Decriminalised but still unsupported Indian queer community faces a quiet crisis in mental health care

Despite decriminalisation in 2018, India's mental health professionals continue practising from outdated textbooks, leaving queer clients without adequate, affirming care. The scale of this challenge is staggering, an estimated 45.4 million people in India identify as LGBTQIA+, representing approximately 3.8% of the population as of 2011 as per estimates from Journal of Psychosexual Health. 

Studies show that the lifetime prevalence of depression and anxiety is more than 2.5 times higher amongst LGBTQIA+ individuals compared to heterosexuals, whilst a study of 59 LGBTQIA+ individuals in northern India found that 66.07% experienced suicidal thoughts at least once in their lives, as per research by National Library of Medicine. 

The question of how equipped Indian mental health professionals are to address queer issues reveals an uncomfortable truth. As we discussed this with mental health professionals and HR professionals from various workspaces on the sidelines of Rainbow Lit Fest 2025 in Delhi, a common element came through: access to informed care remains deeply tied to socioeconomic privilege.

Manavi Khurana, founder of Karma Care, articulates this reality starkly, "Social class wise, people are aware. Unfortunately or fortunately, this is what happens. So, sadly, if you are a queer person, somebody that is higher on the socio-economic class ladder, you might find a therapist, a doctor that is a little bit more affirming."

Sukanya Hazarika, DEI Lead at Khaitan and Co., observes that whilst conversations have progressed in metropolitan centres, awareness doesn't automatically translate into competent care. "The queer language, of course, is a part of the vocabulary of most of the HR professionals or DEI professionals," she notes, yet this surface-level familiarity often fails to address deeper therapeutic needs. She adds, "In the situations that I have experienced, I think mostly people are aware, whether there's acceptance or not, that's a separate story."

The Training Deficit and Colonial Hangover

The training gap amongst mental health professionals is particularly stark. An analysis at Asian Journal of Psychiatry, of postgraduate psychiatry examination papers from three major Indian institutions between 2013 and 2023 revealed that only 0.46% of questions covered LGBTQIA+ topics, with no significant difference in patterns even after the 2018 decriminalisation of homosexuality. In 2021, the Kerala High Court ordered the removal of queerphobic content from undergraduate medical textbooks, yet no concrete action has followed. 

Recognising this deficit, organisations like the Mariwala Health Initiative launched the Queer Affirmative Counselling Practice course in 2019. However, these remain voluntary certifications rather than mandatory components of professional education, leaving the vast majority of practitioners unprepared to address the specific mental health needs of India's 45.4 million LGBTQIA+ individuals.

The lack of comprehensive training for mental health professionals on queer issues also stems partly from India's colonial legacy. "We were taken a few years back in our laws also by the British," Khurana observes. "Thankfully, because of social media, this information explosion, a lot of people are getting to know. But still, we've been taken back so many years. Information is not there in the villages, in the rural areas."

Harish Iyer, Head of DEI at Axis Bank and prominent queer rights activist, emphasises that the concept of "queer-affirming" counsellors is itself problematic. "If you are a therapist, you should be a queer-friendly therapist," he states. "The whole idea of a queer affirmative counsellor is so defeating. I think universally, all spaces need to be affirming of queer people."

Hazarika remains cautiously optimistic about progress in professional training, "Things are definitely becoming informed. I am actually a lawyer by training, I'm not an HR professional by training, I have not done any specific courses, but I got here by learning, absorbing information."

The Need to Go Beyond Traditional Counselling Models

Harish challenges the very framework through which we approach mental health support. "When we talk about mental health, we only talk about counsellors," he argues. "We need to think beyond the context. We need to see how self-help groups work, how our social systems work."

At Axis Bank, they've implemented "Wellness Sherpas"—training people to provide emotional first aid. "We train people to be emotional first aid providers. If somebody is expressing anxiety, you don't need a counsellor for that. You need a good friend for that at the beginning," Iyer explains. This approach acknowledges that not everyone has access to formal therapy. Khurana emphasises this point, "Not everyone has the idea of a counsellor or goes to a counsellor. Class and caste, and all those dynamics come into the place."

Iyer insists that "counselling is for long-term therapy, but SOS counselling is something that we all can learn." This is particularly vital for marginalised communities where formal mental health services remain largely inaccessible.

The Data Documentation Crisis

Perhaps the most significant challenge is the absence of consolidated data and case studies. When questioned about data availability, the experts acknowledge a void. However, Iyer offers a nuanced perspective: "Is there one consolidated space for data? No, there isn't. But I think that's a good thing also." 

He explains, "Our solution to compilation should not be to put everything in one category or to have one authority deciding on putting everything together. We want to be Wikipedia, we don't want to be a website." This reflects the evolution of queer identity itself. "When I started practice, there were three alphabets: L, G, B and T. Now there are so many and in those many additions I have found explanations for parts of me," Iyer notes.

The path forward requires multiple interventions. As Hazarika observes, "It will take a while. It is not today at the pace that you would want it to be, but I think eventually we will get there."