BRICS NIMHANS Network: Scaling Mental Health in Primary Healthcare

Overview

The designation of the National Institute of Mental Health and Neuro Sciences as the coordinating apex for the BRICS Network of Centres of Excellence establishes a dedicated multilateral framework. It integrates psychiatric care directly into primary health systems.

Shifting institutional knowledge from tertiary psychiatric hospitals to community health centres creates a practical model for emerging economies facing severe workforce shortages.

As of March 2026, low- and middle-income nations across the Global South confront massive psychiatric treatment gaps and severe specialist deficits. Anchoring mental health delivery within comprehensive primary healthcare transforms psychiatric support into an accessible, rights-based public health entitlement rather than an urban clinical luxury.

The National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, was officially designated as the coordinating Centre of Excellence for the BRICS Network of Centres of Excellence on Mental Health and the BRICS Training Hub Network.

This institutional milestone involves key diplomatic developments:

• Multilateral Ratification: Endorsed during the 16th BRICS Health Ministers' Meeting and reaffirmed at the 18th BRICS Summit.
• Shared Clinical Mandate: Member nations agreed to pool clinical expertise, conduct multi-centric research, and scale community-oriented psychiatric solutions across the Global South.
• Shift in Health Priorities: The BRICS declaration formally recognises neuropsychiatric conditions as a major driver of chronic disability and economic output loss in developing economies.

India's public mental healthcare architecture is shifting away from centralised asylum-based institutionalisation. It now focuses on decentralised community-level interventions through the National Mental Health Programme (NMHP), operationalised at the grassroots level through the District Mental Health Programme (DMHP).

The delivery model rests on three distinct tiers of administrative and clinical care:

• Primary Tier (Ayushman Arogya Mandirs): Frontline health workers conduct population-level screenings, offer basic psychoeducation, and dispense essential psychotropic medications under the Comprehensive Primary Health Care framework.
• Secondary Tier (Community Health Centres and District Hospitals): Medical officers, psychiatric nurses, and clinical psychologists under the DMHP provide outpatient consultations, emergency psychiatric stabilization, and counselling.
• Tertiary Tier (Centres of Excellence like NIMHANS): Specialised psychiatric institutes manage refractory disorders, run post-graduate training programmes, and guide national policy formulation.

This tiered decentralisation operationalises statutory mandates under the Mental Healthcare Act, 2017. Section 18 of the Act establishes a legally enforceable right to access affordable, non-discriminatory mental healthcare funded by the appropriate government.

The BRICS Network of Centres of Excellence on Mental Health operates on four foundational pillars designed to bridge institutional deficits across member states. The 18th BRICS Summit New Delhi Declaration detailed these mechanisms to advance collaborative clinical research, policy harmonisation, digital health integration, and capacity building.

The operational pillars comprise:

1. Collaborative Research and Epidemiological Surveillance: Establishing joint data registries to track the prevalence of common and severe mental disorders across diverse demographic cohorts.
2. Standardised Manpower Training: Utilising the BRICS Training Hub Network at NIMHANS to upskill general medical practitioners, community nurses, and public health managers.
3. Knowledge Translation and Best-Practice Scaling: Implementing the BRICS Compendium of Best Practices on Promotion of Mental Wellness to replicate validated low-cost interventions.
4. Vulnerable Population Interventions: Delivering structured Mental Health and Psychosocial Support (MHPSS) strategies tailored for children, adolescents, and communities facing acute humanitarian or climate-induced crises.

NIMHANS is the technical anchor. It designs curricula and standardises clinical protocols across emerging health systems. By establishing common diagnostic matrices, the network enables emerging economies to bypass expensive Western models in favour of community-based psychosocial approaches.

Decentralising psychiatric services across India faces structural bottlenecks that sustain a severe treatment gap. According to the National Mental Health Survey (NMHS 2015-16), 10.6% of Indian adults suffer from a diagnosable mental disorder, with lifetime prevalence reaching 13.7%.

The systemic treatment gap ranges between 70% and 92% across major psychiatric conditions, standing at 85% for common mental disorders and 73.6% for severe mental disorders. Several structural hurdles perpetuate this disparity:

• Severe Manpower Deficits: India possesses approximately 0.75 psychiatrists per 100,000 population, falling far short of the World Health Organization recommendation of at least 3 psychiatrists per 100,000.
• Fiscal Under-allocation: Public spending on mental healthcare accounts for less than 1% of India's total health budget, compelling families to bear substantial out-of-pocket expenses.
• Macroeconomic Losses: Studies published by the World Health Organization and the Lancet Commission estimate that mental health disorders will cost the Indian economy over $1.03 trillion in lost economic output between 2012 and 2030.
• Social Stigma and Urban Bias: Specialist mental health infrastructure remains heavily clustered in tertiary medical colleges in urban centres, leaving rural populations reliant on informal providers.

The Ministry of Health and Family Welfare (MoHFW) leverages digital architecture and task-shifting strategies to overcome clinical shortages. The National Tele Mental Health Programme operationalises Tele-MANAS (Tele Mental Health Assistance and Networking Across States) as a round-the-clock digital lifeline via toll-free numbers 14416 and 1800-891-4416, anchored by NIMHANS.

Tele-MANAS operates through a structured two-tier service delivery model:

• Tier 1 (State Tele-MANAS Cells): Staffed by trained clinical psychologists and tele-counsellors, this level handles inbound distress calls, triage, basic psychological first aid, and immediate crisis management.
• Tier 2 (Specialist Consultation and Linkage): When callers present severe psychiatric distress or active suicidal ideation, cases escalate to senior psychiatrists, clinical psychologists, and localised DMHP physical facilities for in-person management.

At the physical frontline, task-shifting frameworks train Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). They learn to recognise early behavioural symptoms and lead community anti-stigma campaigns.

Concurrently, the District Mental Health Programme has been sanctioned across 767 districts, establishing an administrative footprint to anchor these primary referrals.

The BRICS Mental Health Network is a reciprocal knowledge corridor for developing countries confronting identical epidemiological burdens. Through the BRICS Compendium of Best Practices on Promotion of Mental Wellness, member states exchange scalable, low-cost community health innovations.

Key avenues of multilateral learning and contribution include:

• Adapting Brazil's CAPS Architecture: Brazil's Centros de Atenção Psicossocial (Psychosocial Care Network - CAPS) provides an open-door, community-based alternative to psychiatric hospitalisation. India can adapt this model to prevent long-term institutionalisation in state psychiatric hospitals.
• Exporting India's Digital and Community Footprint: India's rapid deployment of Tele-MANAS and its extensive ASHA cadre offer a blueprint for large-scale digital triage and grassroots screening in geographically dispersed nations.
• Integrating Traditional and Complementary Medicine: The BRICS Health Track has established a dedicated Expert Working Group on Traditional, Complementary and Integrative Medicine (TCIM) to explore evidence-based holistic interventions and herbal formulations for stress reduction.

Decentralisation via South-South collaboration is a structural necessity. Training enough specialist psychiatrists to meet World Health Organization benchmarks will take decades. Consequently, India must adopt community-based task-shifting models validated across the Global South to close its mental healthcare gap.

The governance of mental health intersects directly with human dignity and constitutional safeguards. Article 47 of the Constitution directs the state to raise public health standards as a Directive Principle of State Policy. Modern jurisprudence also locates mental well-being firmly within the enforceable fundamental right to life under Article 21.

The Mental Healthcare Act, 2017 introduced transformative rights-based protections:

• Decriminalisation of Suicide: Section 115 establishes a statutory presumption of severe stress for any individual attempting suicide. It explicitly places an affirmative duty on the government to provide care, treatment, and rehabilitation rather than prosecution.
• Advance Directives and Nominated Representatives: The law empowers individuals to legally document their treatment preferences in advance and nominate trusted representatives, checking involuntary confinement and clinical abuse.
• Protection of Civil Liberties: The legislation strictly curtails coercive practices, mandating that psychiatric treatment respect individual autonomy and bodily integrity.

Sustainably closing India's psychiatric treatment gap requires structural health financing, institutional accountability, and continuous workforce expansion. Translating international declarations into community-level outcomes depends on targeted policy interventions:

• Enhancing Dedicated Budgetary Allocations: Progressively increasing mental health expenditure towards 5% of the total health budget is essential to ensure a reliable supply of essential psychotropic drugs across primary health centres.
• Institutionalising Task-Shifting Protocols: Legally empowering and incentivising Community Health Officers, ASHAs, and general medical officers to deliver basic cognitive interventions relieves pressure on tertiary facilities.
• Strengthening DMHP-Primary Health Linkages: Upgrading physical infrastructure across all 767 sanctioned DMHP districts ensures patients identified via Tele-MANAS receive seamless secondary clinical follow-up.
• Targeted School and Adolescent Interventions: Scaling evidence-based psychoeducation through national school health initiatives protects vulnerable youth from rising anxiety, depression, and self-harm.

• NIMHANS Bengaluru is the coordinating Centre of Excellence for the BRICS Network of Centres of Excellence on Mental Health and the BRICS Training Hub Network.
• India faces an acute shortage of mental health professionals, with only 0.75 psychiatrists per 100,000 population, against the World Health Organization benchmark of 3 per 100,000.
• The National Mental Health Survey (NMHS 2015-16) documented a treatment gap of 85% for common mental disorders and 73.6% for severe mental disorders.
• Section 18 of the Mental Healthcare Act, 2017 establishes a legally enforceable right to accessible mental healthcare, while Section 115 effectively decriminalises suicide attempts.
• Grassroots integration relies on a dual strategy: digital triage through the two-tier Tele-MANAS network and decentralised physical screening across Ayushman Arogya Mandirs and 767 DMHP districts.