Are India’s regulatory gaps leaving patients with substandard mental health counsellors?

When Amit Malik* from Bengaluru in south India consulted a tele-counsellor recommended by his psychiatrist for help navigating a bitter separation, he was advised to go public on social media with his wife’s affair to make her life miserable. His parents intervened to stop him from following this advice.

Graduate student Amrita Bhatnagar* visited the head of her university’s student counselling unit after being bullied. But, she says, she came out of her session feeling worse. “Everything he said seemed to trigger me and I felt insecure.” Later she found out that the counsellor had no qualification in psychology, he was an Ayurveda doctor.

India’s severe shortage of qualified mental health counsellors and clinical psychologists, combined with regulatory compliance gaps, is making such instances common.

With 1.36 psychiatrists per 100 000 people, India has fewer than half the 3 per 100 000 advised by the World Health Organization. Just 3372 clinical psychologists—0.24 per 100 000 people—are registered with the Rehabilitation Council of India (RCI), the body governing services for people with disabilities including mental health problems.1

Additionally, the most recent National Mental Health Survey (conducted in 2015-16) estimated that 15% of the population (about 210 million people) needed active intervention for a mental health problem. But resource shortages and a lack of awareness mean that only 3% are seeking care.2

This leaves a gap where “sub-standard counselling services run by well meaning but insufficiently trained people, as well as rogue counsellors out to make money, abound,” says Sujit Sarkhel, professor at the Institute of Psychiatry, Kolkata, and editor of the Indian Journal of Psychiatry.