It’s Okay To Not Be Okay. But Who is There to Help?
India has had a big mental health win. For years, mental illness was something to hide. Today, more people are willing to talk about it, and we are slowly moving to a world where ‘it’s okay to not be okay’. While the narrative on national and social media is an indicator, there is harder evidence too. Tele-MANAS, India's national mental health helpline, has handled more than 47 lakh calls to date. A 2025 survey of young Indians found that 57% had used AI for emotional support.
But telling people to reach out makes a promise: that someone will be there when they do. A 2023 Parliamentary Standing Committee report captured the shortage - just 0.75 psychiatrists per lakh people compared with 3 recommended. We cannot solve this gap simply by producing more specialists. The same report argued for a layered approach with different cadres providing different levels of support.
It is important to get this right. Besides the obvious stakes for wellbeing and quality of life, there are significant economic costs too. The WHO estimates that mental health conditions could cost India US$1.03 trillion in economic losses between 2012 and 2030. The cost of inaction is also visible in the burden of suicide. A Lancet study estimated that suicide alone imposed an economic burden of US$8.8 billion on India in 2023, with people aged 20–34 accounting for nearly half of it.
India has begun building towards this layered model in which community workers identify and support people, Community Health Officers provide screening and psychosocial care, doctors diagnose and treat, and specialists provide care through referral and teleconsultation. Mental health is now part of the service mandate of more than 1.87 lakh Ayushman Arogya Mandirs. More recently, the Supreme Court has extended newer responsibilities to educational institutions, ordering every institution with 100 or more students to engage a counsellor, psychologist or social worker, and to train staff twice a year in recognising warning signs and providing psychological first aid.
This is a strong enabling policy architecture. But mandating responsibilities is not enough. It is important to make sure that the mental health providers are trained, competent and well supported to deliver the care. Three things need to happen.
First, define common standards for competence and certification across cadres
Today, different groups involved in mental health—from health workers and teachers to peer educators—are governed by different programmes and manuals. These are useful in defining responsibilities, but often focus on knowledge and sensitisation rather than demonstrable competence.
What is needed is a National Mental Health Workforce Competency Framework that brings all these cadres together and defines, for each role, what a person must be able to do and to what level. It should set competencies at different levels, specify the training required to build them, establish how they are assessed and refreshed, and make hand-offs between cadres explicit so that people do not fall through the gaps between systems. These competencies should be linked to validated, standardised certification, with periodic reassessment to ensure that certification reflects current competence rather than simply completion of a training programme.
Second, certifications will work only if we enable training, continuous learning & competence at scale.
When people seek mental-health support, lives can be at stake. And mental health skills are not learned simply by reading a manual or attending a workshop. They involve listening, asking the right questions, recognising warning signs, communicating difficult information and knowing when to escalate. These are skills that improve through practice and feedback.
We need to experiment and invest in technology-led approaches that can make this possible at scale. AI-based role play, for example, can allow frontline workers to practise conversations repeatedly with simulated patients, receive feedback and try again. Early research on AI-assisted role play suggests that it can help people practise skills such as reflective listening and asking better questions. India should build and test these tools for its own mental health workforce.
Third, give people the time, support and incentives to do the work
If we ask non-specialist cadres to share responsibility for mental health care, the ministries responsible for them must fund the capacity building set out above. Job design must also make room for the work, through protected time, supervision and incentives built for each cadre.
Mental health cannot simply be added to an already crowded list of responsibilities and expected to happen. We need to think harder about what will make each cadre invest in doing this work well. Today, mental health activities for ASHAs are bundled into broader service packages and incentives. What would change if this work were recognised and rewarded as a distinct part of the job?
We also need to test whether existing cadres are enough. Brazil, for example, has supported primary-care teams by embedding specialist support through regular case discussion, joint care and supervision. Alaska took another route, creating a dedicated Behavioral Health Aide workforce with four levels of practice, each with more responsibility, competency requirements and clinical supervision. India needs test-beds for both: specialist support for CHO-led teams, and a dedicated community mental health worker, for example one for every 20 ASHAs or one at each primary health centre. Then we must measure which design actually improves access, quality and continuity of care.
We have spent a decade teaching people that it is okay to ask for help. The next decade should be about making sure that someone capable is there when they do.
Author Bio
Kriti Krishnan is a co-founder of Ally for Mental Health Foundation, a non-profit building open-source infrastructure to supercharge India’s mental health workforce. In her decade long career, she has worked across law, philanthropy and public health; Varun Aggarwal is co-founder of Change Engine, a first-of-its-kind accelerator backing exceptional founders to build nonprofit unicorns (organisations that can meaningfully impact 1M+ people). An entrepreneur, AI researcher, and author, his work spans technology, research, and institution-building; Views presented are personal.