India has roughly one psychiatrist per 200,000 people. In rural India and tribal areas, the ratio is effectively zero. The treatment gap for mental health disorders — the difference between people who need care and people who receive it — runs above 80 percent nationally. For tribal populations in states like Odisha, it is higher.
The standard response to this gap is to argue for more psychiatrists. Train more doctors. Build more facilities. Sangath began from a different question: given that psychiatrists will not exist in sufficient numbers in rural India for the foreseeable future, what mental healthcare can be delivered by people who are not psychiatrists?
The answer to that question — developed over twenty-eight years through one of the most rigorous research programmes in global mental health — is called task-sharing. And it has changed how the world thinks about delivering mental healthcare in resource-constrained settings.
Who They Are
Sangath was founded in 1996 in Porvorim, Goa, by seven volunteer professionals who established Goa's first multidisciplinary child development clinic. The name comes from the Sanskrit for "journeying together." What began as a child guidance service became one of India's most influential health research organisations — headquartered in Goa with hubs in Bhopal and New Delhi, with projects across India and international collaborations with UCL, Harvard, the London School of Hygiene and Tropical Medicine, and others.
Sangath has completed some of the largest population-based cohort studies and randomised controlled trials for mental disorders conducted anywhere in the world. Their research has been cited in four Lancet series — child development, mental health, adolescent health, and universal healthcare in India — and in two World Health Reports (2001 and 2005). The 2008 MacArthur Foundation International Prize for Creative and Effective Institutions recognised them for what they do better than almost any civil society organisation: generating rigorous evidence and translating it into policy at scale.
The SUNDAR Framework
Sangath's foundational innovation is the SUNDAR approach to task-sharing: using lay people — with appropriate training and supervision — to deliver psychosocial interventions for a range of mental health conditions. SUNDAR stands for Simple, Unimodal, Normalising, Delivered, Affordable, Replicable — the criteria that an intervention must meet to work in low-resource settings.
The evidence base for SUNDAR is extensive. Multiple RCTs conducted in Goa, Madhya Pradesh, and other states demonstrate that lay counsellors trained in specific structured psychological interventions can deliver effective treatment for depression, alcohol use disorder, and other common mental health conditions — with outcomes comparable to those achieved by specialist practitioners.
In Madhya Pradesh, one of India's least-resourced states, Sangath has partnered with the state government's health department to train approximately 500 ASHAs as frontline mental health providers. ASHAs were originally focused on maternal and child health. Sangath's expansion of their role into mental health — backed by training, supervision, and evaluated through research — represents exactly the kind of government-system strengthening that civil society organisations can uniquely do.
The Adolescent Mental Health Evidence
Sangath's PRIDE programme (PRemIum for aDolEscents), conducted from 2016 to 2022 in low-income schools in Goa and New Delhi, developed and evaluated a suite of psychosocial interventions for emotional problems in school-based adolescents. PRIDE demonstrated the sustained effectiveness of sensitisation and brief psychological interventions delivered by lay counsellors in school settings.
The METROPOLIS programme (2024-2028), funded by the Wellcome Trust, builds on PRIDE's evidence base to compare the effectiveness of two brief peer-delivered psychotherapies for university students with depression in New Delhi. The evidence-to-programme arc here is the model: RCT → peer-reviewed publication → larger follow-on programme → policy translation.
The PRIDE programme was recognised at the 2023 ACAMH (Association for Child and Adolescent Mental Health) awards as highly commended in the category of innovative research in low- and middle-income countries.
The Digital and Tele-Health Frontier
Sangath's current digital initiatives include Baatcheet (It's Ok To Talk) — a bilingual storytelling platform co-designed with youth for adolescent mental health; tele-psychiatry connecting psychiatric care to underserved Tibetan settlements in Karnataka (1,200+ sessions delivered); and a COVID-19 Wellbeing Centre offering multilingual mental health support during the pandemic.
The HCLTech 2024 Grant winner in health category recognised Sangath's work on effective and low-cost models for perinatal mental health — building India's perinatal mental health workforce at scale.
What This Means for Odisha
Odisha has no functional community mental health system in its tribal districts. The Mental Health Task Sharing Practice Note in JaBaSu's Knowledge Commons outlines how community health workers — including ASHAs — can be supported to deliver basic mental health interventions. Sangath's evidence base and training methodologies are the most robust available for designing such programmes in India.
For Odisha's health NGOs, Sangath offers something specific: a model that has been evaluated in conditions similar to rural Odisha's (Jharkhand RCTs, Madhya Pradesh government partnership), published in top-tier journals, and demonstrated to work when delivered through existing government health infrastructure rather than requiring parallel systems.
Contact and Further Reading
Website: sangath.in | Contact: contactus@sangath.in | Porvorim, Goa and hubs in Bhopal and New Delhi
Key evidence:
- Sangath website: sangath.in — current programmes, SUNDAR framework, PRIDE, digital health
- MacArthur Foundation 2008 International Prize documentation
- PMC: SUNDAR: Mental Health for All by All — Vikram Patel (2015, BJPSYCH) — foundational task-sharing framework
- WHO Bulletin: Vikram Patel: Fresh Ways of Delivering Mental Health Care (2023) — most recent published interview on Sangath's approach
- PRIDE Programme page: sangath.in/projects/pride
JaBaSu Knowledge Commons · knowledge@jabasu.org · jabasu.org/knowledge