In the past couple of years, the conversation around mental health has seeped into the mainstream of Indian cities. We witness the proof in suicide prevention hoardings at metro stations and the conversation about trauma by Instagram reels influencers, talking about a drastic increase in the visibility of mental well-being as a social issue. But visibility does not necessarily mean access. While urban India seems to have more "awareness" about mental health matters, the reality about who can access care—particularly psychotherapy—tells of profound and dark inequalities. For the majority of Indians, therapy remains too costly, and the mental health economy, which is mostly unregulated and urban-centric, ends up reinforcing the very exclusions it purports to overcome.
Underlying this crisis is the prohibitively high cost of therapy. A standard 50-minute session with a trained psychologist in metropolitan cities like Delhi, Mumbai, or Bangalore can cost between ₹1,500 and ₹3,500, and in a few cases, the charge exceeds this figure. The number of weekly sessions that are recommended for optimal therapeutic intervention amounts to cumulative expenditures of ₹6,000 to ₹14,000 a month. Considering the per capita income in India in the year 2023 was around ₹1.7 lakh a year (around ₹14,000 a month), as estimated by the Ministry of Statistics and Programme Implementation, such financial burdens place therapy beyond the reach of a huge number of urban dwellers, including those who might well fall into the middle-income bracket. The economics of therapy in India pose a gigantic irony: those who stand most to benefit from psychological treatment cannot afford it, while those who can afford it are the least likely to need such treatment.
The problem is compounded by the lack of public infrastructure committed to mental health treatment. Based on the National Mental Health Survey (2015–16) by NIMHANS, India currently has 0.75 psychiatrists and 0.07 psychologists per 100,000. Such numbers are woefully short compared to global averages, and there has been only incremental improvement since. Governmental mental health facilities are scarce and far between, and even in urban areas, public hospitals that offer psychiatric treatment are understaffed, underfunded, and beset with lingering stigma. Long waiting lists, lack of adequate staff, and a focus on medication rather than psychotherapy mean that such centres, though free or low-cost, do not provide significant psychological assistance to most patients. As a result, people who want therapy are forced to seek out private therapists or online therapy, both of which are significant financial burdens.
The post-lockdown COVID-19 pandemic has seen a boom in online therapy platforms, which have been hailed as a revolutionary move. YourDOST, MindPeers, and BetterLYF began offering online therapy, and tele-counselling was promoted as a means to increase accessibility. But though these platforms began price differentiation, some of them charging sessions between ₹500 and ₹1,000, the overall quality of care remains patchy. Further, most online platforms have interns or inexperienced graduates working for them, thus raising serious questions about ethical and clinical standards being adhered to or not. Today, there is no robust legal framework that decides who can deliver therapy in India. Though the Mental Healthcare Act (2017) has come a long way in addressing rights-based care, its enforcement is in want, and the distinction between a qualified psychologist, a counsellor, and a life coach gets lost in the private sector. The regulatory loophole leaves individuals in distress vulnerable to exploitation, misdiagnosis, or mediocre therapy.
The aesthetic and linguistic features of the Indian mental health sector have a strong class bias. In urban elite environments, therapy has evolved as a symbol of progressive selfhood, as a lifestyle branding strategy. The catchphrase "everyone should be in therapy" is propagated far and wide across social media, always with the desire to do good; however, it disregards the structural impediments that bar access to such interventions. This aesthetic therapy threatens to exclude those who are not English speakers, those who come from working-class backgrounds, or those whose psychological suffering is defined by material insecurity. Second, therapists, who are predominantly upper-middle-class urban professionals, are themselves lacking in proper training to understand the complexity of caste, class, or cultural contexts, and so the communication and trust are compromised. As Dalit scholar Suraj Yengde describes in his book Caste Matters, an understanding of emotional suffering in India involves an understanding of how violence, marginalisation, and intergenerational trauma around caste are articulated in individual psyches. However, most therapeutic interventions used in urban India are Western-centric and do not take into account these specifics.
The gendered aspect of access to mental health is just as stark. Though women experience more depression and anxiety, they are also more likely to have their distress downplayed, medicalised, or ignored. Domestic violence, emotional abuse, and unpaid work—three potent causes of bad mental health—are seldom framed as clinical issues by the medical establishment. Things are worse for queer and trans people. Though there are some LGBTQIA+ affirming therapists who work in Indian cities, the industry as a whole is heteronormed and unskilled in gender-sensitive practice. For many, particularly those with unsupportive families, therapy is not just costly—it's risky. This is not to suggest that hope is completely lost. There are many grassroots collectives and organisations that are working to build more accessible and responsive models of mental health care. Programs like the Mariwala Health Initiative have offered funding to community mental health initiatives that use a sliding scale and incorporate considerations like caste, gender, and geography into their therapeutic practices. The Blue Dawn, a Bangalore organisation, offers queer-affirmative therapy and peer support services at reduced charges. Also, iCall, a helpline run by the Tata Institute of Social Sciences, offers free tele-counselling services in a range of Indian languages. These efforts are, however, relatively few in number and tend to be underfinanced. They are exceptions, rather than norms.
To make therapy actually accessible in urban India, a holistic strategy is needed. Firstly, there needs to be more public spending on mental health infrastructure, not just hospitals, but professional training, outreach, and awareness. The government's budgetary allocation to mental health in the year 2023–24 was a paltry ₹670 crore, less than 1% of the overall health budget, a figure that speaks of the absence of priority. Secondly, regulation is necessary. Adoption of a transparent accreditation system for therapists, demarcation of different practitioners, and punishment for unethical practice is needed. Thirdly, and perhaps most importantly, the practice of therapy itself needs to be decolonised and democratised. This means the development of therapeutic modalities that are based in Indian contexts, that speak the language of the people, and that recognise the complex social determinants of mental health. Urban India is usually conceived of as liberal, modern, and enlightened; however, it still has extremely large exclusions regarding mental health. Therapeutic interventions are gradually being understood as a cultural asset for the affluent; meanwhile, healing cannot be commodified. Unless the obstacles posed by economic constraints, language, social stigma, and institutional indifference are overcome, therapy will continue to be an insulated privilege and not a right. In a country as socially and emotionally intricate as India, this is a tragedy that cannot be perpetuated.