Tele-MANAS offers a lifeline for India’s mental health crisis, but operational hurdles and fiscal gaps threaten its scalability and long-term success.
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India’s mental health landscape has historically been characterised by significant treatment gaps. The National Mental Health Survey (2015–16) estimated that nearly 150 million individuals require psychological intervention. However, less than one in 10 receive adequate care. The reasons are both infrastructural and social: a severe paucity of qualified mental health professionals, patchy service delivery across geographies, and deep-rooted stigma that consistently discourages help-seeking behaviour. Against this backdrop, digital mental health services have started offering a promising and scalable alternative.
In October 2022, the Ministry of Health and Family Welfare (MoHFW), in partnership with the National Institution of Mental Health and Neuro Sciences (NIMHANS), launched Tele-MANAS, which is short for ‘Tele Mental Health Assistance and Networking Across States’. This round-the-clock tele-mental health platform is designed to expand access, particularly in rural and underserved regions where conventional services are sparse. By providing real-time remote consultations and triaging support, Tele-MANAS attempts to bring the long-ignored margins of mental healthcare into the fold.
Although early signs are encouraging, the system is not without its limitations. Success will hinge on factors such as the integration of digital platforms with existing health infrastructure, sustained public investment, and improvements in digital literacy. If these barriers can be addressed, India can turn a chronic weakness into a frontier for innovation, leveraging technology not only to deliver mental healthcare at scale but to reframe the national conversation around mental wellbeing itself. The programme aligns with India’s commitment to Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality from non-communicable diseases (NCDs) by one-third and promote mental health and well-being by 2030.
Tele-MANAS is steadily emerging as a critical component of the country’s health infrastructure. According to the Rapid Assessment Report, the programme spans across the nation, with 53 Tele-MANAS cells delivering round-the-clock mental health support in 20 regional languages. With over two million calls received, the platform reflects a strong and rising demand for accessible, remote psychological care.
With over two million calls received, the platform reflects a strong and rising demand for accessible, remote psychological care.
The two-tiered structure of Tele-MANAS supports effective triaging by delineating roles across levels of care. In Tier 1, trained counsellors manage initial assessments and provide frontline psychological support. More complex or severe cases are escalated to Tier 2, where individuals are referred to psychiatrists and clinical psychologists, frequently through eSanjeevani video consultations. This two-fold approach enables the strategic allocation of specialist resources, ensuring their optimal use in cases requiring advanced clinical intervention. With its scalable, cost-effective, and culturally responsive design, Tele-MANAS is fast proving to be a vital intervention within India’s mental health landscape and a potential model for other low- and middle-income countries. However, several challenges must be addressed to enable the programme to achieve scalable implementation and deliver sustained, meaningful impact.
Tele-MANAS’s early success is increasingly challenged by fiscal, structural, and operational issues which could affect its long-term sustainability. A key concern is the declining financial support. According to the Budget for Mental Health: Analysis of Union Budget 2025–26 by the India Mental Health Observatory (IMHO), the budget estimate for fiscal year (FY) 2025–26 stands at INR 80 crore, down from INR 134 crore in FY 2023–24. While this reduction may partly reflect one-time capital expenditures in earlier years, the persistent underutilisation of allocated funds points to deeper systemic flaws. In FY 2023–24, only 25 percent of the budget was spent, a pattern consistent with FY 2022–23. These repeated shortfalls highlight structural challenges in fund disbursement and absorption, underscoring concerns about administrative capacity and the limited prioritisation of mental health within broader national health planning.
Furthermore, the transition of Tele-MANAS from a centrally sponsored scheme to integration under the National Health Mission (NHM) introduces new challenges. While decentralisation through state-led Programme Implementation Plans (PIPs) may enhance local responsiveness, it also risks funding inconsistencies, administrative delays, and uneven political prioritisation. These variations could weaken national uniformity and limit access in underserved regions. Ensuring Tele-MANAS’s scalability will require sustained funding alongside strong institutional coordination and accountability across both central and state levels.
Operational inefficiencies further compound the financial challenges facing Tele-MANAS, threatening the fabric of its long-term viability. The most urgent among these is workforce instability. Without a standardised salary structure, counsellors often face irregular payments and receive no additional compensation for night shifts or overtime, despite being responsible for a 24/7 helpline. These conditions contribute to burnout and declining staff retention. Furthermore, hiring is based on population size rather than actual call volumes, leading to significant workload imbalances across states.
Training gaps further weaken the system. Tier 1 counsellors receive standardised basic training, but Tier 2 professionals often lack structured training in crisis management, evidence-based interventions, and supervisory protocols. This undermines the intended efficiency of the two-tiered model, especially when handling complex or high-risk cases. Infrastructure challenges also persist. Many Tele-MANAS centres operate out of cramped, poorly soundproofed rooms, which compromises caller confidentiality and reduces staff concentration. Inconsistent internet access and subpar equipment, such as outdated headsets, frequently disrupt consultations and slow down response times.
Without a standardised salary structure, counsellors often face irregular payments and receive no additional compensation for night shifts or overtime, despite being responsible for a 24/7 helpline.
Lastly, uneven public awareness across regions has contributed to low call volumes in several states, perpetuating stigma and limiting the platform’s reach. Enhancing digital literacy is crucial to improving both access and engagement. Although digital infrastructure has expanded significantly, only 38 percent of Indian households are digitally literate, creating a significant barrier to effective use. Aggravating this issue is the weak coordination between Tele-MANAS and in-person services such as District Mental Health Programme (DMHP) clinics, resulting in high dropout rates between Tier 1 and Tier 2 care. Furthermore, the absence of structured feedback mechanisms means frontline workers rarely receive updates on patient outcomes, hindering continuous learning and service refinement. Addressing these operational gaps is vital for Tele-MANAS to evolve into a resilient, scalable, and integrated mental health care system.
India can draw valuable insights not only from its ongoing implementation experience but also from established frameworks and international models that have addressed similar challenges. Adopting and adapting best practices from countries with mature digital mental health systems can inform effective design, delivery, and governance mechanisms tailored to the Indian context. The priority should be financial reform to ensure long-term viability. Funding should be ring-fenced within state-level PIPs under the NHM, minimising fund diversion and echoing strategies such as the United Kingdom’s (UK) NHS Long-Term Plan, which designated £2.3 billion annually for mental health and improved access metrics.
Alongside fiscal measures, addressing workforce instability is an equally urgent facet. A national compensation and training framework is needed to standardise salaries and guarantee timely digital payments. Staffing allocations should reflect actual call volumes rather than population size to ensure appropriate coverage during peak periods. To maintain service quality, all counsellor and specialist roles should align with the World Health Organization (WHO) digital health competency framework. Annual recertification via the existing Tele-MANAS e-learning platform should be made mandatory to institutionalise training and ensure accountability.
To improve clinical efficacy, triage systems require structural strengthening. Drawing lessons from Australia’s Head to Health initiative, Tele-MANAS could benefit from embedded clinical decision-support tools and standardised escalation protocols. Implementing brief, validated screening instruments such as the Kessler Psychological Distress Scale (K6+) at the first point of contact through an Interactive Voice Response System (IVRS) can improve diagnostic accuracy, support real-time risk assessment, and enable data-driven service planning. These reforms are essential to transition Tele-MANAS from a largely reactive helpline into a proactive, integrated arm of India’s mental healthcare system.
This transformation also depends on robust infrastructure and technological adaptability. Minimum infrastructure standards should include soundproof booths, ergonomic workstations, reliable high-speed internet, and standardised hardware such as noise-cancelling headsets. Transitioning to cloud-based, geo-redundant call routing, similar to Lifeline Australia, can reduce wait times and manage call surges. Moreover, seamless integration with platforms such as eSanjeevani and the Ayushman Bharat Digital Mission (ABDM) would enable smoother referrals and care coordination.
The UK’s decade-long ‘Time to Change’ campaign—which combined mass media with community celebrities—significantly improved mental health awareness and help-seeking behaviour.
Finally, sustained public engagement, digital literacy, and institutional learning must be built into the system. For instance, the UK’s decade-long ‘Time to Change’ campaign—which combined mass media with community celebrities—significantly improved mental health awareness and help-seeking behaviour. India can adapt this model by launching a large-scale Information, Education, and Communication (IEC) campaign. This could involve Accredited Social Health Workers (ASHAs) distributing Tele-MANAS materials and organising local mental health days, an approach that has proven effective in other public health programs. To support this, the National Digital Literacy Mission should collaborate with ASHAs to lead community-based digital education and promote inclusion, thereby addressing critical gaps in access and awareness. Furthermore, to ensure the system remains adaptive and evidence-driven, user feedback and implementation research must be institutionalised. In line with WHO’s recommendation, a dedicated share of the Tele-MANAS budget should be allocated to independent evaluations and rapid-cycle pilot studies to improve service delivery.
Taken together, these interventions lay the groundwork for a more accountable, adaptive, and accessible mental health ecosystem. Tele-MANAS represents a significant stride toward closing India’s mental health treatment gap through a scalable, inclusive digital platform. While its achievements in access, infrastructure, and coordination are commendable, its long-term sustainability is at risk due to fiscal instability, uneven state implementation, and operational inefficiencies. To ensure its viability and contribution to SDG 3.4, Tele-MANAS requires a robust, equity-driven policy overhaul focused on financial security, workforce resilience, technological modernisation, and culturally responsive care.
Shaivi Shroff is a Research Intern at the Observer Research Foundation. She is a student at the University of British Columbia studying psychology and international relations.
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Shaivi Shroff is a Research Intern at the Observer Research Foundation. She is a student at the University of British Columbia studying psychology and international ...
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