Making Mental Healthcare Accessible, Accountable and Evidence-Based
By Arunima Rajan
In an interview with Arunima Rajan, Nupoor Mohan, Founder and CEO of The Full Circle, talks about widening access to accountable, evidence-based mental healthcare, strengthening practitioner verification, closing insurance gaps, confronting workplace stress and preventing distress without medicalising everyday life.
What does accessible mean in practice, and what do you expect the second National Mental Health Survey to say about access?
Accessible is a word our sector uses far too loosely, so let me define it the way we hold ourselves to it. At The Full Circle, access has four measurable dimensions. Affordability, which is why our sessions start at Rs 999, to reduce the biggest barriers to accessing mental healthcare. Availability, meaning a client can talk to an appropriate mental health professional without having to wait, because a waiting period is where most intent to seek help quietly dies. Fit is about having a multi-speciality panel of psychologists, psychiatrists, and art therapists, across languages, so that the first session feels relatable for diverse clients. And continuity, because access to one session is not access to care; access to a completed course of therapy is.
On NMHS 2, I would be cautious about predicting the direction of any single number before the findings are published. What is encouraging is the breadth of the exercise. Unlike the first survey, which covered 12 states, NMHS 2 is designed to cover all 28 states and eight Union Territories, and it is looking not just at prevalence but also at treatment gaps, pathways to care, service utilisation and the availability of mental health services and resources.
I expect that the picture will be uneven. We may see areas where access has improved, particularly through newer models of care such as teletherapy, but I would expect affordability, availability and continuity of care to remain important barriers. What I hope the survey ultimately gives us is a much clearer picture of who is reaching care, who is not, and where the gaps remain.
If the new survey prompts the country to confront the scale of the gap as honestly as the 84% figure did a decade ago, that would be valuable. In mental healthcare, an honest number is the beginning of policy.
What does evidence-based mean operationally at The Full Circle?
You are right that the term can become a slogan unless it is backed by clear clinical standards. At The Full Circle, evidence-based means that the approaches our practitioners use should have an established clinical base appropriate to the practitioner's training, scope of practice and the client's presenting concerns.
This includes cognitive behavioural therapy and CBT-informed approaches, acceptance and commitment therapy, dialectical behaviour therapy-informed practice and interpersonal therapy, alongside structured psychiatric care wherever appropriate. Art therapy is used as a clinically supervised adjunct rather than positioned as a standalone treatment for clinical conditions.
We also have clear boundaries around what we do not offer. We do not permit unvalidated therapeutic or healing claims, or interventions that fall outside our clinical standards.
On outcomes, we use standardised, validated measures such as the PHQ-9 for depressive symptoms and the GAD-7 for anxiety, where clinically appropriate, to assess symptoms and monitor change over the course of care. We look at these alongside continuity and engagement data. Because a client disengaging from care is a signal that needs to be understood rather than simply recorded. Our internal five-stage care framework is used alongside clinical assessment and outcome measures to help structure the client's journey.
And on the third part of your question, which is the one that matters most: when a therapist drifts outside these boundaries, cases can be reviewed under senior clinical supervision, with retraining or corrective action where appropriate. Serious or repeated deviations can result in removal from the platform.
And so I believe evidence-based care has to come with accountability; otherwise, the term loses its meaning.
How do you vet practitioners, and what should a client understand the word verified to mean?
This is one of the more uncomfortable realities in Indian mental healthcare, and I would rather answer it honestly than reassuringly. Clinical psychologists and psychiatrists are subject to specific registration requirements, but India does not currently have a single statutory licensing framework that covers everyone practising as a counsellor or psychotherapist. In that environment, platforms have a significant responsibility to establish rigorous standards for the practitioners they onboard.
Our vetting runs on four layers. First, credential verification: qualifications are checked with the issuing institutions where possible, applicable professional registrations are verified, including RCI registration where relevant, and psychiatrists are verified against their applicable medical registration. Second, demonstrated competence: practitioners are assessed on their clinical approach and case handling before they see a client. Third, supervised practice, with early cases reviewed under senior clinical oversight. And ongoing accountability through outcome data, session reviews and a client grievance mechanism with defined processes for review and escalation.
So when a client sees the word “verified”, they should understand that the practitioner's stated qualifications and applicable registrations have been checked by us, and that the practitioner has gone through our clinical onboarding and governance processes. Verification is not a substitute for statutory regulation or national licensure, and we should be transparent about that distinction.
If India creates a statutory register for counsellors and psychotherapists, platforms like ours should be among its strongest supporters. Clear standards and meaningful regulation ultimately protect both clients and credible practitioners.
What has insurance parity actually changed for the person paying out of pocket, and have you attempted insurer partnerships?
Parity, as it stands, is a principle that has arrived before the product. The Mental Healthcare Act, 2017 established the principle of parity between mental and physical healthcare, and the IRDAI circular of October 2022 gave insurers specific direction on providing cover for mental illness. That matters because for people whose policies cover psychiatric hospitalisation, the regulatory position today is materially better than it was a decade ago. But you have put your finger on the structural gap. Much of mental healthcare is outpatient: a weekly therapy session, a monthly psychiatric consultation, ongoing follow-up. Routine outpatient therapy generally depends on whether the policy includes an applicable OPD benefit. So for someone paying ₹999 or ₹2,500 out of pocket every week for therapy, that regulatory progress may still translate into very little practical relief. Their care still sits in a part of the insurance system that traditional products have not been designed to serve well.
The economic case for closing this gap is arithmetic. According to WHO's 2025 report, mental health conditions are the second biggest reason for long-term disability worldwide, while mental health receives only around 2 percent of health budgets globally. WHO-led economic analyses have also estimated that scaled-up treatment for depression and anxiety can generate roughly four dollars in improved health and productivity for every dollar invested. An insurer that covers therapy is investing in earlier intervention, with the potential to reduce downstream costs associated with untreated or undertreated mental-health conditions.
And yes, we are actively pursuing this. We are exploring partnerships around employer-funded and group OPD benefits, where there is an opportunity to build more meaningful coverage for outpatient mental healthcare. Our position with insurers is straightforward: we bring structured protocols, standardised outcome measurement and clean utilisation data, giving insurers the kind of evidence they need to assess outpatient mental-health care more confidently. I will be candid that these are longer conversations than I would like, but I expect employer-funded coverage of therapy to become more meaningful over the next few years, with retail OPD potentially following as the evidence base and utilisation data mature.
When your data shows the problem is culture or workload, what do you tell the client who signs the invoice?
I will not pretend the tension away, because it is real. The latest India data makes clear that workplace stress is not a marginal issue. Deloitte’s workplace mental-health study estimated that poor mental health costs Indian employers around $14 billion a year through absenteeism, presenteeism and attrition, with workplace-related stress identified as the biggest factor affecting mental health by 47 percent of those surveyed. More recent data from ekincare also points to a different challenge: even as use of workplace mental-health services grows, a significant proportion of people who book counselling do not attend.
So yes, in some cases, the employer signing our invoice is also part of the environment contributing to the distress our clinicians are helping people navigate.
Our answer to that tension has two non-negotiables. The first is confidentiality: employers do not receive information about individual employees' participation or session content, except where disclosure is required by law or under clearly defined clinical-safety exceptions. The second is honesty in reporting: what employers receive is aggregated, de-identified insight designed to protect individual confidentiality. When that insight points to workload concentration in a particular function, concerns around a management layer, or a culture in which people feel unable to take leave, we say so. I tell clients that if they wanted a vendor to tell them their people simply need more resilience, they have hired the wrong platform. Structural sources of distress cannot be solved through individual therapy alone, and pretending otherwise risks wasting their money and failing the employees they are trying to support.
Has it cost us? It has certainly cost us comfort, and there have been conversations where the room went quiet. But here is what I have found: organisations serious enough to invest in mental health are usually serious enough to hear the truth about it. The accounts worth keeping stay because we are honest. An account we could keep only by being flattering is not revenue; it is a liability with a billing cycle.
Where is the line between prevention and medicalising ordinary distress?
It is the right question, and the line, for me, is drawn by function, not by feeling. Ordinary sadness, grief, exam stress, heartbreak, or anxiety before a big decision are not disorders, and we must never treat them as such. The distinction becomes concerning when distress becomes persistent or begins to impair functioning, relationships, work, sleep or daily life, or when a person's usual coping resources are no longer sufficient.
Prevention helps people recognise what is happening, build useful coping skills and seek appropriate support early. There is also good evidence that prevention can work when it is targeted appropriately.
What we insist on at The Full Circle is that preventive work be honestly labelled. We do not upsell wellness into diagnosis, and our clinicians are trained to step people down as readily as they step them up. The goal of preventive mental healthcare, done ethically, is fewer people reaching a point of crisis, not more people becoming clients. If prevention is working, some of its success should be visible in people who never needed clinical care at all.
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