Dr. Rucha Arun Shete: Yes, after my initial struggles, I went through a mental illness myself, which deeply influenced my perspective. When I took the entrance exam, I didn't focus on pursuing a specific field but chose whatever was available in Mumbai. The more you delve into it, the more it becomes about practical, real-world applications rather than just textbooks and lectures. It’s when you engage in research, go into the community, speak with people, and really understand their challenges that it becomes more meaningful. As a clinical doctor, you understand the health aspects, but as a community doctor, you have to look at the broader picture—the social factors affecting health, such as housing, education, and finances. That’s what made me passionate about solving these social problems, and I felt a strong drive to make a difference in people’s lives. It was during this time that I truly fell in love with community medicine.

Dr. Rucha Arun Shete: Mental health, unfortunately, is not yet a major priority for the government. While we've made significant strides in moving away from focusing solely on infectious diseases towards tackling non-communicable diseases, mental health is still part of that category, but it doesn't yet get the attention it deserves. There has been some progress, though, such as the telemedicine program Tele-MANAS, a toll-free number (14416) for telephonic counseling, which has received a significant portion of the health budget. However, there is still a huge gap in terms of accessible mental health services provided by the government.

One of the main challenges is that psychiatric services are still largely institutionalized. The focus is on centralized, hospital-based care, but mental health services need to be decentralized. We need to move towards more community-based care, integrating mental health into primary healthcare systems. Until we achieve this, issues like stigma and lack of access to services will continue to be significant obstacles.

Dr. Rucha Arun Shete: The Tele-MANAS program has made a difference, and many people are using it, but when you look at the number of calls, it's still a drop in the ocean compared to the mental health needs of the population. The program has received a large number of calls, but considering the vast population of India and the mental health issues that many people face, the number of people who are truly benefiting is still small in comparison to the overall demand.

It is a good start, but there’s a lot of work that needs to be done. Since the program is still new, many people are not aware of it yet. Awareness campaigns need to be ramped up to ensure that more people know about these services and feel encouraged to use them. This is especially important in rural areas where access to mental health services is limited, but the need is still significant.

Dr. Rucha Arun Shete: As part of the State Mental Health Authority, my role is to advise the government on mental health policies and programs. This includes strengthening mental health services in hospitals, as well as the district mental health programs. I recently had a meeting with the Director of Health Services and the Director of Mental Health Services to discuss what needs to be done moving forward. While I do my best to support these efforts through my own NGO, the primary responsibility lies with the government, as public health is a state matter. The government must take more proactive steps to integrate mental health care into primary healthcare services

Dr. Rucha Arun Shete: As a medical officer, I worked in Jalna district as part of Project Samvedna, primarily providing psychiatric services in rural areas. I realized that mental illness exists everywhere; the issue is not the absence of the problem, but the lack of someone to address it. When people found out that I was there to focus on mental health, I saw huge crowds outside my OPD. What struck me was that the stigma around mental health was far less in rural areas than in urban settings. People were more open about their struggles simply because no one had ever asked them about it before.

Many patients would tell me that they hadn’t shared their mental health issues with anyone because doctors rarely ask, “How are you feeling?” or “Are there any tensions in your life?” When doctors focus only on the clinical aspects and overlook the emotional aspect, the patient feels unheard. Just taking a couple of extra minutes to listen can significantly reduce their stress.

In rural areas, there’s less fear of judgment compared to cities. People are more willing to talk because they don't face the same societal stigma. However, the challenge is that there aren’t enough services available to meet the demand. People are eager to open up, but there aren’t enough mental health professionals in these areas.

Dr. Rucha Arun Shete: During the first wave of COVID-19, I worked at Seven Hills Hospital. We were screening travelers coming from the airport, many of whom were from countries already experiencing COVID outbreaks. It was my first night duty, and we had to screen around 300 passengers. At that time, we had minimal protection—just gloves and masks—so it was quite a scary experience. We didn’t even know if these travelers had COVID or not; all we could do was check their passports, ask about their travel history, and screen for symptoms like fever. We had to keep them in the hospital for observation, and later, the hospital turned into one where we admitted COVID-positive patients. It was a challenging time, but we learned a lot about handling such crises.

Dr. Rucha Arun Shete: Yes, during the COVID-19 crisis, I had the opportunity of seeing a small space turning into a hospital from the ground up. I learned a lot about the practical side of running a hospital—things you often take for granted, like how many doctors and nurses should be present, what kind of equipment is needed, and even the details of daily operations like stationary supplies.

For example, during the initial phase, we couldn’t reuse equipment like stethoscopes between patients, so we had to ensure there was one at every nurse’s station. Small things like pens, stethoscopes, and the proper flow of materials became crucial in maintaining infection control and preventing cross-contamination. Managing patient flow—how to admit and discharge patients—was a logistical challenge as well.

I worked as the in-charge of the high-dependency unit during the pandemic. Initially, I was the only consultant for two weeks, and it was an intense experience. I had to manage around 100 patients with 60 doctors reporting to me. It was a very high-stakes environment because we were on the edge of ICU care. If patients became critical, we had to quickly assess if there were available ICU beds and transfer them.

The most difficult part was managing everything—decisions had to be made quickly. For example, if a patient’s condition worsened, they needed to be moved immediately, and all of that required my approval. At first, I barely got any sleep because I had to be on top of every situation. But after two weeks, we got additional consultants, and we were able to divide shifts, which made things more manageable.

Dr. Rucha Arun Shete: I learned a lot about management, especially how to make quick, informed decisions under pressure. Running a hospital is not just about clinical care; it’s also about managing resources—whether it's staff, medical supplies like masks and oxygen cylinders, or even calculating the necessary quantities of medicines. For example, you need to ensure that the right amount of supplies is available and monitor their usage.

I also had to manage human resources effectively. No one wanted to take night shifts, so I had to make sure doctors were scheduled properly. I learned to address these issues by working with the administration to recruit more doctors for night shifts. It was an overwhelming but valuable experience in understanding the many facets of hospital administration.

Dr. Rucha Arun Shete: I was always more interested in mental health. I had considered working in the government or private sectors, but starting an NGO felt like the perfect middle ground. The government sector often lacks the creative freedom and independence that I wanted, while the private sector can limit your reach and focus more on profit than providing affordable healthcare. With an NGO, I have the flexibility to be creative and still make a meaningful impact, while being able to reach more people and keep services affordable.

Dr. Rucha Arun Shete: Samvad, which means “conversation,” is focused on providing mental health support through counseling. We offer both online and offline counseling services. People can visit our website, fill out a form, and get matched with one of our seven counselors. The first four sessions are free, and after that, we charge a nominal fee of 300 rupees per session. We try to make it affordable and accessible to as many people as possible.

Dr. Rucha Arun Shete: While our online counseling services are open to everyone, we also run targeted projects that focus on specific communities. For example, we have a project in the slum areas of Bandra that focuses on elderly residents, and another similar project in Palghar district called Project Vatavruksha. Additionally, we run Project Mukta, which provides counseling to inmates in Byculla Prison, helping them cope with emotional challenges and express themselves more effectively.

Dr. Rucha Arun Shete: One of the biggest barriers is the lack of understanding about what therapy actually is. Many people don’t realize that therapy is a structured, evidence-based approach designed to help them change their thought patterns and behaviors. They think it’s just about someone listening to them, and that it won’t provide real solutions. They often believe that help only comes from medical treatments—medicine for physical ailments—so they struggle to understand that therapy can help with emotional and psychological challenges. For example, therapies like Cognitive Behavioral Therapy (CBT) and Rational Emotive Behavioral Therapy (REBT) focus on rationalizing thoughts, accepting oneself, and making behavioral changes. These methods are scientifically proven to be effective, but people need to be educated about how therapy can bring lasting change.

Dr. Rucha Arun Shete: The biggest takeaway for me is that mental health challenges exist everywhere, but often people just need a space to talk, and to be heard. Whether it’s students dealing with anxiety and job-related stress elderly residents in slums or prisoners, the core need is the same—a supportive environment where they can express themselves and get help. These projects show that when you provide people with accessible, affordable services, they open up and begin to address their emotional and mental well-being.