What It Takes to Scale Mental Health: A Conversation with Neerja Birla

Mental health is increasingly recognized as central to not only individual well-being but societal resilience, yet access to care remains deeply uneven across geographies and communities. As awareness grows, so does the need for solutions that move beyond diagnosis and toward meaningful, scalable support. 

Neerja Birla, founder and chairperson of Aditya Birla Education Trust (ABET), has been at the forefront of efforts to expand access to mental health services in India and beyond. Through ABET’s Mpower initiative, Neerja’s work has focused in particular on embedding mental health within education systems and advancing early intervention models that can operate at scale in resource-constrained contexts. Neerja was named World Woman Hero of the Year by the World Woman Foundation during the 2026 World Economic Forum, in recognition of her efforts to position mental health as a critical pillar of economic and social resilience.

In this conversation, Neerja reflects on her unconventional entry point into mental health through education, the challenges of mobilizing philanthropic capital in a historically underfunded space, and the persistent gap between awareness and access. She also shares insights from building scalable models in low-resource settings, offering practical lessons for funders and practitioners working to strengthen mental health systems globally.

You came to mental health through education rather than the health sector. How did that entry point shape Mpower’s model, and how did it change how communities engaged with and trusted the work?

My journey into this work began first through lived experience. Having faced postpartum depression and later stepping into the role of a caregiver, I came to understand personally how critical early support systems are in addressing mental illness.

It was while running schools that I also began to notice a shift in what young adolescents were dealing with. Many were navigating complex challenges such as body image concerns, cyberbullying, family pressures, questions around identity, and evolving social dynamics at an early age. These struggles were often invisible, yet clearly affecting students, teachers, and parents. The stigma around mental health made these issues harder to acknowledge or address early.

What I was witnessing in schools highlighted a larger gap in how mental health is typically approached. It made clear to me the urgent need to build pathways and support ecosystems in India that can identify and respond to mental health concerns at the earliest possible stage.

When viewed primarily through a healthcare lens, support often begins at the point of diagnosis or crisis. While essential, this approach is inherently clinical and reactive. In a country like India, where many hesitate to seek help or may not recognize early signs, intervention often comes much later than it should.

Schools offered a different lens. They made visible the everyday environments where emotional distress first emerges and where trusted adults can respond early. This shaped our belief that mental health support must begin before a crisis and be embedded in the institutions people already trust. It also allowed us to place equal emphasis on awareness, prevention, and capacity building alongside clinical care.

Mental health has historically struggled to attract philanthropic capital relative to other areas of health. What has held funders back, and are you seeing a meaningful shift in how philanthropy is approaching this space?

Philanthropy has traditionally prioritised areas where outcomes are visible, time-bound, and easily attributable. Vaccines delivered, schools built, lives saved can be counted with clarity. Mental health progress is often preventative, cumulative, and shaped by context. The absence of crisis, improved coping, or sustained wellbeing are inherently harder to quantify, making funders more cautious.

Stigma has further constrained visibility, and funding typically follows visibility.

What is changing today is the growing recognition that mental health is directly linked to economic productivity, learning outcomes, and social stability. Philanthropy is increasingly beginning to view mental health not as a peripheral issue, but as central to overall well-being and functioning of a healthy, productive society. In India, there is a growing recognition within philanthropy that mental health is integral to broader development outcomes and societal well-being, reflecting an important shift in how mental health is being prioritised. We hope this will lead to increased support for mental health interventions. 

There’s a growing gap between awareness and access—more people can name their distress but few of them can still reach care. Where should philanthropy focus to meaningfully close that gap?

In contexts like India, awareness has expanded faster than access. While more people are recognizing and seeking support for mental health concerns, access remains constrained by limited specialist capacity, uneven distribution of services, and the lack of connected pathways into care. India faces a significant shortage of qualified mental health professionals, with only around 0.75 psychiatrists per 100,000 people, alongside even fewer psychologists and psychiatric social workers, most of whom are concentrated in urban centres. These structural constraints make it difficult to translate awareness into access. To meaningfully close this gap, philanthropy needs to focus on strengthening systems and expanding capacity. We can do this, first, by building clearer pathways into care. Individuals should be able to move from recognition to support through structured, connected systems rather than isolated touchpoints. This requires linking entry points such as helplines, digital platforms, and institutions to appropriate clinical services. Technology can play an important role here, but it should strengthen care delivery rather than dilute it.

Second, we need to support expanded access to treatment. Demand is rising, but capacity remains limited and unevenly distributed. Strengthening service delivery, particularly in underserved areas, is critical. It is equally important to work with public systems so that mental health is integrated into primary healthcare, education, and family welfare.

Third, philanthropy should invest in efforts to embed mental health within existing systems. Integrating care within these environments reduces barriers and improves uptake. We have used this thinking to shape initiatives for youth that strengthen campus ecosystems through student-led peer networks. This approach equips students to recognise early signs of distress, offer immediate support, and guide peers towards professional care when required. Embedding support within peer networks can create a structured pathway from informal conversations to formal services, making access more immediate and less intimidating. 

Fourth, we need to ensure continuity of care. Mental health support requires sustained engagement over time. Systems that are not designed for follow up and ongoing support risk losing individuals after the first interaction.

It is also important to adapt learnings from global models to local contexts. Approaches developed in the Global North need to be contextualised for the realities of the Global South, making them more accessible and cost-effective at scale. 

Scaling mental health care requires more than programs—it depends on underlying systems, from workforce and financing to integration with education and public health. Where do you see the most binding constraints today, and where can philanthropy be most catalytic?

Globally, every dollar invested in treating common mental disorders returns four dollars in improved health and productivity. According to the World Health Organization (WHO), India alone is projected to lose over 1.03 trillion USD due to untreated mental health conditions between 2012 and 2030. Nearly one in five individuals experience mental health challenges, and the treatment gap ranges between 70 and 92 percent. These numbers point to mental health as both a social and economic imperative.

The constraint, therefore, is not the absence of evidence, but the misalignment between how impact is measured and how mental health outcomes evolve. Funding frameworks have not fully adapted to value long-term and cumulative outcomes.

The second constraint is where investment is directed. Much of the system still responds at the point of crisis, when the human and financial costs are already high. Evidence consistently shows that early intervention is significantly more cost-effective and delivers long-term returns, particularly when focused on young people, as a large proportion of conditions begin early in life.

The third constraint is the ability to scale what works. There are effective models, but they often remain localised. Without sustained, multi-year investment, they do not translate into systems that can operate across populations.

Philanthropy can be most catalytic by first shifting the lens from short-term ROI to long-term value. Mental health cannot be evaluated only through immediate outputs. Its returns are cumulative, visible across education, workforce participation, and societal resilience.

Second, philanthropy can seed outsized impact by investing earlier. The evidence is clear that proactive support reduces long-term burden across families, workplaces, and public systems. It is both more effective and more efficient.

Third, private capital can back models designed to scale. This includes interventions embedded within educational institutions, communities, and the workforce, where reach and continuity can be built simultaneously.

The opportunity for philanthropy is to recognise this shift. Mental health cannot be treated as a peripheral cause. It is foundational to how societies function and grow.

What have you learned about designing mental health interventions that can operate at scale in low-resource settings, and what lessons are most transferable for other philanthropists and practitioners?

Designing mental health interventions for low-resource settings has required a shift in how we think about scale. It is not about building more standalone programmes, but about designing models that can work within existing constraints and still deliver consistent outcomes.

A few lessons have been particularly important. One is that scale comes from integration, not expansion. In low-resource contexts, parallel systems are difficult to sustain. Embedding mental health within existing institutions and public systems allows interventions to reach larger populations without requiring entirely new infrastructure. Equally important is trust. People are more likely to engage with support when it is delivered through systems they already recognise and rely on. 

Second, the workforce model has to be reimagined. Specialist capacity will always be limited, so scale depends on enabling non-specialists such as teachers, peer supporters, and community workers to act as the first line of response. This does not replace clinical care, but it ensures that support is more immediate and reaches further. It also means designing interventions that are relevant to different groups, whether adolescents, youth, women or the working population.

Third, interventions have to be designed for simplicity and consistency. In resource-constrained environments, complexity does not scale. Programmes that are modular, easy to deliver, and adaptable across contexts are far more effective than highly specialised models that depend on intensive resources.

At the same time, there is no single model that works everywhere. Interventions need to be responsive to context, to local stressors, community needs, and how people experience and express distress. All our programmes are designed around these realities, ensuring that they remain relevant while still being scalable.