The pandemic highlighted the mental health crisis in India, underscoring the need to strengthen mental healthcare systems. A growing body of research also links mental health to many developmental priorities, such as poverty, gender, urbanisation, and climate change. These factors have helped create a surge in philanthropic interest for funding mental health in India.

Too many to treat

A recent study by the Centre for Asian Philanthropy India finds that philanthropy for mental health has gathered pace over the last decade in India, with an increasing number of donors driving resources to this sector. However, as the report finds, in the absence of well-defined strategies or entry-points for their giving, many donors opt to by fund care at existing institutions of repute, and/or science and research studies, again, at institutions. These contributions are necessary, especially in the treatment of severe mental illnesses, but they are not enough. India, like many other countries needs decentralized, community-based solutions that reach the last mile.

India’s mental health burden is too large for a few secondary or tertiary care institutions to address—approximately 200 million people are affected by mental illnesses, yet the treatment gap – ranges from 70 per cent to 92 per cent. The country faces a staggering deficit of medical or para medical professionals, with only 9,000 psychiatrists and even fewer psychiatric nurses, clinical psychologists, and social workers. India has just 0.03 psychologists, 0.03 psychiatric social workers, and 0.05 psychiatric nurses per 100,000 people.

To serve its 1.3 billion people, India would require an additional 30,000 psychiatrists and tens of thousands of other mental health professionals – a gap that could take decades to fill at the current rate of training. Moreover, it costs nearly one crore Indian rupees (approx US$130,000) to train a single psychiatrist. Clearly, relying solely on traditional methods of treatment are expensive, inefficient and impractical.

Exploring community-based approaches

Bridging the treatment gap will require a shift in strategy. Philanthropists and other private sector players can help optimize existing resources and build capacity outside the realm of institutional care. Models for these do exist as the CAPI report demonstrates with examples. These include the involvement of community volunteers in providing mental health support, using digital tools for early screening and identification of vulnerable populations, teleconsultations, integrating mental health services into primary care systems, and integrating mental healthcare as a part of other community development project. These capacity-building initiatives expand access and create sustainable community-driven mental health systems, making them particularly valuable in regions with limited access to specialized care.

Nonprofits in India have successfully implemented such initiatives, training non-specialists to meet the mental health needs of their communities – many of these have been spotlighted in CAPI’s report. For instance, the Live Love Laugh Foundation implements its rural mental health program across the states of Karnataka, Odisha, Tamil Nadu, Kerala, Himachal Pradesh, and Madhya Pradesh in collaboration with local partners. It aims to create sustainable and community-owned mental health care systems with buy-in from various stakeholders, including the local government, self-help groups, community-based primary health workers, and volunteers. Another example is the Raintree Foundation, based in Mumbai and funded by the Dandekar family, which has adopted an intersectional lens in its work on climate change and rural development. Partnering with the Bapu Trust, a Pune-based mental health nonprofit, the Raintree Foundation has established a rural counseling center in the nearby Velhe district to support individuals facing high levels of mental distress. It has also developed modules for training local community members to provide first responder-level support in volatile mental health situations and eventually take over the counseling center to ensure that there is no continued dependence on specialists.

Community mental health models focus not only on treatment but often also on prevention and rehabilitation. While the style of execution varies across programs, the CMH model relies on task shifting or task sharing, wherein individuals living with mental health conditions receive care from community-based mental health care workers or volunteers (rather than relying on health experts, such as psychiatrists or psychologists – who are in short supply). This community-based cadre, often known as ‘lay volunteers’ is trained to deliver certain mental health services, recognizing that not all mental health services require the expertise of a psychiatrist or psychologist; tasks such as basic counseling, raising mental health awareness, and ensuring medication adherence can be carried out by non-specialists. Nonetheless, these non-specialists can and do provide referrals up the value chain to medical specialists as needed for more severe conditions.

Despite successes, the discourse around community-centric models has not yet gained mainstream attention or acceptance in India because advocacy and amplification of their success are lacking. Moreover, the historical inclination toward institutionalization is also at play. These factors limit the inflow of funds toward replicating or scaling community health models.

Casting a wider net

Funding is not the only constraint that needs to be solved. Stakeholders embedded within communities also need to be empowered and trained to play a key role in delivering care.

This cohort includes teachers, religious leaders, general physicians, journalists, police personnel, detention officers, self-help groups or cooperatives and community health workers.

Often, many of these leaders serve as the first points of contact for the community, and understand the unique needs and contexts within their neighbourhoods. If trained adequately, they can play a pivotal role in the early identification of mental health concerns. These non-specialists can create a community-wide safety net provided they are equipped with the necessary skills and targeted training to either provide immediate support or referrals to specialists. Training programs and interventions designed for such community leaders focus on mental health first aid, trauma-informed counselling, suicide prevention, reducing access to suicide methods, and more.

The Centre for Mental Health Law & Policy (CMHLP) in India runs an online gatekeeper training program to train secondary and higher secondary school teachers to identify, assess, support, and refer at-risk adolescents for suicide prevention support in Chhattisgarh. CMHLP also runs a course called ‘Reporting Suicides Responsibly,’ which provides free virtual training for media professionals and journalism students on the responsible reporting of suicides and mental health issues, guided by evidence-based practices.

Other nonprofits in India too are offering trainings to improve the skills of qualified professionals as well to develop a stronger talent pool. For instance, Sangath offers a course called– ‘Leadership in Mental Health,’ which is designed to develop the capacities of future global mental health leaders. This course is particularly aimed at those looking to make impactful changes in mental health settings, especially in low- and middle-income countries.

Leverage technology for reach

In the scenario above, digital initiatives can expand the reach of mental health. Leveraging technology can enable the training and support of community workers, allowing them to deliver mental health services more efficiently and consistently. For instance, Dimagi’s CommCare platform has been instrumental in supporting various models of mental health care, including 1-on-1 counselling and group therapy, by empowering non-specialist providers with the necessary tools and knowledge. Through its partnership with the EMPOWER program in India, Dimagi has demonstrated that non-specialist providers can be trained in just a few weeks to deliver effective mental health care, significantly reducing the burden on limited human resources. Additionally, Dimagi is developing ‘PracticePal,’ a chatbot designed to guide clients through psychological and psychosocial interventions, helping them stay on track with their care while providing essential psychoeducation.

Way forward

Indian philanthropy has a unique opportunity to lead the way. By funding and supporting community-based models and leveraging technology, donors can demonstrate how effective, accessible, and culturally relevant mental healthcare systems can be built, even in resource-constrained settings. And India is certainly not alone; many countries are facing an escalating mental health crisis with a severe shortage of medical specialists. Fortunately, there are pathways that go beyond the traditional institutional approaches: donors can invest in capacity-building approaches and strengthen community-based models that can reach a wider group of people.

Success stories from Global South countries like India help demonstrate the effectiveness and sustainability of these models. They highlight the power of empowering communities through capacity building and utilizing digital tools to enhance access to care, especially in areas with limited resources.

Donors can amplify the learnings from these approaches through the various regional, national and international platforms and networks they have access to. This can showcase the viability and impact of these models on a global stage and to governments, catalysing further investment and innovation in community-based mental healthcare. By supporting these strategies, philanthropy can help build robust, and culturally attuned mental health systems that reach those most in need.

Ketaki Purohit is centre head at CAPI. Khyati Dharamshi is research associate at CAPI.