As she sits across from a researcher in a narrow room in Mangolpuri, one of Delhi’s sprawling slum clusters, 19-year-old Bhoomi Singh says she has made up for a lost year and is preparing for her class XII board exams. In fact, she is focussed on scoring high enough to get into a vocational course and be job-ready. “The family conflicts haven’t been resolved yet but two of my friends help me out. The three of us study together in the Delhi police public library. We share each other’s problems and find our own solutions. Only we can take charge of our lives despite the distractions,” she says.
Bhoomi is a participant of the ARTEMIS (Adolescents’ Resilience and Treatment Needs for Mental Health in Indian Slums) project, which began in 2019, the first phase of which was completed in 2023. It is being conducted by psychiatrists and public health researchers from the All-India Institute of Medical Sciences (AIIMS), Delhi, the George Institute for Global Health, Sydney and University of New South Wales. It is tracking how sustained mental health interventions and counselling can mainstream teens in urban slums, a group exposed to constant violence, conflicts and abuse both at home and in school. The studies are being conducted in Delhi, Vijayawada and Hyderabad.
All test participants in the programme so far have come out of depression, controlled their fear, stress and anxiety, improved their knowledge, life skills, attitude and behaviour. They have broken the stigma and reached out to mental health services on their own. The ongoing study is also testing whether life skills taught through an in-person classroom or social media can prevent frustration, disenchantment and depression.
According to Dr Rajesh Sagar, professor of child and adolescent psychiatry at AIIMS Delhi and study co-investigator, adolescence is not just a vulnerable phase but a decisive one. “More than 50 per cent of adult mental health problems begin before the age of 14. Adolescents are the future of the country, yet they remain a neglected population in research. Urban slums were selected for the study because they magnify existing vulnerabilities. These adolescents face multiple adversities, be it poverty, housing insecurity, violence, family rifts, early marriage, dropping out of school and the pressure to earn. And yet, very few studies have focussed on them or what a safe space for talking can transform them.”
Led by Prof Pallab Maulik, who heads research at the George Institute for Global Health, New Delhi, the project screened nearly 70,000 adolescents aged 10 to 19 years for depression, anxiety, and risk of suicide or self-harm. “We are still in the process of publishing the final results but interventions pulled them back from the edge,” he says.
How regular mental health sessions can help
Growing up, Bhoomi witnessed frequent fights between her parents, making it difficult for her to concentrate on her studies. She was emotionally closer to her father, but the relationship between her parents deteriorated to the point that they separated and filed cases against each other. The instability at home, combined with exam pressure, left her anxious and mentally disturbed.
It was during this period that she became a participant in ARTEMIS. As part of the project, she attended multiple counselling sessions with doctors who monitored her sleep, thoughts and daily activities. They also called both parents for counselling, explaining how their conflicts were affecting their daughter. While her mother remained supportive and engaged, her father’s involvement was limited. However, Bhoomi adjusted to her changed family situation in one-and-a-half years and has never thought of dropping out of school.
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The ARTEMIS project used interactive activities, videos, and games like ‘Three Friends’, ‘Bully Case’ and ‘Snakes and Ladders’ to help adolescents understand mental health, identify problems and find solutions. Participants also learned stress-management, self-calming techniques, the value of hobbies, sharing feelings and seeking professional help when needed.
The first challenge, the researchers found, was not diagnosis but denial. “There is enormous stigma around mental health,” says Dr Sandhya Kanaka Yatirajula, a public health researcher at the George Institute who led the on-ground implementation and now heads the follow-up study. “Adolescent distress is often dismissed. People say, ‘They are too young to have real problems.’ But suicide is one of the leading causes of death in this age group.”
The effect of intervention
Bhoomi now manages stress by engaging in activities she enjoys, such as listening to music and drawing. Earlier, she would sit quietly and keep her feelings to herself. According to her mother, she is now less easily irritated and argues much less.
“During this project, I participated in several activities and games. I like Three Friends, where three of us get together, discuss mutual problems and then find solutions as an outsider to each other’s problems. Somehow sharing problems with someone we trust always helps,” says Bhoomi, who also practises meditation and loves team games like cricket and hopscotch. “I now know how to come out of a negative spiral but if the problem becomes serious, we should visit the nearest primary health centre,” she adds.
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How the study was conducted
Using a standard screening tool for depression, the team identified adolescents at high risk. But screening alone, Dr Yatirajula says, would have been unethical.
“There is a massive gap between mental health needs and available professionals. Identifying risk without offering care was not an option. The solution was two-fold,” says Dr Yatirajula. First, the team trained MBBS-qualified primary care doctors working in the same slum areas using the WHO’s Mental Health Gap Action Programme. Second, they ran a large anti-stigma campaign, designed not by experts alone, but by adolescents themselves.
“One of the most important aspects of the project,” Dr Maulik says, “was that adolescents from the community were part of the research team.” They decided what messages would resonate, what language to use and how to deliver them. The result was an array of unconventional tools: street plays written and performed by adolescents, audio dramas, thematic magic shows, and even board games like snakes and ladders.
“In the snake and ladder game,” Dr Yatirajula explains, “ladders represent positive behaviour, seeking help and supporting a friend, while snakes represent stigma or bullying. It sounds simple but is very effective.”
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The team mapped triggers based on the adolescents’ lived experiences: bullying and cyberbullying, sexual harassment by teachers, domestic violence at home, academic pressure, career anxiety, relationship stress, and early marriage, the last particularly common in Vijayawada. The team also reframed mental health conversations around “stress” and “tension”, terms families found more acceptable.
Protecting adolescent mental health
While ARTEMIS focussed on distressed adolescents, researchers were left with a larger question. Dr Maulik wondered if he could help adolescents build coping skills before mental health problems emerge. That question led to ANUMATI, an ongoing trial across 105 slums in Delhi and Hyderabad, which Dr Sandhya now leads on the ground. It has a life-skills curriculum that integrates self-esteem, decision-making, assertive communication, physical activity, substance-use prevention and suicide awareness. These are taught not as abstract ideas but as practical tools for daily life.
“For example,” Dr Yatirajula argues, “assertive communication helps with self-esteem but it also helps adolescents say no to peer pressure. Decision-making skills are taught through structured methods, so that they can weigh consequences.”
As Dr Sagar says, “If we can identify problems early and intervene during adolescence, we can prevent a lifetime of mental health difficulties.”
