Despite having one of the best models in the integration of mental health into primary care and community care offering follow-up care engagement, the stigma of mental health disorders and lack of awareness among the public continue to create a treatment gap in Keralam that the health system is struggling to address.
The National Mental Health Survey -1 (2015-16) reported a treatment gap of 86% in Keralam for common mental disorders, while it was 62.5% for severe mental disorders, indicating that a substantial proportion of people identified to have mental disorders were not receiving adequate care.
Stigma of mental illnesses and the public’s inability to recognise mild mental illnesses or depressive disorder that a chunk of the population, especially the elderly, seems to be suffering from is one reason the treatment gap remains unaddressed, mental health professionals point out.
Elderly
The proportion of the elderly (aged 60 and above) in the State is currently around 18.7% and it is projected to reach 22.8% by 2036. A significant proportion of the elderly suffer from depressive disorders, with many community-based studies from Keralam reporting an average prevalence of around 52.4% to 58.2%.
“Many of these issues that need professional psychiatric care remain unaddressed as families fail to recognise the symptoms to be that of mental disorders. Also, the stigma of mental illnesses is not something that can be tackled overnight. Often, families refuse to acknowledge the problem because they fear that the community would label them for life,” points out a mental health professional.
“We need open conversations to address the issue of stigma but it is easier said than done. A chunk of the mild mental illnesses in the community remain untreated because people do not know that these are mental disorders that need medical support. Accessibility to care is another major issue — people may not be willing to travel far to access care,” says Kiran P.S., State Nodal Officer for mental health.
“The stigma is real. People who come on video consultations on the Tele Manas, the national mental health tele counselling service (dial 14416 or 1-800 891 4416), confess to counsellors how difficult it is for them to approach a mental health clinic for fear of being labelled,” he adds.
Mental health literacy
Stigma is not something that can be reduced through some awareness pamphlets. What is needed is training in mental health literacy, something that should start at the school-level, and the topic should be part of the school syllabus. A lot of misconceptions around mental health are being spread through the social media, which should be clarified for the public.
The District Mental Health Programme (DMHP) has a strong presence in all districts in Keralam, delivering mental health services and follow-up care to people at the primary care level. However, the lack of inpatient care facilities and shortage of human resources – psychiatrists, clinical psychologists, psychiatric social workers – in public health facilities from taluk hospitals upwards is now threatening to widen the treatment gap in the State.
There is no shortage of psychiatrists in the State per se. Keralam meets the national baseline figure of at least one psychiatrist per lakh population (WHO recommendation is three/lakh).
In urban areas
However, there are just about 400 psychiatrists in the public health sector in the Health Service and in government medical colleges, while over 800 of them work in the private sector, almost all of them in urban areas. Every year, some 70 psychiatry postgraduates come out of the teaching institutions in Keralam.
“The demand for mental health care is huge but there is an acute shortage of psychiatrists in taluk, district and general hospitals. There are hundreds of psychiatry specialists who are languishing in the Health Service as medical officers under general cadre, while many general and taluk hospitals do not have a single post of psychiatrist. In the last 10 years, not a single post of psychiatrist was created in Health Service. We also need more inpatient facilities and rehabilitation centres in all districts,” T. Sagar, President, Indian Psychiatric Society (Kerala) said.
Published - October 10, 2026 06:03 am IST