INTRODUCTION

Mental health, widely recognized as a universal basic human right, is critically important yet remains a distant goal worldwide. In 2019, mental illness ranked among the top 10 leading causes of the global burden of disease and was the single largest contributor to disability, affecting about 1 in 8 people and accounting for 1 in 6 years lived with disability [1,2]. According to the National Mental Health Survey of India, 10.6% of adults have mental disorders. Treatment gaps—which refer to the proportion of individuals with psychiatric disorders who remain untreated despite the availability of effective treatments —range from 70% to 92% across various disorders [3]. The inadequate supply of mental health professionals has further widened this gap in service provision. Over 15% of adults require active treatment for one or more mental illnesses, and those with mental illness have a reduced life expectancy compared to the general population [4]. India ideally requires 3 psychiatrists per 100 000 people, translating to approximately 13 000 clinicians; however, only around 3500 psychiatrists exist, yielding a ratio of only about 0.7 per 100 000 [5]. This shortage is even more severe among other mental health professionals, such as clinical psychologists, psychiatric social workers, and psychiatric nurses. Overall, this situation underscores an urgent need for strengthened mental health infrastructure and training programs in the country.

At-risk Underserved Populations

The burden of mental health disorders, alongside other non-communicable diseases, has become increasingly significant in rural and remote regions [1]. Stigma associated with these disorders exacerbates the problem, leading to social discrimination. This challenge intensifies when the affected population predominantly consists of women or older adults. Women face unique obstacles due to gender-based discrimination and violence, compounded by societal expectations to nurture the family [6]. They often suffer in silence, and their mental health needs may be unmet along with other basic health needs [6]. The situation is particularly dire for women who serve as caregivers; these individuals not only manage household responsibilities but also endure the immense stress of caregiving, often without incentives or moral support. This dual burden can profoundly affect their mental well-being. Older adults frequently lack adequate support systems and experience neglect in many aspects of health. Without financial independence, they depend entirely on their families for health-related needs, which can foster feelings of helplessness and isolation.

Many effective prevention and treatment options are available at relatively low cost to mitigate the risk of mental disorders. However, many people lack access, and health systems remain significantly under-resourced; consequently, the responses provided are insufficient and inadequate. Consequently, individuals with mental illness continue to exhibit unmet needs, while facing human rights violations, stigma, and discrimination. The coronavirus disease 2019 (COVID-19) pandemic has further exacerbated this situation: according to the World Health Organization (WHO), the global prevalence of anxiety and depression increased by 25% during the first year of the pandemic [7].

GLOBAL GOALS TO PROMOTE MENTAL HEALTH FOR ALL

The United Nations Sustainable Development Goals for 2030 call for the promotion of mental health and well-being. In India, the National Mental Health Programme is designed to ensure the availability and accessibility of minimum mental health care for all, while focusing on the most vulnerable and underprivileged sections of the population [8]. More than two-thirds (70%) of the Indian population resides in rural areas, compared with 43% globally. The shortage of mental health professionals is a major barrier to integrating mental health into primary health care in low-income and middle-income countries. The WHO recommends task shifting or task sharing—defined as the rational redistribution of tasks among the health workforce—as a potential method to improve access and deliver healthcare services in remote areas [9]. Although health facilities now extend to the grassroots level, mental health services remain out of reach for many populations. India’s Mental Healthcare Act 2017 enshrines access to mental health care as a statutory right and entitlement, including its provision through primary care. The Indian government is implementing various village-level initiatives to develop acceptable, affordable, and accessible mental health facilities. By embedding mental health services into primary healthcare systems, hospital admissions and readmissions for mental health patients can be significantly reduced. This holistic approach both streamlines care and ensures that patients receive comprehensive support from their first point of contact.

Task Shifting Strategy to Deliver Mental Health Care at the Primary Level

The Ayushman Bharat initiative is a transformative step towards strengthening India’s healthcare system. It aims to provide a comprehensive primary healthcare package—encompassing 12 essential services, including mental health screening—at the village level through Ayushman Arogya Mandirs [10]. As the first and most peripheral point of contact between the community and the primary healthcare system, the deployment of Community Health Officers (CHOs), alongside existing Rural Health Organizers and Accredited Social Health Activists (ASHAs), represents a key milestone. Community health workers and the local women’s health committee (Mahila Arogya Samiti) also play a crucial role in raising awareness of the social determinants of health. They leverage the monthly platforms of Gram Sabha and Health Mela as effective conduits for mass awareness campaigns. These gatherings provide an opportunity to educate community members about various aspects of mental health, including common symptoms, risk factors, available treatment options, and strategies to reduce stigma and discrimination. CHOs and ASHAs use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders within their communities. The Mental Health Evidence & Research Team (MERIT) tool is a crucial instrument for screening suspected mental health cases and facilitating early detection at the community level [10]. It includes questions to identify common and severe mental disorders, as well as substance use disorders, and takes approximately 5 minutes to administer per household. At the grassroots level, CHOs utilize this tool to identify potential mental health concerns in their early stages. Screened individuals are referred to linked District Early Intervention Centres or mental health clinics at district hospitals for appropriate treatment. CHOs then ensure continuity of care through regular follow-up, bridging the gap between diagnosis and ongoing treatment—an approach that significantly increases the effectiveness of community-level mental health interventions. In collaboration with ASHAs (Figure 1), CHOs regularly monitor patient progress and ensure adherence to treatment plans. This approach not only facilitates early identification and timely intervention in remote, hard-to-reach areas of the community but also helps destigmatize mental health issues.

CONCLUSION

Integrating mental health services into primary health care will help facilitate the early detection and treatment of mental health disorders. The task-shifting approach empowers local communities and fosters participation, reducing disease burden and offering a sustainable, effective model.

Ethics Statement

This paper is a perspective, so it did not need ethical approval.

Notes

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

None.

Acknowledgements

None.

Author Contributions

Conceptualization: Panneerselvam S, Ramasamy S, Agrawal S. Funding acquisition: None. Methodology: Panneerselvam S, Ramasamy S, Agrawal S. Visualization: Panneerselvam S. Writing – original draft: Agrawal S. Writing – review & editing: Panneerselvam S, Ramasamy S, Agrawal S.

Figure 1

Strategy for community-level integration of mental healthcare services. MERIT, Mental Health Evidence & Research Team; CHO, Community Health Officer; ASHA, Accredited Social Health Activist.

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