A signboard at Delhi's Select City Walk Mall reads 'Largest virtual mental wellness centre'. It points to a two-cubicle space with chairs, tables, computers and headphones where visitors can log on to seek help from a counsellor or psychiatrist. The month-old facility is already quite popular with mall-goers. It gets about 40 patrons a day.
They put on the headphones and pour their hearts out to the professional at the other end, discussing problems at work, problems at home, and homesickness. "If we can have spas and clinics in malls, why not a mental wellness facility," says Shipra Dawar, founder of ePsyClinic.com, the virtual behavioural well-being centre. "We offer patrons the option of discussing their problems with an online expert while out shopping."
The Delhi facility is a first of its kind, but across the country, stress, fast-paced lifestyles and limited access to quality psychiatric care are seeing patients turn to e-counselling, where doctors conduct sessions with patients via video links, live chat, email and even WhatsApp. Mumbai-based psychiatrist Harish Shetty, for instance, currently consults with 12 patients via WhatsApp, up from three in 2013. Of the 12, three live abroad and the rest are in high-pressure jobs that make it difficult to schedule an appointment.
"WhatsApp works well, especially for shy patients. I find that people express themselves more candidly on WhatsApp then they do in person," says Shetty. "In person, or even on Skype, they tend to be more careful about their language, for instance. On WhatsApp many vent without hesitation and are more honest." At Mumbai's Fortis Hospital too, of the 60 patients Dr Parul Tank sees a month, at least six are counselled on Skype. "I still insist on meeting every patient at least once, but many prefer to do follow-ups online," Tank says, adding that such consultations also benefit patients in smaller cities and towns, where finding competent psychiatric care can be a challenge.
At the Delhi mall clinic, two psychologists and two psychiatrists are available online between 11.30 am and 9 pm. The first 20 minutes are free; prices for extended sessions start at Rs 200 for 30 minutes."We in India tend to ignore our mental problems. In fact, seeking help from counsellors or psychiatrists is often stigmatised. A platform like this can make counselling and physiotherapy accessible to a larger number of people," says Kripi Malviya, a psychologist of the centre.
Elsewhere, e-consultations are helping busy professionals reach out where they otherwise wouldn't have, and ensuring continuity of treatment when people move away.
Uday Bakshi*, 24, for instance, kept in touch with his psychotherapist, Mumbai-based Preeyal Bhagchandani, via Skype while studying in the UK in 2014. A dyslexic who had been bullied through his childhood, Bakshi was nervous about joining the foreign university. "My weekly one-hour Skype consultations kept me going, especially in the beginning," he says. "It made more sense to reconnect virtually with a psychotherapist I trusted, someone who knew my history, rather than try to find a new counsellor in a foreign country."
For her part, Bhagchandani says she prefers to have patients visit. "Face-to-face consultation enables me to pick up on non-verbal clues and read a patient's body language better than I can on Skype," she says. "But continuing treatment, even if it's online, is better than no treatment at all." For Bhagchandani, Skype consultations evolved organically, mainly through word-of-mouth. It started four years ago, with one patient who had moved to the US. Today she says she conducts at least 16 Skype consultations a month. "Once you start a therapeutic alliance, you have to stay committed, even if it means online counselling at odd hours. Bailing on a patient is unethical," she says.
There are disadvantages beyond not being able to read subtle cues, though. For one thing, the patient's own environment is not controlled. This could mean a breach of privacy as simple as someone walking into the room when they're talking, says Dr Shetty. The loss of a controlled environment also makes it largely unfeasible to conduct virtual sessions involving more than one patient - such as couples or family counselling. "How do you pacify a bickering couple over Skype?" says Dr Tank.
And medication without a face-to-face consult is a definite no-no, most mental health professionals agree. At ePsyClinic, psychologists and psychiatrists are also trained to distinguish between cases that would benefit from counselling and those that require more intense therapy. For the former, though, psychiatrists believe e-interactions could also ease some of the stigma associated with seeking help.
"In India, one doesn't approach a mental health expert unless it is a medical necessity, which isn't the case abroad," says Dawar. "That's why we call ePsyClinic.com a centre for mental wellbeing, not mental health. And that's part of the reason we decided to open a centre in a mall."
(*Name withheld on request)