Bridging the Mental Health Treatment Gap in India: Cultural Challenges, Regulatory Frameworks, and Innovative Approaches

India faces a substantial mental health treatment gap, with around 10 percent of the population affected by common mental disorders (CMDs) such as depression, anxiety, and substance use disorders, yet over 85 percent do not receive appropriate care (Gautham et al., 2020; NIMHANS, 2014-16). This disparity is often attributed to poor awareness and limited resources, but underlying cultural and systemic factors also play crucial roles. Two implicit assumptions often guide policy: people lack awareness of mental health services, and increased availability would lead to higher service utilization. However, research reveals that CMDs may not be perceived as medical disorders in many Indian communities, affecting care-seeking behaviors (Weaver et al., 2022).

Regulatory frameworks impacting mental health professionals include multiple overlapping Acts, such as the Rehabilitation Council of India Act (1992), the Mental Healthcare Act (2017), and the National Commission of Allied and Healthcare Professionals (NCAHP) Act (2021). The classification of psychology under the broad “Behavioural Health Science Professionals” category in the NCAHP Act has been criticized for being ambiguous and potentially detrimental to mental health service quality (Movement for Psychology Professionals in India, 2021). The psychology community is advocating for a separate statutory council to efficiently regulate all subfields of psychology, establish clear professional standards, and ensure representation at the national and state levels (Movement for Psychology Professionals in India, 2021).

Task-sharing models, training non-specialists like community health workers to provide basic mental healthcare have been expanded in India to address resource constraints and improve access (Patel et al., 2010; Hoeft et al., 2018). While early trials like the MANAS study demonstrated feasibility, subsequent interventions show mixed effectiveness, with modest improvements observed largely within short follow-up periods (Fuhr et al., 2019; Shidhaye et al., 2019; Sikander et al., 2019). These limited outcomes likely stem in part from a cultural mismatch, as biomedical models emphasize clinical diagnoses and treatments that may not align with local understandings of mental distress (Kohrt et al., 2014; Weaver, 2017).

Many Indian individuals, especially women, understand their distress in social or structural terms rather than as a medical illness. For example, the culturally prevalent concept of “tension” relates to external hardships such as poverty and family conflicts rather than internal psychiatric pathology (Roberts et al., 2020; Wahid et al., 2021). This leads to reluctance in seeking clinical care for less severe symptoms, despite awareness of services (Weaver et al., 2022). Stigma is more associated with severe mental illness labels (e.g., “madness”) and the social repercussions of being deemed mentally ill, rather than the distress symptoms themselves (Shidhaye and Kermode, 2013; Marrow and Luhrmann, 2012).

Digital health innovations, such as the Indian Ministry of Health’s “No More Tension” app, aim to bridge awareness and stigma gaps by employing culturally sensitive terminology to promote engagement with mental health resources (Ministry of Health, Government of India, 2016). Such initiatives point toward the potential of technology to expand mental health access, especially when integrated with culturally informed approaches.

To close the mental health treatment gap effectively, interventions must be culturally adapted, integrating local idioms and coping strategies while also addressing entrenched social determinants of mental distress (Kohrt and Jallah, 2016; Roberts et al., 2022). Expanding task-sharing to include community members beyond formal healthcare workers, liaising with traditional and faith healers, and embedding programs in community and social settings can improve acceptability and reach (Halliburton, 2020; Lakshmi et al., 2015).

Sustainable solutions also require substantial structural investments, including strengthening mental health policies, research funding, and workforce training tailored to India’s diverse contexts (WHO, 2021). Researchers emphasize that while scaling clinical services is necessary, addressing the cultural and social contexts of distress is paramount to reducing the mental health burden in India (Patel et al., 2018; Weaver et al., 2022).

In conclusion, closing India’s mental health treatment gap demands a multi-pronged approach: unified regulatory reforms for mental health professionals, culturally sensitive service delivery, innovative use of technology, and addressing social barriers and stigma. Only by aligning mental health interventions with cultural understandings and lived realities can access and utilization be meaningfully improved.

References

• Fuhr et al., 2019

• Gautham et al., 2020

• Halliburton, 2020

• Hoeft et al., 2018

• Kohrt et al., 2014

• Kohrt and Jallah, 2016

• Lakshmi et al., 2015

• Marrow and Luhrmann, 2012

• Ministry of Health, Government of India, 2016

• Movement for Psychology Professionals in India, 2021

• NIMHANS, 2014-16

• Patel et al., 2010

• Patel et al., 2018

• Roberts et al., 2020

• Roberts et al., 2022

• Sasthri and Chandramouli, unpublished

• Shidhaye and Kermode, 2013

• Shidhaye et al., 2019

• Sikander et al., 2019

• Wahid et al., 2021

• Weaver, 2017

• Weaver et al., 2022

• WHO, 2021

About the author:

Pritha Saha Dutta is a counseling psychologist based in Mumbai and founder of Indian Mental Health Summit