In a small, dimly lit therapy room in Mumbai, a young therapist, Swati (pseudonym), sits across from a client who is recounting a traumatic experience. She listens intently, offering empathy and guidance, all while suppressing her exhaustion. She has already conducted six sessions today, each lasting an hour, with barely a five-minute break in between to finish up her notes. 

Her salary, delayed for the third month in a row, barely covers her rent. She knows she should set boundaries, but her organization insists she take on more clients to meet their “numbers.” Quickly, she realizes she is spacing out, so she pulls herself together and focuses on the session.

Swati’s story is not unique. Through semi-structured and narrative-focused interviews with 11 therapists across the country, we uncover a disturbing reality: many mental health organizations, particularly private startups, exploit early-career therapists, trapping them in a toxic work environment. 

Across India, therapists like Swati are buckling under the weight of unsustainable workloads, exploitative contracts, low wages, and inadequate supervision; workplaces with unethical practices, and that prioritize profit over care. Many therapists thus find themselves trapped in systems that mirror the very issues they are trying to address

More broadly, mental health in India operates within a framework marred by systemic exploitation and neglect, and remains one of the least regulated fields. While therapists are trained to help others navigate trauma, burnout, and mental health struggles, this lack of government support and a growing demand for mental health services leaves therapists to navigate a broken system on their own.

Mental Health Care as a Commodity

At the heart of these exploitative practices lies a deeper structural issue: the commodification of mental health care. In India, therapy is delivered through several setups, from solo private practitioners to fast-growing mental health startups. These startups are often structured as for-profit companies that operate on a technology-first model, offering services through mobile apps, AI-integrated chatbots, teletherapy platforms, and subscription-based packages, promising to “democratize” access to therapy. 

For example, MindPeers and The Alternative Story list therapists who charge as low as 500 and 700, respectively, for a 60-minute session. Another company called Rocket Health has a feature that allows people to ‘gift’ therapy to someone. 

These startups invest in aggressive SEO, influencer tie-ins, and social media marketing, while therapists themselves rely on networks of psychiatrists, peer referrals, and word-of-mouth. Platforms may offer group sessions or subscription models starting as low as ₹450 per month to lure clients, but the returns to therapists remain meager. Sliding scale pricing and “pay-what-you-can” initiatives do exist, particularly among ethically-committed collectives—but these often function as a form of mutual aid, not as financially viable business models.

Therapists working within these organisations are usually paid in one of three ways: a fixed per-session rate (often between ₹500 and ₹700 regardless of client fees), a commission-based model (e.g., 60-40 or 70-30 revenue splits), or a flat monthly salary. Thus, while companies might charge clients ₹1,200–₹2,500 per session, therapists may receive a small fraction of this amount, sometimes without knowing the full fee structure. Monthly earnings for such therapists average ₹20,000 to ₹30,000—even when they carry client loads of 5–8 sessions per day.

Arunima, a trauma-informed therapist who exited her first workplace after experiencing persistent exploitation, recounted that the salary advertised was significantly different from what she was paid upon joining. “I was deliberately kept in the dark about how much clients were charged for my sessions,” she said. “It felt shady.”

This culture of secrecy is symptomatic of a deeper systemic issue. Therapists face mounting pressure to achieve unrealistic targets, like onboarding and retaining a certain number of clients per month/quarter, being available on call beyond work hours for clients from employee assistance programmes, and doing social media work. The lack of transparency extends to both the client and the therapist, with neither being aware of the company’s payment structure. 

“My client’s fee increased by 75% (per session), yet my base salary only saw a 15% rise during my time there,” explained Delhi-based therapist Ayesha (pseudonym). “The team also made arbitrary decisions to cut pay during multiple employees’ notice periods.”

Concerns extend to the pathways of economic transparency within these organizations, often leading to severe disparities in pay. Simran illustrated a particularly exploitative payout structure her former company followed: “Therapists didn’t earn anything from the first 10 sessions in a month. They only received half of the session fee from the 11th session onward.” 

Therapists in independent private practice earn more, but only if they have steady referral networks, social capital, and visibility within the ecosystem. Those who supplement one-on-one sessions with income from workshops, clinical supervision, or corporate consulting can earn upwards of ₹50,000 per month. Yet, even for these practitioners, stable income is not guaranteed, especially without institutional support or formal protections, such as recovering therapy fees from a client who has ghosted them without payment.

The Marketplace of Therapy

What emerges is a fragmented industry where care work is governed by market logic. Left undervalued and poorly protected, therapists carry both the emotional labor and the financial risk.

The pay for therapists with up to five years of experience typically caps at around ₹4 lakh per annum. This salary is woefully inadequate to sustain life in a Tier 1 or even some Tier 2 cities, considering rising rental and utilities prices, and a lack of other infrastructural support, like public transport. Therapists are often expected to work long hours, sometimes without breaks or fair compensation. Deeksha (pseudonym), a Mumbai-based early-career therapist, recounted being asked to work from 9 a.m. to 7 p.m., with unpaid overtime if clients arrived late. “The company suggested I stay in the office till 10 p.m. if needed,” she said. 

Many early-career therapists like Deeksha are hired as interns or trainees and paid a pittance—or nothing at all—despite conducting paid sessions for clients. She recounted an interview for an organization that charged clients between ₹1000 and ₹3000 per session. “After a set of interviews, they told me they liked my work and would love for me to join them,” she said. “However, the first three months would be unpaid, as they called it a ‘training period’ to better understand my ‘working style’. Yet, the clients would be charged the full amount instead of a pro bono (no fee) session.” She was also expected to work overtime even during the training period, before becoming a contractual employee. 

After three months, Deeksha would be given a stipend (not salary) of ₹5,000 per month, with them continuing to charge the clients a full fee. Organizations such as hers also forbid her from working elsewhere, despite not offering her full-time employment.

Within a sample of 25 job listings on LinkedIn and Glassdoor, entry-level positions offered as little as ₹15,000–₹25,000 per month despite being forced to take on numerous roles such as social media content, research, admin, marketing, sales, and business development. These included Iswarya Health Pvt Ltd, Divyam Mind Guiding Academy, and Jay Jay Mills. Even Dhirubhai Ambani International School offers a package of 3 LPA for someone with a minimum of five years of experience for a special educator position. 

“After you get hired, you are systematically taught to become a salesperson and sell their packages,” said Simran. “They no longer care about you being therapists.” This could look like being put in charge of acquiring a fixed number of clients per quarter, which a sales team in a corporate setup would take care of, while often being denied fair compensation, timely payments, and basic benefits like insurance.

Many mental health organizations in India are founded by non-therapists who prioritize revenue over ethics, but use glossy apps (like MindPeers, which offers standardised tests for anxiety and ADHD on their mobile app) and corporate partnerships (Amaha boasts Godrej as one of the partners for their employee wellness programmes; BetterLyf lists PVR and JioSaavn as some of theirs) to mask their exploitation with the veneer of innovation.

“They falsely advertised ‘pro-bono therapy’ to attract clients, then pressured us to upsell packages by the second session,” Simran said of her former company. “Therapists who resisted were penalized. The founder celebrated those with high ‘conversion rates’—it was all about minting money, not care.”

Sharada (pseudonym), a Mumbai-based therapist working in one of the larger mental health start-ups, echoes the struggle many therapists face as they navigate the corporate landscape of mental health care. “There’s immense pressure to conform to corporate metrics,” she explained. “We are required to use standardized scales to demonstrate client progress to investors. It’s daunting—you internalize failures when the metrics don’t reflect success.” 

Sharada is happy with how her workplace operates, but she suspects a troubling shift as the company receives more funding. “I am skeptical about scaling up because marketing for mental health is a strange idea for me,” she said. “And growth in therapy is not growth the way investors want to see it. They need us to ‘show’ progress, which comes from revenue increases.”

Lack of Professional Boundaries and Regulatory Oversight

Another common issue was the lack of professional boundaries in mental health workplaces. There are many instances of dual relationships within teams, such as therapists being partners or close friends. Or more inappropriately, between employers and employees. “The senior management would interfere in therapist-client interactions, which even led to client-led termination in a few instances,” said Ayesha. “Employees were often degraded in team meetings for their performance.” 

“Therapists are often expected to be able to manage their difficult feelings and experiences in work settings,” explained Hena F., CEO of the Hank Nunn Institute, a not-for-profit charitable trust based in Bangalore, which focuses on developing and providing long-term support for people with complex needs, including personality disorders. But they are not given structural support to navigate workplace issues. “In fact, the term ‘office politics’ is often used to refer to the resulting informal structures of power dynamics influenced by interpersonal differences,” added Hena F, “which are often left uncommunicated, and subsequently unaddressed.” 

The absence of formal Human Resources departments in mental health start-ups, for example, further exacerbates these tensions. “There was no space for accountability by senior management,” Ayesha noted. 

“All roads led to the CEO, which brought out the worst consequences of a dual relationship,” Ayesha recalled, adding that in her organization, when an employee behaved inappropriately with another employee, the employer’s response was inadequate and lamentable. Dual relationships were an obstacle in reaching a mutually favorable resolution, and they did not have a designated HR person to handle situations like this.

In the worst cases, client information was disclosed to third parties, often their employers. This happens in the case of corporate therapy—or where workplace therapy is provided—because therapists are pressured by HR or higher-ups to share a “report” or their session notes with the company employees. This is in direct violation of confidentiality, as not all employees have disclosed their mental health challenges to their bosses. Therapists try their best to give a brief report/or mask details that they believe could affect their client negatively, but this occurs at their discretion. This damages the general attitude towards therapy because anonymity/confidentiality is the most crucial condition that clients bank on. 

Ayesha recounted how another former company she worked at weaponized the lack of regulatory oversight. She talked about how clients shared thoughts around self-harm on an unmoderated community forum, which was used as a ‘support group’ to discuss mental health concerns. However, anyone with a link could join the forum, which allowed for misuse and bullying, without consequences or appropriate action taken by the founders, Ayesha shared. 

The platform also allegedly attempted to counsel students in Kota, India’s “coaching” capital—a demographic with soaring suicide rates—without parental consent. Organizations worked around that requirement, using unmoderated community forums where bullying and anonymity without consequences were commonplace, in an illegal and especially dangerous move for a mental health organization. Additionally, the company charged clients up to ₹1,000 per session, yet delayed therapist payments for months.

The law is of little help. India’s Mental Healthcare Act (2017) guarantees citizens the right to treatment but ignores those providing it. Unlike Western nations with mandated therapist-to-client ratios, insurance-covered supervision, and overtime laws, India’s mental health workforce operates in a regulatory void. Private clinics face no audits, online platforms exploit contract loopholes, and universities treat interns as free labor. The emotional labor of therapy is dismissed as ‘innate’ rather than skilled work.

The Government of India launched the National Mental Health Programme (NMHP) in 1982, with objectives such as bringing mental health under general healthcare and ensuring access to minimal mental healthcare for all. The NMHP budget, as a share of the Union health budget, continues to fall in recent years, from 0.44% in 2010 to 0.08% in 2022, making it hard to change the status quo of unavailability and inaccessibility. The government stopped disclosing the budget allocated to the NMHP financial year 2023-24 onwards. This lack of transparency makes it nearly impossible to monitor the implementation of and the progress made by the programme. 

To make matters worse, 84% of the mental health budget was allocated to just NIMHANS, Bangalore, as per a report by the India Mental Health Observatory. This is worrying because, as the report states, “when services are centralised, there is also limited opportunity for continuity of care in local settings, which is crucial for mental health conditions, including rehabilitation services, day care facilities and housing provisions among others.”

Psychologists and counselors are governed by the National Commission for Allied and Healthcare Professions Act, 2021, which regulates standards for education and services. However, it does not have provisions to monitor implementation and progress. The Act also fails to address and specify what constitutes good work environments and fair wages for these professions.

Many organizations impose non-compete clauses that prevent therapists from continuing to work with their clients after leaving. The organization is a vessel that makes this relationship possible, and it can actively harm clients if therapists abruptly terminate their relationships. So, non-compete clauses not only harm therapists but also disrupt the therapeutic relationship, which exists between the therapist and client, and which is built on trust and continuity. In some cases, therapists have been asked not to work with any other organization doing similar work for up to six months.

Arunima experienced this firsthand when her organization abruptly reduced her salary during her notice period. “I was intimidated with legal action if I tried to reach out to my clients,” she said. “It felt like such a disrespect to the work we’re meant to be doing.” 

Some organizations make the exit process easy, but not always. In Girija’s (pseudonym) previous workplace, she recalled, her employers encouraged one of her colleagues to bring her clients from her previous company when she joined, citing ‘continuity of care’ as the rationale. Some employees were even permitted to retain their clients post-resignation. But new rules applied to Girija when she left. “We were not permitted to even provide alternate contact details to our clients,” she said.

Lack of Inclusivity

Many therapists report experiencing burnout, vicarious trauma, and even physical health issues, all of which are rarely acknowledged. “I would have stress ulcers and anxiety attacks before supervisions, and breaking down in supervision sessions would be glorified as an act of learning,” Arunima said. “I left the organization full of doubt, unsure if I would ever get back to being a therapist,” she continued. “Every little thing that happened in the therapy space felt like a reflection of me as a person. There was very little room for me to learn and make mistakes.”

Some are forced to abandon the profession altogether, compounding the mental health crisis in a country where access to affordable care is already limited. “From my cohort, almost 75% left their first job within 1.5 years due to toxic work environments and poor pay,” Ayesha said. “Many decided to shift out of therapy entirely.” The cost extends beyond individuals. India barely has 1 mental health professional per 100,000 people, as per the National Mental Health Survey, 2016. Losing even 10% of professionals deepens the crisis. 

Despite the emotionally demanding nature of their work, many therapists are discouraged from accessing mental health support. “There’s a silent judgment,” Delhi-based neurodivergent psychologist Harsha (pseudonym) revealed. “If you speak openly about your mental health struggles, you’re seen as weak or unfit, and people think twice before referring you to patients.” 

Therapists from marginalized backgrounds—including those who identify as LGBTQ+, neurodivergent, or disabled—face additional layers of discrimination. They encounter biases from clients and colleagues, which remain unaddressed by their organizations. Harsha shared, “A client openly stated they didn’t want to work with me because of my identity. Instead of supporting me, my supervisor suggested I remain closeted.”

The lack of diversity and inclusivity in the mental health sector is alarming, considering its direct impact on the quality of care provided. Organizations often fail to establish protocols to protect marginalized therapists from discrimination, further alienating them within their workplaces. Harsha recounted, “I’m neurodivergent, and I’ve had supervisors dismiss my requests for accommodations, saying they were unnecessary. It’s dehumanizing.”

Therapy in India is not immune to the country’s entrenched social hierarchies. Caste, class, and disability create systemic barriers for both therapists and clients, perpetuating cycles of exclusion. Therapists are not encouraged to learn about the intersection of caste, class, gender, sexuality, and mental health. They do not undergo mandatory training in Indian Sign Language and/or Braille, thereby isolating a huge population of individuals with disability from access to therapy. The other problem is that, because so many educational and professional spaces in India are not disability-inclusive, there are very few disabled therapists themselves. This alienates the disabled population even more. 

Harsha further highlighted how caste privilege shapes access to opportunities. “Good supervisors are gatekept through academic networks. If you didn’t study at a top college, you may not even know about senior therapists who could supervise and mentor you in the field.” This disparity is compounded by the financial burden of private practice. “You need social capital to market yourself and money to rent a clinic. Not everyone can afford that,” she added.

Building Alternate Models

Amidst these grim realities, some organizations are striving to break the mold. An organization called Catalysts in Thane, for instance, has created a supportive work environment where psychologists are paid fairly and given growth opportunities. “Since our work can sometimes be unstructured, it does lead to unpredictable work hours, which are fairly compensated,” said Shivani, a junior psychologist at the organization. “Our founders have made the effort to build a strong relationship with each of us, and I feel very supported by them, both personally and professionally.”

Similarly, the Trauma Foundation (T&F India) is pioneering an inclusive, anti-oppressive model of mental health care. “We prioritize therapists and volunteers from historically marginalized communities and reject urgency and the idea of working to ‘deliver,’” said Parth, their founder. “Our policies are collectively decided through a flat hierarchy. Volunteers work a maximum of 10 hours monthly, without policing deliverables.”

The Hank Nunn Institute normalizes secondary trauma as a systemic issue. “We provide free supervision and advocate for organizational accountability,” Hena said, explaining that burnout isn’t a personal failure, but a structural one. These organizations offer a glimpse of what ethical mental health care could look like in India—a system that values clients and caregivers. 

As Jasmeen Kaur, founder of Ehsas Health, wrote in a candid LinkedIn post, “Therapists often find themselves stepping into roles they were never meant to take on: crisis managers, resource navigators, advocates—all while still striving to provide quality care to every client. But this invisible labor comes at a price. Therapists work harder, stretch themselves thinner, and yet the system they are compensating for remains unchanged. This is not sustainable.” 

A robust regulatory framework is essential to address the exploitation of mental health professionals in India. This includes setting standards for fair pay, ethical practices, and workplace safety. Organizations must be held accountable for breaches of these standards through regular audits and penalties. 

Creating inclusive workplaces is critical to fostering a supportive environment for therapists from marginalized backgrounds. This involves implementing anti-discrimination policies, providing sensitivity training, and establishing support systems for marginalized staff. As Hena asserts, “Therapy is political. You can’t separate a person’s pain from the structures that caused it.” The path forward lies in centering marginalized voices, rejecting exploitative models, and fighting for a system where healers, too, can heal.