A young bride in rural Uttar Pradesh, barely out of her teens at 24, had fallen silent. Pooja (a pseudonym), newly married, retreated into the hushed world of her own making, eating only when pressed, her gaze locked onto a fixed point in the room.

To her family, it wasn’t sickness they saw, but stubbornness. Her in-laws called her “badtameez” (ill-mannered). The village elders feared the malevolent spirits, recommending exorcism. 

In their world, there was no word for what had taken hold of her. There was no vocabulary for depression.

In rural India, mental illness is often mistaken for something else. A woman battling postpartum depression is told she’s possessed. A farmer gripped by severe anxiety can only say “mann theek nahi lag raha” (the mind doesn’t feel right). Where language fails, pain finds expression in the supernatural, the physical, or the unspeakable.

It is into this silence that the Swayam Foundation steps in. Co-founded by Shrinkhla Sahai (also the Lead Psychologist) in 2015, the organization has established a foothold across pockets of Uttar Pradesh and Bihar, embedding crucial mental health support in villages where open conversations about emotional distress were once unimaginable.

However, entering that silence is only the beginning. The real challenge lies in navigating the intricate web of structural, social, and economic hurdles that come along the way.

The hardest gaps to bridge

In the districts where Swayam Foundation works, the barriers are layered. 

Basic infrastructure is broken, and many villages remain cut off by crumbling roads and poor transport, making even a single home visit a logistical feat. While teletherapy might seem like a viable alternative, the digital divide ensures it rarely is. 

There’s also a staggering scarcity of trained mental health professionals. As per the Indian Journal of Psychiatry, India has just 0.75 psychiatrists per 100,00 people, most of whom are based in cities. For rural populations, especially in Bihar and Uttar Pradesh, access is practically non-existent. Even when care is available, language becomes a barrier—psychological concepts like anxiety, depression, etc., don’t always translate easily into local dialects, and therapy as a practice often feels foreign.

Then comes the hardest truth: economic vulnerability.

“When survival is the priority, mental health takes a backseat. Many of the women we work with face domestic violence, financial dependence, and a lack of decision-making power. Mental health support alone is not enough,” explains Sahai.

This neglect is mirrored in how mental health is funded. In India, less than 1% of the total health budget is allocated to mental health, and most philanthropic or development grants still prioritize visible, measurable outcomes like maternal health, sanitation, or livelihoods. Emotional well-being remains at the margins—undervalued, underfunded, and often misunderstood.

How Swayam builds lasting change

But naming the problem is only one part of the puzzle. The deeper work lies in quietly building solutions that begin inside the community instead of relying on outside factors. 

Swayam Foundation begins this shift by training local women—often ASHA or Anganwadi workers—to recognize signs of distress, offer basic psychological support, and become mental health champions. These women, already trusted in their communities, become the bridge between formal mental health care and people who need it but won’t seek it.

Another critical shift is in the language. “Instead of imposing clinical language,” says Sahai, “we use culturally relevant metaphors and storytelling to explain mental health concepts. For instance, anxiety isn’t explained as a ‘disorder’ but as a mind full of racing thoughts like an overcrowded village market.” 

Where mental health professionals are absent, Swayam builds a support system through a hub-and-spoke model. Psychologists supervise remotely, often supported by on-site camps, while trained community workers provide on-ground care. 

Recognizing the limitations of digital infrastructure, the foundation follows a low-tech, high-touch model. Video therapy is thus replaced with scheduled phone calls while counselling happens not in clinics, but inside community-based counselling hubs—spaces carved out of existing health centres or SHG rooms.

Men, often the hardest to reach, are engaged through indirect, culturally accepted pathways. Stress management workshops under the guise of boosting agricultural productivity gradually open the door to conversations about mental health. Village elders, local influencers, school teachers, and religious leaders are drawn in to gently reshape community attitudes and soften the stigma.

To address financial and funding challenges, mental health support is integrated into existing programs for health and women’s empowerment. For professionals, flexible roles (part-time and remote) make rural mental health work possible and sustainable. 

And in cases of acute distress, Swayam sets up crisis response protocols—community workers are trained in suicide prevention, and district hospitals are partnered to ensure at least one doctor is equipped to respond to psychiatric emergencies.

Deciding where to begin

Mental health, as Sahai sees it, is needed everywhere. But need alone doesn’t dictate where Swayam Foundation works. What matters just as much is the possibility of building something that lasts. 

So, they begin by identifying high-risk communities where people face compounding layers of distress: mental health struggles intertwined with poverty, gender inequality, caste-based exclusion, or high suicide rates. This includes villages reeling from collective trauma (e.g., farmer suicides) or those where substance use and distress-related behaviors are alarmingly common.

For instance, in one such village in Uttar Pradesh, a young woman had recently died after years of being verbally abused by her in-laws. When Swayam entered, they found many other women carrying the same silent burden. Few had words for what they felt. “Depression” wasn’t mentioned—but its weight was everywhere.

However, even when suffering runs deep, Swayam Foundation doesn’t impose help. Change, they believe, must be welcomed.

They look for signs of readiness: active women’s self-help groups or grassroot organizations, a respected village elder or ASHA worker willing to speak up, or a history of engagement with public health initiatives (e.g., maternal health, TB programs). 

Sometimes, it’s the community that makes the first move. Women who attend Swayam’s sessions in one village will return home and urge others: “Yahan bhi yeh hona chahiye.” (This should happen here too.) 

It’s through this kind of invitation—not intervention—that Swayam’s work expands, gently and with permission.

The first conversation is never about mental health

In Sahai’s words, “Mental health cannot be ‘introduced’ from the outside. It has to be grown from within—through words that feel familiar, relationships that feel safe, and questions that remind people they are more than just their roles as mothers, wives, or workers.”

So, when a Swayam team walks into a new village—often one where the words “maansik swasthya” or “mental health” have never been spoken—they don’t arrive with charts or deliver lectures. Their presence is quiet, almost invisible, folding into the natural rhythm of village life: self-help group gatherings, stitching circles, breaks during farming hours. There is no designated stage, no structured session, but only the slow unfolding of trust through conversation and listening.

And it all begins with a simple question: “Aap kaise hai?” (How are you?)

Followed by a gentle, more probing, “Aap sachmuch kaise hai?” (How are you, truly?)

That second question, Sahai says, often cracks something open. Eventually, it became the foundation of Swayam’s work—an opening through which women who had never spoken of their inner struggles began to check in on each other. Slowly, quietly, a support system began to form.

After all, sometimes, the most powerful intervention isn’t therapy. It’s finally being asked the right question.

In one home, this meant listening to the women who surrounded Pooja—the young bride who hadn’t spoken in weeks. Swayam’s team didn’t walk in with a diagnosis. They entered through the backdoor of daily life—shared routines, quiet tea breaks, idle moments on a charpai.

Through unhurried conversations, they shared stories of other women who had faced similar distress and found relief. As trust began to take root, the volunteers gently posed reflective questions like, “Has she always been like this, or did something change?” and “If she had a physical illness, how would you care for her?”

Their answers that followed revealed something important: The family members weren’t cruel—they were scared. Scared of what this meant, the shame it could bring, and what others might say if the truth (that something was wrong with Pooja) came out.

Training the first line of empathy

Many of the rural women who volunteer with Swayam Foundation carry the weight of their own lived struggles—domestic violence, poverty, caste-based discrimination. So before they’re trained to support others, the work begins inward. The first step is fostering self-awareness and building inner resilience.

Volunteers learn to recognize their emotional triggers and strengths. They practice grounding techniques (breathing exercises, mindfulness, body-based coping strategies) that serve as anchors during moments of emotional distress.

Only when this foundation is steady do they begin learning how to hold space for others. They are taught to create environments where conversations around mental well-being feel familiar and non-threatening. Clinical terms are replaced with culturally rooted metaphors and stories—depression, for instance, becomes “mann ka bhaar” (a heaviness of the heart). 

This training also includes psychological first aid: listening with empathy, validating individual experiences, and knowing when a situation requires escalation to a professional.

By seamlessly weaving emotional literacy into the fabric of everyday life—through stitching circles, women’s group meetings, or quiet chats under neem trees—Swayam’s volunteers become more than just facilitators. They become mirrors, reminding others: You’re not alone. Your pain is seen. And it matters.

So, as Pooja’s silence grew heavy—and with it, her family’s quiet panic over their dignity—Swayam began reframing what healing could look like.

They didn’t call it “mental health treatment”—just “stress relief.” Simple, body-based techniques like deep breathing and grounding experiences allow Pooja and her family to view this treatment as a wellness practice, not a medical intervention. They encouraged a trusted family member, her sister-in-law, to sit with her quietly. The goal wasn’t to force conversation, but to offer presence and comfort without pressure.

One day, during an informal sharing circle with other women, one of the volunteers turned to Pooja and asked, “Aap sachmuch kaise hain?” (How are you really?) For the first time in months, she looked up. Tears rolled down her face, but she didn’t speak. And yet, in that moment, everything shifted.

The work continues in the quiet

Mental health care in rural India requires more than just one-time interventions or visiting experts. Healing, to be meaningful, must continue even after the outsiders leave. That’s why Swayam’s model of aftercare is deliberately local and deeply rooted in the social architecture of village life. It’s a mix of community-driven support, structured follow-ups, and sustainable mental health ecosystems. 

In Mumura and Shaberi in Uttar Pradesh, for instance, women who once sat silently in early sessions now gather every week for what they call “chai circles.” These aren’t formal therapy groups. They’re gatherings in someone’s courtyard, around cups of tea, and everyday chatter, where checking in on each other has become a habit. It is in these spaces that care continues—not as treatment, but as kinship.

That same evening, when Pooja shed tears for the first time in months, her husband quietly approached the Swayam team and asked, “What can I do?” It was a small question, but a powerful turning point—the resistance had begun to soften.

With the family now open to support, Swayam adapted its approach to meet them where they were, keeping the care as non-threatening as possible. 

They encouraged the husband to write her small notes instead of urging her to speak. Depression was explained to Pooja’s family members in everyday terms: “Think of it as the mind being tired, just like the body gets tired.” Additionally, a local woman—someone who had experienced depression herself—began visiting Pooja—not as a professional, but as a peer.

Providing mental health support without a pharmacy

In rural India, where formal infrastructure is patchy and psychiatric medication isn’t always an option—and even when it is, it carries a stigma (“Log kya kahenge?” or “What will people say?)—Swayam leans into what already exists and is culturally resonant with the people. 

Rhythmic activities like grinding grain, kneading dough, or weaving—activities that women do daily and feel calm while doing so—are reframed as grounding practices instead of introducing something unfamiliar. And when therapy rooms don’t exist, the community itself becomes the care system. Trained local women hold listening circles—spaces without judgement or hierarchy—where shared storytelling replaces silence, and isolation gives way to solidarity.

Perhaps, most importantly, Swayam doesn’t ask people to choose between traditional beliefs and modern therapy. Faith-based practices—such as prayer, temple visits, or reciting sacred verses—are not dismissed as mere superstition but embraced as emotional anchors, especially for the village elders. 

What progress looks like

“Unlike a vaccination drive where success is measured in doses administered,” Sahai reflects, “mental health transformation is often invisible. How do you measure a mother unlearning the harshness she grew up with and choosing gentler words for her child? Or a woman who, for the first time in her life, says, ‘Mujhe bhi suno’ (Listen to me too)?”

But just because something is intangible doesn’t mean it’s immeasurable. Swayam approaches impact with a lens that is layered, human, and honest—balancing numbers with nuance.

Community surveys are conducted before and after intervention, using questions as simple—and revealing—as “What is depression?” or “Would you speak to someone about emotional distress?” Where early responses are vague or dismissive, later ones often carry signs of recognition, reflection, and growing willingness to seek help.

Most visible markers include the rise in trained mental health champions, the formation of peer-led support circles, increased usage of self-report tools, behavioral changes, and the frequency of crisis escalations and timely referrals.

But the most striking marker is the presence of men. Sahai notes, “While initially, our workshops were almost exclusively attended by women, men have slowly started engaging, especially when they see their wives, sisters, or daughters benefiting.”

In the end, perhaps the deepest impact lies not in data points—it’s how people start talking differently, seeing themselves differently, and treating each other differently. 

Today, Pooja not only speaks but actively helps other women in her village who struggle in silence, just like she once did. Her journey of recovery has become a ripple, extending beyond her own healing to touch the lives of others. This is the true measure of the impact created by Swayam’s work.