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It’s not okay

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It’s not okay

Friday, 12 July 2019 | Sakshi Sharma

It’s not okay

Young people are willing to open up about their mental health issues but exorbitant counselling fees are holding them back. What are options for students then, asks Sakshi Sharma

Conversations around mental health have somewhat diluted the stigma associated with it, considering role models and influencers have admitted to their frailties in open fora and making good despite them. This awareness has definitely encouraged more youngsters to come out and seek help. But it is the redress mechanism that is holding them back as psychological counselling, consultancies and sessions come at a high cost. The lack of affordable therapy is one of the reasons why “going to a shrink” is often considered an urban luxury than a necessity. 

Although there are regulatory reforms to improve access to government mental health services, for a lot of young people consulting private therapists is becoming a drain as treatment doesn’t get over in a single sitting and a sustained periodic session could cost up to anything between Rs 8,000 to Rs 15,000.

Add to this the scarcity of professionally trained personnel to handle such cases. According to the World Health Organisation (WHO), “the burden of mental health problems is of the tune of 2,443 DALYs (disability-adjusted life year, which is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death) per 1,00,000 population. The mental health workforce in India (per 1,00,000 population) includes psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07).”

 Nandini Rathore, a law student from Delhi, says, “India is among the most depressed countries in the world but does not have enough psychiatrists and psychologists. No wonder the available services, therefore, come at a premium. A big chunk of depression cases in India also comprises students, who crumble under performance pressure and expectations, but cannot afford counselling fees.”

Sharing her experiences, Sakshi Tiwari, a college student from Lucknow, says, “I was diagnosed with depression in 2017 by a private practitioner. I was put on medicine but since I couldn’t afford the sustained therapy that used to cost me Rs 1500 per session, my condition worsened. Later in 2018, when my mental health was in shambles, I finally decided to take a plunge. I started regularising my treatment and therapy in VIMHANS, Lajpat Nagar. However, it has been really expensive for me as a person who doesn’t have a job yet. Every appointment with the psychiatrist costs me around 1,200 to 1,500 bucks. I’ve got better over time but my pockets have emptied.”

Dr Anuneet Sabharwal, a psychiatrist,  says that while he is aware of the cost burden on students, fact is counselling is expensive, given that methodologies are constantly updated and we use cutting edge technologies. “For example, at my clinic, my psychotherapy uses a small imported device called cranial electro stimulation (CES). Then there are  training and basic maintenance costs. Unfortunately, everyone is running on a tight budget, the private hospitals and practitioners are going to incur a massive loss if they do so. At my clinic if you are taking a 10 session package, it is going to cost you between Rs 1200-1500 per session. If you go for a single session it is Rs 1500 per session. There are more expensive counsellors who are charging Rs  4000-5000 per session in Jorbagh.”

But he feels a lot of government facilities have really evolved counselling modules and are offering them free for students though not many are aware of them. For example, the AIIMS department of Psychiatry runs regular out-patient walk-in and follow-up clinics in addition to weekly specialty clinics for child and adolescent psychiatric disorders, psychosomatic disorders, common mental disorders, severe mental disorders, dual diagnosis disorders and brain stimulation therapies. The department also provides community outreach services six days a week at the CRHSP, Ballabgarh, including one day each at the Primary Health Centre at Dayalpur and Chhainsa. Besides pharmacotherapeutic interventions, psychological treatments, modified electro convulsive therapy (MECT) and advanced treatments like rTMS, tDCS and biofeedback are routinely provided.

Sakshi is aware of subsidised services provided by hospitals like AIIMS but she says, “the queues are never ending and it is difficult to get a slot.”

Another survivor, Jagriti Saxena (name changed) says, “I’ve been living in Delhi for more than five years now. I’ve been a patient of chronic depression and anxiety. Recently, I was experiencing continuous meltdowns and went to a psychotherapist. The charges for around 45 minutes of therapy are Rs 1500. I could go only once, since I couldn’t afford regular sessions. I am not sure how effective the therapy will be, so spending so much money on it is a decision I’m very sceptical about.”

She feels she would have felt better if there would have been more cheaper options available other than AIIMS. “The problem is that the diagnosis takes time. There needs to be regular correspondence with the doctor and every appointment costs money. Due to this, people avoid regular follow-ups.”

Dispelling such fears, Dr Anuneet feels technology can be a real solution. “With health apps coming in, every strata of the society has the choice of interacting with the therapist through tech, voice or video calling and that could work out to be cheap. But the problem is that tele-psychiatry is an emerging discipline and we don’t have evidence to show that they are equally effective.”

Dr Kamna Chhibber, Head of Mental Health and Behavioural sciences, Fortis Hospital, argues that at least students should attempt a first point of contact and judging by the seriousness, some practitioners do work out some options. “The challenge for treatment is that you do not have to take therapy, you first have to look for medical intervention. Students may feel that they cannot afford a long-term treatment but they first need to reach out to an expert and explore the best possible options. You  can’t stay quiet, you need to come out of your zone and speak to an expert. If you can’t take a session, you can talk to a helpline which is free and run by trained professionals. It is not necessary that the personal and tele-counselling will have a vast difference.”

But Nandini claims that tele-sessions, which she has undertaken for the last six months, have had no effect on her bipolar issues. Perhaps because a voice is disembodied and reassurance comes from seeing a mature person in front of you. “There is a major difference as a counsellor upfront will try to access you wholly, right from the body language to the thought process. Also, a major concern is that there are many untrained professionals running tele-psychiatry.”

“Medical care for mental health in India is abysmal as its affordability for youth remains a major concern. The country is reeling under a mental health crisis,” adds Sakshi.

Some NGO’s like Raahi, Sanjivani and Sarthaak are working for mental health survivors. This can be an affordable way out for the students. “But to rely upon the free counsellors is the main challenge,” adds Nandini. As tele-psychiatry and apps have peeped in, it has tried to generate plethora of options but they stand at their own risks. Other than AIIMS, no reliable, affordable options comes in frame. All of this signal the dire need to make the mental health treatment pocket-friendly otherwise it’s not far away that the country will be staring at a mental health epidemic.

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