How New RCI Guidelines Deepen Mental Healthcare Crisis In India?

India is facing a mental health crisis, with a severe shortage of qualified professionals to provide much-needed care. In response, the Rehabilitation Council of India (RCI) has introduced a new four-year undergraduate BSc Clinical Psychology (Honours) programme, which will begin in August. Graduates will be registered as counselling psychologists. While this move aims to address the acute shortage of mental health workers, especially in community settings, it raises significant concerns. These guidelines are likely to exacerbate existing issues in mental healthcare accessibility, rather than solve them, particularly for LGBTQIA+ individuals and other marginalised communities who bear the brunt of mental health issues and already face exclusion, bigotry and trauma in mental health spaces.

Current Discourse

Despite the significant mental health burden faced by India and the need for accessible care, there has been little to no coverage of this announcement in the news media. On social media, much of the debate has centred around the academic and professional challenges that practising and aspiring counselling psychologists may face. Valid concerns have been raised, including that this BSc degree requires entrants to have studied science in Grade 12, and limits the number of seats in each institute to 30. This heavily restricts the availability of trained professionals, and furthermore, minimises the work of practising counsellors who have been providing vital support to clients in both community and institutional settings.

These new guidelines bundle counselling into an undergraduate degree of clinical psychology. This undervalues counselling skills and the therapeutic relationship, reducing them to a side note in the conversation about mental health. A clinical psychology degree also often places undue emphasis on medical and clinical aspects, neglecting the sociopolitical root causes of mental health issues. This approach is likely to further exclude marginalised communities seeking inclusive mental healthcare.

However, this discourse still overlooks the deeper issues around the inaccessibility of mental healthcare in India.

Limited Understanding and Oppression in Mental Health Spaces

Beyond these academic and professional challenges lies a deeper issue of pervasive discrimination within mental health spaces. “Your bisexuality is causing most of your relationship problems. Men cannot accept such things. Your boyfriend won’t consider you a serious prospect for marriage because of that, which is why he’s breaking up with you.” This is what my therapist, a qualified clinical psychologist at one of the country’s most famous hospitals, said to me on a sweltering summer morning in Delhi in 2018. I never went back―it took me years to even reach out for therapy again.

This encounter is emblematic of a broader issue in India’s mental health landscape. Queerness and homosexuality remain stigmatised in India and continue to be treated as “disorders” by a large number of registered mental health professionals across the country, due to their lack of sensitivity and understanding of diverse sexual orientations and gender identities. For example, despite bans on the baseless practice of conversion therapy that has led to the deaths of multiple queer people, it remains a rampant issue, with even qualified mental health professionals prescribing everything from medication to electric shocks in misguided, coercive and traumatising attempts to “cure” queer people of their gender-sexuality. These guidelines perpetuate this disconnect by emphasising clinical qualifications over cultural competence and affirming care, thereby failing to address the systemic barriers faced by marginalised communities in accessing inclusive mental healthcare.

The debate on these guidelines should not only be about the academic/professional aspects, but also about making mental healthcare truly accessible. Educational qualifications and registration in psychology have their place, but they are clearly no guarantees of affirmative, safe, or high-quality therapeutic spaces for LGBTQIA+ people. Psychology and psychiatry have histories of stigmatisation and violence against LGBTQIA+ people. Most psychologists are not trauma-informed, caste-informed, or queer-affirmative, and licensed practitioners still perpetuate harm towards queer people.

Effective and responsive mental health support needs to understand and tackle the stigma and homophobia that queer communities face in society and in mental health spaces. These guidelines fail to address these issues. Instead, it further perpetuates the oppressive status quo of “experts” providing poor care to queer communities.

Deeper Issues of Accessibility

Much of the discourse around these guidelines misses another issue: the lack of culturally appropriate, trauma-informed and affirmative mental healthcare. In a country as vast and diverse as India, the social norms, challenges and support systems vary greatly among different communities. For instance, a queer student in Delhi faces distinct challenges as compared to a Dalit woman experiencing domestic violence in Chennai. Thus, their mental healthcare needs, including counselling and social support, are equally different.

Social factors such as discrimination and violence against LGBTQIA+ people, casteism, racism, and exclusion within both community and mental health settings contribute significantly to mental health issues. These factors underscore the need for mental healthcare that addresses the root causes rather than merely treating the symptoms.

No amount of qualified “experts” can meet the need for mental healthcare in India without contextual understanding of the community and the lived realities of the people within. The mental healthcare that different communities need looks very different. A one-size-fits-all, expert-led approach that does not address the root causes are not only less effective, but also more expensive to implement. Mental healthcare also needs to include access to support that eases the root causes of distress (such as employment support, legal help to leave abusive households, sensitisation of family members, and more). It should not focus just on the individual treatment of “disorders”.

Creating a cadre of “expert” counsellors as proposed by these guidelines causes a greater divide between the contextual needs of a community and destabilises existing support systems that communities may already have in place to holistically care for their own. Many queer people have spoken of the importance of “chosen families” for their mental well-being. They express that the feeling of acceptance and the freedom to be themselves amongst peers without stigma, eases their emotional distress. Academically trained counsellors cannot replace these community-based care systems that have provided mental health support to community members for decades.

Alternative Solutions

There are multiple layers of problems with these new RCI guidelines: not only does it make mental healthcare less accessible by gatekeeping the profession, it has also created uncertainty and anxiety for counsellors and community workers who have been providing support for years. More importantly, these measures don’t solve the inherent problems in the psychology profession, where LGBTQIA+ people are isolated, excluded and traumatised in therapeutic spaces, receiving poor support, if at all.

Mental healthcare needs to be viewed holistically. Counselling psychologists in offices and hospitals are not what we need. Rather, support, inclusion and training of community workers and peers already providing care at the grassroots is essential. Peer support is much more cost-effective, readily accessible and generates more trust within the community than external professionals. We need people from the community to be co-designing mental health services and for their expertise to be treated at par with academically trained professionals in order to deliver relevant and impactful mental healthcare. To truly be accessible in India, mental healthcare must be contextual and centre the lived realities and wisdom of diverse communities.

These new guidelines exacerbate existing challenges by restricting access to mental healthcare, particularly for marginalised communities. Instead of gatekeeping the profession to academically trained professionals, there should be a greater emphasis on community-led solutions. Social factors causing mental health distress require collective and community-based solutions. This approach involves integrating community members with lived experiences into mental health planning and implementation, leveraging peer support networks, and collective care practices that respect diverse identities and contexts.

(The author works in mental health philanthropy, and is also a therapeutic play practitioner for disabled children)