Mental Health Awareness to Accessibility: Confronting the Crisis of Mental Health Care in India

Mental health awareness | Representative image | Photo courtesy: Special arrangement

Indian society has undoubtedly evolved in its understanding and recognition of mental health awareness and care. A promising 2018 survey revealed that nearly 87 percent of respondents across five major Indian cities were aware of mental health issues. While this shift towards greater awareness is a step in the right direction, it is merely the tip of the iceberg. In our zeal to spread awareness and reduce stigma, we have neglected a fundamental aspect: accessibility to affordable mental health services in the country.

The incessant pursuit of productivity in our free-market economy has a darker side — escalating stress levels and, consequently, a surge in mental health problems. But what happens when those seeking help find the doors of therapy either shut or prohibitively expensive? Private practitioners often charge fees that make their services a luxury, and a long-term commitment to psychotherapy further deepens the financial burden. On the flip side, government-run hospitals offering affordable options are swamped, unable to meet the high demand for psychotherapy services.

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Moreover, regulation and quality assurance are other grey areas. With the mental health market operating much like any other sector, how do we ensure that services meet a certain standard? Given that effective psychotherapy demands a long-term commitment, both in time and resources, the stakes are incredibly high. Missteps are not just costly but can also be severely detrimental to the mental well-being of the patient. 

While we laud the strides made in mental health awareness, it’s time to turn our focus to systemic changes. Whether it’s subsidising psychotherapy costs, implementing rigorous accreditation systems, or expanding government-provided mental health services, action is needed—now more than ever. Ignoring this critical issue could pose a long-term threat to the nation’s overall productivity and well-being. It's not just enough to be aware; we must also be equipped to act.

We have come a long way in recognising the importance of mental health awareness in India. Yet, the burgeoning costs associated with treatments remain a significant obstacle for many. For instance, a treatment plan for mild depression, which involves psychiatric consultations, medication, and weekly therapy sessions over a three-month period, could easily cost upwards of INR 25,000. Unfortunately, most insurance plans do not cover outpatient psychotherapy, rendering these essential services a distant dream for the majority.

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Furthermore, from a clinical psychologist's viewpoint, the return-on-invested-time for treating mild depression is 18 times higher than that of a regular doctor dealing with a one-time consultation. Despite the evident income potential, the number of qualified clinical psychologists is staggeringly low—just 3,372 registered professionals in a nation of 1.4 billion as of August 2023. The laws of supply and demand are clearly at play, but at a cost that is far too high for a society grappling with mental health problems. This dire scarcity has opened up a dangerous marketplace for unqualified counsellors and life coaches, leading not just to subpar treatment but also deteriorating the public's trust in mental health services.

This crisis isn't just about mental health awareness and reducing stigma anymore; it's also about confronting the systemic issues that make mental health care a luxury for many. The shortage of trained professionals, combined with an unregulated influx of self-proclaimed experts, creates a ticking time bomb. It exposes vulnerable individuals to inept care, potentially exacerbating their mental health conditions and further stigmatising the notion of seeking help.

The urgency of this situation cannot be overstated. While increasing the supply of qualified professionals is a long-term objective, short-term solutions like government subsidies for mental health treatments, inclusion of outpatient psychotherapy in insurance plans, and stringent regulations for practising psychologists could act as significant steps forward.

It's time to acknowledge that while we have made strides in raising mental health awareness, we are woefully behind in making mental health care accessible and affordable. As we continue our quest for a mentally healthier India, we need to ensure that the services are not just available but also within reach of those who need them the most. We cannot afford to leave anyone behind.

Over the years, India has consistently made commendable progress in acknowledging the importance of mental health, yet systemic issues like high costs and unregulated services continue to loom large. Addressing pricing and regulatory challenges is crucial to ensure that mental health care is not just a privilege for the few, but a right for all. To get there, sweeping changes are needed in how we train, employ, and regulate mental health professionals.

Firstly, we need to increase the supply of qualified clinical psychologists. Currently, the number of professionals in this field is woefully inadequate to meet the country's growing mental health demands. Expanding existing M.Phil. programs in Clinical Psychology and establishing new, accredited courses can help remedy this shortage. But the key to attracting talent lies in financial incentives. The current stipend for M.Phil. students in Clinical Psychology stands at a dismal INR 10,000 per month, a far cry from the INR 70,000 stipends that M.D. students receive. Such an enormous disparity not only reflects the low value placed on mental health but also deters promising students from entering this field. Competitive stipends are crucial to attract and retain talent.

Secondly, private hospitals must allocate more resources to mental health departments to meet the escalating demand. Increasing the number of clinical psychologists on staff and offering affordable mental health services can go a long way. The current pricing model, built largely on supply and demand mechanics, is not sustainable and serves to perpetuate inequality. Financially viable models that don't compromise on care quality must be explored.

Thirdly, robust regulatory oversight is indispensable. The current system, or the lack thereof, allows for self-proclaimed therapists and life coaches to exploit the unmet demand. Establishing stricter licensing requirements can prevent unqualified individuals from offering psychotherapy services, thus safeguarding consumer welfare.

By addressing these issues, India can lay the groundwork for a more accessible and inclusive mental health care system. The time for change is now. Regulatory reform, combined with incentivised educational opportunities and equitable allocation of resources, will not only make mental health services more affordable but also uplift the overall standard of care. In doing so, we can move closer to a society where mental well-being is prioritised, stigma is eradicated, and quality mental health care is accessible to all.

Rachna Mishra is an Assistant Professor of Psychology, and Rakesh Chaturvedi is an Associate Professor of Economics at FLAME University in Pune.

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