There is a common belief—especially among urban populations—that those living close to nature enjoy better mental health. But our experience in the tribal communities of Dangs district in Gujarat, India, tells a different story. Despite its scenic beauty, Dangs—a small tribal district with around 2.8 lakh people—faces deep socio-economic challenges such as poverty, low literacy, and seasonal migration. These hardships severely affect health and well-being, particularly for women.

Access to mental health care in such areas is extremely limited. According to the WHO Mental Health Atlas 2017, low- and middle-income countries have only 0.51 psychiatrists, 0.26 psychologists, and 0.28 social workers per 100,000 people. In tribal areas like Dangs, the geographical terrain, erratic weather, poor transport, and difficult socio-economic conditions make accessing even these scarce services harder. Mental illness is often misunderstood—as a curse or punishment—leading to stigma, silence, and isolation. As a result, 80–90% of people with mental illnesses in rural India go untreated, and the situation is worse in tribal regions.

In such settings, community-based mental health care is essential. It focuses on shifting care from a specialist-driven model to a primary health care approach. With the support of trained field workers, telepsychiatry, and linkages to rehabilitation services, the treatment gap can be significantly reduced, even for the most vulnerable.

We share below the stories of two young women—Roshni and Jyoti (names changed)—to show how timely, compassionate, and community-based care can change lives.

Roshni, aged 35, developed schizophrenia after the birth of her second child. Her husband abandoned her, and she lived with her elderly mother and two daughters. Without treatment, her condition worsened. She wandered in and around her village, unaware of her surroundings or even her clothing. She faced abuse and exploitation, which led to two more unintended pregnancies.

Jyoti, aged 21, comes from another vulnerable family. She has an intellectual disability with behavioural challenges. Her father died young, her mother is chronically ill, and her brother dropped out of school to care for them. As her condition worsened, she began wandering alone, often putting herself in danger.

Both women were identified by our field workers and connected with our telepsychiatry service. Roshni improved significantly with regular treatment and consistent support from field staff. Jyoti, however, did not benefit much from medication due to a lack of family support. She was eventually placed in a rehabilitation centre, where she is now safe, cared for, and steadily improving.

Call for Compassion and Systemic Change

Addressing mental health in tribal areas requires a shift from a purely medical model to a community and rights-based approach. Women like Roshni and Jyoti deserve dignity, protection, and inclusion. Key interventions to support patients in remote locations include:

1. Training Local Health Workers

We train community health workers and field supervisors to identify mental illnesses using a simple symptom-based checklist that even a layperson can use. Once a potential case is identified, field workers counsel individuals and families—often over multiple visits—to build trust and encourage treatment. Their persistence is critical; without it, many patients would never access care.

2. Teleconsultation

An uninterrupted supply of medicines, rationally prescribed and monitored by a psychiatrist or trained general practitioner, is crucial. In remote locations like Dangs, where psychiatrists cannot be physically present, telepsychiatry is a game-changer. We conduct fortnightly telepsychiatry sessions, where trained staff connect patients with psychiatrists remotely. Prescriptions are filled at our primary care clinic, and medicines are delivered to patients by health workers. We also organize periodic mental health camps to allow for in-person consultations.

3. Building Community Support

Establishing a support system within the community is especially important for individuals like Roshni and Jyoti, who are abandoned or lack family support. Based on our experience, this is the most difficult task and requires years of sustained effort. It involves building awareness about mental health and trust in the program. Patients who have recovered often act as community ambassadors, helping reduce stigma and garner support.

4. Strengthening Referral Linkages

While only 1–3% of patients with mental illness need long-term institutional care, this small percentage represents some of the most vulnerable individuals. For women from deprived socio-economic backgrounds, institutional care can offer safety and dignity—if done right. Jyoti was successfully placed in such a facility where she is receiving care and rehabilitation. However, it’s vital to take the family and community into confidence and remain alert to the risk of exploitation within such institutions.

Conclusion

The mental health crisis among tribal women remains largely hidden but demands urgent attention. Without timely intervention, mental illnesses can lead to tragedy—not only for patients but also for their families. However, with a compassionate, community-based approach, recovery and rehabilitation are possible. It’s time to bring mental health out of the shadows, ensuring that no one, especially women from marginalized communities, is left behind.

Authors: Shyamsundar Raithatha – A community and family physician working with a non-profit in western India, Shyamsundar manages a telepsychiatry program and primary care clinic in a remote tribal area bordering Gujarat and Maharashtra.
Simran Jha – A public health professional, Simran is developing a community-oriented primary care initiative around the same clinic.

Competing interest: None

Handling Editor: Neha Faruqui