areas? Does urban policy work for rural areas or do they need different policies? The prominent reason could be counted as the different context of rural areas . The lack of awareness, traditional beliefs attributing mental disorders to supernatural causes, and insufficient government intervention further contribute to the mental health crisis in rural areas which demands special attention (Kumar, 2020).  Mental health is a critical determinant of overall well-being, yet it has been historically neglected in India, particularly in rural areas. Despite mental health disorders affecting a significant portion of the population, most people in rural regions lack access to proper diagnosis and treatment (Government of India, 2016). The NMHS (2016) reported that 10.6% of Indian adults suffer from mental disorders, with higher prevalence in urban metro areas (13.5%) compared to rural regions (6.9%). However, this lower reported prevalence in rural India is more likely due to underreporting, social stigma, and inadequate healthcare access rather than an actual lower burden of disease (Pallab, 2023). Even  Seeking help for mental health issues in rural areas is often met with six major barriers, as identified by researchers are : Fear of societal stigma, Lack of awareness and knowledge about mental health. Myths and misconceptions (e.g., fear of being possessed),  Reliance on prayers and magic for healing, lack of specialized services and providers and Economic constraints. As per the National Mental Health Survey 2015-16, common mental disorders such as depression, anxiety and substance use disorders affect nearly 10 percent of the Indian population. However, facilities to treat such disorders are mostly found in the district hospitals or a private practitioner in the nearest urban hub or medical college.

Defining Mental Health

Mental health is defined by the World Health Organization (WHO, 2023) as a state of well-being in which an individual can cope with daily stresses, work productively, and contribute to their community. In common language it is often referred to as state free of mental disorders. Mental disorders involve disturbances in cognition, emotion, or behavior, and include conditions such as depression, anxiety disorders, schizophrenia, and bipolar disorder (National Institute of Mental Health [NIMH], 2022). These conditions arise due to multiple risk factors, including genetic predisposition, environmental stressors, and substance abuse (Venkatesha Reddy, 2021). Poverty, violence, and social isolation further contribute to the worsening mental health conditions in rural communities (Yadav et al., 2018). The lack of trained professionals and limited healthcare infrastructure in these areas significantly reduces access to treatment and rehabilitation services (George, 2021).

Mental Health Status in India

Mental, neurological, and substance use disorders account for over 10% of the global disease burden, but about 85% of individuals in low-income and middle-income countries lack access to treatment. Being a middle income country India faces a significant burden of mental health disorders, with approximately 56 million people suffering from depression and 38 million from anxiety disorders (WHO, 2017). Despite this, only 15–25% of affected individuals receive any form of treatment (The Hindu, 2020). The treatment gap is particularly severe in rural areas, where healthcare services are limited, and cultural barriers discourage individuals from seeking medical help (GOI, 2016). According to a national survey, the mean duration of untreated psychosis in rural India is 3.15 years, significantly higher than in urban areas (Sudha, 2022). Substance abuse is also more prevalent in rural communities, with alcohol and tobacco dependence being major contributors to mental health deterioration (National Survey on Drug Use, 2019).

Mental Health in Rural India

People living in metropolitan cities in India have better access to appropriate mental health care through psychologists and psychiatrists compared with those in rural India. The mental health of those living in rural India is worsened due to additional factors as argued ago, such as illiteracy, poverty, poor education around mental health, little exposure to modern medicine, and stigma and lack of support from religious groups regarding mental health disorders. The rural-urban divide in mental healthcare is evident in multiple dimensions, including accessibility, infrastructure, and cultural attitudes. While urban areas have specialized mental health professionals and institutions, rural regions rely on under-equipped primary health centers (PHCs) and informal support systems (Shields-Zeeman, 2021). In many villages, mental health issues are still attributed to supernatural causes, and traditional healers or religious interventions are sought instead of medical treatment (The Lancet, 2023). Economic insecurity, unemployment, and outward migration contribute to rising anxiety and depression among rural populations (Tugnawat et al., 2021). Suicide rates, particularly among farmers, are alarmingly high, with studies showing that 82% of individuals who attempted suicide had undiagnosed mental disorders (Sivakumar et al., 2020). The lack of awareness and low literacy levels further prevent people from seeking professional help (Shields-Zeeman, 2021) therefore, the goal should not be the “universalization” of services.

India’s public health system continues to fall short in serving rural and remote populations, with mental health facilities disproportionately concentrated in major cities. The integration of mental health services into the public health sector is significant neglected, hindering the development of a community mental health system in India. Public mental health education, recognized for improving mental health literacy, dispelling ignorance, correcting faulty beliefs, and promoting help-seeking behaviors, is crucial to curb mental health morbidity in rural areas. Addressing the uncrystallized and diffused information held by the rural communities requires educational initiatives such as state-level awareness programs, mass media campaigns, talks in schools, and organizing rural awareness camps to address the myths and misconceptions embedded in their system.

Existing Policies and Challenges

India is making steady progress in mental healthcare with initiatives like PM-JAY, which helps poor families afford hospital care, and the Ayushman Bharat Digital Mission, which aims to create digital health records for better treatment and research. But healthcare isn’t just about policies—it’s also about people. In many rural areas, mental health is still deeply tied to traditional beliefs, making community involvement essential. When local experts and stakeholders help shape policies, like they did with the Mental Healthcare Act (MHCA), solutions become more practical and widely accepted. Similar efforts are needed, especially for groups like adolescents who require specialized care. Inspired by global efforts like the WHO Special Initiative for Mental Health, India’s mental health programs are moving in the right direction, but the key to real change lies in working together, prioritizing research, and ensuring care reaches those who need it most. ( The lancet, 2023) 

Even the  biggest challenges in rural mental health care include universalization , barriers in seeking help , human resource gap , limited infrastructure, insufficient funding, and a severe shortage of trained mental health professionals (Kumar, 2021). Social stigma and cultural beliefs prevent individuals from seeking medical help, further widening the treatment gap (Rahul Mathur, 2020). Additionally, poor integration of mental health services into primary healthcare and an overburdened public health system contribute to fragmented care (Sudha, 2022).

Case Studies of Successful Interventions

Despite these challenges, several initiatives have shown promise in addressing mental health issues in rural India. In Haryana, a pilot program trained Accredited Social Health Activists (ASHA) workers to identify and support individuals with common mental disorders (CMDs). While the program improved awareness, it faced resistance due to social stigma (George Institute for Global Health, 2020). In Odisha, community engagement initiatives successfully challenged superstitions that attributed mental illness to black magic, leading to increased acceptance of medical treatment (Shields-Zeeman, 2021).

A notable intervention in Andhra Pradesh, the SMART Mental Health Model, involved training ASHA workers to screen and refer to individuals with mental health conditions. The program significantly improved early diagnosis and treatment outcomes (Maulik, 2021). In Madhya Pradesh, mobile mental health clinics were introduced to provide psychiatric services in remote villages, helping bridge the accessibility gap (Tugnawat et al., 2021). All of it could be implemented at the national level after seeing its glorified success. 

Recommendations

A comprehensive policy framework must be informed by an in depth understanding of the root causes of rural mental health challenges. The causes behind poor mental health in rural India are: Fear of societal stigma, lack of awareness and knowledge in mental health service, Mad fear, Prayers and magic to cure mental health disorder, Unavailability of specialized services and providers and economic conditions. And to improve mental healthcare access in rural India, a multi-sectoral approach is necessary. 

Firstly there is a lack of mental and general health-care services in both government and private sectors. Therefore, de-professionalization as well as de-centralization of mental health care is the need of the hour. We have to develop it by  moving away from an urban centric model. We can implement it the same way we developed local self government. We should integrate psychiatric care into primary health services (PHCs) and Community Health centers (CHCs).  Also we have to focus on educating ASHA workers, teachers, and local leaders to provide mental health first aid.  Furthermore, “Traditional healers” should be incorporated into the mainstream of mental health delivery, as the first step of de-professionalization of services.

Also the “pathway to care” is long and complicated and the first contact with specialized services is delayed because of stigma, poor knowledge, inherent faith in traditional and alternative medicine, and lack of immediate access to specialized services. Community leaders can be used as an effective resource for facilitating service delivery to the unreached rural population. Engaging and educating community health workers, teachers, and other stakeholders can be an effective step to enhance mental health awareness holistically.

Despite the existence of community health centers and mental health services, the “realized access,” an indicator of “actual service” utilization, remains quite low. In rural areas, we found people preferred visiting their areas of faith, for example, Mehandipur Balaji Temple, even with the long distance, due to the enhanced “perceived benefits” from temple visits. Therefore, service providers should prioritize addressing “felt needs” and overcoming potential barriers like a lack of faith in the practice of medicine. Prioritizing internal resources and addressing culturally determined rationales emphasize the importance of aligning mental health initiatives with local needs and cultural context. Educating them with the right reasoning might help here. 

Additionally, Telepsychiatry is recognized as a cost-effective means of expanding treatment options, particularly in rural and remote areas. It enables individuals to receive psychiatric services within their communities, addressing issues related to geographical distance and limited access to mental health professionals. While telepsychiatry may face challenges in terms of low acceptability, it is considered a valuable alternative. The use of telepsychiatry services, even with potential reservations, is seen as a better option than having no service at all. This approach helps bridge the gap in mental health-care accessibility, especially in areas where traditional in-person services are limited.

To bridge the mental health gaps, there is a call for a paradigm shift from the current “biomedical model” to the “ethnographical model.” In addition, addressing the scarcity of mental health professionals, particularly the uneven distribution favoring urban areas, is important for comprehensive mental health care nationwide. The mandatory 3 months district residency posting for the postgraduate trainees by the National Medical Commission is a positive step toward promoting mental health education in rural communities. Primary care psychiatry teaching in rural areas should extend beyond diagnostic or therapeutic skills, incorporating leadership and administrative training to enhance their community mental health competence.

Also there is very little scope in psychology study and India doesn’t have enough human resources and also there is no scope of research which needs to be addressed. Funding and motivating policy could work there. Along with that India needs Targeted policy for the intervention,  because in various surveys the demography has been divided into various categories like Gender, Age, Occupation, Education and all of them deserve attention according to their need. Generalized policy could not work as a solution because their context is different and so they deserve special attention. 

Further, the Digitization Policy needs an hour. It works in two ways by decentralizing mental health services and providing access to anywhere in the world. Although Ayushman Bharat has been developed, it still lacks implementation. However, the success of  Maharashtra’s Atmiyata app motivates us to work towards Digitization.  It divides people with emotional stress and common mental health problems & People with severe mental illness. Which further helps in targeted intervention. 

In short, India needs a holistic multilayered policy for this.  Expanding gender-sensitive mental health programs by training female health workers and establishing women’s mental health collectives can help address the unique challenges faced by women in rural areas (Shields-Zeeman, 2021). While increasing awareness campaigns through community engagement and mass media can help reduce stigma and encourage help-seeking behavior (Rahul Mathur, 2020).  Also, Strengthening mental health infrastructure by integrating psychiatric services within PHCs and deploying mobile mental health units can ensure wider coverage (Kumar, 2021). Finally, leveraging digital health solutions such as telepsychiatry services, along with improving internet connectivity in rural areas, can bridge the gap in mental healthcare accessibility (National Mental Health Programme, 2022).

Conclusion

Mental health in rural India is still a deeply overlooked issue, with stigma, lack of awareness, and poor healthcare facilities preventing people from getting the help they need. While policies like the Mental Healthcare Act (2017) and Ayushman Bharat aim to improve access to care, the reality is that many villages remain underserved. The struggle isn’t just about medical treatment—it’s also about breaking cultural barriers and making mental health a priority at the grassroots level. However, successful initiatives in Andhra Pradesh, Odisha, and Madhya Pradesh show that real change is possible when communities are actively involved. Moving forward, the focus should be on bringing mental health services closer to people, using technology to bridge the gap, training local health workers, and ensuring that mental health is treated as an essential part of overall well-being, not just an afterthought. With the right mix of policy, awareness, and community support, India can create a future where mental healthcare is accessible to everyone, no matter where they live.

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