Published Jun 14, 2026 | 7:05 AM ⚊ Updated Jun 14, 2026 | 7:05 AM
Young people "were more willing to seek help when providers were perceived as warm, empathetic, and non-judgmental".
Synopsis: A systematic review of 26 studies finds that Indian adolescents avoid mental health counsellors primarily because they fear breaches of confidentiality. Stigma, low mental health literacy and structural barriers compound the problem. With 95 percent of adolescents receiving no care, researchers call for trusted, youth-friendly services and school-based interventions.
When an adolescent in India recognises that something feels wrong—persistent sadness, anxiety, or an inability to cope—the next step is rarely a visit to a counsellor. More often, they turn to a friend. And the reason, researchers have found, is simple: they do not trust that what they say will remain private.
A systematic review published in SSM – Mental Health, led by researchers at The George Institute for Global Health, synthesised findings from 26 studies conducted across India between 2010 and 2025. It examined what prevents adolescents aged 10 to 19 from seeking formal mental healthcare and what, on occasion, helps them access it.
The findings cut through the familiar narrative that awareness alone drives help-seeking. Adolescents in the review knew they were struggling. What stopped them was something more structural: a healthcare system they did not trust, services that did not feel designed for them, and a social environment that punished disclosure.
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Across the studies reviewed, adolescents consistently reported fears that counsellors would breach confidentiality by sharing what they disclosed with parents, teachers, or peers. This was not a minor concern. It emerged as a decisive barrier, pushing young people towards informal support networks and away from trained professionals.
The review found that “discomfort in discussing sensitive issues with unfamiliar counsellors, combined with concerns about confidentiality, often discouraged adolescents from engaging with services”. Continuity also mattered. When counsellors changed across sessions, adolescents were more likely to disengage. The review noted that “disruptions in counselling continuity, such as being assigned different counsellors across sessions, reduced adolescents’ engagement and hindered progress.”
The opposite was true when trust developed. Young people “were more willing to seek help when providers were perceived as warm, empathetic, and non-judgmental”, leading the authors to conclude that “the quality of therapeutic relationships plays a pivotal role in shaping help-seeking behaviours.”
Dr Sudha Kallakuri, Senior Research Fellow at The George Institute for Global Health India and lead author of the review, said: “Adolescence is an important phase for emotional and psychological development, and many young people face barriers that limit their access to timely support. Evidence shows that stigma, low mental health literacy, worries about privacy, and frustrations in accessing services deter many from seeking help. Addressing these challenges requires coordinated efforts across schools, communities, families, and health services.”
Confidentiality fears do not operate in isolation. They sit within a broader architecture of stigma, which emerged as the most frequently reported barrier across all 26 studies.
The review described how “self-stigma and anticipated public stigma, manifesting as feelings of shame, embarrassment, and fear of judgement, discouraged adolescents from disclosing emotional distress and seeking care.” Among adolescents experiencing depressive symptoms or suicidal ideation, researchers documented “high levels of perceived stigma … which was associated with reduced willingness to seek professional support.”
Public stigma compounded the problem. Stigma “originating from peers, teachers, and family members was also frequently reported across study designs as a barrier to accessing services”, operating across “multilevel” pathways that shape adolescent help-seeking behaviour.
The authors noted that “different types of stigma including self-stigma, public stigma and structural stigma were identified as key factors that interfered with help-seeking”, adding that this finding “is consistent with global reports documenting how institutional and professional stigma fosters shame, concealment, and withdrawal among young people with mental health concerns.”
Before stigma or confidentiality fears can take effect, adolescents must first recognise that what they are experiencing may constitute a mental health problem. The review suggests that this recognition often does not occur.
“Adolescents, parents, and teachers often struggled to recognise symptoms of mental health problems or distinguish them from typical adolescent behaviour, contributing to delays in seeking support.” Quantitative studies similarly recorded “limited knowledge about conditions such as depression, suicide risk, alcohol misuse, and available coping strategies”, pointing to widespread gaps in mental health literacy.
The picture was not entirely bleak. “Interventions specifically designed to improve mental health literacy demonstrated positive effects, with participants showing more favourable attitudes and increased intentions to seek help after receiving structured psychoeducation or skill-building programmes.”
Even adolescents who overcome stigma and recognise their distress face a system that places further obstacles in their path.
The review identified “limited availability of trained mental health providers, long travel distances and transportation challenges, and financial constraints that affected affordability and continuity of care” as structural barriers across settings. It further noted that “academic pressures and competing school commitments were also commonly identified as constraints, restricting adolescents’ ability to attend appointments or engage consistently with services.”
Negative encounters with providers left a lasting impression. “A consistent concern across studies was the lack of adolescent-friendly services, alongside fears about confidentiality breaches and negative interactions with healthcare professionals, including dismissive or disrespectful behaviour.” Many adolescents were also unsure where to seek help, while competing school and household responsibilities further constrained access to services.
Prof Pallab Maulik, Director of Research at The George Institute for Global Health India and co-author of the review, said: “The findings highlight that improving adolescent mental health requires much more than expanding clinical services. Young people need trusted, accessible, and youth-friendly support systems. Strengthening mental health literacy, reducing stigma, improving confidentiality within services, and building the capacity of teachers, lay counsellors, and community-based workers can help bridge the large treatment gap that currently exists.”
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In the absence of trusted formal services, adolescents built their own support pathways. “Adolescents often preferred to discuss emotional difficulties with friends, viewing them as accessible and trustworthy confidants.” Peers and school counsellors were considered “appropriate and acceptable sources of help when mental health concerns arose.”
Family members shaped outcomes in both directions. The review noted that “family members, particularly mothers and siblings, also played a significant role in influencing whether adolescents sought formal care, either by encouraging help-seeking or, in some cases, contributing to delays.”
School- and community-based interventions showed the clearest evidence of impact. The review recorded that “life skills education, problem-solving interventions, and teacher-supported programmes enhanced adolescents’ knowledge, coping abilities, and social-emotional skills.” Adolescents also “wanted mental health content to be integrated into the school curriculum and expressed a need for more trained and approachable teachers who could identify and respond to emotional difficulties.”
Digital tools showed promise but raised their own concerns. The review found that “innovative delivery models including mHealth, digital decision-support tools, and co-design approaches were highly acceptable within low-income and underserved communities, particularly when materials were culturally relevant and developed collaboratively with adolescents.” Privacy concerns, parental acceptance, and access to devices continued to constrain uptake.
The review covered studies from Delhi, Mumbai, Chennai, Hyderabad, Pune, Bengaluru, Goa, Odisha, Bihar, Assam, and Vijayawada. Yet it found almost no research on adolescents living in urban slums, despite the compounding vulnerabilities many face.
The authors noted that “very little evidence exists regarding the magnitude of the treatment gap specifically among adolescents or the contextual barriers driving low service use in this age group”, and called for future research to “prioritise these populations to inform equitable mental health policies and interventions.”
India’s adolescent mental health treatment gap is estimated at 95 percent. The review concluded that closing it will require action across individual, relational, and structural levels simultaneously, including “reducing stigma, integrating mental health literacy into schools and community programmes, strengthening the capacity of lay counsellors and teachers, improving confidentiality and trust in services, and developing culturally resonant educational materials.”
