Accessing mental health support in India, overcoming the challenges of cost and stigma

It was 2021, and I was 22 years old when I experienced my first panic attack. As the COVID-19 pandemic was widespread then, I began exploring online therapy options to address my symptoms. I found one and gave it a go, but I quickly realised that I was not gaining much insight or relief from it.

The next year, when the pandemic was under control, I decided to try offline therapy. I found an expert affiliated with a reputed hospital, but the consultation fee was Rs 1,500 per session. Though it was expensive for me, I decided to go ahead with it.

At the therapist’s clinic, the doctor was with a patient inside a small, open cubicle, and their conversation was audible to everyone waiting outside. Alarmed, I left the clinic, as it seemed to me that the fundamental principle of patient privacy was being compromised.

Over the past year, I have been undergoing therapy with another doctor with some success. However, the issue of high cost of therapy (around Rs 1,800 per session) continues.

And this is a challenge that most people seeking mental health support in India face.

According to estimates, there are about 0.75 psychiatrists for every 1 lakh inhabitants in India, while the recommended number is 3 per 1 lakh people. The shortage of mental health professionals in the country has led to a huge demand-supply gap, ultimately resulting in a heavy cost for patients.

High treatment cost

YourStory’s enquiries with half a dozen professionals and people undergoing therapy revealed that, in major Indian cities, the average cost per hour for a counselling session or psychiatric consultation is around ₹1,500. It even soars to as high as ₹2,000-₹4,000 in some cases.

For many, the high cost of mental healthcare is a big deterrent to seeking support.

Kashish Sharma*, a former journalist, has been undergoing intermittent therapy for the last three months, coughing up nearly Rs 2,000 per session. She wants to undergo therapy on a regular basis but is not able to do so because of the high costs involved.

“It is becoming challenging for me to pay for regular sessions, no matter how much I want them,” she says.

It’s not therapy alone that’s expensive; the charges for those requiring hospitalisation due to mental illness are also exorbitant.

According to the National Sample Survey 2017-18, the average medical expenditure per case of hospitalisation for psychiatric and neurological ailments is Rs 26,843, with the average cost for care in public hospitals and private hospitals being Rs 7,235 and Rs 41,239 respectively.

Recently, a study titled ‘Catastrophic Health Expenditure and Poverty Impact Due to Mental Illness in India’, published in the Journal of Health Management, highlighted that about 22.5% of rural households in India were pushed from being non-poor initially to below-poor, due to the cost of treatment of mental illness. The comparable figure in urban households is 17%.

Ankita Mishra*, a teacher, had been diagnosed with depression 10 years ago. On an average, her medication and doctor fees used to cost more than Rs 3,000 a month.

Four years after being diagnosed with depression, her doctor advised her to stop the medication. However, in a year’s time, her condition relapsed and she was asked to restart the medication along with therapy. This meant additional expenses for Mishra, who comes from a middle-class family.

“My mental health condition has prevented me from working, and my father has to bear the burden of my medical expenses,” rues Mishra.

“Each therapy session costs around Rs 1,800, making it difficult for me to afford more than two sessions a month,” she adds.

Dr Dhanya Chandran, consultant of clinical psychology, at Amrita Hospital, Kochi opines that, although psychotherapy has become much more affordable in the country now, costs ought to come down further.

She says many people postpone seeking medical help due to financial constraints, waiting until their mental health problems become unbearable.

“Youth and adults belonging to high- as well as middle-income groups are able to afford therapy at current rates in private establishments, and those in the low-income groups seek the services available in the government sector as well as NGOs,” she adds.

While IRDAI (Insurance Regulatory and Development Authority) has mandated coverage for mental illnesses in all health insurance policies, many insurance plans primarily focus on covering hospitalisation costs for mental health treatment, and only a few policies cover outpatient services.

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Other challenges

Apart from cost, the other major stumbling block in seeking help is the stigma associated with mental health.

In Indian society, too much importance is given to what others would think or say if one goes to a psychiatrist, psychologist or therapist. Concerns about potential marriage prospects also prevent people from seeking help from an expert.

Dr Meenakshi Jain, Assistant Professor, Dept of Psychiatry, Amrita Hospital, Faridabad believes multiple cultural and societal factors such as lower socioeconomic status and education, lack of social support, lack of awareness about mental health, and the stigma associated with mental health issues affect the willingness to seek therapy.

Dr Chandran feels many parents still see mental health concerns as ‘fads’. “They believe it can be ‘managed’ if their children just become stronger. Therefore, many of them do not encourage seeking help or psychological services,” she says.

Mental health is also often stigmatised as a sign of insanity. Due to such myths and misconceptions prevalent in society, a significant number of patients either do not start treatment or go to a mental health professional only in the late stages of illness, leading to difficulty in treatment, says Dr Chandran.

There are also challenges along the journey of diagnosis and treatment.

Dr Jain points out that a significant number of patients are reluctant to share accurate and sufficient information with their doctor/therapist, thus making the diagnosis and treatment process challenging.

The emergence of non-qualified people (quacks) and fewer trained professionals is another persistent concern, according to Dr Chandran.

Sharma recalls an experience she had when she started therapy, wherein she discovered that the practitioner she was working with lacked the necessary qualifications and a valid licence to practice.

The lack of structure and absence of immediate diagnosis make the process even more challenging, say people who have undergone therapy.

Mishra says, “I have been to two therapists so far and I have realised that most of these sessions lack remedies and are devoid of proper strategies which should be provided by the expert.”

What kind of strategies can therapists follow so that patients don’t feel short-changed and feel like they are making progress?

Dr Jain explains that every patient comes with a unique set of challenges, which would take time to resolve. However, if a patient feels they are not progressing, then they should talk to their therapist about it, she adds.

“Therapy is always a collaborative approach. Only by being truthful a patient can expect to gain from therapy.”

The therapist should also be supportive and encouraging of the patient in need, says the doctor.

“Redefining problems, goals and expectations should be done as and when required. A workable frame for the treatment should be discussed. The frame decided by the therapist should fit the patient’s cultural, social and religious values and beliefs,” she adds.

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Helplines and support groups

Today, there are quite a few free helplines run by NGOs and state governments to provide relief and support to persons with mental illness—Kiran, run by the Ministry of Social Justice and Empowerment; a helpline by Vandrevala Foundation; and the Centre’s National Tele-Mental Health Program (Tele-MANAS), to name a few.

While free helplines and support groups, run by the government and NGOs, help address the issue of cost and encourage people to come forward to seek, they cannot replace the contribution of trained mental health professionals, say experts.

Dr Jain says helplines, support groups, and other techniques such as self-help books, relaxation training, and guided meditation can be used to relieve stress and minor mental concerns, but they are not alternatives to help from trained mental health professionals.

Sharma recounts her experience while contacting one of these helplines, “Many times, these helplines are either non-functional or remain unanswered, which makes them less effective. It’s also challenging to ascertain the qualifications of the individuals we interact with.”

Strategies and solutions

The need of the hour is destigmatising mental health issues by promoting open conversations and awareness and bringing down the cost of mental health services. Catering to a large population with limited mental health resources is a big challenge and it calls for innovative approaches like group therapy and teletherapy.

“Tele-mental health services have been one of best innovations so far as it brings the cost of travelling to a specific location to zero,” says Dr Jain.

Dr Rohan Kumar, Consultant Psychiatrist, Regency Hospital, suggests using online platforms, chatbots, and AI-assisted therapy for basic emotional support.

The role of NGOs in addressing mental health in India is also key, although they may have certain limitations.

“NGOs can provide valuable mental health services, especially in areas with limited access to traditional therapy. However, they may not always offer the same level of expertise or specialisation as trained psychologists. They can be a cost-effective and stigma-reducing alternative for some, but severe cases may require professional therapy,” advises Dr Kumar.

Budget 2023 increased the allocation for the National Tele Mental Health Programme from ₹121 crore to ₹133.73 crore, signalling the government’s intent to give an impetus to mental health support in the country.

What’s needed is proper allocation of these funds to improve accessibility to quality services and ensure essential resources reach those who need them the most. The country also requires more trained professionals to bridge the demand-supply gap and bring down the cost of mental health support.

(If you or someone close to you is facing mental health issues, you can contact the national 24x7 toll-free Mental Health Rehabilitation Helpline KIRAN at 1800-599-0019).