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How can we make therapy affordable?

Even as we witness a steady increase in the number of counselors and therapists, accessibility and affordability continue to be big challenges, especially for those who need them the most

The National Mental Health Survey observes that availability, accessibility and affordability of mental health services are major drivers of utilization

A couple of years ago, I received a call from a lady who wanted references to a few good counselors. After collecting a few more details, I suggested a couple of counselors and therapists to her. Her response was that she knew about them but could not afford their fee. She was looking for someone who would charge much less. I suddenly realized that beyond government hospitals or NGO-run counseling centers, I did not have a good list of references for her in the price range she was looking for the service.

Even as we witness a steady increase in the number of counselors and therapists, accessibility and affordability continue to be big challenges for most who need them. Consequently, they remain unserved.

There’s a fundamental issue in the manner in which the distribution of mental healthcare services is taking place in the country today. A large number of private practitioners are chasing a small population that voice their demand for services and can afford the high fee structure. On the other hand, a small number of mental health professionals in the country cater to an unmanageably large number of people with mental health issues through government-run hospitals and NGO-run services.

We could ignore the trend by saying that the demand-supply science is playing out here and things will settle down over a period of time. However, it is critical that there are efforts put in to correct this trend and make mental healthcare services accessible to all.

There are several factors that play in this lopsided distribution of mental healthcare services. To begin with, we are only slowly emerging out of the situation where privately practicing mental healthcare professionals were nearly absent. The demand for therapists, counselors and psychologists are picking up in the urban spaces. However, even in these cities, most service providers are catering to a certain section of the society. A rate of 1,500-3,000 per session can be prohibitively expensive for most people, given that they would be expected to visit the therapist 2-3 times a month. However, given the high number of those who can afford such rates, several popular professionals have long waiting periods.

Moreover, at that fee structure and given the profile of the ‘clients’, there’s a certain requirement on the professionals to offer services with higher standards of physical infrastructure. For instance, opening the consulting office in a more accessible (read expensive) area of the city. This, in turn, could possibly impact the free structure.

Not surprisingly, there’s immense pressure on government institutions and NGO-run establishments that offer mental healthcare services. NIMHANS receives more than half a million people in a year. This is potentially a huge ‘market’ that remains to be tapped by mental health professionals.

It’s a little surprising that we are not able to see the demand that exists in the unserved communities and geographies. Clearly, there’s huge room for innovation to address the affordability issue in mental healthcare.

One such model is technology-enabled teleconsulting. More and more people are feeling comfortable speaking with a therapist or a psychologist over a phone/video call. The model significantly cuts down the costs incurred, which can mean lower fee. Through teleconsulting, increasing number of mental health professionals are serving people who otherwise were cut off due to geographic limitations and pricing issues.

Then there is pay-what-you-want (PWVW) model that is being experimented by some of the mental healthcare professionals. Paras Sharma, who founded Alternative Story offering regular counseling services, today also offers PWYW services to his ‘clients’. Keeping in mind a government-run hospital rate of 100 per visit and a typical NGO-run counseling center at 500 per visit, Alternative Story started PWYW services at a suggested price of 299. He believes that the model has helped his team cater to a section of the society, who, otherwise, would have stayed away from accessing services due to the affordability factor. “And, I get to fill up certain slots that would have possibly remained idle,” he adds.

It’s also a wrong perception that there’s lower demand among those who cannot afford to pay a high fee or are in geographies that do not have easy access to mental healthcare professionals. Our experience at White Swan Foundation tells us that people from smaller towns are constantly looking for solutions to mental health issues. Six of the top ten cities that give us traffic to our portal are smaller towns. More than 50% of our traffic to our portal consume knowledge in languages other than English.

It is, therefore, imperative, that we begin to find ways to serve these populations and significantly increase the treatment ratio among them. The country today requires tens of thousands of therapists and counselors who speak the local languages. We must introduce training courses for therapists and counselors in these languages so that these new breed of mental health professionals could serve in smaller towns and villages of the country.

Making mental healthcare services affordable to all will also bring about a change in the general perception that such services in the private space are elitist.

Essentially, it comes down to our ability to ‘feel’ the market and serve them through innovative service models.

FundaMental Truth is a series on mental healthcare by Manoj Chandran, Founding CEO of White Swan Foundation, a not-for-profit organization that offers knowledge-led solutions in the area of mental health

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