The dirty underbelly of India’s mental health Industry

Sadaf
4 min readNov 30, 2020

Badly burnt out counselors are an inside joke and a well-kept secret of the mental health services industry in India. Of course, because of the lack of regulation, licensure options and uniformity of education, how many good counselors, psychologists and therapists are there, is an unanswered and troubling question in itself . However, the way the industry treats it’s counselors leaves no desire or motivation to better oneself.

Having worked across a variety of setups like startups (for profit), school, NGO/field action projects, consulting with CSR projects, and private practice, I am now privy to some common grievances that plague the mental health setup in India, and one of the biggest concerns is the way that the counselors’ are treated. Having friends in the field who have worked in helplines and hospitals (I have not), confirm the same biases exist everywhere.

Within the medical setup, psychiatrists at least get some basic level of respect because of the white coat, but psychologists are not able to cash into that. In the medical setup, the psychiatrist (usually male) is seen as superior, with whom most of the decision making power rests. Medical setups are also extremely hierarchical with “sir/madam” cultures very much prevalent. As a counselor, if you see that some programs are not benefiting clients and you raise a voice, it is seen as anti-establishment (what isn’t, in this country?) and you might not get work or might get actively singled out and targeted, till the point you give up and resign.

The NGO sector/development sector is no better, with rigid hierarchies very much in place. The “do good” mentality is used to cover up treating employees badly, uprooting their self-esteem, paying them poorly, not sanctioning their leaves and also, rampant casteism and classism. Somehow, speaking English a certain way and being savvy in making presentations (all a product of certain types of education) makes you a better employee than someone who may be a first generation learner and struggling with these ideas. Most of the high level decision makers in these organizations are very well off and cut off from the ground reality of their employees and grassroots workers, and expect unreasonable levels of “dedication”. These bosses tend to talk differently to the outside world and the media about employee burnout and mental health, and behave entirely ableist when it comes to their own employed counselors who may be struggling with mental or physical health issues. This is something they share with crisis helplines and other crisis/field intervention projects, too.

Schools/colleges (most of them) employ counselors only because they are mandated to. The counselor is usually supposed to “make the children behave”, and discipline and performance are the two main goals. In order to “justify the salary”, counselors are often given administrative and academic tasks, which means that they cannot meet the students they are supposed to work with, regularly enough. Due to this lack of follow-up, no deep work can be done with the kids and they continue to be in cycles of stigma and referrals.

The “hip” new players on this scene are mental health startups and companies started by 30 something CEOs. Broadly, these might be EAP providers (employee assistance program) to corporates (sometimes to other organizations such as schools or hospitals or government agencies too), or those working directly with individual clients. Because of the “casual” culture, counselors initially get thrown off, thinking that these places are better than medical/NGO/educational setups. The “we” language, the focus on technology, and all the “cool stuff” — cute mugs, pet days, casual wear, can make the person feel like they have finally arrived. However, pretty much the same behaviour persists. Be it undervaluing of the counselors’ job, wanting to “justify” their salary by giving them a million other tasks, not understanding the burnout caused by providing therapy or ruthless ableism, these spaces are as toxic as the rest. In a twitter thread, a researcher psychologist explained her struggles working with one such organization in India. Her plight shows how it was very much a one-way street and there was no accountability on the higher-ups. Most people end up not fighting with the management because mental health circles are small and messing with the wrong people can cost you strongly.

Therefore, what happens eventually is people who love to do therapy go abroad, study further and become researchers, therapists and teachers there. Those who are able to, transition within the country to coordinator and manager roles or enter academia in the country itself. Many switch fields. Since most therapists are women and get fed up of this field, they choose to become full-time home-makers instead. In a country with such a huge mental health gap, we cannot afford to drain our therapists and counselors like this. Medicine alone is not enough. As much as we need community models of care, we also need quality therapists and counselors. One part of the solution to this is more, better and consistent education. Another huge part is to stop the rampant abuse of counselors at the hands of fame/money chasing organizations.

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Sadaf

Love psychology, economics, art, music, books, poetry, blogs, cooking and select sports.A jack of all trades, perhaps master of none. Psychologist.