Why India’s Mental Health Helplines Are Failing: A Deep Dive into Systemic Gaps

Written by: Muskan Shah, Moitrayee Das

A helpline is akin to a life jacket—an intervention designed to prevent a person from drowning, whether in a water body or in a sea of panic and despair. But what happens when this very helpline fails at its most basic function: answering the phone when it matters most?

The rise of mental health awareness in India over the last five years has brought significant changes, one of the most notable being TeleMANAS, the National Tele-Mental Health Programme. The helpline offers two toll-free numbers that are said to be available round the clock, seven days a week, to provide “equitable, accessible, affordable, and quality mental health care” to citizens across the country. The prevalence of mental health issues in India is estimated at 13.7%, while 15% of the adult population experiences concerns requiring intervention (Ministry of Health and Family Welfare, 2025). Despite these national figures, the budget estimate for this initiative has been reduced from Rs 120.98 crore in its inception year (2022–23) to Rs 80 crore in 2025–26, with actual fund utilisation declining from Rs 66 crore in the initial year to Rs 45 crore in 2024–25 (Centre for Mental Health Law & Policy, 2025). Alongside TeleMANAS, several other organisations and websites claim to offer full-time, free, accessible helplines such as iCALL, Vandrevala Foundation, YourDost, and more.

What happens when calls go unanswered?

The idea behind establishing these helplines is invaluable—providing individuals with immediate access to trained counsellors during moments of intense distress, to talk them off a ledge both literally and metaphorically. These services are not meant to replace therapy or serve as long-term solutions; their purpose is to de-escalate crises and bring individuals to a place where they can seek long-term help.

However, most helplines seem to operate on fixed, office-like schedules. Despite advertisements claiming 24×7 availability, many follow specific timings such as Monday to Saturday, 10 a.m. to 7 p.m. A 2020 report by The Print found that even during these official hours, several helplines failed to answer calls (Misra, 2020a). Even if crises conveniently occur during this narrow time span, attempts to connect with helplines remain a hit-or-miss experience rather than a reliable one. Reports show that some well-known helplines answer only two to three calls out of every five attempts, shifting attention away from the crisis at hand and increasing feelings of helplessness, anger, and anxiety (Misra, 2020b). Many helplines fail to answer overnight, keep callers waiting with endless automated menus, and have unnecessarily long processes.

If you’re lucky and your call does get answered, you still don’t know what awaits on the other side. Callers have reported both comforting and distressing interactions with counsellors, leaving them unsure of what to expect. The lack of a consistent training curriculum, standardised protocols, and adequate supervision leads to massive variation in the quality of care provided (Sagar & Singh, 2022). Incorrect terminology, insufficient training in crucial areas such as suicide risk assessment and psychological first aid, and inconsistent service delivery can inadvertently worsen a caller’s condition. This lack of clear guidelines also raises an important question: When the system fails, who is responsible? With a tangled network of public, private, and non-profit stakeholders, questions of accountability remain unresolved.

The toll behind the telephone

Mental health helplines in India are often staffed by employees who treat the role similarly to a call-centre job—not because of a lack of passion or empathy, but because higher managerial bodies fail to acknowledge the importance and emotional weight of the work. Employees often receive inadequate training and minimal support. Although guidelines recommend hiring experienced psychologists to run helplines and offer counselling or psychotherapy, these guidelines are suggestive rather than legally binding (NIMHANS, 2020). As a result, untrained or underqualified individuals may be hired instead.

When underqualified staff are placed in such roles, they require extensive training to understand the complexity of situations they may encounter, how to navigate responsibilities, and how to protect their own mental health. Being on the receiving end of constant distress, trauma, and crisis calls can significantly impact an employee’s emotional and psychological well-being. With centres often understaffed and underpaid, employees frequently face not only emotional burden but also financial strain. For instance, 361 workers employed at the women’s counselling helpline “181” in Uttar Pradesh reportedly went unpaid for more than a year between 2019 and 2020 (Srivastava, 2020). More recently, a former TeleMANAS employee expressed her distress on LinkedIn regarding delayed salary payments and advocated for colleagues who had not been paid for over eight months (Bansal, 2025).

These factors raise a critical question: If employees are poorly treated, overworked, and underpaid, how can they sustainably offer high-quality care day after day? An exhausted workforce cannot operate a crisis helpline effectively when they themselves lack support and resources. Issues related to funding, training, supervision, and infrastructure reveal significant gaps that must be addressed before expanding helplines further.

So, now what?

The need of the hour is structural reform—practical interventions that strengthen helpline systems from the ground up. These include establishing national standards and accreditation systems, ensuring consistent funding, conducting independent audits, and investing in both technological and human capital.

National standards must outline clear training modules for all employees working at accredited helpline centres, including minimum training hours, essential modules (such as suicide risk assessment, psychological first aid, referral mapping, and ethics), mandatory supervision, and continuous professional development. These standards must be legally enforceable for all organisations offering mental health helpline services.

Steady funding is crucial, as it allows for predictable budgets that can be fairly allocated to training, hiring, and payroll. Stable funding ensures timely salaries, supervision, and employee well-being.

Independent audits can help assess budget utilisation and evaluate service effectiveness. Metrics such as call volume, answer rates, waiting time, and follow-up rates must be reviewed regularly. Annual audits, made transparent through public dashboards, help restore public trust and promote accountability.

Investment in technology can facilitate follow-up services, linking callers to local clinics, telemedicine services, and relevant organisations for long-term care. Investment in human capital—especially hiring supervisors—can improve service quality through case reviews, support during difficult cases, and opportunities for professional growth. When employees feel supported, quality of service improves, turnover decreases, and both callers and providers benefit.

Helplines are not symbolic gestures or PR tools; they are emergency services with the power to save lives. A failed helpline is not a minor lapse—it can be a matter of life and death. As India strives for progress on multiple fronts, mental healthcare cannot advance without strengthening its foundations. To transform helplines into true lifelines, improvements in training, supervision, regulation, and auditing are essential. Only then can helplines move beyond being a gamble and become a reliable, trustworthy support system.

Citations

Bansal, A. (2025, May 29). It’s been 6 months — six months without salaries … [Post]. LinkedIn. https://www.linkedin.com/posts/amola-bansal_its-been-6-months-six-months-without-salaries-activity-7308377135549755392-fzNz/

Department of Clinical Psychology, NIMHANS, 2020. Guidelines for tele-psychotherapy services. Bengaluru: National Institute of Mental Health and Neuro Sciences. https://nimhans.co.in/wp-content/uploads/2021/09/Guidelines-for-Telepsychotherapy-2020.pdf

Misra, S. (2020a, September 10). Suicide helplines go unanswered in India. Or you get untrained volunteers. ThePrint. https://theprint.in/opinion/pov/suicide-helplines-go-unanswered-in-india-or-you-get-untrained-volunteers/499565/

Misra, S. (2020b, June 16). Most suicide helplines are of little help as they don’t work when people need them. ThePrint. https://theprint.in/health/most-suicide-helplines-are-of-little-help-as-they-dont-work-when-people-need-them/442287/

Sagar, R., & Singh, S. (2022). National Tele-Mental Health Program in India: A step towards mental health care for all?. Indian journal of psychiatry, 64(2), 117–119. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_145_22

Srivastava, P. (2020, July 22). Over 350 employees of UP ‘women helpline’ not paid salary for a year, threaten hunger strike. ThePrint. https://theprint.in/india/over-350-employees-of-up-women-helpline-not-paid-salary-for-a-year-threaten-hunger-strike/465951/

Muskan Shah is postgraduate Student at Christ University, and Moitrayee Das is an assistant professor of Psychology at FLAME University, Pune.