Individuals in distress adopt varied pathways in pursuit of care that aligns with their individual needs. Prior work has established that the first resource an individual leverages can influence later care and recovery, but less is understood about how the design of a point of care might interact with subsequent pathways to care. We investigate how the design of the Indian mental health helpline system interacts with complex sociocultural factors to marginalize caller needs. We draw on interviews with 18 helpline stakeholders, including individuals who have engaged with helplines in the past, shedding light on how they navigate both technological and structural barriers in pursuit of relief. Finally, we use a design justice framework rooted in Amartya Sen’s conceptualization of realization-focused justice to discuss implications and present recommendations towards the design of technology-mediated points of mental health support.