| Condition (WHO, 2023) | People affected worldwide | What WHO says helps |
|---|---|---|
| Anxiety disorders | 470 million, incl. 146 million children and adolescents | Psychological treatment; medicines depending on age and severity |
| Depression | 322 million, incl. 43 million children and adolescents | Psychological treatment; medicines depending on age and severity |
| Bipolar disorder | 36 million | Psychoeducation, social functioning support, medicines |
| Schizophrenia | About 27 million (1 in 300) | Medicines, psychoeducation, family interventions, rehabilitation |
| Eating disorders | 18 million, incl. 4.7 million children and adolescents | Family-based and psychological care |
| Avoid | Prefer | Reason |
|---|---|---|
| "committed suicide" | "died by suicide" | Removes the suggestion of a crime |
| "successful" or "failed" attempt | "suicide attempt" | WHO: these imply death is a desirable outcome |
| "a schizophrenic", "mental patient" | "a person living with schizophrenia" | The person comes before the diagnosis |
| "pagal", "mad", "crazy" | Plain description of what the person is going through | Slurs keep people from asking for help |
| "suffering from" | "living with" or "has" | Avoids defining a life by illness |
| Recorded cause (NCRB) | Share of suicides, 2024 |
|---|---|
| Family problems (other than marriage related) | 33.5% |
| Illness (physical and mental) | 17.9% |
| Drug abuse or alcoholic addiction | 7.6% |
| Marriage related issues | 5.0% |
| Love affairs | 4.6% |
| Bankruptcy or indebtedness | 4.4% |
| Unemployment | 1.5% |
| Failure in examination | 1.2% |
| Causes not known | 10.1% |
| Fact (WHO, 2023) | What it means for a field worker |
|---|---|
| Talking openly can give a person other options or time to rethink | Asking directly about suicidal thoughts is safe and can help |
| People who talk about suicide may act on it | Take every mention seriously |
| People who are suicidal are often ambivalent and want relief from pain | Support at the right moment can tip the balance toward living |
| Acute risk is often short-term | Getting through the crisis matters most |
| Most suicides are preceded by verbal or behavioural warning signs | Learn the signs and act on them |
| Many people who are suicidal have no mental health condition | Debt, violence, pain and loss can be enough; screen widely |
| Poverty dimension | Association with common mental disorders (Lund et al., 2010) |
|---|---|
| Education | Relatively consistent and strong |
| Food insecurity | Relatively consistent and strong |
| Housing | Relatively consistent and strong |
| Social class and socio-economic status | Relatively consistent and strong |
| Financial stress | Relatively consistent and strong |
| Income, employment | More equivocal |
| Consumption | Particularly equivocal |
| Area | Examples | Where programmes act |
|---|---|---|
| Demographic | Age, sex, ethnicity | Targeting adolescents, older people, women |
| Economic | Income, debt, unemployment, inequality | Livelihoods, social protection, credit |
| Neighbourhood | Housing, safety, infrastructure | Urban upgrading, water, lighting |
| Environmental events | Disasters, conflict, climate change | Disaster response, migration support |
| Social and cultural | Social support, education, discrimination | Schools, collectives, anti-discrimination work |
| Form of stigma | How it shows in South Asian settings |
|---|---|
| Public | Marriage prospects of a family harmed by a member's diagnosis |
| Self | A person stops going to a clinic to avoid being seen there |
| Structural | Laws, insurance exclusions and institutional practices that treat mental illness differently |
| Section | What it provides |
|---|---|
| s4 | Presumption of capacity to make mental healthcare decisions |
| s5 | Right to make an advance directive |
| s14 | Right to appoint a nominated representative |
| s18 | Right to access mental healthcare from public services |
| s19 | Right to community living |
| s21 | Equality with physical illness, including insurance (s21(4)) |
| s23 | Right to confidentiality |
| s29 | Duty to run promotion, prevention and suicide reduction programmes |
| s95 | Prohibited procedures, including chaining |
| s99 | Consent and safeguards in research |
| s115 | Presumption of severe stress in attempted suicide |
| Route | Section | Key safeguard |
|---|---|---|
| Independent admission | s86 | An adult asks to be admitted, of their own free will, and understands the purpose |
| Admission of a minor | s87 | Application by the nominated representative and two independent examinations |
| Supported admission, up to 30 days | s89 | Two independent examinations; risk of harm to self or others or inability to care for self; least restrictive option, taking any advance directive into account |
| Emergency treatment | s94 | Only to prevent death, serious harm or serious damage; limited to 72 hours or until assessment, whichever is earlier; no ECT |
| BNS section | Offence | Punishment |
|---|---|---|
| s107 | Abetment of suicide of a child, a person of unsound mind, a delirious person or an intoxicated person | Death, life imprisonment or up to 10 years, and fine |
| s108 | Abetment of suicide | Up to 10 years and fine |
| s226 | Attempt to commit suicide with intent to compel or restrain a public servant from discharging official duty | Simple imprisonment up to 1 year, fine, both, or community service |
| Guideline (summarised from the judgment) | Who it binds |
|---|---|
| Adopt a uniform mental health policy drawing on UMMEED, MANODARPAN and the NSPS | All educational institutions |
| Engage at least one trained counsellor, psychologist or social worker | Institutions with 100 or more students |
| No batch segregation by academic performance or public shaming | All institutions, coaching centres in particular |
| Written referral protocols; helplines including Tele-MANAS displayed | Hostels, classrooms, websites |
| REDS | What the strategy intends |
|---|---|
| Reinforce | Leadership, partnerships and institutional capacity |
| Enhance (the strategy's own term) | The capacity of health services to provide suicide prevention services |
| Develop | Community resilience and societal support; reduce stigma |
| Strengthen | Surveillance and evidence generation |
| Question to ask of a state budget | Why it matters |
|---|---|
| How much of the mental health line goes to hospitals versus the DMHP? | Shows whether money follows the community-care mandate |
| Are DMHP funds released in the first half of the year? | Late release delays hiring and medicines |
| Are half-way homes and supported housing funded? | Required by sections 18(4) and 19(3) |
| Is the State Mental Health Authority funded and meeting? | It oversees rights and research permissions |
| Country | Main mental health law | Attempted suicide | Notes |
|---|---|---|---|
| India | Mental Healthcare Act 2017 | No general offence in BNS 2023; MHCA s115 presumes severe stress | Tele-MANAS, DMHP in 767 districts, NSPS 2022 |
| Bangladesh | Mental Health Act 2018 | Penal Code s309 still listed | Repealed Lunacy Act 1912 |
| Pakistan | Mental Health Ordinance 2001; provincial acts | s325 PPC omitted 2022; FSC held it restored May 2026; appeal pending (Art. 203D) | Health devolved after 2010 |
| Nepal | No dedicated act (as of 2021 review) | No offence; Penal Code 2017 s185 punishes abetment only | Strategy and Action Plan 2020 |
| Sri Lanka | Mental Diseases Ordinance (1873 origins) | Penal Code s302 repealed by Act No. 29 of 1998 | Draft Mental Health Bill before Cabinet, 2026 |
| Component | What it teaches |
|---|---|
| Problem solving | Breaking a practical problem into steps and acting on one |
| Behavioural activation | Returning to activities that give pleasure or purpose |
| Strengthening social support | Reconnecting with people who can help |
| Stress management | A simple breathing technique for physical tension |
| Model | Where | Who delivers | Main finding |
|---|---|---|---|
| Thinking Healthy | Rawalpindi, Pakistan | Lady health workers | Major depression 23% vs 53% at 6 months |
| HAP (PREMIUM) | Goa, India | Lay counsellors | Remission 64% vs 39% at 3 months |
| CAP (PREMIUM) | Goa, India | Lay counsellors | Harmful drinking in men; published 2017 |
| PM+ | Peshawar, Pakistan | Lay health workers | Lower anxiety and depression at 3 months |
| Friendship Bench | Harare, Zimbabwe | Lay health workers | Depression symptoms 13.7% vs 49.9% |
| Atmiyata | Mehsana, Gujarat | Village volunteers | OR 2.2 for recovery at 3 months |
| Setting | What to add | Evidence or authority |
|---|---|---|
| Early childhood | Caregiver support; screening mothers for depression | Thinking Healthy (Rahman et al., 2008) |
| School | Social and emotional learning; a counsellor; referral route | WHO fact sheet 2026; Sukdeb Saha (2025) |
| Coaching centres and hostels | No public ranking; helplines displayed | Sukdeb Saha (2025) |
| Child protection | Mental health support for children in care or after abuse | WHO fact sheet 2026 |
| Online | Safe reporting of suicide; moderation of harmful content | WHO media guidance 2023 |
| Layer | What it involves | Example |
|---|---|---|
| 4. Specialised services | Mental health care by specialists | Psychiatrist treats psychosis after a cyclone |
| 3. Focused non-specialised supports | Basic mental health care by primary care doctors; emotional and practical support by community workers | Trained ASHA runs PM+ sessions |
| 2. Community and family supports | Activating social networks, traditional supports, child-friendly spaces | Women's groups restart weekly meetings |
| 1. Basic services and security | Basic services delivered safely and in ways that protect dignity | Fair, transparent food distribution |
| PHQ-9 score | Severity band (Kroenke et al., 2001) |
|---|---|
| 5-9 | Mild |
| 10-14 | Moderate |
| 15-19 | Moderately severe |
| 20-27 | Severe |
| Level | Indicator | Source |
|---|---|---|
| Outcome | Mean change in PHQ-9 or GAD-7 score at 3 months | Validated tool, local language |
| Outcome | Share in remission (PHQ-9 below 10) | As used in HAP |
| Outcome | Functioning or disability score | WHODAS 2.0, as in PM+ |
| Output | People referred who reached a service within 30 days | Referral register |
| Process | Counsellor sessions reviewed in supervision | Supervision log |
| Equity | Coverage of people screened positive, by social group | Programme MIS |
| Element | What to write down |
|---|---|
| Services | Name, address, days and hours, phone, languages, cost |
| Criteria | What kind of need goes to which service |
| Consent | How the person agrees to the referral and what is shared |
| Urgent route | What to do for immediate risk, any hour |
| Follow-up | Who checks within a week that the person reached the service |
| Review | Test every number each quarter; update the sheet |
| What you notice | What you do | Who acts |
|---|---|---|
| Worry or low mood that does not stop daily life | Listen, normalise, share Tele-MANAS and self-help options | Any trained staff |
| Low mood or anxiety for two weeks or more, affecting work or care | Offer referral to the Ayushman Arogya Mandir or DMHP; follow up in a week | Field staff with supervisor |
| Talk of hopelessness or of not wanting to live | Ask directly about suicidal thoughts; make a safety plan; same-day referral | Supervisor or counsellor |
| Immediate risk to life | Stay with the person, call 112 or the nearest hospital and Tele-MANAS; do not leave them alone | Whoever is present |
| Signs of psychosis, mania or confusion | Do not argue; ensure safety; arrange medical assessment | Supervisor with family |
| Disclosure of violence | Safety first; refer to One Stop Centre or protection services; offer mental health support | Trained staff |
| Session | Content | Method |
|---|---|---|
| 1. What mental health is | WHO definition, continuum, common conditions in plain words | Discussion of staff's own words for distress |
| 2. Noticing | Changes in mood, sleep, work, withdrawal; local idioms | Case vignettes |
| 3. Responding | Listening, asking directly about suicidal thoughts, safety planning | Role-play in pairs with feedback |
| 4. Referring | The pathway sheet, Tele-MANAS 14416, consent, follow-up | Practice call to a service |
| 5. Doing no harm | Confidentiality, safe messaging, the programme's own stressors | Review of a real programme process |
| 6. Looking after yourself | Supervision, warning signs, where staff can get help | Group discussion |