What stops people from seeking mental health care

This article is authored by Amit Malik, founder and CEO, Amaha.

We have seen tremendous progress when it comes to mental health conversations in India. These conversations have pierced the walls at schools, workplaces, social media, and even within families. If we go back a decade, this would have been unimaginable. Yet today, we don’t shy away from using words like anxiety, burnout, trauma and therapy.

Mental Health (Shutterstock (PIC FOR REPRESENTATION))

But, even with a great deal of progress, there is still one difficult truth to face - conversations about mental health have not translated into care at the scale it needs to in India.

We no longer wonder if people believe in mental health. They do. In fact, many are vocal about it. However, this begs the question: then what actually stops someone from getting the right help at the right time, especially when they’re struggling?

What I see today, while building Amaha, India’s largest private mental health provider, is that this has less to do with stigma and more to do with a series of bottlenecks. They may seem minor in the grand scheme of things, but they could lead to delayed care for months, and sometimes years.

You will find a multitude of symptoms that are associated with almost every mental health condition. There is no clear label attached to each. There could be someone with depression who may show signs of exhaustion, irritability, poor concentration, and even loss of interest. On the other hand, anxiety may look like headaches, overthinking, sleeplessness, or digestive issues. Someone with OCD may get labelled as being fussy or rigid. ADHD could look like laziness, and even trauma may show up as anger or withdrawal.

One might end up overlooking all of these symptoms as they may seem like everyday life occurrences. People might internalise the struggle by thinking of themselves as weak or that they’re not trying hard enough or not able to handle things better. As a result, more often than not, they blame themselves rather than denying the suffering itself.

Another reason for the delay can also be functioning. Many individuals who need help will go to work, parent children with utmost care, look after their ageing parents, and do all of the everyday chores while still looking fine. And in India, families and workplaces admire this ability to keep going.

But being well and functioning fine are not the same. There could be someone leading meetings during the day and breaking down on the commute home. Or a parent who manages to keep everyone else’s life in order while losing themselves.

We often brush aside what doesn’t meet the eye. If you don’t see any visible collapse, there’s no possibility of emotional distress. But that’s far from the truth, and any person who’s been struggling will find themselves delaying help because of this cause alone.

Even families, while they only wish the best for their loved ones, might unintentionally add to this delay. Although they care intensely, that may not always translate into the right response.

For instance, if a young adult feels anxious, they may be told to avoid using their phone. If a new mother feels low after childbirth, she may be told that it’s just a difficult phase and it will pass. While their intent is love, the impact can be delayed.

Even if you cross all of these barriers, there’s still the confusion about where to go.

The pathway is usually clearer for physical health. If you have chest pain, you know which doctor to visit. You will find mental healthcare harder to navigate. Should I see a therapist or psychiatrist? Will a counsellor help? Will I need medication? Will therapy be enough? How would I know if someone is qualified?

For someone who’s already overwhelmed, this pool of questions can be paralysing.

Telling them to seek help is only useful if help is easy to understand, find and trust.

Trust can be its own barrier.

Mental healthcare is intimate. One might have to open up about their fears, struggles, relationships, childhoods, addictions, intrusive thoughts, grief, and even shame. And share that with a stranger, no less.

So, they ask, sometimes openly, often silently, "Will my information remain confidential?” Will they judge me? Will they understand my language, culture, or family structure?

These questions matter. Someone who might be technically qualified may not always be the right fit. And unsatisfactory first experiences can push people away from care for years.

There’s also the question of cost and time - both equally important.

Therapy doesn’t give you results in just one consultation. Psychiatric care may involve follow-ups. Recovery needs sustained engagement and support between appointments.

For many Indians, this might be a difficult adjustment to make. Balancing work life, commute, caregiving, exams, household responsibilities, and financial obligations can get overwhelming. So, even if they can afford one session, they might worry about ongoing care.

The possibility of the illness itself getting in the way isn’t lost either.

Depression may reduce motivation to seek care, anxiety can make people avoid difficult conversations, and trauma can build a wall that makes trusting someone that much more difficult.

So, when we say, “Why couldn’t they just reach out?” we misunderstand the nature of the problem. Reaching out is often the hardest when help is most needed.

This is why we cannot rely only on an individual’s willpower when it comes to mental health care. The system has to shoulder this responsibility too.

Easier entry points can pave the way for better mental health care. Primary care doctors should be better equipped to identify common mental health conditions. Credible support systems at schools and colleges can help individuals seek early care. We need workplaces to invest in providing real access to care while families need to be trained to recognise warning signs without panic or blame.

The goal should be to stop treating mental health care as a last resort, but something people turn to when distress starts interfering with the life they want to lead.

The biggest hurdle in India is not just stigma. It is the uncertainty surrounding mental health care. Whether it is not knowing what’s happening to you, whom to trust, whether what you’re feeling is serious enough, or whether your family will understand, we need to cross these hurdles by going beyond conversations.

India needs mental health care that is easier to access, easier to continue, and easier to believe in.

Because people are not failing to seek help. More often, the path to help is failing them.

(The views expressed are personal)

This article is authored by Amit Malik, founder and CEO, Amaha.