The post-pandemic era has seen a sudden and significant rise in mental health start-ups. On offer to 60-70 million Indians struggling with their mental health are a multitude of products: guided meditation audios for managing your stress, chat-bots for curing depression and AI-driven apps for help with social anxiety, ADHD and OCD. There are even websites with a slew of carefully curated resources to help improve marriages
There are products being developed for therapists too. These include platforms to be listed on and tools to make interacting with clients easier. Most of the marketing around these products states that their mission is to make mental health care accessible and affordable.
Accessibility and making these services available at scare are important goals given the extreme shortage of mental health professionals in India. There also seem to be founders who take the Indian context into consideration in meaningful ways. The wellness app AUMHUM, for example, is available in multiple regional languages including Hindi, Kannada, Marathi and Tamil.
How are these goals met in practice and how are these products influencing the Indian mental health landscape?
As a therapist, I frequently receive messages from start-up founders on LinkedIn seeking my insights about their products. However, when I ask about consultation fees for my expertise, I rarely receive a direct response. It seems there’s an expectation that therapists should be willing to provide detailed and relevant feedback to entrepreneurs for free.
While this practice is an obvious undervaluation of therapists’ knowledge, skills and training, it also raises important questions about the legitimacy of such products and the manner in which they are being developed.
The American Psychological Association has already voiced concerns regarding this practice. It would be grossly unethical and negligent to design medical equipment without having doctors involved at every stage of the process. Yet, when it comes to mental health, people seem to be designing products without consulting and adequately compensating experts. This may be because expertise in mental health is considered care work or feminised labour and is hence undervalued.
The widespread integration of AI, bots, mood journals and meditation apps in our lives raises questions about the limitations of technology when it comes to our mental health. There are many complexities to consider. In a report by Mozilla, it was discovered that mental health apps ‘fail spectacularly’ at protecting users’ privacy. Several of them were found to be monetising and capitalising on their users’ most private thoughts and feelings.
Users of cognitive behaviour therapy chatbots have reported receiving insensitive and exasperating responses. Another concern that has been raised is that technology often replicates and exacerbates existing inequalities. Most mental health apps have not been designed to account for people’s diverse social locations. Their responses remain the same regardless of one’s religion, caste location, gender, sexuality and cultural identity.
What makes these apps so appealing?
In spite of their shortcomings, seeking support from a mental health app is an enticing prospect. In an increasingly result-driven and goal-oriented society, it’s easy to imagine why one would opt for an app. They have a sleek, aesthetically pleasing interface and can guarantee an 80% improvement from depression and anxiety within 4-8 weeks.
This is especially appealing when compared with the expensive and often arduous work of finding a therapist who is a good fit and then baring your soul to a stranger.
Sadaf, Therapist Researcher and co-founder of Guftagu, talks about how mental health apps have certain benefits. However, when they are falsely advertised as a substitute for therapy, it does a disservice to lay persons.
“If they approach a therapist who says, okay it will take these many months or years. And if there is an app which is saying that you can constantly track your thoughts with me and this will take a matter of weeks. As a client, I’m more inclined to go for the simpler, short-term solution. But it’s not the same as the long-term changes that you get by a consistent therapeutic relationship, right?” Sadaf emphasises that deeper change occurs when clients work through unhelpful relational patterns in therapy. This is in line with studies indicating that the therapeutic relationship is an integral component of effective therapy.
She adds, “So, they lose confidence and then they don’t know the difference between what the app was offering and what a good therapist will offer. So, when they have a lukewarm experience, they are like, okay then the whole field is of no use to me.”
With the mental health industry valued as a 3 billion dollar opportunity, there has also been an increase in the number of organisations which provide traditional therapy. This monetisation and commodification of mental health also can also end up being exploitative to therapists. For meagre salaries, they are often expected to do an excessive number of sessions in a day along with engaging in multiple other activities related to marketing and content creation.
Tanuka, a counselling psychologist from Kolkata, spoke about the manifold challenges of working in organisations with non-therapist founders. They said, “Their approach is more on quantity. They really also don’t care about your qualifications or work experience. They just care about how many clients you can take. It’s more about the numbers [than quality of service]. Obviously, young therapists are their most ideal target. Because to a fresher, they can also say that I’m going to give you exposure. I’m going to give you this many clients. Freshers don’t know the burnout and the exhaustion they are going to face if they take so many sessions in a day.”
An organisation that doesn’t understand therapist’s bandwidth or care about their therapist’s own mental health cannot provide quality services to its clients.
Finding the right balance
There are many issues with how start-ups are currently impacting the mental health ecosystem, but it’s important not to throw the baby out with the bathwater.
There are a number of ways in which startups can intervene ethically when it comes to mental health.
To begin with, they need to involve mental health professionals at every step of the process to understand the field well and provide quality care.
Clear messaging around what an app can and cannot do is also important. For example, an app can make information about more mental health accessible, or provide useful grounding tools for anxiety. This does not make an app a replacement for therapy.
Hiring accessibility consultants in the building of their technologies to ensure their products are inclusive is another step.
There also needs to be a governing body led by psychologists to regulate entrepreneurship in mental health. This is also to ensure organisations are protecting their users’ data and adhering to best practices.
Leveraging technology to scale mental health services is not the only answer to a mental health crisis in a country with a massive digital divide. Neither is a reductive over-emphasis on the privatisation of mental healthcare.
Public funding for the mental health sector needs to increase. There also needs to be a greater emphasis on funding directed toward community mental health models. These models address the treatment gap, by training community workers in the basics of mental health support. These are especially useful in remote areas.
The mental health landscape in India is complex and multifaceted. It would be hubris to claim that any one approach is definitively ‘correct’ or ‘incorrect.’ Rather than providing a prescriptive solution, we must think about how to centre collaboration, care, and access in our approach.
Farah Maneckshaw is a therapist, researcher and co-founder of The Mirrored Room, a queer led mental health initiative.
This article was originally published on The Wire on August 23, 2024.
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