A first-generation college student sits in the library, staring at his textbook but seeing nothing. His grades are excellent, his professors praise him, yet he cannot shake the feeling that he does not belong here. Yesterday, a classmate casually asked, “Are you here on reservation?” The question was not new, but it landed as always—heavy, humiliating. He wants to call home, but what would he say? That success feels like trespassing? That every achievement comes wrapped in doubt? When he finally leaves the library that evening, he wonders if belonging will always feel like an impossible dream.

On World Mental Health Day, as we discuss academic pressure and student wellness, we must confront a crisis hiding within these conversations: the mental health cost of caste-based exclusion.

The Weight of Exclusion

Dr B.R. Ambedkar understood what contemporary mental health discourse often ignores—that discrimination inflicts wounds far beyond economic deprivation. He observed how a meritorious individual from marginalised communities would forever be labelled “a leader of the Untouchables”, never simply “a great Indian leader”. This subtle yet systematic diminishment, he argued, was “no less galling than economic discrimination”.

Today's data validates Ambedkar's insight with devastating clarity. The research carried out by institutions such as NIMHANS states that the rates of anxiety disorders and depression among Scheduled Caste students are very high compared to those of other students.

Research using WHO's Study on Global Ageing and Adult Health (SAGE) highlights the persistent mental health disparities faced by SC/ST individuals. The study found that 46% of SC/ST respondents reported depression compared to 41% of higher caste Hindus, while anxiety affected 57% of SC/ST individuals versus 49% of higher caste Hindus. Importantly, the researchers accounted for material disadvantage by controlling for factors such as education, assets, household expenditure, and rural–urban location. Even after these adjustments, the elevated rates of anxiety among SC/ST groups remained, suggesting that social discrimination and exclusion—rather than economic deprivation alone—are significant drivers of psychological distress. This underscores how caste-based marginalisation inflicts harm that goes far beyond material disadvantage.

Over 50,000 instances of atrocities against SCs are reported by the National Crime Records Bureau each year, but these numbers cannot capture the daily microaggressions (the raised eyebrows over surnames, the questions about vegetarianism, the surprised compliments on English proficiency). These microaggressions, which may appear to be harmless when considered separately, yet lethal when they occur in large quantities, form what researchers refer to as ‘death by a thousand cuts’.

When someone remarks, ‘You speak such good English,’ with visible surprise; the underlying message becomes painfully clear: competence was never expected. Even words meant as praise transform into reminders of one's abilities, which remain perpetually under scrutiny. The negotiations of this day-to-day life, so mindful of the way surnames are given, so dodging of the intrusion, so bearing of the pressure of insults disguised as compliments – all this adds to a burden of psychological life that increases with each day.

The saddest example of this exclusion is suicide rates in the upper educational institutions. According to government statistics, of 122 cases of student suicides within the period 2014 to 2021, 68 were of backward communities (55%). On the face of it, such a percentage may seem to be proportional; however, the disproportionate influence becomes quite obvious when we understand that SC/ST students represent only 22-23% of higher education enrolment – and yet they are represented in these sad numbers almost twice as often as their proportion of enrolment.

The cases have exposed a very frightening trend: Rohith Vemula at the University of Hyderabad, Muthukrishnan at IIT Madras, and Payal Tadvi at BYL Nair have been hospitalised – all of these deaths were preceded by observed institutional isolation, casteist comments, and systematic alienation. These are not some accidental figures; these are the lives of young people that have been trampled to death by the burden of institutional alienation in environments that purport to promote excellence but only continue to foster exclusion.

Researchers have termed this phenomenon “caste battle fatigue”—a form of chronic trauma characterised by persistent anxiety, emotional numbness, and social withdrawal. Marginalised individuals live in perpetual defence mode, managing identities, anticipating humiliation, and navigating invisible minefields in spaces that claim to be meritocratic.

The Compounding Crisis

The stigma around mental health compounds exponentially when layered with caste—seeking therapy becomes an admission not just of personal struggle but of community “weakness”. This pressure takes place in several directions, which form an impossible double bind. From within marginalized communities comes the cautionary message: ‘Don't show weakness—they already think we're inferior.’ I’ve heard a Dalit professional describe how his own family discouraged him from seeking therapy, saying, ‘Log kya kahenge?’ They already despise us, and do not give them cause.

The disdainful answer is delivered by an outsider: “See, they can't handle the pressure—reservation is the problem, not caste.” Between these conflicting forces, it is almost impossible to find any assistance; it is a confirmation of the internal fears and the external preconceptions at the same time.

High-functioning anxiety among marginalised professionals deserves particular attention. Their success stories mask elaborate survival strategies. They excel academically, secure competitive jobs, and maintain composure in hostile environments. Outwardly, they embody achievement. Internally, they navigate constant self-doubt—not ordinary impostor syndrome, but the internalised voice of a society that has always questioned their belonging.

Perfectionism becomes mandatory. A single mistake confirms stereotypes. One emotional outburst validates prejudice. When a breakdown comes, it is spectacular and lonely.

Men from marginalised communities face compounded silence. Patriarchal norms forbid emotional expression; caste discrimination ensures their pain is dismissed as “playing victim”. Substance abuse and suicide rates among SC/ST men are alarmingly high, yet conversations about men's mental health rarely acknowledge how caste compounds vulnerability.

India's elderly from marginalised communities face another invisible crisis. As younger generations migrate for education—often the first in their families to do so—parents are left behind with neither economic security nor social support.

Consider a pattern that repeats across countless families: a manual labourer sells a small piece of ancestral land to fund his son's engineering education—the family's first college graduate. The son succeeds, secures a job in a distant city, and sends money home regularly. Meanwhile, the father lives alone in the village, managing diabetes and hypertension. But his depression goes unaddressed—no one speaks of mental health in that context, only of ‘budhaape ki kamzori’ (weakness of old age). He doesn't voice his loneliness or his lost sense of purpose, speaking only of physical ailments.

This scenario replays across thousands of families where first-generation educational mobility creates isolated elderly parents whose psychological needs remain invisible and unmet. Meanwhile, sanitation workers and manual scavengers continue work that is physically gruelling and psychologically devastating, with zero mental health support.

From Awareness to Action

Some might argue that reservation itself causes stigma. But this deflects responsibility from the discrimination that necessitates affirmative action in the first place. The question is not whether reservation creates discomfort but why merit is assumed absent until proven otherwise for some students while presumed present for others. 

What seems to be even more interrogative is the concept of ‘merit’. According to Anoop Kumar, we do not measure merit but rather some show of accrued privilege. Urban cultural capital, including the capacity to afford coaching and standards of English fluency and urban cultural capital that are dramatised in the admission processes, are not the recognition of inherent ability but rather the recognition of advantage. In the system with the unequal starting line, true merit cannot be evaluated. The conversation about the reservation brings out the ability of the students less than how competent it has been conditioned that the society has placed its trust in the competence of others.

While it is evident that mental health is an outcome of these larger oppressive systems, the field of mental health continues to ignore this, and mental health and care are conceptualised in a very individualistic way. For example, in March 2025, UGC issued new draft regulations that tried to redefine “discrimination”. and introduced a section on “false complaints”, which puts students at further risk than protecting them from caste-based discrimination (an important systemic intervention for mental health).

Alarmingly, there exists no standardised audit system to ensure discrimination complaints are evaluated fairly and transparently. In the absence of these mechanisms, the focus on false complaints will put the burden of proof of the occurrence of such complaints on the victims, and this will be accompanied by the fact that the accusation is punishable. This is a chilling effect: rather than ensuring students are not discriminated against, it may endanger any student who is still discriminated against to speak up, thus making already vulnerable students that much more reluctant to declare casteist harassment.

However, even within the individualistic nature of care, India's mental health infrastructure is catastrophically inadequate. With approximately one psychiatrist per 100,000 people, access to care remains a privilege concentrated in urban areas.

The Mental Healthcare Act of 2017 represented a significant step forward, which would allow mental and physical health to be equally covered by insurance, an important step that might allow providing therapy to millions of individuals who otherwise cannot afford it. Yet implementation remains patchy and inconsistent across states and insurers. Without rigorous enforcement of these insurance provisions, therapy remains unaffordable for most. Stigma is still intact.

Educational institutions perpetuate rather than prevent mental health crises. When a student dies by suicide, we issue statements and move on. We do not ask why SC/ST students are disproportionately represented in these tragedies.

Solutions require both policy and cultural transformation that are not caste blind. Mobile counselling units and teletherapy services could bridge rural gaps. Making therapy financially accessible requires enforcing the insurance requirements of the Mental Healthcare Act – the Act promised parity between mental and physical health coverage, but patchy implementation means therapy remains unaffordable for most.

Educational institutions need mandatory counsellors trained in caste-aware mental health support apart from systemic measures to protect students from caste-based discrimination and promote inclusivity. Workplaces require subsidised therapy, mental health leave, and genuine consequences for casteist harassment—not performative diversity statements.

Communities must create peer support networks that acknowledge caste trauma without pathologising identity. Training teachers and community workers in trauma-informed care enables early intervention. And individuals must practise honest acknowledgement: “I am not okay, and that is okay.” Seeking help is strength, not weakness.

The Moral Imperative

Behind every statistic is a person who could not find help. Behind every percentage point is someone who fought battles others never saw. Mental health is not an individual failing; it is a collective responsibility.

Ambedkar wrote that social discrimination's psychological impact was subtle yet real. Seven decades later, we can no longer claim subtlety. The evidence is overwhelming, the harm undeniable. The question is whether we possess the moral courage to name caste as a mental health crisis and dismantle the structures that sustain it.

On this World Mental Health Day, let us commit not to awareness campaigns that fade by evening but to sustained action that centres the most marginalised. Let us build a society where no one must choose between identity and dignity, where healing is accessible to all, and where existence itself is not exhausting.

Recovery is possible. Justice is necessary. But first, we must stop breaking people.

Acknowledgements

My thanks to Dr. Swathi S.B. for her valuable review and to my colleagues at C-CDoH, Institute of Public Health, Bangalore, for their encouragement and support in writing this piece.

Edited by Christianez Ratna Kiruba

Image by Gayatri