What happens when a child with autism, an intellectual disability, or ADHD turns 18? For most Indian families, the answer is stark — the carefully-structured supports built around school-based systems abruptly end, leaving young adults and their caregivers to navigate an uncertain future.
Data from studies in India indicates a significant mental health burden among children, with prevalence rates in the community ranging from approximately 6% to 16% and higher in schools. While many children require support, 80-90% do not receive it, and only about 0.05% of India’s health budget is allocated to mental health. Children with intellectual disabilities and other conditions including autism, anxiety, and depression face challenges, with 50% of children with mental disabilities never attending an educational institution, according to the People’s Archive of Rural India’s analysis of Census 2011 data.
Loss of support at 18
“In India, most structured supports stop at 18 because they are largely designed around school-based systems and child-focused programmes,” says Mithun Prasad, consultant, psychiatry, SIMS Hospital, Chennai. “Once young adults leave school, there are very few options for continued care or vocational training. This transition gap leaves families worried and often struggling to find meaningful activities or support. Many young adults feel lost and isolated because the system does not prepare them for life beyond school.”
Shorouq Motwani, child and adolescent psychiatrist, SRCC Hospital, Narayana Health, Mumbai, explains that the gap is systemic. “Most public and NGO services are organised around child development frameworks. Policy cut-offs, workforce shortages and fragmented ministries create an administrative cliff at the end of school age,” she notes. The result, she adds, is functional decline, social withdrawal and mounting caregiver stress.
What exists, what’s missing
There are some scattered services available. “NGOs do run vocational training or day-care centres, but these are few and concentrated in cities,” says Dr. Prasad. “Higher education opportunities are rare and largely lack necessary accommodations.”
According to Yayathee S., consultant psychotherapist & counsellor, Rela Hospital, Chennai, tertiary care and rehabilitation centres do exist. “In Chennai, organisations such as The Banyan and SCARF, and at the national level NIMHANS, offer inpatient and outpatient support. But what’s missing is a well-established community rehabilitation system. After acute care, many individuals get lost in the community due to poor family or community support. Some tragically end up wandering or begging on the streets.”
Dr. Motwani points to international evidence-based approaches such as the Clubhouse model for social recovery and Individual Placement and Support (IPS) for employment. “While small pilots exist in India, they are not scaled up. Community-based housing, supported education, and systematic transition planning are still glaringly absent.”
Toll on caregivers
For families, the burden is heavy. “Financial barriers make things even harder. Insurance rarely covers mental health or developmental services. Respite services for caregivers are almost nonexistent,” says Dr. Prasad. Parents often quit jobs or reduce work to provide full-time care, leading to burnout and financial strain.
Dr. Yayathee emphasises the insurance gap. “Even now, no insurance company in India supports mental health services in a meaningful way. The cost of therapy, rehabilitation, and inpatient treatment is enormous. Caregivers not only shoulder financial losses but also emotional exhaustion.”
Dr. Motwani adds that this creates a “missing-middle” problem — middle-income families, who cannot afford long-term private therapy yet fall outside welfare safety nets, are left especially vulnerable.
An ideal system
Experts agree that India needs a continuum of care that bridges adolescence to adulthood.
“An ideal system would include smooth transition services, vocational training, inclusive higher education, community-based day programmes, regular mental health support, respite services and financial support for families,” says Dr. Prasad.
Dr. Yayathee suggests a public–private partnership model. “Starting from early identification in schools, proper vocational and community-based rehabilitation with family involvement is essential. Insurance coverage would be a game changer.”
Dr. Motwani outlines features seen in successful international systems: “Transition planning starting in adolescence, local Clubhouse-style hubs, supported employment at scale, disability-friendly higher education, community-based housing, and robust financial protection.”
The way forward
What can be done? Doctors propose a multi-sectoral approach. “Collaboration between governments, NGOs, and private institutions is essential and support should not stop at 18, but continue across the lifespan.”
On government level, a national transition policy with dedicated funding, scaled-up community day-care and respite schemes, and strict enforcement of insurance parity.
And at NGOs level, replication of Clubhouse and IPS models, building respite networks, and providing transition counselling for families. The private sector could also conduct internships, CSR-backed vocational hubs, workplace training, and public–private pilots for supported living and education, they say.
As India moves towards expanding mental health infrastructure, experts say the measure of success will be whether young adults with autism, intellectual disability, or psychiatric conditions are able to live with dignity, participate in communities, with access to education and employment.
Published – October 05, 2025 08:00 am IST
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