Why Psychologists are struggling to find clients in a country of 1.25 billion people where 1 out of 20 is depressed? — my 900 days of learnings.

Can you guess how many trained mental health professionals are there in India — a country with 1.25 billion population in which almost 150 million adults are suffering from mental health issues and almost 9.8 million under 17 years of age require severe psychological intervention? If you have any doubt about these numbers, let me tell you that these numbers are not thrown by any private body or NGO rather it’s highlight of the National Mental Health Survey- 2016 conducted by Health Ministry (Govt of India) in 26 states with a sample size of around 40,000 people. And it’s ‘Sarkari Data' (you know what does that mean in India) that too about people who have already admitted ‘in problem' which is again a huge challenge for Indians to accept. This data does not include millions of people who are in severe stress about their career, jobs, relationship, sex life and chronic diseases but never going to admit it.

The Shocking Truth

Anyway, let me frame my question again for you, what do you think about the minimum number of trained mental health professionals required to deal with almost 16,00,00,000 people (a population that is more than entire population of many big countries including Britain, Russia, Germany, France etc) who are already identified as people struggling with mental health disorders? I am sure, the numbers you might be able to guess would be at least 100 hundred times higher than the reality. So, my friend there are only 7,000 trained mental health experts available in India to deal with mental health issues (data available on internet & cross checked with actual practitioners).

So, going by the fundamental of business “when there is a gap between demand and supply the value of the product or service will be naturally high”, all these 7,000 mental health professionals including Clinical/ Counselling Psychologists, Counsellors must be over burdened and there must be a ‘waiting period' to get the appointments fixed with these Psychologists but unfortunately it’s not true. They are struggling badly to find clients, business and leaving their core practice to join HR, Training and Skill Development divisions in MNCs or Schools as Counsellor (which is just a formality) to earn their livelihood. Those who are not looking for choices are left with dilemma, struggle and limited options to survive their career as mental health professional. But why they are not able to get clients in such situation where there is scarcity of trained professionals? While running my online consultation venture AdviceAdda which is now ConsultOn for last 3 years where we helped over 2 million people in distress, I realised that undoubtedly there are certain social, infrastructural & policy issues that are responsible for such an unfortunate scenario in mental health service industry where despite of huge business opportunities Psychologists are struggling hard to survive their counselling practice. But when it comes to put the actual onus for this unfortunate situation, I will like to say bluntly that ‘it’s only them (mental health professionals) who are responsible for all the practice challenges that they face at ground level in aquiring clientele because they live with a lot of apprehensions and they have not made adequate individual efforts to change this unfortunate scenario’.

Why I believe mental health professionals are themselves responsible for the business challenges they face as a practitioner?

In a highly judgemental society like India where people are judged upon their complexion, dress, language, food habits & daily life choices if you are expecting the society to behave responsibly in this matter & not to judge people living with Depression, Bipolar Disorder & Schizophrenia, I can only empathise with your innocence & thought process. I have seen that most of the mental health professionals blame the ‘Social Stigma’ attached with mental health as the biggest challenge for their profession/ business as a reason for not able to have enough clients because for them it’s the easy way out to underplay their own personal/ professionals inefficiencies that they are unwilling to admit/ work upon. But trust me after a lot of one to one interactions and long discussions over this issue with more than 50+ mental health professionals in my connection & 3 years of observations of the counselling process, professional practices, approach, client management & overall attitude of more than 150 mental health professionals (Psychologists/ Counsellors) active on my online platform ConsultOn(AdviceAdda in past) I felt there are many alarming institutional, behavioural & professional issues that are real threat & challenge for this entire fraternity but either they don’t realise it or are reluctant to admit it (I don’t know why?).

Before writing down my observations I would like to admit that I am not a mental health professional so there may be certain professional/ practicing issues that I may not be able to understand as an outsider but whatever I am writing is based on an understanding that evolved being an active part of a system that dealt with mental health professionals as service provider. So here is the list why I believe majority of mental health professionals struggle to find/ retain clients.

1. The Unwanted Chaos — So, I strongly believe that a major reason why mental health professionals are struggling in their profession is because of unwanted chaos in the entire eco-system about clear cut guidelines for practice in this sector. A common man hardly understands the much required difference between different titles/ profiles carried by these professionals like Clinical — Counselling Psychologist, Counsellor, Psychotherapist etc. The relationship & career coaching has become an area where any damn person claims that he/ she is an expert. There is a statutory body called RCI that is authorised to take actions against any unethical practice but it only deals with Clinical Psychologists which is just one portion of this entire eco-system. How to know whether a Counselling Psychologist or Counsellor is qualified enough to practice in this space? is unclear to common man. There are many professionals just like ‘Jhola Chhap Doctors’ who do not have any degree/ authority to practice in this space but no-one speaks against them. Many of the experts I spoke were highly concerned about this issue but they are unable to take any concrete action. I think, mental health is a very serious & sensitive space and it should not have such prevailing issues that are a life threat for people suffering from mental health problems.
2. Lack of Adequate Opportunities for Psychologists — Once we planned to do a massive campaign to create awareness about mental health issues at pan India level, we were in touch with all the top hospitals in Delhi-NCR and none of them showed interest in becoming partner in the campaign. I spoke to one of my friends who used to be CEO of a well known multi-speciality hospital on this. Whatever he said, I could not ever imagine as it was another unfortunate truth. He told me that “Since in India people do not approach mental health practitioners so easily, it’s a non-profit space for hospitals, this is the reason why hardly any hospital has full fledged mental health division and even if they have they will employ only a Psychiatrist not a Psychologist.” If they have to hire any Psychologist it will be only for formality or fulfilling certain norms.
3. Lack of Professional Integrity — I have realised that there is no feeling of integrity among mental health professionals practising in India. Most of them are involved into Love-Hate relationship with each other and are always busy in criticism. There is no institutional known body that is truly working at ground level to help this community in getting over it’s problems. There are certain groups & organisations active in different parts of the nation but most of them are only limited/ restricted to the periodic ceremonial events/ workshops/ seminars and not strong enough to represent mental health experts fraternity on different fronts including Government where they can influence as a community to enact certain laws/ policies or create a better environment in the country for mental health practitioners by creating right mechanism and effective addressal system to deal with mental health issues that can be beneficial for professionals & sufferers both.
4. Wrong Business Model (for Psychologists)— Yes, it’s a harsh truth that most of the Counselling & Clinical Psychologists do not have any direct business/ revenue model in a country like India where nobody accepts the fact that he/she requires psychological intervention easily. And if they accept it, they straight away look for medication and approach a Psychiatrist while the cycle should start from counselling not medicine. This is the reason why a big chunk of Counselling & Clinical Psychologists depend on referrals from Psychiatrists. Going by the natural logic of how mental health condition of a person requires psychological support, the role of a Psychologist comes first and that poses a clash of interest between both the mental health professionals (Psychologist & Psychiatrist), I am sure this scenario must be affecting the potential of this business model as well that they rely upon for their practice and survival.
5. Expensive Fee Structure — Since most of the Psychologists/ Counsellors don’t have huge client turn out at their clinics and hardly 20–25% of the clients (it’s my own experience at my platform) appears for follow up counselling sessions, the mental health professionals try to exploit all the available existing clientele to manage their infrastructural set-up cost (clinic), professional fee & salaries of their employees and because of that they charge heavily to their clients. A counsellor with hardly 3 years of experience can charge Rs 2,000 to Rs 5,000 for a 60 minutes session and a more experienced professional with almost 5 to 10 years of practice can charge Rs 5–10,000 / 60 minutes session. Since no problem in mental health space can be sorted out in 1 or 2 sessions and it does not create immediate visible changes in client’s mental health conditions, the client starts feeling ‘exploited’ and decides not to carry it in further (in many cases). Because of no standard fee structure in this space a common misconception is created that Psychologists are very expensive where as Psychiatrists are available at Rs 500 at multi-speciality hospitals OPD. That's why people in distress approach Psychiatrist not a Counsellor or Psychologist.
6. Unprofessional Attitude — It may sound really harsh but it’s a reality that we still lack good professionals in this domain who strictly follow their code of conduct as a mental health professional and believe in ethics & norms of non-judgemental approach as a Counsellor. I have seen couple of people in this space passing judgements on client’s actions, background & beliefs. I have also witnessed incidents when they are too harsh, insensitive and make fun of the situations in clients life. I believe such things are crime in this profession and more over it ultimately maligns the image of Psychologists and makes it more un-accessible for people who are in distress & have heard of such incidents from someone else.
7. No efforts to create awareness — I was very surprised to see that every mental health professional says that the main reason for ‘not so good situation’ in this space is the social stigma attached with mental health issues but what I could not understand is why don’t they do something at their own personal level to spread awareness about this issue while it directly affects their own practice/ business & ultimately lifestyle. I think if Psychologists and Counsellors would start sharing even only the different Case Studies about their patients who came to them and ultimately become fine after counselling sessions on their blogs/ social media platforms, it may also change the current scenario and could actually help them garner clientele for themselves as it adds a lot of trust value in prospective clients's minds who are hesitant to approach mental health professionals. They need to join hands and create groups, may be as City Chapters and start making efforts jointly to sopread awareness about their field. It will also make common man realise that they are available near by and equally accessible just like other professionals.
8. No Sensitivity for the Cause — It was January, 2017 when we were planning a mass campaign at pan India level to reach upto 25 crore people in 6 months to spread awareness about mental health issues. We approached scores of mental health professionals and asked them to support this campaign where they had to adopt just 1 person and counsel him/ her for 3 months on pro-bono basis to help him get out of his/ her problems. We had tied up with dozens of media houses who had millions of outreach to cover this entire campaign for next 6 months. We wanted to create live examples to show the world, how mental health services can save lives who might end up committing suicide someday if not helped properly. It was also a great branding opportunity for them but since we were not offering money and were looking for pro-bono support, we could only convince 1 or 2 people for this which was very disheartening for us as it was not a commercial campaign, since no one in this space was doing anything concreate we thought of contributing 2 cents from our side to spread word for mental health services in the country. I have spent more than a decade in media as a journalist/ Editor before starting my venture and I believe there is a strong similarity in between two professions — Journalism & Psychological services and that is the commitment towards the cause, society & humanity. Though it’s ultimately a profession but it’s different from being an Engineer or Pilot. It certainly requires huge sensitivity to serve people who approach you in distress but unfortunately it’s missing in a lot of professionals and that’s not good for the overall fraternity.
9. Not Able to Optimise Online Presence — The internet penetration in India has created huge opportunity for everyone including experts as it's going really fast and right now we have around 500 million users. It can help experts including Psychologists in building an effective online presence & it is also a medium to reach out to potential clients by using right digital marketing techniques. There are many professionals who understand this and they built their own websites as well along with creating social media channels on Facebook, Twitter & Linkedin but the problem is that they are not able to monetise their online presence because they dont have any expertise in it and it requires huge time, effort and finance commitment at regular basis which they are unable to make. I am sure if they will do it in the right way by creating right content, design & educational videos and will promote it to right audience in right way, they will certainly start getting better results (leads, references & business). I believe this space is still not being explored by mental health professionals while it has enormous possibilities for them.
10. Unaware of Advanced Marketing Tools — A big reason why mental health professionals are not able to optimise their online presence (website) on different online platforms (social media channels) is that they are unaware of advanced marketing tools and smart practices like Webinar, E-mail & Content Marketing and they never tried to explore them. All these tools/ practices are most efficient marketing techniques to reach out to right potential audience and convert them into regular paid clients. But it will also require certain skill set, finance, efforts & time investment to get right response but it’s worth learning & experimenting. If they will start using these tools, their problems around 'How to reach right audience?' will be sorted out and they might strat seeing growth in their clientele in short span of time.
11. Not Very Open to Technology — I still remember when we launched our online consultation platform AdviceAdda (now ConsultOn) in July, 2014 and started approaching experts to take them on-board, mental health professionals were the toughest section to convince to join us as they had huge reservations about Online Counselling on Private Calls, Chat & Queries. They were not willing to leave their traditional style of counselling practice while they should understand that technology is the single point solution for all their challenges as mental health professional that are barrier in growing client base, earning well & take the practice to new heights because it's the only way that gives privacy guarantee to a client who has a lot of apprehensions in visiting a Psychologist as he is feared of being judged in society. The technology makes it super easy for clients and counsellors to join each other on the go over phone using internet without any hassle. I believe Psychologists and Counsellors should start using it more often setting aside their apprehensions on methodology & practice norms as this is the only way to reach out people who will never come to them in person. After a lot of efforts & Q&A sessions with mental health professionals we started getting them on board and by the time we started getting thousands of users on the platform the number of mental health experts also rose to 150 who are still there on platform and using it to grow their online practice. Though the acceptance of technology has increased among Psychologists & Counsellors in last 2-3 years but it still requires much engagement & active participation. They need to understand that it’s only the technology that can enable them to reach out to more clients in such a judgemental society & help them grow their business as mental health expert.
12. Unaware of Parallel Revenue Channels — I do believe that most of the mental health professionals are not aware of alternative sources of income that’s why they only rely on one to one counselling sessions which are not always sufficient. When they are not able to survive their practice they start looking for other options. And it happens because they don’t know how to create parallel revenue stream. I believe if they could actually start exploring innovative ways to offer their services in different packaging like — Long duration Counselling Programmes for different set of groups, Online Webinars around niche topics, Offline Workshops, On-demand Counselling Service to Schools/ Corporates, Writing for Niche Websites/ Magazines on Relationship, Emotional Well Being etc, they won’t have to take such decisions. At ConsultOn we do recieve a lot of queries where MNCs & other organisation approach us to hire such professionals as part time contributors for different short term/ long term projects. I think if mental health professionals would start undertanding their potential as an Expert and would keep their eyes open to look for opportunities online/ offline, they would certainly be able to take their practice to new hights and the struggle of survival would end up very soon.

I may not be right in some of my observations as an outsider but it was all based on my first hand experience of the last 3 years in my journey as CEO of my online consultation platform AdviceAdda (where we served 2 million people in distress & got recognised by organisations like iCONGO & UN along with 70+ national-international media including BBC World Service). We have recently re-branded our venture AdviceAdda as ConsultOn as it’s almost 20 times bigger/ better & advanced tech platform than the previous version. We have 150+ mental health experts on board & we try help them grow online by doing whatever it requires because we truly want to help people in distress who are not open enogh to visit a psychologist in person and we are concerned about the fact that more than 1,30,000 people are commiting suicide in India every year.

PS : You can write me at [email protected] to share your feedback.

[At ConsultOn we help experts grow online without any hassle by incorporating all our learnings and advanced marketing tools. Along with online practice we are also in the process of partnering with MNCs/NGOs to create offline programmes/ events engaging our mental health experts on board. If you are a practising mental health professional and you are committed to bring ground level change. We would love to have you on-board as an Expert. Check out ConsultOn Features & Create Your Expert Account.]