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Mental health and workplace: Where we stand?

Ambrish Dharmadhikari, Psychiatrist & Head - Medical Services, Mpower - The Foundation, writes about the acute need for organisations and employers to recognise mental issues faced by employees as valid health concerns and take appropriate measures to combat the rising mental disorders among India's working population

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Recently during a consultation session, I received an unusual request— my client requested a certificate for advising rest on the grounds of physical illness. He wanted to be away from the toxic work environment that his workplace harboured. I explained that I cannot forge the certificate but he could get the certificate for mental health issues. He wasn’t convinced; we further discussed the reasons for the same. It was painful to understand his position. His opinion was that his manager or even the HR will not take his mental health issue seriously to grant him a reduction in the work burden, forget to grant him a leave.

This got me thinking— how many times do we hear that someone has been allowed to take rest because he/she is stressed, or someone applied for a leave citing depression or anxiety as reasons. There is a lot of stigma attached to mental illness, to the extent that we hide any illness and organisations deny its existence. In India, many companies have policies in place to promote the physical health of employees. From participating in marathon to utilising a standing desk to family health insurance, organisations tend to do a lot for employees’ physical health. But hardly do they ever do anything for their mental health. Team bonding and fun activities are organised, but their effect is often shortlived.

If an organisation, in a true sense, wants to help its employees to be productive and healthy, they will have to take mental health seriously and act on it. Mental health issues are a ticking time bomb for India as reflected in a recently conducted National Mental Health Survey. And most of the organisations are unprepared for this growing burden. Let’s look at the numbers.

Mental health scenario in India:

Mental disorders contribute to a significant load of morbidity and disability; a few of these conditions even account for an increased mortality rate. As per the Global Burden of Disease report, mental disorders account for 13 per cent of total DALYs lost for Years Lived with Disability (YLD), with depression being the leading cause. Mental disorders affect everyone, irrespective of their age, gender, residence and living standards. Though some groups are at a higher risk for certain illnesses, the impact varies. Also, some cases are known better than others. For example, mental disorders among children, depression among pregnant mothers, and dementia among the elderly are well known.

Growing evidence from research has demonstrated the close association of mental disorders as precursors/risk factors/co-morbid conditions /consequences of a wide range of acute and chronic conditions like Non-Communicable Diseases, injury and violence, maternal and child health conditions. For example, depression and cancer are known to coexist, while anxiety disorders are linked to the occurrence of cardiovascular disorders. Non-recognition of associated mental health problems often leads to delayed recognition and recovery.

Recently, National institute of mental health and neurosciences conducted the biggest national mental health survey (NMHS). The figures for the prevalence of mental problems are too staggering to be neglected. It is estimated that excluding tobacco use disorders, mental morbidity of individuals above the age of 18 years currently was 10.6 per cent in India. The lifetime prevalence in the population was 13.7 per cent. This proportion of the population currently suffering from a mental disorder requires active intervention. Translated to real numbers, nearly 150 million Indians require active interventions.

Across all diagnosis of mental health, the prevalence in urban metros was higher than in rural and urban non-metro areas (with less than 10 million population). The prevalence of schizophrenia and other psychoses (0.64 per cent), mood disorders (5.6 per cent) and neurotic or stress-related disorders (6.93 per cent) was nearly 2-3 times more in urban metros. One can speculate and consider the contribution of several factors (fast-paced lifestyle, stress, complexities of living, breakdown of support systems, challenges of economic instability) for this higher prevalence. With continuing urbanisation, the burden is expected to rise and hence, there is a need for an urban specific mental health programme. These programs need to be led by today’s leading organisations, both in the public and private sector. Majority of these mental health issues are arising due to employment and work-related factors.

Common mental disorders, including depression, anxiety disorders and substance abuse disorders are a huge burden, affecting nearly 10.0 per cent of the population. This group of disorders is also closely linked to both causation and consequences of several non- communicable disorders (NCD), thereby contributing to a significantly increased health burden. These disorders have previously been unaddressed in the planning and delivery of health care programmes in organisations. Individuals and families also ignore and neglect these disorders until they become severe, resulting in loss of work hours, reduced productivity, loss of revenue and financial downturn.

It is a misconception that mental health disorders affect mainly children and older adults— national mental health survey (NMHS) reports that males in the age group of 30 – 49 years were the most affected indicating that mental disorders contribute to greater morbidity in the productive population. The prevalence of most mental health disorders peaks in this age group affecting work productivity, earning potential, and quality of life. Females have a much higher risk when it comes to neurosis and stress-related disorders- nearly twice as much as males.

NMHS further reveals that nearly 1 per cent of the population reported a high suicidal risk. The prevalence of high suicidal risk was more in the 40-49 age group (1.19 per cent), among females (1.14 per cent) and in those residing in urban metros (1.71 per cent). While half of this group reporting suicidal risk had a co-occurring mental illness, the other half did not report any co-morbid mental disorder. This warrants the need for multi-sectoral actions including employers.

Organisation’s role:

These staggering numbers are enough to alarm anyone, and employers need to be specifically wary. Every organisation should have the following three key things to address this growing problem:

1. Mental health policy – Formulating a mental health policy makes a big difference. It catalyses the conversation around mental health and stamps out any stigma. Policies should give mental health and equal status as physical health. Impacting It should be realised that mental health issues can have similar severe impacts like physical illness. This way, no one will have to hide his/her mental health issues. Policies should also direct normalisation of talk surrounding mental illness, creating more awareness about mental health issues.
2. Training of employees – Next step to policymaking will be the training of employees into first aid techniques in mental health. Across the globe, CPR training is popular. However, we do not consider mental health emergencies or conditions in first aid training. Organisations should actively take up courses like ‘Youth Mental Health First Aid (YMHFA)’ to train their employees. YMHFA is already being practised across the globe and is spreading in India as well.
3. Service provision- Closing the loop is the most important aspect and to do that, organisations should take up mental health service delivery. They could opt for cell model where psychologist visits organisations and provide services in-house, or can form reference tie-ups to nearby mental health service providers. We at Mpower offer both the models and in the last two years have grown substantially due to more and more organisations availing services.

Today is the date to act and work together to tackle this growing epidemic of mental health issues. I strongly believe that in the near future, many organisation will take positive steps to maintain the mental hygiene of employees.

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