Innovative Solutions to Mental Health Challenges in India: A Conversation with Dr. Lakshmi Vijayakumar
Aisha Kokan
INTRODUCTION
Dr. Lakshmi Vijayakumar is a psychiatrist, World Health Organization (WHO) consultant, and founder of SNEHA, a non-governmental organization (NGO) specializing in community mental health interventions. Her pioneering work at the intersection of clinical psychiatry and public health policy has yielded innovative, culturally-adapted approaches to suicide prevention and mental healthcare delivery in India.
INTERVIEW
1. Suicide is a major public health concern in India. What are some of the community-based strategies you’ve implemented to address this issue?
"One of the biggest risk factors for suicide in rural India is easy access to pesticides. In response, we launched a community pesticide storage program, where farmers store pesticides in a centralized, locked facility rather than keeping them at home. This intervention was implemented in 54 villages, and we saw a marked decrease in suicide rates compared to neighboring villages where pesticides remained easily accessible."
Another initiative Dr. Vijayakumar highlights is Contrast and Safety Planning (CASP), which was developed for high-risk communities like Srinagar refugee camps, where suicide rates were alarmingly high–as much as 6.1%.1.
"CASP is a structured approach where trained community members check in on individuals identified as high-risk. In our study, we saw a decline in suicidal behavior over a year compared to the control group. A similar approach was used after the 2004 tsunami, where bereaved families who received monthly visits from trained volunteers showed reduced depression and suicidality."
2. How does mental health care in India differ from Western approaches?
"One of the most significant differences is the role of family. In the West, mental health care often focuses on the individual, but in India, the family plays an active role in treatment. This can be particularly beneficial for individuals with schizophrenia, studies show that schizophrenia outcomes in India tend to be better than in Western countries because family support reduces social isolation."
Dr. Vijayakumar also notes that psychiatric medication is far more affordable in India.
"In the U.S., some antipsychotic medications can cost several dollars per dose, making long-term treatment difficult for many patients. In India, these same medications are available at a fraction of the cost, which makes a significant difference in adherence to treatment."
However, she acknowledges the heterogeneous landscape of mental health care in India, where faith healers and alternative medicine practitioners play a significant role.
"Many people first seek help from faith healers before considering psychiatric treatment. Instead of dismissing these practices, we’ve developed training programs for healers, teaching them to recognize severe mental illness and refer patients to psychiatrists when necessary. This collaborative approach has helped bridge traditional beliefs with medical care."
3. What are the biggest structural challenges facing mental health care in India today?
"The biggest challenge is the shortage of trained professionals. The government has expanded the District Mental Health Program (DMHP), which ensures that every district in Tamil Nadu has a psychiatrist, psychologist, and social worker. But disparities persist, particularly between northern and southern states, and between urban and rural areas."
Dr. Vijayakumar has also worked on policy-level interventions, including reforms in academic testing to reduce student suicides.
"In Tamil Nadu (the southernmost state of India), academic failure was a major factor driving student suicides. Many students who failed their final exams felt hopeless because they had to wait an entire year to retake them. In 2004, we successfully advocated for supplemental exams within months of the original test, so students wouldn’t lose a full academic year. This change led to a 60% reduction in exam-related suicides."
She is also pushing for decriminalizing attempted suicide in India, as it remains a punishable offense under Indian law.
"When suicide is criminalized, people are less likely to seek help. Decriminalization would encourage more people to access mental health support without fear of legal consequences. India’s National Suicide Prevention Strategy is a step in the right direction, but more work needs to be done at the policy level.”
Specifically, perhaps it would be prudent to consider facilitating the development of mental health support groups and mandatory psychiatric health training in the workplace, with the intention of increasing awareness and acceptance of mental health as an important and systemic issue.
4. How is urbanization changing mental health trends in India?
"Urbanization has had both positive and negative effects. On one hand, awareness and access to care have improved in cities. On the other hand, migration from rural areas to cities brings new mental health challenges, economic hardship, isolation, and stress."
Western influence is also shaping new mental health concerns, particularly around body image and eating disorders.
"Fifteen or twenty years ago, we rarely saw eating disorders in India. But with increased exposure to Western media and beauty standards, body image issues are becoming more prevalent. It would be interesting to study how exposure to Western ideals affects self-perception, comparing individuals with high versus low exposure could provide valuable insights."
5. How do you see technology influencing mental health care in India?
"Telehealth has expanded access, especially after COVID-19. Patients in remote areas can now consult psychiatrists online, which was not possible before. But at the same time, we need to be cautious about unregulated mental health apps. Many of these apps offer advice without clinical oversight, and there is little research on their long-term effectiveness."
Dr. Vijayakumar sees task shifting as a key strategy for the future.
"We need to train community health workers to provide basic mental health care. We can’t rely solely on psychiatrists, there simply aren’t enough. If mental health services are integrated into primary care, we can reach more people and close the treatment gap."
Looking Ahead
Despite the resource constraints, Dr. Vijayakumar remains optimistic about the future of mental health in India.
Her work serves as a model for balancing traditional and modern approaches to mental health, demonstrating that cultural context is just as important as clinical intervention in improving outcomes.
About the Author
Aisha Kokan ('26) is a junior at Harvard College concentrating in history of science and government.
References
Dr. Lakshmi Vijayakumar is a psychiatrist, World Health Organization (WHO) consultant, and founder of SNEHA, a non-governmental organization (NGO) specializing in community mental health interventions. Her pioneering work at the intersection of clinical psychiatry and public health policy has yielded innovative, culturally-adapted approaches to suicide prevention and mental healthcare delivery in India.
INTERVIEW
1. Suicide is a major public health concern in India. What are some of the community-based strategies you’ve implemented to address this issue?
"One of the biggest risk factors for suicide in rural India is easy access to pesticides. In response, we launched a community pesticide storage program, where farmers store pesticides in a centralized, locked facility rather than keeping them at home. This intervention was implemented in 54 villages, and we saw a marked decrease in suicide rates compared to neighboring villages where pesticides remained easily accessible."
Another initiative Dr. Vijayakumar highlights is Contrast and Safety Planning (CASP), which was developed for high-risk communities like Srinagar refugee camps, where suicide rates were alarmingly high–as much as 6.1%.1.
"CASP is a structured approach where trained community members check in on individuals identified as high-risk. In our study, we saw a decline in suicidal behavior over a year compared to the control group. A similar approach was used after the 2004 tsunami, where bereaved families who received monthly visits from trained volunteers showed reduced depression and suicidality."
2. How does mental health care in India differ from Western approaches?
"One of the most significant differences is the role of family. In the West, mental health care often focuses on the individual, but in India, the family plays an active role in treatment. This can be particularly beneficial for individuals with schizophrenia, studies show that schizophrenia outcomes in India tend to be better than in Western countries because family support reduces social isolation."
Dr. Vijayakumar also notes that psychiatric medication is far more affordable in India.
"In the U.S., some antipsychotic medications can cost several dollars per dose, making long-term treatment difficult for many patients. In India, these same medications are available at a fraction of the cost, which makes a significant difference in adherence to treatment."
However, she acknowledges the heterogeneous landscape of mental health care in India, where faith healers and alternative medicine practitioners play a significant role.
"Many people first seek help from faith healers before considering psychiatric treatment. Instead of dismissing these practices, we’ve developed training programs for healers, teaching them to recognize severe mental illness and refer patients to psychiatrists when necessary. This collaborative approach has helped bridge traditional beliefs with medical care."
3. What are the biggest structural challenges facing mental health care in India today?
"The biggest challenge is the shortage of trained professionals. The government has expanded the District Mental Health Program (DMHP), which ensures that every district in Tamil Nadu has a psychiatrist, psychologist, and social worker. But disparities persist, particularly between northern and southern states, and between urban and rural areas."
Dr. Vijayakumar has also worked on policy-level interventions, including reforms in academic testing to reduce student suicides.
"In Tamil Nadu (the southernmost state of India), academic failure was a major factor driving student suicides. Many students who failed their final exams felt hopeless because they had to wait an entire year to retake them. In 2004, we successfully advocated for supplemental exams within months of the original test, so students wouldn’t lose a full academic year. This change led to a 60% reduction in exam-related suicides."
She is also pushing for decriminalizing attempted suicide in India, as it remains a punishable offense under Indian law.
"When suicide is criminalized, people are less likely to seek help. Decriminalization would encourage more people to access mental health support without fear of legal consequences. India’s National Suicide Prevention Strategy is a step in the right direction, but more work needs to be done at the policy level.”
Specifically, perhaps it would be prudent to consider facilitating the development of mental health support groups and mandatory psychiatric health training in the workplace, with the intention of increasing awareness and acceptance of mental health as an important and systemic issue.
4. How is urbanization changing mental health trends in India?
"Urbanization has had both positive and negative effects. On one hand, awareness and access to care have improved in cities. On the other hand, migration from rural areas to cities brings new mental health challenges, economic hardship, isolation, and stress."
Western influence is also shaping new mental health concerns, particularly around body image and eating disorders.
"Fifteen or twenty years ago, we rarely saw eating disorders in India. But with increased exposure to Western media and beauty standards, body image issues are becoming more prevalent. It would be interesting to study how exposure to Western ideals affects self-perception, comparing individuals with high versus low exposure could provide valuable insights."
5. How do you see technology influencing mental health care in India?
"Telehealth has expanded access, especially after COVID-19. Patients in remote areas can now consult psychiatrists online, which was not possible before. But at the same time, we need to be cautious about unregulated mental health apps. Many of these apps offer advice without clinical oversight, and there is little research on their long-term effectiveness."
Dr. Vijayakumar sees task shifting as a key strategy for the future.
"We need to train community health workers to provide basic mental health care. We can’t rely solely on psychiatrists, there simply aren’t enough. If mental health services are integrated into primary care, we can reach more people and close the treatment gap."
Looking Ahead
Despite the resource constraints, Dr. Vijayakumar remains optimistic about the future of mental health in India.
Her work serves as a model for balancing traditional and modern approaches to mental health, demonstrating that cultural context is just as important as clinical intervention in improving outcomes.
About the Author
Aisha Kokan ('26) is a junior at Harvard College concentrating in history of science and government.
References
- Vijayakumar, L., Mohanraj, R., Kumar, S., Jeyaseelan, V., Sriram, S., & Shanmugam, M. (2017). CASP - An intervention by community volunteers to reduce suicidal behaviour among refugees. The International journal of social psychiatry, 63(7), 589–597. https://doi.org/10.1177/0020764017723940.