With 289 million people in WHO’s South-East Asia Region alone living with mental conditions and 208,000 commiting suicide annually, countries from India to Singapore are embedding screening and therapy into routine primary visits, catching depression early where trusted doctors treat fevers and hypertension, slashing stigma as patients realize mental distress is just another health check
Dec 17, 2025 – On a humid morning in rural Nepal, Sita Devi (not her real name) walks into her local health post with complaints of persistent headaches and sleeplessness. A few years ago, she would have been sent home with painkillers, her underlying depression undetected. Today, the health worker conducting her examination has been trained to recognize mental health symptoms and can prescribe basic treatment on the spot.
This scene, once rare across Asia, is becoming increasingly common as countries throughout the region undertake one of the most significant shifts in mental health care delivery in decades: moving services from specialized psychiatric hospitals into the primary care system where most people first seek help.
The Treatment Gap
The scale of the challenge is staggering. Mental health conditions cost the global economy over $1 trillion annually largely due to reduced productivity, according to recent WHO analysis. In the WHO South East Asia Region alone, approximately 260 million people live with mental health conditions, yet only 2 per cent of total government health expenditure and 1 per cent of global development assistance for health are dedicated to mental health.
The consequences of this neglect are profound. Dr Poonam Khetrapal Singh, Regional Director of WHO South East Asia, emphasizes that “we need to make mental health and wellbeing a priority for all by reorienting and integrating mental health services into primary health care ensuring equitable and affordable access to care and services”.
Traditional models of care concentrated services in large psychiatric institutions in urban centers, far from where most people live. This approach failed on multiple fronts: geographic barriers prevented access, stigma attached to psychiatric facilities deterred help seeking, and the focus on severe mental illness meant common conditions like depression and anxiety went untreated.
The Global Context
The WHO Mental Health Atlas 2024, drawing on data from 144 countries, reveals the magnitude of the problem. Mental health receives only 2% of health budgets globally, with critical shortages in the workforce. According to the Atlas, resources available for the provision of mental health services have not increased since the last survey, with budgets remaining at a median of 2% of government health spending and staff at one government mental health worker per 10,000 population.
Dr Shekhar Saxena, Professor of Global Mental Health at Harvard’s T.H. Chan School of Public Health and former WHO Director of Mental Health and Substance Abuse, argues that “when it comes to mental health, all countries are developing countries. No country has mental health care services worked out quite satisfactorily”. He emphasizes that mental healthcare must be integrated at all levels, “starting from basic primary care to highly specialised care”.
Singapore’s Systematic Approach
Singapore has emerged as a regional leader in primary care integration. In 2023, the government launched its National Mental Health and Well-Being Strategy, a comprehensive blueprint for transforming mental health care delivery.
The centerpiece is expanding mental health services at general practitioner clinics and polyclinics, state-run primary care facilities. Thus far, 41,000 patients have benefitted from GP and polyclinics mental health services. The government plans to onboard more GPs under the Healthier SG initiative to provide assessment and medical treatment for mental health conditions.
The integration offers significant advantages. Integrated care for both mental and physical health enables holistic patient management, opportunistic early detection and intervention for mental health needs, and may minimise the stigma of seeking help. Research shows that about 13.9% of people with chronic physical disorders have mental health conditions, while 53.6% of those with mental health conditions suffer from chronic physical disorders.
Despite progress, challenges remain. A 2024 survey found that 82.6% of respondents agreed or strongly agreed that there is stigma surrounding mental health issues in Singapore. The government has committed to addressing these barriers. Deputy Prime Minister Lawrence Wong stated: “We will introduce mental health services to all polyclinics, and 900 more GP clinics”. The plan includes increasing public sector psychiatrists and psychologists by approximately 30% and 40% respectively.
India’s Digital Revolution
With a population of 1.4 billion and vast rural areas, India faced unique challenges in expanding access. The government’s response combined traditional infrastructure with digital innovation.
The District Mental Health Programme, now covering 767 districts nationwide, represents the backbone of India’s integration strategy. Under the Ayushman Bharat initiative, the government has transformed over 1.73 lakh (173,000) primary health centers into comprehensive health facilities. Mental health services have been added to the package of services provided at these centers, now called Ayushman Arogya Mandirs.
The digital innovation that has drawn international attention is Tele MANAS, launched in 2022. As of February 7, 2025, the Tele MANAS helpline has handled over 1.81 million calls since its launch, providing essential mental health support across the country. The service operates through 53 cells in 36 states and union territories, supported by 23 mentoring institutes and 5 regional coordinating centers.
The World Health Organization has praised Tele MANAS as an effective and scalable mental health solution. The October 2024 launch of the Tele MANAS App expanded access further, offering self-care strategies, stress management tools, and direct access to mental health professionals.
Yet significant gaps persist. Dr Vikram Patel, Paul Farmer Professor and Chair of Global Health and Social Medicine at Harvard Medical School and co-founder of Sangath, an Indian mental health NGO, has long championed the importance of primary care integration. He explains: “The principle of universal health coverage, no matter what disease or health issue you’re concerned with, whether it’s HIV or maternal health or mental health, the foundation of an equitable and efficient health care system is primary care”.
However, India has approximately 0.75 psychiatrists per 100,000 people, below the WHO recommended minimum of 1 per 100,000, with most concentrated in urban areas. Research shows that medical officers at primary health centers therefore lack confidence to diagnose and treat common mental disorders, even after short trainings.
Dr Saxena, who helped draft India’s first National Mental Health Policy, notes that “one of them is to use primary health professionals such as general doctors, general nurses, as well as community health care workers, to assist in identifying and treating at least some of the basic mental health disorders”. He adds that “the mhGAP package developed by WHO provides very useful information about how to train non-specialist providers, in identifying and treating mental, neurological and substance use disorders. It has been successfully used in more than hundred countries”.
Thailand’s Four Decade Journey
Thailand offers perhaps the most mature example of primary care integration in the region, having begun the process in 1982. The country’s experience provides valuable lessons about both possibilities and limitations.
Currently, 91.7% of community hospitals and 100% of general hospitals can provide outpatient services for the early management of common psychiatric disorders, continued care of chronic patients, and crisis intervention. This represents remarkable coverage achieved through decades of systematic effort.
The system is organized around 13 regional mental health centers that coordinate and support local health networks. Thailand has approximately 8,800 sub-district health centers providing basic services, with 695 district hospitals offering more comprehensive care. The integration means mental health care is embedded at every level of the system.
However, gaps remain even after 40 years. District hospitals typically stock only basic medications like haloperidol for schizophrenia and amitriptyline for depression. General practitioners often lack confidence in psychiatric diagnosis, and many patients are still referred to specialized facilities for ongoing care. The experience suggests that integration is not a one-time achievement but requires sustained investment and support.
Vietnam’s Emerging Model
Vietnam is at an earlier stage of integration but moving rapidly. The government launched a National Target Programme for Mental Health running till 2035, focusing on integrating mental health into general healthcare at the primary care level.
WHO Vietnam is currently supporting the government in establishing model programs for integration. At present, only central and provincial levels have psychiatric departments providing care and treatment, highlighting the need for expanded services. The initiative aims to enhance public health protection through strengthening preventive measures, early detection, and treatment management.
The approach reflects growing recognition that Vietnam’s current system, which primarily focuses on pharmacological treatment with limited psychotherapeutic options, must evolve. As the country works to build capacity, it faces challenges familiar to other nations in the region: workforce shortages, limited resources, and persistent stigma.
Nepal’s Community Focus
Nepal offers insights into integration in a low-resource, post-conflict setting. Following a decade-long civil war that devastated health infrastructure, the country has pursued creative approaches to expanding access.
The Community Mental Health Care Package Nepal, developed in 2017, guides integration efforts based on WHO’s Mental Health Gap Action Programme (mhGAP). The plan encompasses 12 care packages delivered across community, health facility, and organization platforms.
A key innovation is the use of Female Community Health Volunteers, trained community members who provide basic screening and support. However, implementation faces significant challenges: inadequate supervision of trained workers, irregular supply of psychotropic medications, and weak referral systems connecting primary facilities to specialized care.
Research with Nepali primary care workers reveals the complexity of integration. They identify sustainable medicine supply and avoiding overburdening already stretched staff as critical concerns. The experience underscores that successful integration requires more than training, it demands systemic support including supervision, supplies, and manageable workloads.
The Evidence Base
Across these diverse contexts, common principles emerge from successful integration efforts. WHO and the World Organization of Family Doctors jointly developed ten principles for integrating mental health into primary care (pdf), based on experiences from 12 countries across four continents.
Professor Helen Herrman, President of the World Psychiatric Association and Director of the WHO Collaborating Centre for Mental Health in Melbourne, has emphasized that “the profession needs to work with service users, community groups, family carers, and other professionals to improve mental health”. She notes that “the aim was, and remains, to offer treatment at or close to home. Obtaining enough support for mainstream mental health care is important, as is linking mental health, primary health, and social services”.
Key advantages of integration include reduced stigma, better treatment continuity, lower costs for patients, and opportunistic early detection during routine visits. Primary care providers can identify and treat common conditions like depression and anxiety, referring complex cases to specialists. This collaborative care model maximizes limited specialist resources while extending reach.
Research from Qatar provides quantitative evidence of impact. Between 2018 and 2023, anxiety screenings in primary care increased from 199,465 to 1,119,006, while depression screenings rose from 187,653 to 1,107,551. These dramatic increases reflect both expanded capacity and reduced stigma as mental health becomes normalized within routine care.
Dr Patel’s research through Sangath has demonstrated the effectiveness of task-sharing approaches. He explains: “We began to look at different approaches to delivering care, and hit on one which had been used with great success in maternal and child health. This involved empowering ordinary people and community health workers to deliver mental health care, with training and supervision from experts”. His work has shown that “there is now a body of evidence that includes randomized controlled trials done in more than 40 countries, demonstrating the effectiveness of task-sharing for prevention and care of a range of mental health conditions”.
The Challenge of Sustainability
Despite progress, sustainability concerns loom large. According to a 2024 analysis published in Translational Psychiatry, the number of psychiatrists in almost all countries and territories in Asia-Pacific was below the OECD average of 18.1 per 100,000 population, and there were, on average, fewer than 5 per 100,000 population mental health nurses in low and middle-income Asia-Pacific countries.
Dr Saxena warns that policymakers must ask “not whether they can afford to invest in mental health, but can they actually afford not to, they are playing with the human capital of their country and communities”.
Workforce challenges persist across the region. Training primary care providers in mental health adds to already heavy workloads. Without adequate numbers of staff, integration can lead to burnout and poor quality care. Countries must invest not just in training but in expanding the overall health workforce.
Medicine supply chains often fail. Even well-trained providers cannot treat patients without consistent access to essential psychotropic medications. Many facilities experience stock-outs, undermining patient trust and treatment adherence.
The shift from funding focused on institutional care to community-based services involves difficult political and budgetary choices. Established psychiatric hospitals have constituencies and political support; reallocating resources to primary care can encounter resistance.
Digital Innovation and Data
Digital technologies offer promise for overcoming some barriers. India’s Tele MANAS demonstrates how telephonic and app-based support can extend reach to underserved areas. Thailand launched the Step by Step app for depression, while other countries develop telepsychiatry systems connecting primary care providers with specialist consultation.
Dr Saxena emphasizes the potential: “Using websites or mobile phone apps people can access care when there is no health care worker around. Technology can also help in training primary care providers, wherever they are, in identifying and taking care of mental disorders”.
In July 2024, WHO South East Asia launched a regional Mental Health Dashboard to track prevalence, service coverage, and outcomes. The dashboard’s launch aligns with commitments made by Member States in the Paro Declaration on Universal Access to People-Centered Mental Health Care and Services. Better data enables evidence-based policy and targeted interventions.
However, digital solutions must be culturally adapted and cannot replace face-to-face care. Technology is a tool for extending reach, not a substitute for adequately resourced health systems.
Reducing Stigma
Perhaps the most significant impact of integration is destigmatization. When mental health care happens in the same clinics where people receive treatment for diabetes or hypertension, it becomes normalized as part of overall health rather than a separate, shameful condition.
Research from multiple countries shows reduced reluctance to seek help when services are available at familiar primary care facilities. Patients appreciate the convenience and privacy of addressing mental health during routine visits rather than traveling to specialized psychiatric facilities.
However, stigma persists. Even in Singapore with its advanced system, over 80% of respondents recognize ongoing stigma. Changing attitudes requires sustained public education alongside service expansion. Several countries now include mental health literacy in school curricula and workplace wellness programs.
The Paro Declaration and Regional Cooperation
In September 2022, WHO South East Asia member countries adopted the landmark Paro Declaration, committing to Universal Access to People-Centered Mental Health Care and Services. The declaration calls for developing country-specific targets to achieve universal primary care-oriented mental health services.
Dr Poonam Khetrapal Singh stated that “increasing investments in mental health, including for preventive and promotive services at the primary care level, reduces treatment costs and increases productivity, employment and quality of life”.
Member countries committed to developing multisectoral policies addressing mental health risks across the life course, increasing funding for community-based networks, ensuring continuous medicine supply, and strengthening data gathering and monitoring.
Between 2024 and 2025, regional cooperation intensified. Bhutan convened the PEMA Mental Health Symposium, and Thailand hosted the 2nd International Mental Health Workforce Training Programme with WHO Support. Such exchanges allow countries to learn from each other’s successes and challenges.
Economic Imperatives
The economic case for mental health investment strengthens. Essential mental health care packages in low-income countries can be delivered for as little as $3 to $4 per person, offering significant returns on investment. Beyond economic benefits, investing in mental health enhances productivity, social inclusion, and broader health outcomes.
India’s Economic Survey 2024-25 drew direct connections between mental well-being and productivity, emphasizing that the country’s demographic dividend depends on the mental health of its youth. However, budget allocations often lag behind such recognition. Translating rhetoric about mental health importance into sustained funding remains a critical challenge.
Progress varies widely. Singapore’s well-resourced systematic approach differs markedly from Nepal’s creative adaptations to severe resource constraints. Yet common threads unite these efforts: recognition that traditional models failed too many people, commitment to reducing stigma through normalization, and understanding that primary care offers the best platform for expanding access.
Challenges remain formidable. Workforce shortages, funding gaps, supply chain failures, and persistent stigma could undermine integration efforts. Success requires sustained political commitment, protected budgets, continuous training and supervision, and patience as systems adapt.
The WHO Regional Roadmap for Results and Resilience 2024-2029 identifies mental health as a key priority area. Member countries have set ambitious targets, but achieving them demands more than declarations. It requires the unglamorous work of training thousands of health workers, ensuring medicine supply chains function, building supervision systems, and gradually shifting entrenched attitudes.
Yet the early evidence offers grounds for optimism. Millions of people now receive mental health care who would have gone untreated under old models. Screenings have increased dramatically. Digital innovations extend reach to previously underserved populations. And gradually, mental health is losing its exceptional status, becoming recognized as integral to overall health.
For patients like Sita in Nepal, the difference is profound. Rather than her depression remaining undetected until it becomes severe, she receives help at the first point of contact. Her experience, multiplied millions of times across Asia, represents the promise of integration: not perfect care, but care that is available, accessible, and offered without shame.
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