29-year-old Rishika* is feeling better now. However, she believes there is always a scope of improvement. “…periodic fine-tuning is always needed,” she told Financial Express.com.
Rishika* decided to go for therapy when she realised some unresolved mental roadblocks is affecting her life.
“I decided to go for therapy when I found myself thinking about things that I had not acknowledged started to affect my mood and productivity. It was then that I realised I am not able to talk about how I am feeling to anyone even though I have people who would listen. I carried all those thoughts with me and they started to affect day-to-day activities,” She revealed.
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However, her journey from the decision to get therapy to actually getting into the sessions wasn’t easy.
‘Therapy is expensive’
Mental health is extremely important and it plays a crucial role in the overall well-being of a person. Globally, the burden of mental health conditions is worrisome. According to the World Health Organization (WHO), more than 1 billion people are living with mental, neurological and substance use disorders. In India, although the landscape is evolving, there is still a massive gap concerning affordability and accessibility.
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 has contributed huge demand-supply gap, ultimately resulting in a heavy cost for patients.
“Therapy is expensive. Period. I can take a subsidised package but that just ties me to the organisation and even if I don’t like the therapist, I have already paid for it. Additionally, the therapists who move out of the organisation do not reduce the fee, even though now they do not have to pay the organisation they were part of. The client does not get any benefit,” Rishika* told Financial Express.com.
When Financial Express.com reached out to a couple of people undergoing therapy, they revealed that there is a standard cost and the average cost per hour for a counselling session or psychiatric consultation is around Rs. 1,500 and it can even be as high as Rs.5000.
“When I had started therapy and as far as I remember, per session, the cost stood somewhere around Rs. 1,200 (maybe a bit more or a bit less) as part of the package. However, I just checked and one session with the same therapist has reached Rs. 2,500 at the very moment. Similarly, when I switched to another therapist, I paid Rs. 1,500 when she was with the organisation. I am still paying the same. To know how expensive it gets – when my therapy started, I had to take it every two weeks. A direct monthly cost of Rs. 3,000 is involved,” Rishika* highlighted.
Dr Aastha Dewan, Psychotherapist and Mental Wellness Coach told Financial Express.com that India faces significant challenges in providing adequate therapy and counselling resources.
“These include a severe shortage of mental health professionals, inadequate training, and uneven distribution of resources across urban and rural areas. Stigma surrounding mental health issues often prevents people from seeking help. Additionally, the mental healthcare system is underfunded, with only 1%i of the total health budget allocated to mental health, leading to insufficient infrastructure and services,” Dr. Dewan pointed out.
Cost is usually a big deterrent for people who want to seek therapy and get mental health support.
“…While it may not be a huge amount, I stay in another city and there are many associated costs with living in cities other than your base location,” Rishika* emphasised.
Moreover, people who require hospitalisation due to mental illness suffer from more financial issues. 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.
‘Internet is full of therapists and very few of them can help’
Manisha, 25, was forced to experience many traumatic life events in the past few years. From losing a parent to an abusive relationship, Manisha had no other option but to feel every consequence of these ordeals.
After eight months of therapy and two years of self-healing, Manisha* can get hold of her life and look at it from a new perspective.
“I knew it was time to seek help when I had been through back-to-back traumatic events within a very short period (loss of a parent, realisation that I was abused in many ways in a previous relationship, etc). Since this was also a time when I suddenly had to become responsible as the elder child of the family, I ignored my mental state initially. I didn’t have time to deal with my emotions because I was too busy trying to make a career, take care of my family, etc.,” she told Financial Express.com.
After a few months of suppressing my traumas and joking about it, some close friends made me realise that it’s unhealthy and I should finally get help, she revealed.
Even if she was mentally prepared to get the necessary help, finding a good therapist became a challenge for her.
“The biggest challenge was to find a good therapist. I discovered that the internet is full of options (given the recent buzz about mental health awareness) but very few of them are good options. There are so many Instagram pages and websites with underqualified therapists acting like experts. My first therapist was from one such platform and she was useless. She didn’t know how to ask questions and I had to go to another therapist to get rid of the first one,” she told Financial Express.com.
Finally, after two months she found a therapist that was able to help her.
“This time, I didn’t go looking around on the internet. I just reached out to a professional who had been practicing for years. I had already known her for years but was too shy to reach out to her initially,” she added.
She revealed that her first therapist charged Rs.1,500 per session but she had no previous experience and no valid testimonials. Her second therapist, who was finally able to help her, charged Rs. 800.
“Since I was just a student back then and my source of income was just freelancing, these session were expensive for me and my therapist was not at all worth it. If I had got the right help I would have understood. There are no quality options available on Instagram but there are so many mental health pages. The second therapist was good and there were verified proof and testimonials of her experience,” Manisha revealed.
She also emphasised that it is a task to find the right therapist and one needs to do a lot of research and background checks before actually consulting one.
“It’s best to do your research before choosing but also remember that you may have to go through a couple of therapists to find the right one for you. Don’t settle for one just because you’ve invested in 1-2 initial sessions. Sometimes one therapist may be able to recommend you to another because they also have specialisations,” she told Financial Express.com.
Even for Rishika*, finding the right therapist was a task.
“My first therapist may have been a good one for some but her approach did not suit my case. Apart from this, taking time out, and budgeting for therapy expenses were other challenges that were faced. I had started offline therapy with the hope that it would be more helpful but the commute was just an added expense I was not able to get the right therapist in the first go. It seemed like dating. Keep on meeting until you find the right one,” she told Financial Express.com.
I had 3-4 sessions with the first therapist before finally accepting that it would not work out. I was lucky to find the therapist the second time around, which took me 4 months, she revealed.
Status of Mental Health in India
The mental health situation in India is alarming, with over 30 percent of the population experiencing mental health issues. According to Dr. Dewan, the prevalence of disorders such as depression, anxiety, and substance abuse has been on the rise.
“Contributing factors include stigma, lack of awareness, stress, physical health issues, gender inequality, and poverty. The COVID-19 pandemic has further exacerbated these issues, particularly among the younger population. Despite some governmental efforts, such as the National Mental Health Policy and the Mental Healthcare Act, the overall mental health landscape remains challenging,” she told Financial Express.com.
She also highlighted that mental health therapy and counselling in India are largely unaffordable and inaccessible for many.
Meanwhile, Dr Nimesh G. Desai, Independent Consultant in Psychiatry and Public Mental Health, former Director, Institute of Human Behaviour and Allied Sciences (IHBAS) Delhi, revealed that mental health therapy and counseling in India are often unaffordable and inaccessible for the majority of the population. High costs, coupled with a lack of insurance coverage for mental health, place significant barriers in front of those seeking care.
“The provision of Mental Healthcare as a Right in the new law needs to be implemented through various mechanisms, including insurance coverage in both privately procured insurance schemes and public-funded schemes. To improve this situation, it is essential to increase government funding, expand insurance coverage to include mental health and implement community-based mental health programs. Public education campaigns to reduce stigma and promote mental health awareness are also crucial,” Dr. Desai told Financial Express.com.
According to a report by Your Story, while Insurance Regulatory and Development Authority (IRDAI) 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.
“With less than 30 million people receiving it whereas 150 million people needing the services, clearly there is a huge gap. To improve the situation, the government needs to increase funding for mental health, expand training programs for professionals, and implement widespread awareness campaigns. Additionally, integrating mental health services into primary healthcare and using technology to reach remote areas can help bridge the accessibility gap,” she said.
Challenges in mental health treatment in India include a shortage of trained professionals, lack of infrastructure, social stigma, and limited public awareness.
“To improve the status, a multi-faceted approach is required: increasing budget allocations for mental health, expanding education and training for mental health professionals, enhancing community-based services, and implementing nationwide awareness campaigns to reduce stigma. Collaboration between government, non-profits, and private sectors can also bolster the reach and effectiveness of mental health services,” Dr. Dewan pointed.
‘Need for holistic approach’
Rishika* who is still taking therapy sessions emphasised that although it is expensive, therapy is important.
“Since I faced the financial challenge, I can for sure say that I may feel the need for frequent sessions but they are too expensive to schedule. Having said that, it is important. Therapy is important. Mental health is important. Sure, you can vent out to your friends but after some time, a structured approach is needed. The exercises that one does in therapy will be documented and serve as a reminder to you as to how far you have come. It feels good. Additionally, it will help in changing the inner monologue, which is a game changer in many ways. So, if you feel the need for therapy, go for it. It may be needed. It is an investment if done with the right therapist,” she told Financial Express.com.
Although the landscape of mental health support has evolved a lot, there is still a long way to go for affordability and patient care. Experts opine that AI and health tech apps have the potential to provide affordable and scalable mental health support.
“They can offer preliminary counselling, self-help resources, and symptom tracking, which can be particularly useful in remote or underserved areas. However, these technologies should complement, not replace, human therapists. Ensuring data privacy, establishing regulatory standards, and integrating these tools with traditional mental healthcare systems are crucial steps to maximize their effectiveness and reach,” Dr. Dewan told Financial Express.com.
To access affordable and quality mental health treatment in India, individuals can utilize government healthcare schemes, seek services from NGOs and community mental health programs, and explore telehealth options and mental health apps, she emphasised.
“Increasing awareness about these resources through public health campaigns is essential. Additionally, integrating mental health services into primary healthcare settings and providing subsidies or insurance coverage for mental health treatments can enhance accessibility and affordability,” she added.
Rishika* also suggested that it would have been highly beneficial if therapies were offered in colleges and offices.
“…These are the places where a person spends most of their life. It is important to make the places a little more wellness-oriented. Additionally, they should be offered for free or subsidised rates to college students because it is a place where students from every stratum come. It will help in making therapy more inclusive,” she highlighted.
Addressing mental health in India requires a holistic approach that includes increasing mental health literacy, reducing stigma, and fostering community-based interventions. Schools, workplaces, and communities should be involved in promoting mental well-being.
According to Dr. Dewan, collaboration between governmental bodies, the private sector, and civil society can create a more supportive environment.
“Emphasizing preventive care, early intervention, and integrating mental health into broader health and social policies will be crucial in addressing the mental health crisis effectively,” she said.
*Names changed on request
DISCLAIMER: If you or someone you know is struggling with their mental health or in distress contact the Vandrevala Foundation’s helpline (+91-9999666555) which is available in 11 languages including English and can be accessed via telephone or WhatsApp 24×7. You can also contact Fortis Hospital’s National Helpline number 91-8376804102 which is available 24×7. You can also contact the Government Mental Health Rehabilitation Helpline ‘KIRAN’ at 18005990019 which is available 24×7.
