Published May 03, 2026 | 7:00 AM ⚊ Updated May 03, 2026 | 7:00 AM
Girls living in the slums face surveillance, curtailed movement, and expectations that boys largely do not carry.
Synopsis: The ARTEMIS project brought together youngsters between the ages of 10 and 19 from urban slums in New Delhi and Vijayawada. These youngsters — with the potential to inflict self-harm — shared their experiences of stress arising from parental pressure, peer relationships, academic stress, gender-based restrictions, and fears about the future.
In the slums of Vijayawada and Delhi, community women volunteers knocked on doors, sat with teenagers, and used an Android app. Their task: Assess whether the youngster in front of them wanted to die.
The women were not psychiatrists. They were neighbours. They had secondary school certificates and the trust of local leaders.
Researchers at The George Institute for Global Health (TGI) handed them a decision-support tool called the SMART Mental Health platform. The women were asked to do something India’s public health system had never managed to do at this scale: find the teenagers nobody was looking for.
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India carries the world’s largest adolescent population. More than 250 million young people, many of them living in urban slums where poverty, overcrowding, and a near-total absence of mental health infrastructure converge.
The country does not have enough psychiatrists to serve them.
The ARTEMIS trial, published in JAMA Psychiatry on 29 April 2026, ran across 60 slum clusters in two cities. It enrolled 3,739 adolescents aged 10 to 19. Nearly half, 47.1%, were identified as high risk for depression or self-harm.
The question the trial set out to answer was whether a digital tool, carried by an ordinary woman into an ordinary slum, could substitute for an entire missing tier of the health system.
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Dr Sandhya Kanaka Yatirajula, Program Lead for Mental Health at TGI-India, described what the volunteers encountered when they began visiting homes.
“The ARTEMIS project brought together youngsters between the ages of 10 and 19 from urban slums in New Delhi and Vijayawada,” she said. “These youngsters shared their experiences of stress arising from parental pressure, peer relationships, academic stress, gender-based restrictions, and fears about the future.”
These were not clinical abstractions. They were the daily texture of adolescent life in a slum.
The app the volunteers carried used a priority-listing system. It ranked teenagers by symptom severity so that the most at-risk received priority attention. It also created a two-way information channel between the volunteer and the treating physician, allowing clinical information to move between them without the teenager needing to travel anywhere.
Around 86% of high-risk adolescents consulted a physician at least once during the 12-month intervention.
In a setting with no psychiatrist, no government clinic, and no existing referral pathway, the number represents a system built from scratch.
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The trial ran an anti-stigma campaign alongside the digital tool.
Locally adapted videos, street plays, games, and audio dramas reached communities across both cities. The campaign drew on principles of social contact, placing adolescents with mental illness in direct conversation with their peers.
Knowledge scores improved. Attitude scores improved. Behaviour scores, measuring willingness to interact with someone facing mental illness, improved significantly during the 12 months.
But the score, measuring whether adolescents would seek help for themselves, did not shift significantly.
The researchers offered a careful explanation. For teenagers, the decision to seek care does not rest with them alone. Parents decide. Communities watch. Stigma does not dissolve because a teenager watched a street play.
The data raises an uncomfortable possibility: People learned the right answers without changing what they actually do.
To read the ARTEMIS trial is to encounter a gap that should disturb anyone who follows global health research.
This is the first large-scale clinical trial to focus specifically on adolescents with mental illness living in urban slums in India.
Prof. Pallab Maulik, Director of Research at TGI -India and Principal Investigator of the project, described the approach the team developed to fill that gap.
“The ARTEMIS project was a two-pronged approach to overcoming these problems,” he said. “The first involved the use of locally tailored multimedia campaigns to eliminate the stigma associated with mental disorders. The second approach was to use a digital system to screen adolescents for psychological distress and risks of self-harm and provide treatment to those at high-risk.”
This combination had never been tested at scale in this population before 2022. It says something about whose health has historically counted in research funding decisions.
The trial’s most uncomfortable finding sits in a single comparison.
At 12 months, 68.2% of high-risk adolescents in the intervention group achieved remission from depression. In the control group, which received almost nothing beyond basic information, 59.4% also achieved remission.
That gap did not reach statistical significance.
The researchers attributed this partly to the natural remission rate of adolescent depression, which runs higher than in adults. Time, it turns out, heals a measurable proportion of depressed teenagers regardless of intervention.
The trial was also underpowered for this specific outcome. Researchers had assumed a 15% absolute difference between the groups. They observed 7%.
The depression severity scores shifted significantly. The intervention group scored 4.05 on the PHQ-9 against 4.92 in the control group. The intervention reduced how bad depression felt, even if it did not dramatically accelerate full recovery.
The question of what counts as success in adolescent mental health treatment does not have a clean answer here.
The trial was designed to use government primary care physicians and government-employed community health workers known as accredited social health activists.
It ended up using neither.
Administrative delays and a failure to secure formal government approvals on time forced researchers to recruit private practitioners and community volunteers instead. The government system moved too slowly to participate in a study built to inform it.
In Vijayawada, researchers could not enlist a single government psychiatrist. Of the 109 adolescents referred to psychiatrists, only 10.1% actually consulted one.
In Delhi, where a government psychiatrist agreed to visit slums directly, 75% of those referred made contact.
The difference between the two numbers is one willing doctor.
Among the high-risk cohort, 57.3% were female.
The volunteers who reached them were also women. That was a deliberate choice, and it mattered in communities where young women do not easily speak to male strangers about self-harm.
But the intervention did not differentiate. It screened boys and girls with the same tool, the same questions, the same follow-up pathway.
Dr Yatirajula noted that the teenagers spoke of gender-based restrictions as a source of stress. Girls in the slums face surveillance, curtailed movement, and expectations that boys largely do not carry.
Whether a gender-blind digital tool served both equally, the trial data does not fully resolve.
Over 70,000 adolescents across 60 slum clusters encountered the ARTEMIS intervention in some form over twelve months.
They encountered it because a woman with a smartphone knocked on a door.
The trial authors concluded that community-driven, technology-enabled approaches offer a scalable pathway for adolescent mental health in low-resource settings. They are careful about the word scalable. Scaling this model means training more women, sustaining the app, and persuading a health system that moved too slowly to approve the original trial to adopt its findings.
None of that is simple.
But the volunteer is already there. She lives in the slum. She knows who the quiet teenagers are. She knew before the trial began.
The phone just gave her a way to do something about it.
(Edited by Majnu Babu).
