This org’s ‘pay-what-you-want’ therapy is filling an important void in mental healthcare

India is facing a serious mental health crisis, with the World Health Organisation estimating that between 60-70 million people in the country are suffering from common or serious mental health issues. However, therapy doesn’t come cheap, with the average cost per session at around Rs 1,500.

Paras Sharma and Rashi Vidyasagar—both doctoral scholars from the Tata Institute of Social Sciences (TISS)—wanted to find out how financial barriers delayed or prevented access to mental health care. They asked 31 participants from intersectionalities of caste, gender and income disparities whether they would take therapy if it was offered at a fee under Rs 300. 

They found out that by removing the financial barriers, people would be less hesitant to seek help. This enabled them to prioritise their mental well-being without the stress of excessive costs. 

The study gave the duo a profound insight into the need for a pay-as-you-want therapy model in a country where the care gap for common mental illnesses is alarmingly high (up to 95% according to a study done by the All India Institute of Medical Sciences and other mental health institutions.) 

Moreover, the findings revealed that 20 participants had no financial support from their family or loved ones. 

A person who faces a significant physical health and mental health challenge and does not receive any financial support is likely to be quite strained financially. And that’s why, despite the diversity in the annual incomes of the participants, most of them lived with two or more marginalisations,” according to Sharma and Vidyasagar.

This led them to start the pay-what-you-want mental health (PWYW) platform, The Alternative Story in 2018. It was officially registered in 2019.

Learning from experience

The impetus to start The Alternative Story also arose from Sharma and Vidyasagar’s personal experiences. With a professional background in the social development sector and firsthand experience with the prohibitive costs of therapy in cities like Mumbai, the duo experienced glaring inadequacies in access to mental health services in India. 

While at TISS, Sharma had been working for a national helpline, attending crisis calls every day and travelling extensively for work, and Vidyasagar was part of a project addressing violence against women. 

They struggled to find the time and resources to care for their own mental health. “I was experiencing issues relating to vicarious trauma (the indirect exposure to trauma through a firsthand account or narrative of a traumatic event), as well as grief due to my own life circumstances,” says Vidyasagar.  

“My partner and I often found ourselves rationing therapy sessions due to rising costs,” recalls Sharma. “We knew something had to change—not just for us but for countless others in similar situations.”

Later, his stint at a private mental health company catering to corporates highlighted a contrasting issue—resources were abundant, but uptake of services was minimal.

These experiences underscored the need for a platform that was both accessible and trusted, more so for marginalised communities who often dealt with systemic neglect and resource limitations.

How the model works

The early days were far from easy. The duo and their small team faced the arduous task of balancing affordability with sustainability. 

“We wanted to provide therapy at a price point that people could afford without compromising on quality or burning out our therapists,” says Sharma. To achieve this, they adopted a model that allowed clients to self-identify their financial capabilities without intrusive vetting.

The founders were also grounded in the reality that Bengaluru, where they launched the service, comprised many people who came from smaller towns and could not afford the high costs of mental health services in the city.

“We envisioned a service that would be affordable to people, but reliable enough that they could access it on demand,” says Sharma. “So we tried to think about what would be the sweet spot in terms of pricing, and realised soon enough that there isn’t one, because it would be different for different people,” he adds. 

Sharma referred to a similar model of ‘sliding scale’, a flexible payment structure that adjusts and reduces the cost of therapy sessions based on a client’s financial circumstances.

With a sliding scale, however, Sharma says the user typically has to request a reduced fee, leading to uncomfortable negotiations where the counsellor ultimately decides the price or eligibility. “We didn’t want to do this kind of gatekeeping.”

Instead, their PWYW model is based on self-identification. Clients are encouraged to self-identify their circumstances without the need for justification, creating a system that is accessible and inclusive. To maintain sustainability, The Alternative Story’s model is capped, with about two-thirds of sessions offered under PWYW and one-third at regular fees. “We also notify clients when our PWYW slots are full so that we can prioritise existing clients,  manage capacity, and ensure our counsellors aren’t burnt out,” says Sharma.

Their current PWYW slots are priced at a base price of Rs 700, with free tiers available to whoever needs them.

The organisation has chosen to not take venture capital funding, which Sharma and Vidyasagar believe often comes with pressures for rapid scaling. This, they worry, can compromise their quality and values.

A feminist, trauma-informed approach

Vidyasagar’s personal challenges with mental health, along with her experience working with the criminal justice system and against workplace sexual harassment, nurtured an acute awareness of systemic oppression. This informs the platform’s unique approach that prioritises cultural sensitivity and shared humanity over pathologising individuals for their symptoms, while overlooking their sociopolitical environments.

Vidyasagar emphasises that every choice in therapy—from the language used to co-creating healing plans with clients—challenges patriarchal and other power hierarchies.

The platform’s trauma-informed care acknowledges how systemic oppression, historical trauma, and generational marginalisation impact mental health. Vidyasagar illustrates this with examples from their queer support groups, which are led by queer therapists and designed through the lens of lived experiences. “If I don’t live an experience, I don’t create the intervention,” she asserts. 

The platform has catered to 15,000 users and close to 30 companies and institutions since it launched.

She describes the hiring process at The Alternative Story as a meticulous, blind recruitment model that prioritises emotional intelligence and situational understanding over traditional skills, which she says can always be developed. 

“Candidates respond to anonymised client scenarios and evaluate their own responses, allowing the team to assess their empathy, insight, and potential for growth,” she says. “Interestingly, we see that individuals from marginalised backgrounds often excel in this process. They naturally pick up on nuances because these scenarios mirror realities they’ve lived,” she says.

“Mental health is not a fad; it’s a human right,” Vidyasagar insists. The Alternative Story’s focus remains on fostering a collaborative ecosystem where multiple organisations address gaps collectively, rather than competing for market dominance.