The Tele-MANAS programme: design and evolution

Tele-MANAS was rolled out nationwide on 10 October 2022 (World Mental Health Day) as a free 24/7 tele-mental-health service. It operates through a toll-free hotline (14416 or 1-800-891-4416) that any individual can call to receive counselling, basic psychological support and referrals. A key principle of Tele-MANAS is accessibility: the service is available in over 20 Indian languages, ensuring linguistic and cultural reach across India’s diverse population. Callers can remain anonymous, an important feature to reduce the fear of stigma or judgement that often deters help seeking. The service is organised in a multi-tier system: at the first tier, trained mental health counsellors and psychologists provide immediate tele-counselling and problem-focused support; more complex or severe cases are escalated for stepped-up care, where psychiatrists and clinical psychologists can offer tele-consultation or direct the caller to in-person services. This stepped care model allows efficient triage, addressing common distress in the majority of calls and reserving specialist intervention for those who need it most.

Technologically, Tele-MANAS is integrated with India’s broader digital health ecosystem. The platform aims to integrate with e-Sanjeevani, and aligns with the Ayushman Bharat Digital Mission’s health ID system to enable secure sharing of health records where appropriate. ^{Reference Suhas, Kumar, Math and Manjunatha3} Such integration helps provide continuity if a caller needs ongoing care. For instance, a Tele-MANAS counsellor can refer the person to a local mental health professional or an Ayushman Bharat Health and Wellness Centre, with their prior consent, ensuring the next level of care is informed. ⁴ Tele-MANAS’s governance structure spans central and state levels: initially funded and guided by the Union Ministry of Health, it established 23 mentoring institutes and five regional coordinating centres to support implementation through the 53 cells across the states and union territories. ⁴ The long-term plan is to integrate Tele-MANAS into each state’s health system under the National Health Mission for financial and administrative sustainability.

The Tele-MANAS counsellors are trained in psychological counselling, triage protocols and mental health interventions. Additionally, the training framework includes dedicated modules on crisis management, suicide risk assessment, aggression, risk of harm to others and mental health first aid. Counsellors are trained to identify warning signs, assess immediate risk, provide emotional stabilisation, follow defined do’s and don’ts, involve caregivers where appropriate and escalate cases to Tier 2 mental health professionals or local emergency services when clinically indicated. Competency assessment includes role plays and simulated calls involving difficult scenarios such as suicide risk and crisis calls. These processes are supported by documentation, supervision, referral pathways and linkages with local mental health and emergency services.

Another important aspect of Tele-MANAS is its emphasis on privacy and security. All calls and digital interactions are encrypted, and operational protocols ensure that counsellors only collect minimal necessary information (such as the caller’s first name or location, if emergency intervention is required). India’s evolving regulatory framework – including Telemedicine Practice Guidelines and the Digital Personal Data Protection Act, 2023 – provides a legal backbone for protecting patient data and guiding ethical tele-mental-health practice. Importantly, Tele-MANAS follows a data-minimisation approach in which most personal identifiers (e.g. name, age, gender and location) are optional, and services can be accessed anonymously. Phone numbers are masked within the system, and audio or video interactions are not recorded. Data access is restricted to authorised personnel using role-based controls. ⁵ Tele-MANAS adheres to these standards, instilling public trust that one’s identity and conversations will remain confidential. This trust factor, combined with the convenience of phone-based help, aims to lower the threshold for people to seek help early rather than delay care.

Early outcomes and impact

In its first few years, Tele-MANAS has rapidly scaled into one of the world’s largest public mental health initiatives. As of March 2026, the service handled nearly 3.43 million calls from across the country ⁴ – a volume that underscores the immense pent-up demand for accessible mental health support in the community. The majority of callers (estimated ∼70%) have been young adults in the 18–45 age bracket, with slightly more men reaching out than women (in one analysis, 56% of calls were from male callers). ^6,7 This pattern of male predominance has been replicated in other studies as well. ^{Reference Javed and Kakunje8} This demographic skew may reflect gender differences in available resources, phone access and help seeking. Nonetheless, the engagement of young men is notable, given that traditional clinic settings often see lower male participation in mental health services due to stigma.

The presenting problems reported to Tele-MANAS have largely been common mental health issues and issues pertaining to psychosocial stressors. According to a government rapid assessment, the top concerns include disturbances in sleep, feelings of sadness or low mood, anxiety and work or relationship stress. Together, these issues account for well over half of all calls, indicating that Tele-MANAS serves as a first-line support service for mild-to-moderate mental health needs that otherwise might go unaddressed. Importantly, a smaller yet significant fraction of calls (∼3%) have involved suicidal thoughts or acute distress crises. For these high-risk situations, Tele-MANAS counsellors follow established protocols – providing emotional stabilisation, ensuring the person is not left alone if possible, and facilitating emergency help (such as alerting local authorities or connecting to community support) when needed. Such cases highlight the programme’s potential to act as a safety net for individuals who might not have any other avenue for urgent help.

Geographically, Tele-MANAS has achieved wide coverage. The 53 functioning Tele-MANAS cells are distributed across all 36 states and union territories of India, ensuring that even smaller and northeastern states have local capacity. This decentralised network allows language and culture-specific services; for example, a caller from a tribal district can ideally speak to a counsellor who understands their regional language and context. To bolster reach in remote areas, the programme utilises not just phone calls but also a recently launched Tele-MANAS mobile app (introduced in October 2024). The app offers self-help resources, psychoeducation materials and a chat-based interface to contact counsellors, which may appeal to younger, tech-savvy users who prefer texting or multimedia over voice calls. Additionally, video consultation capabilities have been piloted via the app in a few regions (e.g. Karnataka, Tamil Nadu, and Jammu and Kashmir), enabling face-to-face virtual sessions when clinically appropriate. While the app extends the platform’s functionality, the toll-free phone line remains the backbone of the service, given its ease of use for individuals with basic phones and low digital literacy.

The early performance of Tele-MANAS has drawn international attention. In 2024, the WHO conducted an independent rapid assessment of the programme and praised Tele-MANAS as an ‘effective and scalable solution’ for mental health care in a low-resource setting. ⁷ The assessment noted the robust technology architecture and the iterative improvements made to enhance service quality. For instance, software upgrades have streamlined call routing to reduce wait times, and training modules for counsellors have been standardised nationally to ensure quality control. The WHO also highlighted Tele-MANAS’s alignment with principles of equity and affordability in mental health, citing it as a model that other countries could adapt. This external validation has added momentum to the initiative, with the Indian government commemorating Tele-MANAS’s 2-year anniversary in late 2024 and reiterating its commitment to strengthen the platform further.

Notwithstanding these achievements, Tele-MANAS’s massive uptake also illuminates the unmet needs in India’s mental health landscape. The next challenge is to consolidate these gains and address the limitations that have emerged.

Implementation challenges and strategies

While Tele-MANAS shows promise as a scalable model, its implementation has faced several challenges that must be managed to ensure long-term success. Many of these challenges are typical for digital health initiatives in LMIC contexts, but some are unique to the mental health domain. Table 1 summarises key challenges identified in the rollout of Tele-MANAS and the strategies (both ongoing and proposed) to tackle them. This mapping of challenges to solutions highlights how the programme is attempting to transition from merely closing the basic treatment gap (i.e. providing access) to closing the ‘care gap’ – delivering quality, continuous care for all who seek help. Challenges such as funding, workforce, technology access, continuity of care and data protection are being addressed through a combination of policy integration, capacity building, technological solutions and process innovations. Together, these strategies aim to enhance Tele-MANAS’s resilience and effectiveness as a national programme. Key challenges and strategies to handle the same are discussed in Table 1.

Table 1

Key challenges in Tele-MANAS implementation and strategies under implementation

Tele-MANAS, Tele Mental Health Assistance and Networking Across States; SMS, Short Message Service; IVR, interactive voice response; WHO, World Health Organisation.

Future directions

Tele-MANAS marks a paradigm shift in India’s approach to mental healthcare delivery – from a system of scarce, clinic-based services to a digitally enabled, decentralised support network. Looking ahead, the focus will be on deepening its impact and ensuring its sustainability. As a programmatic overview, the data presented in this manuscript are preliminary and largely descriptive, underscoring the need for future evaluations of outcomes and effectiveness. One priority is to formally evaluate clinical outcomes – for example, establishing whether Tele-MANAS interventions lead to measurable reductions in distress, improved functioning or successful linkage to ongoing care. This means moving beyond counting calls to assessing the quality of care. The concept of closing the ‘care gap’ becomes pivotally important. Tele-MANAS must strive not only to reach people, but to actually help them achieve better mental health and maintain it. Developing a robust outcome-tracking mechanism (potentially by integrating Tele-MANAS with patients’ electronic health records via digital health IDs) could enable follow-up on whether callers attended referrals or showed improvement on standardised scales. The nationwide network of decentralised, language-specific Tele-MANAS cells ensures broad geographical reach, although detailed region-wise utilisation patterns warrant further systematic analysis. Over time, such data can inform evidence-based refinements to the service, especially in assessing region-specific needs and providing appropriate interventions. Future work should systematically examine cultural and regional variations in presenting complaints and conceptualisations of distress using Tele-MANAS data.

Another future direction is expanding the scope of Tele-MANAS in preventive and promotional mental health. The large user base offers an opportunity for population-level interventions – for example, sending periodic wellness tips or stress management content to callers who opt in, or using aggregate call trends to inform public health messaging and promote well-being. The service could also integrate AI-driven tools carefully, such as chatbot assistants for triage or multilingual speech-to-text analysis to aid counsellors, while keeping human oversight at the core. Importantly, as India’s first national tele-mental-health platform, Tele-MANAS can act as a template for other LMICs. Its early success demonstrates that even with limited specialists, a helpline model can extend basic mental health care to millions at a low cost, if backed by political will and technology. Countries with similar treatment gaps can adapt Tele-MANAS’s ‘hub-and-spoke’ architecture, where a central hub provides guidance and local spokes deliver services in native languages. The emphasis on anonymity and cultural sensitivity in Tele-MANAS also provides a lesson in reducing stigma – an issue that plagues mental health uptake globally.

In conclusion, India’s Tele-MANAS initiative is an ambitious and pioneering effort to democratise mental health care through digital means. In just a few years since its inception, it has connected millions of individuals with support, many for the first time, thereby chipping away at the formidable treatment gap. Challenges remain in ensuring service quality, equity and continuity, but the programme’s adaptive strategies and supportive policy environment bode well for its evolution. Tele-MANAS illustrates how a public sector innovation can leverage technology to bring mental health care within everyone’s reach – ‘anyone, anywhere, anytime’. The Tele-MANAS model offers important policy-relevant insights for other LMICs seeking to address large mental health treatment gaps. Its emphasis on digital platforms, task sharing and integration within existing public health systems demonstrates how scalable and cost-effective mental health services can be developed in resource-constrained settings. The approach highlights the value of leveraging multilingual accessibility, decentralised service delivery and stepped-care frameworks to enhance reach and equity. These principles may inform the design and adaptation of similar national-level tele-mental-health initiatives in diverse global contexts. Tele-MANAS could serve as a global blueprint for integrating mental health into primary care using telemedicine, especially in resource-constrained settings. Ultimately, its success will be measured by the lives improved and the precedent it sets for mental health system transformation in the digital age.