I am often asked if millennials are worse off from a mental health point of view than the older generations. In my opinion, the answer to that is a “yes". However, it’s not that simple.

The minimum qualifying criteria for a state to be considered as an illness is that the experience shouldn’t be normal, which means it cannot be the norm for an overwhelming majority of a given cohort. But you will see a pervasive sense of fatigue, gloom and worry if you ask millennials when was the last time they felt happy and fulfilled, well-rested and calm or even hopeful about their future. This, I must say, is common among most millennials today.

The World Health Organization in 1948 defined well-being as “a state of complete physical, mental and social well-being and not merely the absence of a disease or infirmity". At the time, the world we lived in was a simpler one, and the health-related challenges one faced were mostly acute and life-threatening conditions. Fast-forward to today, and the health-related challenges most adults of working age face are chronic illnesses—be it physical or mental. In line with WHO’s definition, maintaining good health while holding down a full-time job in a metro can seem a Sisyphean task for many young Indians.

Though poor mental health cannot be considered to be the cause of poor financial health (or vice-versa), multiple studies have shown a link between having a mental health problem and being in debt. These debts are usually a mixture of credit card bills (due to impulse spending), and unpaid utility bills (as one may not be able to keep track of due dates for bills or procrastinate opening a bill as it may be anxiety-inducing). There is also evidence to suggest that those with a drinking problem or drug dependence, severe depression and anxiety, and a history of self-harming behaviours are more likely to be in debt than the average population.

The catch-22, however, is that one needs a full-time job to be able to afford regular therapy. Life, for most working young adults with mental health challenges, is a never-ending struggle between finding a full-time job that helps them afford regular mental healthcare and staying mentally healthy enough to hold down a full-time job. It’s a vicious cycle.

The acute shortage of mental health professionals in India (about one professional for every 100,000 people) means most people who require regular mental healthcare need to access private mental health professionals. This comes at a heavy cost. The average cost of a counselling session or a psychiatric consultation in any Indian metro is around 1,500 an hour, with some professionals charging as high as 2,000-4,000 an hour. Say, you need a weekly therapy appointment which costs 1,500x4, a monthly psychiatric consultation at 1,500 and daily medicines which on average would cost 500 per month. This by itself is a monthly expense of 8,000 on average (which does not include the loss of pay due to reporting late to office and days missed due to mental health).

To make things worse, individuals with mental illness not only find it difficult to get employed full-time, but they are also likely to get lower pay packages and fare worse on their performance appraisals compared to others. Ultimately, they may also be asked to leave on the grounds of poor performance. What that leaves you with is a situation where you need to bear significant financial expenses just to stay mentally healthy, but with little or no guarantee of financial security.

Therapy is an expensive, long-term project. The space in the middle is now being exploited by the “self-care" industry. It is not uncommon for me to see clients spend their last rupee on a weekend “wellness retreat", a piece of pop-culture nostalgia, expensive hobby classes, luxurious electronics, or even automobiles. All this happens not from a place of pragmatism but solely for the emotional succour these purchases offer. While impulsive purchases like these earn millennials a bad name for being “financially irresponsible", one cannot blame them for resorting to things that give them even a momentary sense of joy, in times when nothing else seems to.

While the questions are many—one answer is to make mental healthcare affordable and accessible. Often, one may be willing to access therapy but could find it unaffordable, while on other occasions, the unavailability of a therapist is a matter of concern. Online therapy solves part of this problem by making therapy accessible to a wider audience geographically. From an economic point of view as well, online practice is far more operationally sustainable. However, that still leaves out a large chunk of people who may afford to pay some, but not the full fees charged by therapists. Sliding scales, such as pay-what-you-want therapy options help address these concerns by ensuring that those needing therapy continue to do so without therapy becoming a source of financial strain in itself.

While the problem at hand is one that has come into being and sustained due to the collapse of multiple systemic factors, this perhaps is one of the ways forward.

Paras Sharma is a Bengaluru-based counselling psychologist and founder of The Alternative Story

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