In July 2025, the Supreme Court in Sukdeb Saha vs State of Andhra Pradesh recognised the right to mental health as an integral element of the right to life. Taken at face value, the verdict is a remarkable achievement. But does this apply to all citizens?
Queer Indians often find themselves navigating a deeply challenging terrain. On one hand, the law, at least in theory, is on their side. Transgender people and same-sex couples enjoy certain constitutional protections and rights, with notable exceptions such as the right to have same-sex marriages or unions not recognised by the law. On paper, queer people are promised lives free from discrimination, harassment, and stigma by the state. Even so, what the law promises and what queer people actually face remain worlds apart.
In the realm of mental healthcare policy, two major developments in the last decade have significantly shaped how queer people access care in India.
- The first was the 2017 enactment of the Mental Healthcare Act, 2017, which made access to mental health services a statutory right and explicitly prohibited discrimination in the provision of mental healthcare on the grounds of gender, identity, and sexual orientation, among other identities.
- The second was a 2021 Madras High Court judgement that categorically prohibited ‘conversion therapy’ by medical professionals.
But the gap between what exists on paper and what happens on the ground shows up most clearly in the lives of queer people trying to access therapy in India today.
The client–therapist mismatch
For Meenakshi,* a 36-year-old queer media professional from Mumbai, queer-affirmative therapy was a lifeline that helped her to manage depression and anxiety for nearly a decade. Despite finding a queer-affirmative therapist, she faced additional challenges. Specifically, she noted her therapist’s limited understanding of the distinction between gender and sexuality: “I think she is queer herself and she understands sexuality issues, but gender is more of a mystery to her.” This reveals a broader issue of patient–provider mismatches that stem from inadequate clinical pedagogy, right from classroom education. Add to this the constant mental calculation that Meenakshi keeps doing to track her sessions, asking herself, “How many sessions can I afford this month? Can I go next month?” This is a phenomenon she described as ‘therapy rationing’.
Laxman,* a 29-year-old gay management consultant from Delhi-NCR, found himself in a place of deep uncertainty and did not feel that he could lean on his friends. A close friend recommended him to a therapist who had worked with queer clients, but once Laxman started therapy, he realised that it was not working out. “It was a great conversation,” he said, “but after a year, I realised it was just conversation.” In other words, it was a classic case of therapeutic misalignment—or what Caitlin Opland and Tyler J Torrico call a ‘patient–provider mismatch‘.
Laxman elaborated, “I think she was very empathetic. I think she understood it as much as she could in general. I just felt her personality type wasn’t the most congenial for me. In such situations, I need people who are more aggressive and more pushy. I found her passive. She was trying to create that space for me to talk, but I don’t think the connect was there at that level.”
This shows that awareness of queer issues alone was not enough for Laxman. In fact, studies show that therapy works best when there is a real meeting of minds, when personalities and approaches align to create a therapeutic alliance. Given that queer clients often juggle multiple pressures at once, such as career decisions, family expectations, and personal identity with societal prejudices, finding the ‘right’ therapist can indeed be difficult.
‘Queering’ therapy
Not only is therapy largely inaccessible and inconsistent in quality across India, it also frequently fails to account for the specific mental health needs of queer people.
There is no mandatory core curriculum on gender and sexual diversity within mainstream psychology degrees.
Across healthcare systems globally, professionals often lack the training required to work effectively with queer clients. The situation in India is particularly troubling. There is no mandatory core curriculum on gender and sexual diversity within mainstream psychology degrees. And queer-affirmative training, wherever it exists, is largely external to formal education, or restricted to optional electives, rather than being treated as foundational clinical knowledge. In contrast, some graduate programmes in the West include dedicated electives or certificate tracks focused on queer issues. In the United States and parts of Europe, cultural competency training programmes addressing sexual orientation and gender identity have also become increasingly common across healthcare settings.
Due to a lack of similar training in India, even well-intentioned Indian therapists may not have the knowledge required to work meaningfully with queer clients. In the absence of formal, institutionalised pedagogy, the only other way to acquire this understanding is through external modalities such as ad hoc, self-funded trainings; informal mentorship networks; or community-based learning pathways.
Trisha,* a Mumbai-based queer psychologist who has been practising since 2018, described the gap very clearly. “I have a bachelor’s and a master’s degree in psychology and I’ve done a lot of courses after my master’s to stay updated…I also work with a lot of queer clients,” she said. Despite all this training, her formal education barely acknowledged queer lives. “In all my years of studying, I’ve never had a teacher talk about homosexuality. The only time it came up in class was in evolutionary psychology, from a biological angle.”
This absence is exactly why programmes like the Queer-Affirmative Counselling Practice (QACP) course run by the Mariwala Health Initiative became a turning point in her training.
“We were one of the first batches,” she said. “One of the first things they emphasised was unlearning what we were taught in college.”
The QACP programme helps mental health practitioners to unlearn pathologising frameworks and to rebuild their understanding of gender and sexuality from an affirmative, community-rooted perspective based on the everyday realities of clients. For example, instead of treating family conflict merely as an individual pathology, participants are encouraged to situate their clients’ distress within broader structures of caste, class, religion, gender, sexuality, and disability to better understand how the threat of exclusion can shape mental health outcomes. The training is offered in English and costs INR 20,000 for the online version.
Similarly, Socially Souled, a large digital mental health education platform that runs online psychology training, peer-support communities, and therapy resources, offers a longer Queer Affirmative Therapy (QAT) course. This programme blends self-paced learning, live classes, and supervised casework over roughly three to four months. The QAT programme is conducted fully online in English and is priced at INR 2,999.
Who can access queer therapy training?
Though well intentioned, what remains deeply troubling about both QACP and QAT is the persistent issue of access. For one, these programmes are almost exclusively offered in English. This means they remain out of reach for a vast number of current and aspiring mental health practitioners in India who would otherwise benefit from queer-affirmative training in regional languages. Ironically, the linguistic barrier created by this English-only approach largely mirrors the very exclusions that queer-affirmative frameworks aim to dismantle.
1. Queer-affirmative therapy is shaped by language
Trisha points out that language is a powerful marker of privilege within therapeutic spaces. “There’s definitely segmentation in who comes to me. There’s a certain level of privilege. I only speak English and Hindi, so clients need to know one of those languages to access me. My mother tongue is Konkani, but hardly anyone seeks therapy in Konkani, so I can’t serve them.” Her observation addresses how access to therapy, particularly queer-affirmative therapy, is shaped by language, class, and urban location, effectively curating a narrow pool of therapists and clients who are able to find one another.
This linguistic and economic filtering contributes to what several commentators have already described as the growing elitism of therapy in India. It is a practice that remains largely oriented towards urban, upper-caste, English-speaking, white-collar populations, while remaining distant from the lived realities of working-class communities and those located outside metropolitan centres.
The result is not merely the exclusion of specific voices, but also the enforcement of silence where issues of caste, labour, precarity, and structural violence are often under-engaged, if not actively avoided, within mainstream therapeutic discourse.
2. Early-career counsellors can’t afford expensive courses
Secondly, the financial burden is significant. QACP, starting at INR 20,000, is far beyond what many early-career counsellors and community mental health practitioners can realistically afford. Even the more affordable QAT programme, at INR 2,999, is still expensive. According to PayScale estimates, the average annual salary for a mental health therapist in India is around INR 2,00,000 per year, with many earning closer to INR 80,000–1,20,000 per year at the start of their careers. At these income levels, even an INR 3,000 course can represent a week or more of take-home pay. An INR 20,000 fee can amount to nearly two to three months’ worth of disposable income for some practitioners.
A sustainable alternative to mental health training
According to the Indian Council of Medical Research, in 2017 approximately 197 million Indians were living with mental disorders. The contribution of mental disorders to India’s overall disease burden more than doubled between 1990 and 2017.
We simply do not know the prevalence, incidence, or burden of mental illness within queer populations in India.
Layered onto this already alarming picture is the additional vulnerability faced by queer people whose numbers, experiences, and health outcomes are not officially enumerated by the government health department. As a result, we simply do not know the prevalence, incidence, or burden of mental illness within queer populations in India. What we do know, however, is that mental health outcomes are deeply shaped by socio-cultural environments, and queer lives in India are structured by specific forms of stigma, precarity, and exclusion.
In this context, ad hoc, urban-centric, ‘certification-first’ approaches to queer-affirmative mental health care are inadequate, especially if access is to meaningfully reach Tier-II and Tier-III cities, peri-urban regions, and rural India, where understandings of queerness are even more variegated and are further mediated by caste, language, age, geography, and religion.
The government and other public-spirited stakeholders, therefore, need to play a more proactive role. The state’s capacity to respond to these realities remains questionable. Meenakshi, for instance, was deeply unconvinced of the transformative potential of rights-based legislation alone. She said, “I don’t think the Mental Healthcare Act has any relationship with what queer and trans people face in their realities. The act is too abstract and it won’t trickle down into the training that therapists experience.”
It is important to note, however, that the Government of India has attempted to address at least part of this access gap. In 2022, under the aegis of the Ministry of Health and Family Welfare, the Union Budget announced the National Tele Mental Health Programme—Tele Mental Health Assistance and Networking Across States (Tele-MANAS). The initiative promises universal, equitable, and accessible mental health care, and as of October 2025, Tele-MANAS is said to operate in 53 centres across India, with more than 600 trained counsellors offering 24/7 support in 20 languages. Further, it has reportedly responded to over 2.7 million calls. In terms of scale and infrastructure, it represents one of the most ambitious public mental health interventions India has ever seen.
And yet, scale does not automatically translate into access. A 2024 cross-sectional study involving 207 participants from the Delhi-NCR region found limited public awareness of the programme. Only 34.3 percent of respondents in the study were familiar with Tele-MANAS, while 65.7 percent had no awareness of it at all. If the state is serious about inclusive mental health access, particularly for queer populations located outside elite urban networks, it will need to significantly strengthen its outreach strategies.
To put it simply: A sustainable response to the limitations of programmes like QACP and QAT, as well as the broader gaps in the law and policy framework governing mental healthcare, requires centring the lived realities of queer persons seeking care in a manner that is equitable, inclusive, and intersectional.
As Meenakshi noted, “I’m looking forward to a new therapist who is trans-affirmative, more affordable, and more assertive so that I can figure out my vocabulary.” In practice, an assertive approach does not necessarily mean being aggressive, but instead, being grounded and equipped to actively name patterns rather than leaving clients to do the interpretive labour themselves. For clients like Meenakshi, who were still arriving at the language for her gendered and sexual experiences, ‘finding vocabulary’ refers to the slow, often fragile process of moving from inchoate discomfort and dysphoria into words that feel socially legible and emotionally accurate. “I didn’t have vocabulary around dysphoria for example or existing as a trans person—and she didn’t either,” she said.
The challenge, therefore, is not in finding ways to offer more private courses; rather, it is to reimagine queer-affirmative mental health training in a country as linguistically, economically, and socially diverse as India.
*Names changed to maintain confidentiality.
Rohini Nair also contributed to this article.
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Know more
- Read how intergeneration trauma in Kashmir can be addressed.
- Learn about the mental healthcare challenges of growing up as a queer person in Northeast India.
