Scaling Community-based Mental Health Interventions for Elderly Women in Tamil Nadu

The number and share of India's elderly population is projected to increase dramatically over the next four decades—a demographic shift driven largely by declining fertility rates and increasing life expectancy. Tamil Nadu finds itself at the forefront of this demographic transition, with the elderly projected to comprise more than one-fifth of the state's population by 2050.

This shift heightens the mental health burden among older adults, who are at high risk for depression and loneliness yet have limited access to mental health services. The Tamil Nadu Elderly Panel Survey reveals that depression is especially prevalent among women, particularly elderly women living alone. Improving mental health in a scalable, community-based way is therefore a crucial aspect of increasing wellbeing for this underserved population.

Under the Government of Tamil Nadu (GoTN)-J-PAL institutional partnership, in collaboration with the Tamil Nadu Corporation for Development of Women (TNCDW) within the Rural Development and Panchayati Raj (RDPR) Department, the impact of two mental health interventions delivered by trained, government-embedded Community Resource Persons (CRPs) is being assessed through a randomized evaluation led by J-PAL-affiliated researchers Esther Duflo (MIT), Frank Schilbach (MIT), Madeline Melway (Dartmouth), and Girija Vaidyanathan (IAS, retired). Preliminary results show significant reductions in depression (7 percentage points) and functional impairment (5.5 percentage points) among participants receiving both interventions. By focusing on services that can be delivered by training existing CRPs, the study demonstrates a scalable, sustainable, and cost-effective solution that reduces symptoms of depression and feelings of loneliness among elderly women while improving their ability to perform daily activities.

Drawing on these promising findings, the partnering RDPR Department, with technical support from J-PAL South Asia, plans to initiate a statewide scale-up of the two complementary interventions: (i) group activities to reduce loneliness by enabling social interaction and light physical activity; and (ii) cognitive behavioral therapy to address depression and loneliness by offering healthy, constructive alternatives to negative thought patterns.

Implementation will follow a phased, district-wise rollout over two years, ultimately reaching elderly women across the state while enabling learning, adaptation, and quality assurance throughout implementation. This proposal seeks funding to support the technical assistance provided by J-PAL to enable robust monitoring and evaluation, ensure program fidelity, build government capacity, and strengthen implementation and oversight systems. Together, these efforts aim to embed the program within government structures, ensuring its long-term sustainability and institutionalization.