Davangere/New Delhi: Lakshmanna survived a vehicle crash a decade ago, but he was no longer the same. The 25-year-old agricultural labourer, once a pillar of support for his mother and sister, grew angry, aggressive, and violent. To prevent him from unleashing havoc, his desperate mother Yallamma resorted to tying him up in an outhouse on their property in Karnataka’s Davangere district.
“Volunteers were scared to enter the house because he was extremely violent,” recalled Janardhana A L, director of the mental health and district disability development programmes with the NGO Association of People with Disability (APD).
Ten years on, that menacing Lakshmanna has vanished. Now 35, he listens attentively to the speakers at a mental health awareness camp organised by the NGO LiveLoveLaugh (LLL) Foundation. Occasionally, he stands up to greet neighbours and share a joke.
His transformation wasn’t a solitary effort. Lakshmanna might still be shackled in a shed had the APD volunteers not recognised he needed help and taken him to a nearby district hospital, where a psychiatrist diagnosed him with schizophrenia and prescribed medication. To eliminate potential financial barriers to treatment, APD ensured that the local government medical centre stocked his medication.
APD also worked with the LiveLoveLaugh Foundation, which delivers mental healthcare in rural areas through partnerships with other organisations and governments, to provide regular counselling to Lakshmanna and his family. This holistic approach, combining medical care with emotional support, yielded encouraging results. Over a period of three to four years, Lakshmanna became well enough to help his mother with household chores like buying vegetables and drawing water from the well.
With a Rs 10,000 seed fund from APD, Yallamma invested in three sheep, tended to by Lakshmanna. The family now owns eight sheep and earned Rs 80,000 last year.
Lakshmana isn’t the only success story in Davanagere. Since 2017, 2,178 people with mental illness have been successfully reintegrated into society through the combined efforts of APD and LLL, according to Anisha Padukone, CEO of LLL.
This rural mental health initiative has now achieved self-sustainability, with a strong network of supporters and professionals, from the area. Each of the six taluks in the district now has ‘champions’ — family members of those affected by mental illness— who dedicate themselves to helping others in the community.
It’s not just Davangere. Across swathes of rural India, NGOs and other private players have stepped up to address the gaps left by government interventions and meagre budgetary allocations for mental health.
There’s no hard data about the prevalence of mental health issues in rural areas, where about 65 per cent of India’s population lives. The last pan-India survey on mental health, carried out in 2015-16, highlighted that 150 million people across the country need mental health intervention, but that only about 20 per cent of them seek care. However, it skimmed over the urban-rural divide. There’s also no mechanism to gauge the financial load on caregivers tending to individuals with severe mental health issues.
“The fact that barely 2 per cent of the healthcare budget is allocated to mental health in India shows how much the government really cares. Lip service gets us nowhere,” said lawyer and mental health advocate Gaurav Bansal, adding that the challenges of accessing care would be significantly amplified in rural areas.
Also Read: ‘0.75 psychiatrists per 1,00,000 people’ — House panel urges govt to increase MD psychiatry seats
Sharing the burden in Karnataka
When it comes to accessible and affordable mental healthcare at the district level, Karnataka is one of the country’s first movers.
The District Mental Health Programme (DMHP) under the National Mental Health Programme was rolled out in Bellary district in 1986 with the aim of arming general physicians with the skills to swiftly detect and treat common mental illnesses. Since then, the programme has expanded to cover all 30 districts of the state.
However, there are still big gaps. According to a report published by the nonprofit CHD group, only 0.37 per cent of Karnataka’s healthcare budget was allocated for mental health. And only 74.4 per cent of the allocated funds for the DHMP were utilised in 2018-19. ThePrint made multiple calls to Rajini Parthasarathy, state deputy director (Mental Health), Department of Health and Family Welfare, but did not receive a response.
Like with many government schemes, affordability, awareness, and advocacy do not necessarily reach those in the greatest need due to red tape and complex processes. There has been no door-to-door outreach or intervention as part of the schemes. No one would follow up or even educate people about the medication.
Superstitious beliefs and stigma created further hurdles, deterring many people from seeking help. Others are forced to travel to larger cities for costly treatment. Even those who managed to get treatment often relapsed due to the unavailability of essential medicines and caregivers struggled to provide consistent support due to a lack of awareness and financial strains.
Lakshmanna’s family poured nearly Rs 4 lakh into his care, while farmer Malleshappa spent over Rs 2 lakh to treat his wife’s deteriorating mental health following the loss of their first child. He’d curse god for his misfortune whenever he had to make the trip to Shivamogga to access treatment and fetch medicines for his wife, shelling out close to Rs 5,000 each month.
Now, however, he is breathing easier. “His spending has been reduced to a mere Rs 50 per month after we got 16 medications for various mental ailments under the essential drugs list (stocked at the primary health centre),” said Padukone.
Many like Malleshappa have also been made aware of government benefit schemes like the disability pension, which guarantees a monthly sum of Rs 2,000 for those with severe mental illness, and Ayushman Bharat for health insurance.
Nagamma is another beneficiary of LLL. After her husband’s leg was amputated following an accident, he developed serious mental health issues. With the assistance of the mental health team, she was able to get an Ayushman Bharat card, which offers up to Rs 5 lakh of insurance coverage and encompasses 17 packages for mental health disorders. This support allowed Nagamma’s family to navigate the financial burden triggered by her husband’s ailment. She is now an active member of APD and LLL’s mental health initiative and conducts awareness camps.
Gujarat ‘champions’ & a side of faith
After his turbulent divorce, 30-year-old Sannibhai from Dangarva village in Gujarat’s Mahesana district not only suffered deep psychological wounds but also confronted the barriers that societal norms place on men seeking help. This realisation spurred him to become a mental health ‘champion’, actively supporting those in need in his community.
“It makes me happy that I have been able to help many who have struggled with mental health issues, including some who were also suicidal,” he said.
Champions like Sannibhai are the first responders in Gujarat’s rural mental health programme, performing a role akin to ASHA (Accredited Social Health Activist) workers. The initiative is a partnership between the state government and Atmiyata, a community-led initiative that utilises non-specialised volunteers to identify, support, and refer individuals with mental illness in villages.
It offers a low-cost model that can be scaled up to improve access to community mental healthcare and has been recognised by the World Health Organization.
“Formal and informal mental health services need to go hand in hand. That is how we have built up a solid maternal healthcare system in India,” said Dr Soumitra Pathare, director of the Centre for Mental Health Law and Policy, under which Atmiyata operates.
Atmiyata has a four-pronged approach to addressing mental health concerns in rural India— basic counselling for common mental illnesses, linking people to social benefits, providing access to psychiatrists in severe cases, and raising awareness through mobile-based films.
“There is rising concern over untrained mental health professionals flooding the market, but the champions are trained and given a certificate before they start field work,” Pathare said.
After a successful pilot in 41 Maharashtra villages in 2013-15, Atmiyata’s Gujarat branch was established in Mahesana in 2017, supported by the Mariwala Health Foundation (MHI) and the Department of Child and Family Welfare. It played a crucial role in supporting migrant workers during the 2020 Covid lockdown, with 700 trained champions providing “mental health first aid” across 500 villages, Pathare said.
The Atmiyata programme operates as a virtuous cycle. Mir Johraben Manubhai, who identified her daughter’s anxiety post-mentorship classes, has been a champion in Sartanpur since 2021. She completes her housework by 11 am and then embarks on rounds in the village to offer assistance. “We make social visits anyway; getting to help someone during these visits is a bonus,” said Manubhai.
Over 7 per cent of Gujarat’s population grapples with mental illnesses, according to the 2016 National Mental Health Survey. But there’s a treatment gap for 78 per cent of common cases and 44 per cent of severe disorders. The state allocates 0.82 per cent of its health budget to mental health, with a utilisation rate of 97 per cent, according to the report.
While issues with mental healthcare delivery persist, Gujarat has taken some innovative steps to improve access. One of these was the Dava and Dua Programme (DDP) at the Mira Datar Dargah in Mahesana, effectively bridging science and faith. Launched in 2007, this programme recognised that mujavars (traditional healers) often serve as the initial point of contact for mental health issues. Given this, these healers were trained to identify symptoms and refer patients to professionals.
Both the Atmiyata mission and the Davangere initiative embrace this approach, aligning interventions with intrinsic belief systems and even superstitious notions in communities.
“There is a temple nearby where people would take those with mental health issues, thinking they’d get rid of evil spirits. That is where we set up our first awareness programme,” said Janardhana. Engaging with faith healers and getting them to endorse medication proved highly successful in Davanagere, he added.
Keeping it simple in Odisha
In Lakshmipur, Odisha, where access to first aid healthcare is a half-day journey away, mental health intervention is now at people’s doorsteps through NGOs like the LLL and Women’s Organisation in Rural Development (WORD).
Highlighting the gendered nature of mental health, WORD secretary Rachel Raykumari pointed out that the burden of both affliction and care disproportionately falls on women.
“It is almost a default system in India where women are seen as the natural choice for being a caregiver, no matter what the ailment,” she said.
Due to the efforts of LLL and WORD, many in this Koraput district village, like 57-year-old Ghasini Muska, have been able to get the help they need, instead of being chained like domestic cattle in their homes. Detected with mental illness five years ago by a team from the NGOs Ghasini received free psychiatric treatment and eventually even started earning a living again.
Her sister Dei Muska recalled that Ghasini used to contribute to the household as a labourer until she fell ill. “She would run around and scare people with her antics,” Dei said.
The family initially tried ‘local’ medicine, which came with a hefty price tag of Rs 2,000, but to little avail. However, when WORD caregivers started making monthly visits and even delivering medicines when Ghasini and Dei couldn’t make the trip to the hospital, things started improving. Now, Ghasini and Dei craft brooms to sell in the nearby market to earn their livelihood.
In Odisha, the National Mental Health Programme is implemented in all 30 districts and free psychotropic drugs are available in public hospitals under the Niramaya scheme. However, the state allocated only Rs 2 crore for mental health in 2022-2023, and the remote tribal interiors remain severely underserved.
In villages like Ghasini and Dei’s, the absence of essential infrastructure, including roads, coupled with acute poverty and limited access to health systems, creates a complex challenge requiring targeted solutions.
In Lakshmipur, WORD and LLL collaborate with ASHA workers to raise awareness about mental health and encourage attendance at mental health camps. This joint effort has already impacted 800 beneficiaries and their caregivers, with numbers steadily increasing. With street plays, handbills, and wall art, volunteers have successfully engaged villagers in conversations about mental health.
Across each of the states— Karnataka, Gujarat, and Odisha— mental healthcare workers underscore the importance of using a simple, relatable vocabulary to peel away resistance to seeking help. For instance, Atmiyata positions itself as an initiative that helps people deal with life stress, avoiding medical jargon. Nagamma’s ‘awareness sessions’ resemble friendly conversations rather than expert lectures.
Also Read: Everyone’s a therapist in India—influencers, dentists, homeopaths. It’s the new epidemic
Toward ‘self-sustainability’
The Mental Health Act 2017 was a groundbreaking legislation, aiming to provide care and protect the rights of people with mental illness. However, India’s mental healthcare system is still wobbly, especially in rural areas, where government interventions fall short. That’s why organisations like MHI and LLL say they have stepped in with community-level interventions.
“The emphasis on community-based workers ensures that interventions are not only psychologically sound but also socially attuned to the unique needs of the population,” said Priti Sridhar, CEO of MHI.
Even within the legislation, there are no separate parameters for rural and urban healthcare plans. “The Mental Health Act itself is based on a Western model that looks to the state to intervene. In India, there is a severe lack of both infrastructure and personnel,” pointed out psychiatrist Dr Vishal Chhabra, president of the Delhi Psychiatry Society.
For Chhabra, the solutions have to be practical, like strengthening the psychiatry wings across hospitals, with facilities and doctors.
Much is still left to be done in the rural health sector, but the success stories in Mehsana, Davanagere, and Lakshmipur offer models that can be implemented and developed in a self-sustainable way.
“We have dealt with malaria and cholera by educating ASHA workers who communicated it to others,” he said. “The need of the hour now is to educate these workers about common mental health problems.”
The reporter visited Devangere at the invitation of the LiveLoveLaugh Foundation.
(Edited by Asavari Singh)