BENGALURU: 20-year-old B COM student Kabir (name changed) identifies as a transman -- as a man trapped in a female body. Along with the despair and confusion of coming out to oneself, coming out to family members and facing denial, he is unable to afford the services of a mental-health professional.
“I need the treatment because this feeling of being in the wrong body is suffocating. It was very difficult to explain my state-of-mind to my parents. They dismiss it as a trend, a phase… they are in complete denial of my identity,” Kabir says, while speaking to City Express.
Kabir is like many youngsters in the city who need access to mental-health professionals, but say that sessions with them are prohibitively expensive. An hour with an accessible and good therapist can cost anywhere between Rs 800 to Rs 3,000.
Experts, who are trying to make mental wellness and doctors more accessible, say that the price is high because there are few facilities and professionals here. Ironically, the premier National Institute of Mental Health and Neurosciences in located in Bengaluru, but it is overburdened with people heading here from all the districts.
Kabir says, “My family’s monthly income is Rs 40,000 to Rs 50,000 per month and my mother is the only earning member. I can’t be pushing her to pay for my treatment. Few hospitals I approached for treatment said that it would cost Rs 2,000 to Rs 3,500 per session, and I cannot afford that”. Kabir adds that there is also a lack of professionals who have expertise in gender identity.
Of the same age, Kritika (name changed) is pursuing a triple major for her undergraduate and says she has been dealing with depression for the past 3 to 4 years, along with suffering insomnia.
“I can’t seek counselling though I really want to because my family’s monthly income is Rs 20,000 per month. My mother is a housewife and my father has to pay for the college fees and my sister’s education as well,” says Kritika. There is also the apprehension of opening up to a stranger.
“I know therapy is important, but medicines and counselling costs are shooting up every day,” she says.
Why is it so expensive?
Dr Anando Chatterjee, founder of non-profit Hank Nunn Institute, that provides low-cost, mental-health care says, "One of the reasons therapy can get costly is because of access, in terms of distance. People come all the way from West Bengal, UP, Bihar and other states to seek low-cost treatment in NIMHANS, which receives funds from the central government. Access is related to affordability. If the clinic is in Indiranagar, it is expensive for someone in the electronic city to come all the way”.
Manoj Chandran, CEO of White Swan Foundation that offers mental health knowledge and resources, says, "One reason for therapy being expensive is high demand for professionals and lack of enough therapists. Also, they spend a lot of time with each patient, maybe an hour or more.”
"Most government hospitals do not have mental healthcare facilities, making it difficult for citizens, especially students to access inexpensive treatment," Manoj adds.
There is no national directory that says who is charging how much, their qualification and specialisation, except for one compiled by Tata Institute of Social Sciences, informs Anando, further adding, ”Free counselling centres exist online and offline. How do we know about their quality? We don't. There is no regulatory body as of yet," Anando says.
While it is a recommended to have a college counsellor on every campus, many don’t, some have the services but may not be competent or may lack confidentiality.
Solutions and Alternatives
Dr Anando Chatterjee and Manoj Chandran say that depending on the severity of the issues, students must seek out either counsellors, psychologists or psychotherapists and psychatrists.
“ For example, if you are a student suffering from a break up, a counsellor with a 1 year training can help you find ways to cope. They are often less costlier and have a sliding scale from anywhere between Rs 600-1000 per session. Lots of people don't know or hesitate to ask for the sliding scale as per their financial situations,” says Manoj.
A member of Parivarthan centre that also offers counselling services says ,”A large majority of the college-going age group does come to us for counselling. When they fill out the form, we ask them if they can pay this much and if not, why. For genuine cases, we provide a sliding scale. These are the students whose parents don’t know they are seeking treatment and therefore don’t provide the required monthly allowance.”
"If it is an emergency situation, where for example, you feel suicidal, resorting to iCALL national helpline is a good idea. They deal with crisis management, recommend to the distressed caller an expert for long term treatment, are free and accessible by phone, functioning as emotional first aid," Manoj added.
Online chat services through websites have also sprung up in the past few years but the qualifications of professionals are not known or regulated by a body. However, Anando points out that it is best not to get too critical.
“In a country where you have nothing, and if you get something sub-standard through online counselling, you can improve it. It is better to have the online services. They are at best equipped as objective listening services but may not be able to deal with severe issues,” Anando says.
Why therapy is costly
- Time spent per session ( 1 hour or more)
- Accessibility in terms of distance and number of centres as per population density
- Lack of subsidized government mental health care or government support for private clinics.
- No national directory of rates, qualification and specialization of work
- Lack of regulatory body to oversee quality of offline and online services.
Prevalent adolescent difficulties
The difficulties faced by adolescents cannot be generalized but to name of a few, they suffer relationship problems with themselves, friends and partner, childhood trauma, abuse, academic stress, family issues, sexuality and gender issues, etc.
- Discuss financial constraints with the doctor and ask for a sliding scale
- Seek help as per severity of problems. In ascending order of depth of work and qualification, there are- counsellors, psychologists, psychotherapists and psychiatrists
- College counselors if competent and confidential
- Free of cost national suicide helpline iCALL for emergencies and emotional first aid (022-25521111)
- Online chat services