"I think my neighbours are plotting against me," said a 45-year-old farmer from Raichur district, who reached out to a government-run mental health helpline after weeks of unease and fear. The counsellor who spoke to him noticed signs of a possible psychiatric disorder and referred him to a mental health professional. It was later found that both he and his wife had earlier been diagnosed with psychiatric conditions, but had discontinued treatment once they began to feel better.

Kilometres away in Bengaluru, a 22-year-old woman, two months pregnant, called the same service seeking help for fear, sleeplessness, and negative thoughts linked to a previous miscarriage. The counsellor guided her through relaxation techniques and connected her to a local facility for in-person assessment and ongoing therapy.

When mental health services were first discussed in India, they were largely perceived as a concern for urban populations -- professionals, students, or those with access to private healthcare. Rural communities, however, were considered largely untouched by issues such as depression, anxiety or stress, and the idea of seeking psychological support was often alien. Moreover, in many of these areas, professional psychological care remained a distant concept, and institutional services rarely reached those who needed them most.

Fast forward to 2025, and the narrative is changing. The Karnataka Tele-MANAS cell, part of the National Tele Mental Health Programme, has been seeing the number of calls multiply nearly 60-fold since its inception in 2022, with rural areas increasingly making up a significant proportion of calls at 68%, highlighting both rising awareness and the growing burden of mental health issues outside cities. The calls coming from urban areas stand at 32% in the State.

Karnataka's Tele-MANAS surge

In Karnataka, the Tele-MANAS helpline now handles more than 340 calls per day. Since its launch in 2022, the number of calls has grown dramatically -- from 1,204 in the first year to 52,302 in 2024, and 70,260 calls have already been recorded so far in 2025. Most callers fall in the 18 to 45 age group, accounting for roughly 68% of all calls. The next largest group, aged 46 to 64, represents 17.1%, while those aged between 13 and 17 comprise around 6.5% of the total.

The growing volume of calls in Karnataka mirrors a larger national trend. Under the National Tele Mental Health Programme, 53 Tele-MANAS Cells now operate across India, functioning as the core mental health units at the State and Union Territory levels. These are divided into two categories based on population size -- Category 1 for States and Union Territories with over 20 lakh people, and Category 2 for smaller regions. Among the larger States, Uttar Pradesh recorded the highest number of calls at 5.18 lakh, while Gujarat received the lowest. Telangana topped the Category 1B list with 1.71 lakh calls, and Nagaland registered the fewest.

Among the smaller territories, Dadra and Nagar Haveli and Daman and Diu handled the most calls at 29,119, while Lakshadweep received the least. Karnataka currently stands fifth nationally. Nationwide, most callers are between 18 and 45 years (69.8%), with 52.59% identifying as male.

Role of ASHA workers

Much of this shift within the rural parts has been attributed to community-level outreach, especially through the District Mental Health Programme (DMHP) and the tireless work of ASHA workers, who introduce families and caregivers to the services available, often in taluk hospitals through monthly Manochaitanya camps.

In Karnataka, the Tele-MANAS helpline now handles more than 340 calls per day. | Photo Credit: K. MURALI KUMAR

Under DMHP, monthly Manochaitanya camps at taluk hospitals introduce mental health counselling to patients already diagnosed with psychiatric, neurological, or medical conditions. These camps have also become a space to inform families and caregivers who may otherwise not know about Tele-MANAS and similar helplines.

The surge in calls, however, doesn't just reflect better access; it also reveals how mental distress is beginning to speak in new forms.

Manjula Devi, an ASHA worker, pointed out that in both rural and urban areas, the voices reaching out for help tell very different, yet connected stories. "In villages, distress often surfaces as confusion, suspicion, or erratic behaviour that families may not immediately recognise as symptoms of stress or a mental illness. In cities, it's more likely to emerge as quiet exhaustion -- sleeplessness, anxiety, or a sense of being emotionally overwhelmed by work, finances, or relationships," she said.

Rural vs. Urban, men vs. women

Interestingly, there is a clear and substantial difference even in call patterns between rural and urban settings. "In rural areas, the majority of calls received by the TeleMANAS relate to disorders -- people with diagnosed conditions or significant dysfunction. Urban calls, by contrast, are largely distress-related, triggered by events such as job loss, academic pressure, heart breaks, or financial crises, but without an underlying psychiatric disorder. Low mood, anxiety, and sleep disturbances, however, are the most common complaints across both groups," Dr. Sanjana Kangil, Senior Resident in Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), said.

In Karnataka, 50.66% of the callers to Tele-MANAS are male, while females account for around 46%. But the nature of their concerns differs sharply.

"Women frequently call about interpersonal issues, domestic violence, or loneliness, while men's concerns more often relate to financial stress or substance use. Among young adults, anxiety usually stems from academic pressures or relationship challenges, whereas middle-aged callers are more likely to seek support for marital or financial difficulties. Older adults, meanwhile, often reach out due to loneliness or the strains of caregiving. Across age groups, the consistent need is the same -- someone who listens without judgment," Dr. Kangil added.

Moreover, while the helpline bridges the shortage of mental health professionals in many rural areas, in urban settings, psychiatrists and psychologists attached with the State Health Department said it tackles a different challenge -- the widespread perception that counselling and mental health support are prohibitively expensive. "Here, the problem is not the lack of services, but the belief that professional help is beyond reach, making accessible helplines an essential lifeline for those seeking support," Dr. Archana P., a psychologist at State DMHP said.

Many people, especially in urban areas, acknowledge that counselling is costly, and this perception often shapes whether and how they seek help.

Garima M. (name changed), a young woman, who began attending free counselling sessions at her college, recalled that each meeting lasted only an hour -- barely enough for her to fully open up or work through her concerns. After graduation, she hesitated to continue, assuming that private counselling would be expensive.

Coupled with the perception that counselling is costly or exclusive, many delay or avoid seeking help altogether. Or, in many cases these days, people turn to AI chatbots, which offer privacy and immediate responses.

Counselling, cost and the AI alternatives

Counsellors have also observed a shift in when people reach out for help. Earlier, most calls used to come between 10 a.m. and 2 p.m., typically when health services were most active. But over the past year, late-night calls have surged. Many of these are from people who feel most alone after work hours or when their surroundings are quiet. Counsellors say this pattern overlaps with the hours when people are also more likely to confide in AI chatbots.

"AI chatbots can offer privacy that many people prefer while sharing their mental health concerns due to existing stigma. They also, in some sense, provide validation to concerns without necessarily challenging thought-processes or helping build human relationships. AI chatbots can individualise mental illness without locating it in the social conditions in which a person is living -- a potentially harmful approach that may pathologise and stigmatise an individual with mental health concerns," Mukta Gundi, faculty, School of Development, Azim Premji University, Bengaluru, noted.

Mukta explained that greater preference for AI chatbots for emotional support, as compared to human counsellors, may suggest two concerning phenomena. "Firstly, it may indicate a lack of trusted relationships and non-judgmental spaces that a person with a mental health condition need. In a fast-paced, unequal world, it raises the question of whether society is investing enough in building social cohesion and support systems to help people cope with stressful situations. As a society, we need to foster social connections, forums that forge and nurture relationships that normalise conversations and sharing around mental well-being."

Mukta said this underscores the need for human counselling services that are more accessible, affordable, and available for all. Human counsellors who are culturally sensitive, who understand diverse expressions of mental well-being, and who are aware of the social realities influencing mental health concerns cannot be replaced by AI chatbots, she emphasised.

Naming mental health

Mental health, experts further note, often hide in plain sight. People may feel anxious, sleepless, or overwhelmed, but the language to describe those feelings rarely exists in everyday speech or language. A woman who cannot sleep for weeks may say she has "tension", not depression. A farmer losing interest in his fields may be seen as lazy, not unwell. Across many rural areas, there are no local words for "mental health" or "therapy," and where terms do exist, they carry the weight of stigma -- "madness" or "weakness."

This absence of vocabulary makes emotional pain harder to name, and therefore, harder to treat. Families, too, struggle to interpret these signs, fearing community gossip or social exclusion if they seek help, experts pointed out.

While this silence defines much of rural India, cities present a different but equally complex landscape. As Mukta explains, "The context of 'urban' needs to be unpacked as it entails diverse sets of populations with different kinds of distresses faced on a daily basis. For instance, many migrants come to the cities to work as daily wage workers. Leaving behind their social capital, staying away from families, adjusting to an unequal, fast-paced, and often, an exclusionary urban life with poor access to affordable health care, and stable income can be distressing."

Counsellors and psychiatrists also explain that it is important to understand that the experiences and the impact of these distresses may differ significantly for women, adolescents, elderly or for those from socially marginalised backgrounds living in urban areas. "Many of them may not even have the vocabulary to express their tensions, worries, and sorrows. Additionally, due to stigma around mental health, many often find it extremely hard to access care due to fear of being shamed or discriminated against. So, in addition to these urban stressors, inability to access care due to stigma, lack of affordable and culturally relevant treatment services affects mental health among urban vulnerable populations," Mukta pointed out.

Understanding rural mental health requires looking through multiple lenses. It is important to ask -- who actually has access to phones, and who can reach out online or via helplines? Which age groups, genders, and socio-economic backgrounds are able to seek such support? While a higher volume of calls from rural areas may signal growing awareness and improved access to telephonic counselling among some communities, vast inequalities remain.

"Many people in rural India still struggle with acute shortages of mental health services. The stressors driving distress in these areas are complex, such as extreme weather events, financial hardships, limited employment opportunities for youth, and the pressures of increasing urban migration all play a role. Higher call numbers, therefore, may still reflect access for a select few rather than the broader mental health reality across rural populations," Mukta said.

Even as helplines expand and awareness grows, counsellors and experts highlight that the distance between recognition and care still remains wide. "A call may connect someone to help, but the path to continued treatment through stigma, poverty, or silence often breaks midway. What the rising calls reveal, perhaps, is not resolution, but the start of a longer conversation India has only just begun to have," said Dr. Manjunath M., a psychiatrist with state Taluk Mental Health Programme (TMHP).

"The surge in calls, however, doesn't just reflect better access; it also reveals how mental distress is beginning to speak in new forms."

"Many people in rural India still struggle with acute shortages of mental health services"Mukta GundiFaculty, School of Development, Azim Premji University

Mental health awareness no longer only an urban phenomenon