Addressing critical mental health needs through community-led interventions
India is home to the largest adolescent population in the world, with over 243 million young people aged 10-19 years. This demographic represents a significant proportion of the country’s population, underscoring the importance of prioritizing their health and wellbeing. However, the mental health challenges faced by Indian adolescents are deeply concerning, with issues like depression, anxiety, substance abuse, and suicide emerging as major public health concerns.
Approximately 7% of adolescents in India aged 13-17 years suffer from psychiatric disorders, with the overall treatment gap for mental health disorders as high as 90%. The economic burden of mental illnesses also outweighs other non-communicable diseases, amounting to 4% of the gross national product. This crisis demands comprehensive, evidence-based interventions to address the mental health needs of this critical population.
To tackle this pressing issue, the Joint Action for Water (JAW) initiative in Maharashtra launched an innovative “Adolescent Health and Well-being Check-up Programme” across three districts – Nashik, Yavatmal, and Panna. This community-led approach aimed to empower adolescents, strengthen mental health support systems, and promote sustainable solutions for holistic wellbeing.
Peer-led mental health interventions in schools
The cornerstone of the programme was the integration of mental health support within the existing Rashtriya Kishor Swasthya Karyakram (RKSK), India’s national adolescent health initiative. Peer educators (PEs) recruited and trained under RKSK played a pivotal role in the intervention, extending their responsibilities beyond the programme’s original scope.
Peer Education Approach
The PEs, aged 15-17 years, were selected through a rigorous multi-level process and trained by Auxiliary Nurse Midwives (ANMs) and medical officers. Their primary responsibilities included:
- Conducting weekly participatory sessions with adolescents in their villages on RKSK’s thematic areas, including mental health
- Forming peer groups to foster discussion and support among adolescents
- Referring adolescents to Adolescent Friendly Health Clinics (AFHCs) when needed
The PEs acted as a critical link between adolescents and healthcare providers, bridging the gap and enabling access to essential services.
Adapting to the COVID-19 Context
When the COVID-19 pandemic hit, the PEs demonstrated remarkable adaptability, expanding their roles to support the broader community response efforts. They:
- Sensitized adolescents and community members on COVID-19 appropriate behaviors through innovative strategies like rallies, posters, wall paintings, and folk songs.
- Distributed essential supplies like masks and sanitizers in their villages to curb the spread of the virus.
- Assisted healthcare workers in contact tracing, monitoring, and other COVID-19 related tasks, drawing on their rapport with the community.
- Played a crucial role in promoting COVID-19 vaccination uptake, addressing vaccine hesitancy through awareness campaigns and leading by example as early vaccine recipients.
This exemplary contribution of PEs during the pandemic showcased their potential to strengthen the public health system, even in the face of unprecedented challenges.
Strengthening the Whole-School Approach
In addition to the peer education model, the programme also implemented a multi-component, whole-school intervention in select schools. This approach, known as the SEHER (Strengthening Evidence-based School Interventions for Adolescent Health) Project, emphasized the importance of a positive school climate to support adolescent mental health and wellbeing.
The SEHER intervention operated at three levels:
- Whole-school level: Fostering supportive relationships, a sense of belonging, and a participatory environment within the school community.
- Group level: Conducting targeted sessions and activities for specific groups, such as students, teachers, and parents.
- Individual level: Providing counseling and support services for students with mental health concerns.
Delivered by trained lay counselors called “SEHER Mitras,” the SEHER intervention demonstrated significant improvements in the school climate, depression, bullying, attitudes towards gender equity, and reduced violence victimization and perpetration among students.
Community-based mental health promotion
While the school-based interventions reached a significant proportion of the adolescent population, the programme also recognized the need to address the mental health needs of out-of-school youth. To this end, a community-based intervention was implemented in the rural areas of the three districts.
Peer-led Approach in Rural Settings
In the rural communities, the programme leveraged the existing network of Accredited Social Health Activists (ASHAs) and Peer Educators (PEs) to deliver mental health promotion activities. The PEs, trained as “Poshan Sakhis” (Nutrition Friends), conducted regular group meetings and one-on-one counseling sessions with adolescents and young adults aged 16-24 years.
The community-based approach focused on:
- Raising awareness on mental health, addressing issues like depression, anxiety, substance abuse, and suicide prevention.
- Promoting help-seeking behavior by linking adolescents and young adults to available health services and support systems.
- Fostering social and emotional skills, such as communication, problem-solving, and resilience.
Preliminary results from the community-based intervention showed promising outcomes, including reduced prevalence of probable depression, increased knowledge, and positive shifts in attitudes towards sexual and reproductive health.
Harnessing digital tools for mental health support
Recognizing the growing role of technology in the lives of young people, the programme also piloted a digital intervention to complement the community and school-based efforts.
Promoting a Mental Health Helpline through mHealth
The digital component involved a text-based mobile messaging service to raise awareness about a dedicated mental health helpline for young women in urban slum communities. The intervention aimed to assess the acceptability and feasibility of using mobile technology to promote access to mental health support services.
The text messages provided information about the helpline, its services, and tips for maintaining positive mental health. Feedback from the pilot study indicated high user satisfaction and the potential for mobile platforms to offer discreet, accessible, and confidential mental health support, especially for vulnerable populations.
Lessons Learned and the Way Forward
The Adolescent Health and Well-being Check-up Programme in Maharashtra demonstrates the power of community-led, multi-pronged interventions to address the mental health needs of adolescents. Key lessons from this initiative include:
- Leveraging Existing Platforms: Integrating mental health support within the framework of the national adolescent health program (RKSK) enabled the programme to build on existing infrastructure and community networks, ensuring sustainability and scalability.
- Empowering Peer Educators: The pivotal role played by PEs, both in their prescribed responsibilities and in their adaptive COVID-19 response, underscores the potential of peer-led models to strengthen adolescent mental health support systems.
- Adopting a Whole-School Approach: The SEHER intervention’s focus on creating a positive school climate, in addition to individual-level support, highlights the importance of addressing mental health at multiple levels within the school ecosystem.
- Engaging the Community: The community-based intervention, delivered through ASHAs and PEs, demonstrated the feasibility and acceptability of reaching out-of-school adolescents and young adults with mental health promotion activities.
- Leveraging Digital Tools: The pilot mHealth intervention showcased the promise of mobile technology in providing discreet, accessible mental health support, particularly for marginalized populations.
Moving forward, the Joint Action for Water initiative plans to scale up and replicate the Adolescent Health and Well-being Check-up Programme across additional districts in Maharashtra. Key priorities include:
- Strengthening the capacity of PEs and expanding their role in mental health promotion and support.
- Integrating the SEHER whole-school intervention into the state’s education system for wider implementation.
- Expanding the community-based mental health model to reach more out-of-school adolescents and young adults.
- Integrating the digital mental health support services with the community-based efforts for a holistic approach.
- Advocating for increased investment and policy support to address the mental health crisis among Indian adolescents.
By building on the lessons learned and the proven effectiveness of this multi-pronged approach, the Joint Action for Water initiative aims to pave the way for a more comprehensive, community-driven mental health ecosystem for adolescents in Maharashtra and beyond.
