Laws, Health Policy Fail To Stem India’s Tsunami Of Mental Health, As Stress Claims Victims, Cuts Productivity

26 May 2023 17 min read  Share

Even as workplaces began a dialogue around mental health thanks to the Covid-19 pandemic, companies in India have a yawning gap to bridge, as laws and health policy fail to stem a tsunami of mental-health issues on the job. At a time when layoffs are rife, many professionals are either quitting jobs or thinking about it to preserve or recover mental health, a situation that, experts say, lowers general productivity and costs India, by one estimate, $14 billion (Rs 1.15 lakh crore) every year.

Representative Image/ CREATIVE COMMONS

New Delhi: Mass media graduate Shruti Sharma thought she had it all when in February 2021  she landed, as her first job, what she considered to be an exciting marketing role at a renowned private university in Jaipur. 

The feeling of fulfilment was short-lived.

Before she knew it, Sharma, then 23 years old, was working 16 hours a day, including weekends, and was told to fill in for her colleagues who quit. When she spoke out against her boss, whom she called “sexist”, Sharma said she was inundated with clerical and redundant work, which made her question herself and her skills.

Indian law restricts working hours to 48 hours per week, but Sharma was clocking about 80 hours, a common occurrence in a country known for some of the longest working hours on the planet. 

In 2021, an International Labour Organisation study of working hours during the pandemic reported Indians as working an average of 48 hours a week, an hour more than Chinese, nine hours more than Americans and less than only five countries in the world.

A 2016 survey more narrowly focussed on 19,000 across 25 countries found no more worked longer hours than Indians: 52 hours per week on average. Long hours combined with other—often unaddressed—workplace issues, such as those related to gender and harassment, create particularly stressful or toxic workplace conditions in India, said experts.

The “mental trauma” grew to a point where Sharma decided to quit, 16 months after starting. “It was taxing and traumatising for me, and I knew I needed to get out of there,” said Sharma, now 24. 

“Imagine being harassed, gaslit, overburdened, rebuked for your gender—all in your first job,” said Sharma. “It cost me my sanity, peace of mind, and I had chronic anxiety attacks.” 

Sharma’s situation is common nationwide, as laws and health policy fail to stem a tsunami of mental-health issues on the job, lower India’s productivity and hold back the economy.

Poor employee mental health costs Indian companies about $14 billion (Rs 1.15 lakh crore in 2022) every year, manifesting in a variety of forms, such as absenteeism and resignations, according to a 2022 survey of 4,000 workers by Deloitte, a consultancy.

Mental-health issues are evident at all levels of the workplace. At a time when layoffs have been grabbing headlines (here , here and here), many Indian professionals are either quitting jobs or thinking about it to preserve or recover mental health, as a series of studies have confirmed.

Indians & The Desire To Quit

In a survey of six countries conducted between February and April 2022 released by Mckinsey and Company, a global consultancy, India topped the chart of people planning to leave their jobs, with 66% planning to do so

Up to 61% of Indian workers were willing to turn down a raise, bonus or promotion in exchange for improved physical and mental health, to achieve better work-life balance and greater “overall happiness”,  according to a  2022  survey of 15 major industries covered in 12 Asia- Pacific markets.  

The 2022 Deloitte study we previously referred to said 80% of India’s workforce reported mental-health issues during 2021, a pandemic year, but one in four did not seek help because of social stigma, and a third continued to work. Only 29% took time off and one in five resigned to better manage mental health.

Nearly 88% of employees in India (versus 70% in the US) would exchange their high paying jobs for comparatively low paying ones with lower stress at work, according to a 2023  survey of 3,400 people in 10 countries by UKG, a US consultancy.

A number of Indian companies, such as Swiggy, Zomato, Paytm, Innovaccer, Schindler, took extra initiatives around mental health during the Covid-19 pandemic, but in general, said several experts, sensitivity to workplace psychological welfare is limited to non-existent.

Depression and anxiety disorders have become a dominant concern among young working professionals globally, according to a June 2022 World Health Organization (WHO) report.

By 2020, quoting the latest available data, WHO director general Tedros Adhanom Ghebreyesus in January 2023 said only 35% of countries reported having national programmes for work-related mental health promotion and prevention. India is one of these countries with a National Mental Health Programme since 1982.

Ghebreyesus identified a number of issues that affect mental-health in the workplace, including bullying and harassment, sexual violence, inequality and discrimination, racism, heavy workloads, underpayment and “a toxic culture”. 

Many of these issues are common in the Indian workplace, but they were exacerbated by the pandemic.

The Role Of Covid-19 In Rising Stress

Alok Sarin, MD, consultant psychiatrist, Sitaram Bhartia Institute of Science and Research, said Covid-19 exacerbated workplace stress and made it more obvious. 

“Workplace stress is a reflection of many other stresses and in the pandemic, other stresses have increased manifold and hence there is a crisis,” said Sarin.

Amit Malik, who heads Amaha Healthcare, an online mental-health platform with centres in Delhi, Mumbai and Bengaluru, said as companies focussed on meeting targets and reducing costs, there was “a need for leadership to develop a greater understanding of how (an) employee’s mental well-being impacts business growth”.

Some said younger Indians in corporate jobs tended to be more open about mental-health issues.

“In my experience, younger professionals come in mainly to talk about adjustment and coping in their professions while older patients complain about burnout and work-life balance,” said Ambika Agnihotri, a Chandigarh psychiatrist.

Karuna Bhaskar, director at Bangalore-based Resilience Works, which offers professional counselling and self-help services, said, “The smaller or newer companies are headed by young entrepreneurs who seem to feel a greater need to have mental health conversations because of what they might have encountered when they started out.”

Unlike the West, workplaces in India have few legal obligations to address mental-health issues.

Legal Guidelines Do Not Help Employees

Although there are laws that address mental illness, their remit and enforcement are limited. No law makes clear the legal redress available to someone who suffers mental-health issues.

The lack of recognition for mental-health issues was reflected by the observations made by the Delhi High Court in January 2023, hearing a plea seeking anticipatory bail from a former secretary of the Central Board of Secondary Irrigation and Power, who was accused of ignoring  emails of a manager who died by suicide in 2020 because of a hostile work environment cases by the behaviour of senior ministry officials.  

“…death caused due to overwork and toxic work environment is a social problem which (sic) requires the government, labour unions,  health officials and corporates to formulate appropriate policies,” said the Delhi high court. “What is needed is an examination of the issues of overwork and occupational stress focusing on mental health at workplace (sic).”

“Instead of pushing for new legislation, we should push for implementation of existing provisions under the Rights of Persons with Disabilities Act, 2016, through advocacy,” said Arjun Kapoor, programme manager and research fellow, Centre for Mental Health Law & Policy, a Pune think tank.

The law allows for “continued livelihood” despite an inability or reduced ability to perform at work because of mental illnesses, and retention of jobs where an employee becomes disabled during the course of employment. Punishment for violations by employers includes financial penalty ranging from Rs. 10,000 to Rs. 500,000 or  imprisonment of 6 months to 5 years with or without fine. 

“This provision is specifically significant for people with mental illnesses that often arise during the productive years of their career and hence, can impact their community and occupational functioning,” said disability activist Satendra Singh, MD, of the University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi.

The Mental Healthcare Act 2017 aims to provide healthcare for those with mental illness through a variety of rights, including access to affordable care, equality in treatment, protection from harassment, free legal services and a right to confidentiality, which, if breached the first time by mental health professionals or employers could attract a Rs-10,000 fine and six months imprisonment, with consequent breaches calling for a two-year jail term and fines up to Rs. 500,000.

The law says those with mental illness have a right to confidentiality with respect to their mental health and treatment. The first breach of confidentiality may attract a monetary penalty of up to Rs. 10,000 or fine up to Rs 500,000. 

These laws, said experts, are of little use to the average employee afflicted with mental-health issues, since they do not directly address the workplace.

Other Nations Do Better

“What Indian law and company policies need to account for is the need to recognise mental health as a spectrum, exactly the same way physical health is viewed,” said Vandita Moraka, an independent legal researcher and founder of One Future Collective, an advocacy group.

In India, said Morarka, only larger companies usually pay for mental health support services and insurance. In “socialist countries”, such as The Netherlands, she said, the government did, “making it easier for companies to implement mental health policies”.   

The Delhi High Court in the January 2023 hearing previously quoted noted that the government of Japan “has drafted policies that address mental health in workplaces”.

Several countries enjoy rights that protect mental health.

Portuguese remote workers, for example, were granted the legal right to disconnect from work , after a communication law in 2021 made it illegal for employers  to contact employees outside of working hours. 

In Finland, employers must protect employees from “hazards from work and the working environment to the physical and mental health of employees”. Dutch employers must pay workers 70% of their salary during any kind of sick leave, which can extend to two years.

There are similar laws in Sweden and the UK, the lack of which allow no redressal for employees who suffer burnout, stress and mental-health declines.

I Missed Out On Seeing My Daughter Grow Up’

 Sandeep Rathod, a 48-year-old engineer, who worked with some of India’s top companies after getting an MBA, said that he did everything his middle-class family expected of him to be “successful”.

Eventually though, Rathod said, the money cost him his mental health. Work hours were erratic, and he could not, he added, balance work with his personal life. 

“I feel I missed out on seeing my daughter grow up during her initial years due to the extreme work pressures, and it resulted in a more frustrated me at home,” said Rathod.

“When work doesn’t leave space for anything else in your mind, you cancel on social commitments and you are also unable to come home early when your family asks you to, which makes you feel under appreciated,” he said. “I would end up snapping a lot at family.”

Always running low on sleep, Rathod nearly dozed off while driving his car to office in Mumbai on a couple of occasions. “I, then, started taking a cab, and would end up sleeping for an hour on the way until the cabbie would shake to wake me up,” said Rathod.

He tried ayurveda, allopathy, yoga and meditation and spent thousands of rupees on sleep therapy, but nothing worked.

The lack of productivity and pressure to perform at work led to emotional insecurity and made him indecisive, said Rathod.

Since there was no redressal that he knew of under the law or otherwise,  Rathod quit his job with a leading global bank in Mumbai in January 2022. When he did, he said, many colleagues confided they wanted to do the same. 

“Some of them asked me how to handle finances, if one wants to take a break,” said Rathod. “They told me they wanted to quit their jobs too.” 

In January 2022, Rathod, who was on antidepressants and sleeping pills since 2008, moved to Ahmedabad with his wife and daughter and resumed therapy after 2021, after trying it in 2010 and in 2014. His sessions are now “impromptu”, he said, since he quit his job and relocated.

 After taking a break from work for a few months, Rathod set up an institute  to train fresh graduates for a banking institute in Ahmedabad.

Even though his salary is 80% lower per month than it once was, he said, he had never felt “healthier and happier” before. 

“I have stopped my blood pressure medicine and even if I sleep only 5 hours on some days, I feel fit when I wake up,” he said, adding that even if he was working similar hours, it was at his own pace and with breaks. 

“My friends keep asking me what has changed, and I say, for the first time in my life at 48 years, I finally have autonomy, personal agency and freedom,” said Rathod. “ The power to say no is empowering.”

Companies Ignore ‘Unique Life Stressors’

Rathod’s story reflects not just the inadequacies of the law but of company practices and support, said experts.

Samriti Makkar Midha, co-founder and partner, Mental Health at Work, a vertical of Equilibrio Advisory LLP, said appraisals almost entirely focus on “the metrics of performance” and do not consider personal challenges and “unique life stressors”, such as losing a family member, being a caregiver to a terminally-ill dependant, or being diagnosed with physical or mental health issues.

Ayushi Chaurasia, a 28-year-old museum archivist from Lucknow,  could not acknowledge the anxiety she was feeling at work until therapy confronted her with burnout and the stress of losing a parent in a car accident.

“At the end of every session, my therapist would say, ‘what’s the one thing you would like to pick from a magic wish bowl in front of you?’” said Chaurasia. “I picked rest, week after week.” 

To recuperate from the looming anxiety, Chaurasia took a break from work after her contract with a museum and archiving organisation ended in January 2022. She, however, continued to write and host a podcast series on Indian Art till August 2022 to sustain herself.

After a nearly five-month sabbatical, Chaurasia joined as consultant archivist with a policy think-tank in Delhi in January 2023. While she works nine hours, an hour more than she did in her previous job, she feels well-rested. 

“I don’t have to worry about having extra jobs as my salary is better, and I have defined my boundaries,” she said. “I manage my work accordingly.” 

Some workplaces do indeed offer support for mental-health

 and overwork issues, and their initiatives, in the absence of legal protection, provide a road-map to others.

Some Support, But Not Enough

A support service that companies have been using is EAP, as it is commonly known, or employee assistance programmes, in existence in India for at least a decade, offering therapeutic services free of cost to employees. 

EAPs are subcontracted services that help employees resolve issues that could impact their lives. But EAPs do not usually offer mental-health programmes. 

Of India’s 1.1 million active registered companies, only 1,000 are estimated to have a structured EAP for mental health, according to a pre-pandemic report by Optum Health International, a leading EAP service provider from the UnitedHealth Group, an American company headquartered in Bengaluru in India and active in over 65 cities.

“I am aware of organisations that allow for people to work only four days a week or the option to work for 10 months and take 2 months off to pursue personal goals,” said Midha, who is also a Mumbai-based clinical psychologist, referring to global practices of many global companies, such as Bain and Co, Fujitsu, LDLC , Swedish employee freedoms, and Dropbox

“There would be an implication on remuneration yet it allows for flexibility young people are looking for,” said Midha of Mental Health at Work, which gave a week off to all employees for mental health in April 2023, for the third year in a row.

Experts said workplace stress could be mitigated if companies established internal structures of support, such as a mentor or buddy system, emergency contacts for people living alone or from vulnerable contexts and re-imagined ways of working by allowing employees to focus on priorities other than being an employee, including parenting, caregiving and pursuing personal goals. 

The work-life balance, according to counsellors, can be achieved through modifying leave policies by offering sabbaticals, hybrid work and reducing  working hours.

Moraka of One Future Collective suggested a grievance-redressal system in the form of a neutral third party or a “safeguard committee” or suggestion boxes in smaller companies to report harassment by an employer anonymously.

A Tapering Off After The Pandemic

A senior team member at Mind Clan, an online mental health support platform based in Mumbai,  said that compared to five organisations who contacted before the Covid-19 pandemic in 2019, 25 reached out to them in 2020 and 2021, and 12 in 2022. 

“We see a lot of firms retracting or not showing as much enthusiasm today,” the team member said, speaking on condition of anonymity. 

But several initiatives that companies began during the pandemic, such as a week off for mental health, no-zoom-call Fridays, have not continued post pandemic according to experts. 

Human Dynamic, a Hong Kong based consulting firm, with an India office in Bengaluru, reported a 50% rise in requests for mental-health assistance programmes during the pandemic. By the second half of 2022, those requests dropped 40%, said a spokesperson.

 “There are certain commemorative days, such as international women’s day, suicide preventive day, world mental health day, when organisations get active thinking about mental well-being,”  said Divya Khanna, director, of client relationships at Human Dynamics. 

 Krishna Veer Singh, CEO and co-founder of a mental wellness startup Lissun in Gurugram, said since their 2021 launch, of the 100 companies they reached out to about starting mental-health programmes, about 10% signed up. 

“When budgets are a constraint, the initiatives that get pruned in the first phase are around mental well-being and DEIB (diversity, inclusivity and inclusion),” said Midha.

That has placed most employees with the same lack of support they faced before the pandemic.

‘A Constant Fear Of Judgement’

Tahir Quereshi, 42, a Delhi-based journalist who was diagnosed with depression when he was 15, said workplaces he had encountered were not safe places to express serious mental health disorders. 

“There is a constant fear of judgement,” said Quereshi. “One isn’t considered unwell if one doesn’t show a physical symptom at work.

Quereshi said he had never accepted offers from international newsrooms because suffered “a constant fear of leaving my hometown Delhi as a depression patient”. In hindsight, he said, “perhaps they would have at least respected my illness”. 

“My medicines have side effects and I need my employer to at least allow flexibility to take a nap in between long hours of work, just like they have in quiet rooms where employees can get some shut-eye,” he said.

Criticising what he called “token initiatives” to address mental health at his office, Hardik Gupta, 28, a strategy consultant with an autonomous body in the government sector in Gurgaon, said: “Webinars on mental health only talk about enhancing productivity, whereas I don’t want to enhance my productivity, if I am sick. Organisations need to normalise having slow days at work.”

Gupta, who was diagnosed with “major depressive and anxiety disorder” in 2019, said he was scared of being judged if he told his employer about his illness.

“What we see at workplaces is a social microcosm and there is a larger need for a cultural shift for mental health  to be incorporated at workplaces,” said Radhika Sharma, a Mumbai-based therapist with 19 years of work experience. 

Sharma suggested an early introduction to mental-health issues, so Indians could feel comfortable talking about them as they entered the workplace. 

“Mental health needs to be acknowledged in prenatal cases, in schools and colleges to be able to have better mental health vocabulary and for us to know how to support people struggling with it,” said Sharma. 

Midha, the clinical psychologist, said some of her clients said they felt vulnerable when they told managers of mental-health issues because it had often “backfired”, with employers considering them “mentally unfit and incompetent to handle leadership roles”.

Up to  73% of Indian employers did not cover mental health in their employee health-benefits packages, thus decreasing employee productivity,  said a 2023 report from healthcare and insurance startup Loop, using inputs from 500 human-resource managers. 

Without meaningful changes in the way companies address mental-health issues, the Indian corporate workplace, said experts, would not change. 

Therapy May Help But Not Without Workplace Change

Sandhya R, 24, who moved from Chennai to Gurugram to join a management consulting practice with a leading global advisory and accounting organisation in September 2021, quit her job in less than two years. 

Sandhya said she pushed herself because of “tremendous work pressure”, and took free therapy sessions arranged by the organisation, but could not continue at a workplace that she said “wasn’t fair” to her and did not offer a “conducive work environment”.

“After seeing emails from my employer about free-of-cost therapy sessions with Zariyaa,  I started sessions with their psychologists,” said Sandhya. 

While Zariyaa’s collaboration with the employer began in September 2021 amid the Covid-19 pandemic, Sandhya started her weekly therapy sessions in January 2023. 

“The sessions were good but they couldn’t change the work environment or address the lack of resources in my firm,” she said. Triggered by the snide remarks about her mental wellbeing by seniors at work, she finally quit her job in April 2023. 

(Aneesha Bedi is an award-winning independent journalist based in New Delhi.)

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