Kairav Negi and Dr. Gayatri Kotbagi । Despite growing awareness, mental healthcare in India remains caught between progressive laws and inadequate implementation. Bridging this gap will require more than policy; it demands political will, budgetary commitment, and a radical shift in public consciousness.

Mental health in India is finally getting the attention it has long deserved. From online campaigns to workplace wellness programs, conversations are becoming louder. Yet behind this increasing visibility lies a grim truth: the treatment gap is still estimated at a staggering 80%, and access to care remains deeply inequitable.

According to the National Mental Health Survey (2016), around 5% of Indians suffer from common mental disorders such as depression and anxiety. But only a fraction receive adequate treatment. The landmark Mental Healthcare Act (MHCA) of 2017 pledged to change this by reframing mental health as a rights-based issue. It laid out clear entitlements such as access to care, informed consent, dignity, and non-discrimination. On paper, it was transformative. On the ground, however, it has struggled to make a dent.

This dissonance between legislative promise and lived reality raises an urgent question: Are India’s mental health initiatives truly working, or are they merely symbolic?

Good Policy, Patchy Practice

At the national level, several well-intentioned programs exist. Ayushman Bharat includes mental health in its insurance packages. The Manodarpan initiative provides psychosocial support to students. The District Mental Health Programme (DMHP), operational since the 1990s, was expanded during the Twelfth Five-Year Plan to decentralize care. In July 2025, the Supreme Court issued 15 binding nationwide guidelines for all educational institutions to implement a uniform mental health policy, mandate counselling support, and display suicide-prevention protocols. These directives aim to hold institutions accountable through referral systems, annual wellness reports, and infrastructure safeguards to curb student suicides.

But programs mean little if they don’t reach people.

But programs mean little if they don’t reach people. Mental healthcare receives just 0.06% of India’s health budget, among the lowest in the world. India has only 0.75 psychiatrists per 100,000 people, well below the WHO’s minimum recommendation. The vast majority of these professionals are concentrated in urban centres, even though over 63% of Indians live in rural areas (Kemp, 2024).

The MHCA mandates mental illness coverage by insurance companies, yet many providers continue to flout this. A 2021 case in Delhi High Court exposed how an insurance firm capped a mental health claim at ₹50,000 despite a ₹35 lakh policy; a direct violation of the law.

Meanwhile, regulatory bodies like the Mental Health Review Boards (MHRBs) envisioned as watchdogs of patient rights have either not been established or remain under-resourced in many states (Gupta et al., 2022). The Central and State Mental Health Authorities, critical to the law’s execution, are still pending formation in several regions.

These aren’t just bureaucratic lapses. They are systemic failures that continue to deny millions of Indians their basic rights.

Learning from Global Models

Evidence from across the globe shows that mental health outcomes improve when economic and social support systems are robust. Brazil’s Bolsa Família, a conditional cash transfer program, not only improved education and nutrition but significantly reduced mortality among those with psychiatric disorders (Taylor, 2025). Similarly, Kenya’s GiveDirectly initiative boosted food security and mental wellbeing, especially among women (Haushofer & Shapiro, 2015).

India’s MGNREGA and Public Distribution System (PDS) could be adapted similarly to buffer against the economic precursors of mental distress. Mental health policy in India still exists in a silo—when it should be part of a broader welfare ecosystem.

The Rural-Urban Divide

In 2022, the government launched Tele-MANAS, a national tele-mental health helpline. While this initiative holds promise, its impact is curtailed by the digital divide. Many rural regions still lack stable internet connections. Mental health professionals are rarely posted in Primary Health Centres, and community health workers—such as ASHAs—feel overwhelmed due to inadequate training and zero incentives for mental health-related work (Varshney et al., 2022).

For 200 million Indians estimated to benefit from mental health services, fewer than 30 million actually seek treatment. The rest are left navigating stigma, silence, and systems that fail to show up for them.

Rights in Theory, Not in Practice

The MHCA signaled a paradigm shift, from a custodial and medical model to a person-centered, rights-based framework. It promised autonomy and dignity. But in practice, adolescents are denied agency, women face patriarchal barriers to access, and the poor remain at the mercy of a fractured system.

It promised autonomy and dignity. But in practice, adolescents are denied agency, women face patriarchal barriers to access, and the poor remain at the mercy of a fractured system.

India's current approach echoes a familiar pattern: laws without implementation, schemes without resources, and programs without monitoring. For instance, although the Juvenile Justice Act (2015) recognizes adolescents’ cognitive maturity and evolving capacity to make informed decisions, the Mental Healthcare Act (2017) denies them equivalent agency in consenting to or refusing treatment. This contradiction exposes a policy gap that undermines adolescent autonomy and the very rights-based framework the MHCA seeks to uphold. Without policy coherence, such contradictions can do more harm than good.

Towards a Mental Health Revolution

1. India doesn’t just need more counselors or hospitals. It needs a revolution in how mental health is perceived, prioritized, and delivered. Here’s what must change:
2. Increase budgetary allocation to at least 5% of the health budget for mental health.
3. Train and incentivize community health workers to deliver basic psychosocial support.
4. Ensure insurance parity by penalizing companies that flout the MHCA.
5. Establish and empower regulatory bodies, including MHRBs and state mental health authorities.
6. Integrate mental healthcare with existing schemes like MGNREGA and school-based nutrition programs.
7. Launch mass awareness campaigns to reduce stigma and inform citizens of their rights.
8. India’s Midday Meal Scheme offers a powerful analogy. By providing free meals, it improved child nutrition while boosting school enrolment. A similar dual-impact strategy can be applied to mental health: combine short-term support (therapy, helplines, medications) with long-term resilience-building (addressing systemic issues, early intervention, and workplace support).

The Path Forward

Mental health must be reframed as a fundamental right and not a secondary service for the privileged. Without this shift, no amount of laws or helplines will close the chasm between policy and reality.

It’s time we moved beyond token gestures and symbolism. Every person has the right to live with dignity, free from psychological distress exacerbated by state inaction. The government has the tools; it now needs to find the political will. Citizens, too, must rise to demand better. If education can be a constitutional right in India, then why not mental health?

_{Kairav Negi is an undergraduate student of Psychology at FLAME University.}

_{Dr. Gayatri Kotbagi is an Assistant Professor of Psychology at FLAME University, Pune.}