Why therapy in India remains out of reach for people in their 40s and 50s

Therapy in India has an age problem. Everyone’s talking about it except the 40- and 50-somethings who could probably use it the most. While therapy in India for those in their 40s and 50s is still seen as unnecessary, the reasons stretch far beyond indifference. Cultural taboos, rigid upbringing, and financial constraints have largely kept this generation away from viewing mental health as a form of care.

In a survey conducted by The Established, with participants aged between 25 and 55 years, 73 per cent said that those in the 45-55 age group are “least likely to seek therapy”. In contrast, 75.7 per cent thought the 25-35 age group was the most likely to sign up for a therapy session. Another survey with therapists echoed this sentiment, with 85.7 per cent saying clients in the 25 and 35 age bracket were the most proactive about therapy. 

At first glance, it may seem like the older generation is simply disinterested in mental health. In reality, their hesitation stems from a mix of cultural, social, emotional, and financial conditioning. To understand the roots of this reluctance, we spoke to psychologists and therapists across India. 

The silence around therapy for middle-aged Indians

India introduced its first mental health-forward policy, the National Mental Health Programme (NMHP), in the 1980s. But therapy in India remained more conceptual than something that is ingrained. The word ‘therapy’ barely existed in the mainstream lexicon until recently. Anand Gholap, a finance professional in his 50s, notes, “It’s not like mental health was a total non-topic previously. However, there was not much awareness around it till about the 2010s. And, even among the minority who knew of mental health, the ‘log kya kahenge’ mindset silenced them.” In fact, the Shah Rukh Khan- and Alia Bhatt-starrer Dear Zindagi, released in 2016, was hailed as one of Bollywood’s first mainstream attempts to normalise the idea. 

A sizeable majority of Indians confess to encountering the term ‘mental health’ for the first time with close friends and family. However, in our research, we found out that mental health had never been discussed in 35.1 per cent of the respondents’ families. While 31.1 per cent admit to having occasional, surface-level conversations about mental health, 17.6 per cent recollect rare conversations that were mostly negative. Backdropped by such complexities, the perception of mental health has been largely camouflaged by stigmas, taboos, and misconceptions, especially for millennials and boomers. Across generations, silence—not awareness—has been the default. The result is a form of learned apathy toward therapy. 

Why therapy in India still feels out of reach for older adults 

“About 60 per cent of my clients would be in the 25 to 40 age group, and 10 per cent would be above the age of 40,” shares Mumbai-based counselling psychologist Yesha Mehta, founder, The Shift Studio. The pattern is consistent across the field. For every ten people who seek therapy with New Delhi-based psychologist Utkarsha Jagga, around 7-8 are between 15-25 years old, while only 2-3 are in the 40-55 age group. These patterns reveal that individuals aged 40 and above have a significantly higher resistance towards therapy. 

“IT’S NOT LIKE MENTAL HEALTH WAS A TOTAL NON-TOPIC PREVIOUSLY. HOWEVER, THERE WAS NOT MUCH AWARENESS AROUND IT TILL ABOUT THE 2010S. AND, EVEN AMONG THE MINORITY WHO KNEW OF MENTAL HEALTH, THE ‘LOG KYA KAHENGE’ MINDSET SILENCED THEM” –– Anand Gholap 

This reluctance stems from a mix of cultural and social conditioning. In our research, 65 per cent of respondents said upbringing played a key role in shaping their likelihood to pursue therapy. According to the How India Perceives Mental Health Report 2021 by actor Deepika Padukone’s The Live Laugh Love (TLLL) Foundation, approximately 20 per cent of the participants—from across Tier-1 and -2 cities—still believe that mental illnesses are caused by “evil spirits,” reflecting mental health’s diabolical status quo in the society.

Goa-based writer and therapist Deepti Dadlani, who finds social conditioning as the foremost reason behind 40- and 50-year-olds’ reluctance towards therapy, says, “The language surrounding therapy and seeking help during their formative years has been tarnished with archaic beliefs of ‘not washing one’s laundry in public.’”

Mehta concurs: “Indian families value privacy, control, and their image in society. The fear of family problems being discussed outside, along with the judgment a family may garner, leads to suppression.” The lack of awareness on the causes and implications of mental illnesses and in a family also breeds stigma around the same, she notes. 

Bhumika Rupani, a Dubai-based engineer in her early 40s, agrees that the intangibility of mental health has worsened the convolution. “When I was growing up, the concept of health was restricted to physical health; issues that were diagnosed through scans and tests were treated. Mental illness is often diagnosed via conversations versus a concrete marker, making it seem trivial.” Vishwas Balwatkar, an operations lead at a logistics firm who is in his late 40s, adds, “The education imparted throughout our schooling life didn’t even remotely address anything to do with mental health. In retrospect, even if schools did, it would have only served academic interest as the acceptance of the concept was severely low.” 

“INDIAN FAMILIES VALUE PRIVACY, CONTROL, AND THEIR IMAGE IN SOCIETY. THE FEAR OF FAMILY PROBLEMS BEING DISCUSSED OUTSIDE, ALONG WITH THE JUDGMENT A FAMILY MAY GARNER, LEADS TO SUPPRESSION” –– Yesha Mehta

Furthermore, the “let-go syndrome,” passed from one generation to the next, has not only normalised suppression, but also toxically orchestrated the state of being emotional as being “weak” or “vulnerable”. 

“Boys don’t cry” and “good girls don’t complain” were once survival lessons; today they manifest as emotional unavailability. “If you grew up in a home where sadness was ignored, crying was seen as dramatic and unnecessary, or anger was met with punishment, you learn that showing feelings is unsafe,” shares psychologist Sanam Devidasani. 

Balwatkar shares, “When we were growing up, knowledge resources were limited and not very accessible. Back then, conventional social structures standardised fixed templates for every role.” The black-or-white approach applied to mental health struggles as well. “Mental health issues simply meant “yeh mental hai,” in a condescending way, so no one took notice until things got visibly bad.” Our research corroborates this: 79.7 per cent of the respondents feel people avoid therapy due to their fears of being called “mentally weak,”, while 71.6 per cent think public judgment is also a key factor. 

The cost of care—and why it still feels out of reach

Stigma (40 per cent) and cultural perceptions (29 per cent) remain significant barriers to better mental health access; money matters too. Socio-economic constraints (55 per cent) and high fees  for therapy (47 per cent) pose massive challenges. The struggle multiplies for those in their 40s and 50s, who shoulder the responsibility of their families, reducing their personal well-being, mental health, and therapy to a non-priority. 

For many older adults, therapy wasn’t even a viable option growing up, says Deepti Chandy, therapist, Anna Chandy & Associates. “It was either too expensive, too inaccessible, or simply not talked about. Financially, therapy used to be seen as a luxury.” While high-cost consultations do pose a challenge for middle-aged individuals, most of whom also play the family’s breadwinner role, value perspective becomes a lurking layer too. “A transactional mindset has been ingrained in the older generations. So, a middle-aged individual is bound to think whether signing up for therapy—and its recurring costs—even makes sense at an age where the time to perceive chances of productive personal and/or professional progress is relatively lower than someone in their 20s or 30s,” says Balwatkar. He adds, “In the later stages of life, most people may also want to carefully spend on pressing health concerns, the treatment of which can promise tangible benefits over mental health, whose positive outcomes are subjective and variable.” 

Over half—60.8 per cent—of the respondents in our survey also think that lower costs and insurance coverage* would make therapy more appealing and accessible to 40- and 50-year-olds. *The 2017 Mental Healthcare Act mandated parity between mental and physical health in insurance, but unclear terms and long waiting periods continue to limit access. 

A shortage of therapists who empathise and understand

India’s mental health infrastructure lags far behind the demand. According to The Indian Journal of Psychiatry, India has 0.75 psychiatrists per 100,000 people, whereas the World Health Organization (WHO) recommends at least 3 psychiatrists per lakh people. The result: up to 70 to 92 per cent of people  with mental health issues in India never receive care. 

In juxtaposition, since the psychotherapy market in India is projected to grow rapidly, the country has observed an influx of younger mental health professionals, leaving an apparent gap of trained, well-experienced, and similar-aged therapists to cater to 40- and 50-year-olds.

While Dadlani had no second thoughts about seeking therapy, finding the right therapist was a struggle. “Many of the therapists that I had spoken with appeared inexperienced, exhausted, and overwhelmed.” Mehta agrees, stating that it is possible that many 40- and 50-year-olds question if a therapist is really able to understand what being in their shoes feels like, due to a lack of life experience. “India is also a country where respect and competence are gauged by age and the number of years of experience an expert has.” she says. 

How younger generations see therapy differently

Between 2019 and 2022, mental health services among 18–26-year-olds in India grew by 45 per cent, the biggest jump across any age group. For Gen Z (currently 14 to 28 years old), therapy in India feels less like a form of treatment and more like self-care.

“The younger generation has grown up in an environment where conversations about mental health and its importance have been normalised. Due to social media, more individuals have been open about their own vulnerabilities without stigma despite the fear of judgment,” notes Mehta. 

She also notices that younger people are more open to the idea of self-improvement and exploring their identities. “When we look at therapy trends through the lens of Maslow’s Hierarchy of Needs, the reason for the contrast between younger and older generations becomes clearer. The older generation spent more time and effort fulfilling the bottom tiers of the pyramid—think physiological and safety needs such as food, clothing, shelter, and safety. Since for most young people, these needs are already met, they focus on belongingness, love, esteem, and self-actualisation, pushing them to seek answers via therapy.”

Our research echoes Mehta’s observation. Over half (55.4 per cent) of respondents in their 20s see therapy as self-care, 48.6 per cent use it to solve specific problems, and 31.1 per cent treat it as a lifestyle choice.

Devidasani notes that most younger clients view therapy as a safe, ongoing practice. “Younger people are living in a world where nothing feels steady—jobs, relationships, friendships, even where you live can change in a moment. Therapy gives them an anchor. For younger adults, therapy isn’t just about crisis; it’s also about growth. My younger clients will often say things like, ‘I just want to understand myself better’ or ‘I want to break patterns I see in my family.’ That’s not something I usually hear from people in their 40s.” 

Why therapy could matter most during midlife 

Many in their 40s and 50s assume they’ve outgrown the need for therapy. In reality, however, experts say this age group could benefit from therapy the most. 

There’s so much that can come up in your 40s and 50s, cites Chandy. “Empty nests, or even questioning your identity or purpose, now that certain roles have shifted. These decades often bring deep reflection—and sometimes grief, loneliness, or confusion.” Leena Ruparel, a homemaker in her 60s, agrees, “In the later stages of your life, when you have fulfilled all your responsibilities, that’s when you sit by yourself, and self-introspect like never before.” While doing so, suppressed trauma is bound to resurface. “You realise certain things still bother you, or have impacted you adversely, and since you have more time to yourself, the wounds may reopen, underscoring a pressing need for therapy.”

Devidasani adds, “When an older client finally opens up, I often hear, ‘I’ve never told anyone this before,’ in context to something that happened to them 25 years ago. It’s hard to imagine how someone has been carrying that weight for this long.” According to her, therapy at such a stage is less about learning new skills and more about giving them permission to finally put words to their experiences. Giving words to those experiences, notes Mehta, also helps break cycles of generational trauma. “People often say diabetes is hereditary; what most people miss is that so is mental health,” shares Ruparel. “Just like we begin fixing our diet and lifestyle to fix diabetes and prevent passing it on to the next generation, looking into your mental diet is the key to put a full-stop to generational trauma, and safeguard those in line.”

How to make therapy feel less intimidating for midlife adults 

Even when they understand the benefits, many people in their 40s and 50s still resist therapy. Years of social conditioning, internalised prejudice, and fear of reactions from family often make it feel like forbidden territory. But this doesn’t have to continue.

Chandy recommends starting by first talking to friends of the same age who’ve tried therapy. “Ask for recommendations and look for a therapist who feels relatable—not just in terms of age, but someone who understands your cultural context and the stage of life you’re at.” Devidasani assures that taking small steps helps. “Book one consultation, just to see how it feels. Don’t think of it as a lifelong commitment—just think, ‘Let me try one conversation.’ That takes the pressure off.”

According to Mehta, partners and families play a vital role in creating a sense of safety around therapy. “People around them need to validate their need for support and remind them that they do not need to go through this alone; it would not make them ‘weak’ to seek support. Encouragement, patience, and removing judgment go a long way in helping someone in midlife feel safe enough to take that first step,” she shares. 

“Instead of saying, ‘You need therapy,’ which may come across as an accusation, it helps to say, ‘You’ve been carrying so much. Maybe talking to someone could help ease that burden.’ Even offering to sit with them while they look for a therapist online can make it feel less overwhelming,” adds Devidasani. “If I were to convince a friend my age to seek therapy, I would do so by openly yet positively showing her the mirror, and encouraging her to see what’s ignoring. It is important to explain what therapy actually entails, and the pros of it, to make a hesitant individual feel comfortable.”

Chandy adds that emotional fatigue in this age group often shows up subtly. “If someone is feeling persistently low, disconnected, restless, or like they’ve lost their sense of direction—those are all signs. Struggles with relationships, work burnout, grief, or just this nagging sense of ‘Is this it?’ are very common.”

Ultimately, therapy is for anyone who needs it. Normalising therapy for those in their 40s and 50s calls for cultural visibility—through families, workplaces, and public figures they can relate to. Citing Sachin Tendulkar’s 2019 ‘Shaving Stereotypes’ campaign with Gillette, Gholap shares, “When advertisements around mental health, albeit a few, feature renowned personalities, there is a kind of recognition to these matters, which is always welcome.” Ruparel notes, “Mental health must become a part of school curriculum, so that kids are not only well-versed with the concept from the get-go, but can also share the knowledge with elders at home.”

The McDonaldisation of therapy may have commercialised healing, but there is no substitute for therapy. Especially for those who need it most, and just don’t know it—yet.