The Indian Economy Blog

July 6, 2007

Mental Health In The Workplace: Food For Thought

Filed under: Business,Health,Human Capital — Shefaly @ 3:37 pm

My first experience of seeing mental illness, beyond the one-word shorthand in Hindi ‘paagal‘ and the figurative usage ‘dimaag kharab hai‘, came when I was an engineering student. I used to visit my rakhi-brother in the medical college. Now a specialist in child psychiatry and a professor at one of the world’s leading medical schools, he was then in the process of finishing his MD in psychiatry – something that makes him a great visionary in my eyes.

With his wife, also a specialist doctor in a different field, I often visited him in the Psychiatry OPD where patients and their families awaited their turn. The range of emotions writ large on the faces of the accompanying members of the family of the patient ranged from exhaustion to exasperation, whereas confusion, fear, uncertainty and a host of others lined the faces of patients.

My brother took the time to explain various things to me: what the known causes of some mental illnesses were, how the various illnesses manifested, how to tell signs that there is an emergent problem, how one label differs from another, how the patients were treated, what the role of their family and work environment was in their recovery and so on. For a young teenager, I was probably then one of the most well-informed people amongst my friends and family.

More importantly the experience taught me to manage my prejudice. I say ‘manage’ because illnesses manifest differently and misunderstandings, about how dangerous mentally unwell individuals are, abound even though the patients are more likely to harm themselves than others.

The truth remains that it is the lack of awareness and therefore the abundance of prejudice (Latin praeiumacr.gifdicium: prae-, pre- + iumacr.gifdicium, judgment) not just at the workplace but also in the immediate and extended family, that keeps the incidence of mental health well-hidden in India. Now and then there comes a film, which tries hard to bring up the issue, such as Aparna Sen’s ’15 Park Avenue’ or Mahesh Bhatt’s ‘Woh Lamhe’, albeit not without enforcing the same stereotypes of violence, aggression, suicide and such like and then, nothing. Silence.

Things may be changing, if ever so slowly, as you can see from this blog by an Indian mother chronicling her daughter’s schizophrenia. Even so, by and large, the management of mental health issues remains a dominantly NGO activity in India, as captured wonderfully in this book.

With growing urbanisation, increasing work pressures (I am tempted to list all the personal blogs by Indian bloggers that admit to feeling listless, tired, demotivated and depressed about their work!), social isolation, increasing economic disparities and such inevitable joys of globalisation and industrialisation, the numbers of Indians with chronic depression, anxiety, mood and personality disorders, and eating disorders are only likely to increase.

There are however signs that in some workplaces in India, there is recognition that mental illness is not necessarily a red flag that calls for immediate dismissal of the employee. In a more structured and simpler social environment such a dismissal would be grounds for a lawsuit for discrimination but that is for another discussion, perhaps. More than ever before, an employee, who has suffered a bout of mental illness, needs a supportive environment and – in the absence of a universal healthcare system – money for ongoing medication and psychiatric evaluation and consultation sessions.

A few aware managers are taking the initiative to manage the concerned employees well by supporting them and helping them manage their workload, while ensuring that the employee does not face discrimination, ridicule, sarcasm, stigmatisation, further isolation and other behavioural traits of mental health related illiteracy in the workplace. Tall order for a manager, requiring resourcefulness, a great deal of emotional intelligence, authority and influence in the workplace, and to some extent, a willingness to take personal risk in his or her own career!

Much as I should like to name the multinational firms in Delhi, Bombay and Bangalore, where I know these practices to be well-rooted, my doing so will violate the privacy of many individuals. Thanks for your understanding.

You are an enlightened reader group. Do you have stories or experiences from your workplace to share? Please use the comments link below.

19 Comments »

  1. Shefaly,
    Very topical. I have been reading studies which name work-related stress of Indian managers as one of the major fall-outs of the booming economy.
    As you mentioned, lack of resources, low emotional maturity and inability to take risks prevent managers from understanding issues that they are expected to.
    I have faced issues relating to mental ill-health both at home and at work and I must say that the stigma in Indian society is really very harmful even when we say that we are progressive….I have had personal experiences and it is painful. I can just hope that professionals and the mainstream society wake up to such concerns.

    Comment by Shreyasi — July 6, 2007 @ 6:00 pm

  2. Shreyasi: Thank you for sharing your views. If you have references to some of the studies you mention, it would be great. As a professional in boom-time India, your experiences have some unfortunate companionship from several others. Thanks for reading.

    Comment by Shefaly — July 6, 2007 @ 6:08 pm

  3. [...] You can read it here.  If you have views, please do share them using the comments link below the post. [...]

    Pingback by Mental health in the workplace « La Vie Quotidienne — July 6, 2007 @ 9:34 pm

  4. Very well written. Mental illness effects so many families yet the social taboos against us confronting and dealing with it cause so much hidden pain. The effects in the workplace are huge as well. Thank you for writing the good write!

    Comment by Misha — July 6, 2007 @ 10:33 pm

  5. Shefaly, I like a lot of the points you’ve made. Especially the point that in India there really is very little recourse to those with any sort of mental illnesses.

    Leaving aside medically diagnosed conditions there are so many out there with severe problems arising out of basic insecurities, family problems, etc that tapping this area will bring huge benefits to companies keyed in on this.

    Comment by Nikhil — July 7, 2007 @ 12:19 am

  6. Misha: thank you for your kind words.

    Nikhil: thanks and you touch upon a very important point. Depression may not be high on the to-deal-with list of a poor person but abject poverty could well be contributing to the depression and anxiety which interfere with that person\’s ability to function day-to-day.

    My hope is that there may be limited recourse now, but with an educated young generation arising now, things such as this will become less of a taboo and that something substantial and concrete will come out of it for the benefit of long term mental well-being of the Indian population at large.

    Thanks for reading.

    Comment by Shefaly — July 7, 2007 @ 1:58 am

  7. Hi again..

    Had to comment.. The state of acceptance of mental disease in urban and educated India (and NRIs) today is similar to that in the US in the 1940′s and 1950′s.. i think that if they could move on… so can we..

    bye for now

    Comment by SR — July 7, 2007 @ 3:12 am

  8. Shef,
    Extremely topical and relevant. Faced a situation just last week when a colleague had an epileptic seizure (a neurological disorder rather than a mental health issue – but still an area where taboos and old wives\’ tales abound) at work. It was appalling to find that all of us were unprepared to deal with this! Suggestions revolved around placing an \’iron\’ object in the sufferer\’s hands in true filmi style (a complete disservice by the media there – most likely to cause harm than anything else!), slapping him awake etc.. Luckily, we managed to contact a friend who is a doctor who advised us appropriately. The good thing that has come out of this is that we are now taking the initiative to have a few people trained in essential emergency care – this may happen as a matter of course in larger companies but is certainly not mandated in smaller ones. It often takes a jolt before the Indian workplace reacts!

    Comment by KS — July 7, 2007 @ 8:24 pm

  9. Thanks for highlighting this issue. I apologise at the outset for having rambled on for a bit. I blame you :) for touching on a topic so close to my heart.

    When it comes to dealing with mental health issues, India is still in the dark ages.

    I say this from personal experience, for I have had the opportunity to compare. Having to deal with mental health issues as a part of my job in the West, and for many years, being supportive of a close family member with depression in India.

    What holds us back is the stigma that society attaches not only on the person but also the family. This stems purely from ignorance compounded by tradition of many myths. These illnesses are in a way no different from diabetes or high blood pressure. And any justification to stigmatise to isolate it to affected families is long outdated, and the practice should be sent back to the dark ages; along with our caste system.

    The bottomline is, it is a form of abnormal biochemical physiology of the brain, the exact nature of which is yet unknown to advanced medical science. The day we know (hopefully with advanced scanning techniques and understanding of the normal physiology) and have medicines to ‘cure’ or effectively controlling these conditions, it will cease to be seen as a stigma. Unfortunately that is still a long long time away.

    I am not sure if our legislation includes ‘disability discrimination’ by employers? It is time we caught up with the West on such laws. It can only become a major issue with our changing workstyle and workscenes.

    I would be grateful if you could write about Workplace Harassment and Bullying, and if or how Indian workplace managers deal with it?

    Comment by little indian — July 7, 2007 @ 10:54 pm

  10. Shefaly, I wasn’t refering to the poor! Insecuritty and family problems are rampant among many profesionals. Scratch beneath the surface a little. But that is a discussion for another day.

    Comment by Nikhil — July 7, 2007 @ 11:48 pm

  11. Shefaly, thanks for writing this! Very topical and certainly not only for the Indian society! I have worked in many countries around the world where incidents of work stress, depression, anxiety, mood and personality disorders have been quite often and the treatment has always been the same: ridicule, sarcasm, discrimination and further isolation. In most cases the story ended up with the ‘crazy’ employee getting fired which was used as a kind of a threat from the managers to the rest of the employees who dare to show such symptoms! Unfortunately, most of us in the western and developed world are still very illiterate regarding mental illnesses, their causes and their treatment.

    Comment by Ioanna Boulouta — July 9, 2007 @ 5:26 pm

  12. Thank you all, for so many thoughts and messages.

    SR: I am glad you feel optimistic about this. The need for it is understood; now how about some action from us all? Thanks.

    KS: If a jolt is needed, does that make the Indian workplace very different from an Indian family where only a heartattack will make an Uncle-ji start walking daily and an Auntie-ji stop putting ghee-ka-tadka in his daal everyday? But you raise a serious issue about lack of health literacy too which is probably worth a longer discussion. Thanks.

    Little Indian: Thanks for sharing your views. I think disability based discrimination was outlawed recently in India, but having a law and having it properly enforced are two different ball-games, no? After all dowry has been illegal for ages, has it not? Some of my well-educated MBA friends got married with trousseaus whose value exceeded that of an entire London detached property (which I assure you is a lot of money). A complex of social and educational and behavioral factors have to be at play for a law to be effective, I think. What do you think? And thanks for the topic suggestion. I will keep it in the folder as it needs some research before I can write a plausible piece. Thanks again.

    Nikhil: You are right. Sorry I mis-read your remark, or rather interpreted it too narrowly. Very apt – perhaps I will scratch some surfaces subtly now and may return to this later. Thanks.

    Ioanna: Thanks for demonstrating how Indians are in great company! :-) Health illiteracy appears to be a global problem for me and in each problem there is an opportunity dying to get out. Thanks again.

    Comment by Shefaly — July 9, 2007 @ 6:09 pm

  13. Came to your site through http://diggindianews.com... correctly said. I am still not sure how many managers would want to reduce the workload from the employees and the workspace at this moment. I am a software professional at a MNC in india and the manager does go out of the way to help us cope with the work load. But, still the work stress and the high demand of work keeps us under stress most of the time.

    Comment by Mohan Singh — July 9, 2007 @ 6:15 pm

  14. Thanks Shefaly, for reading my ramble.
    You said,

    “A complex of social and educational and behavioral factors have to be at play for a law to be effective, I think. What do you think?”

    Or one successful litigation for 7-8 figure sums, which will leave a precedence. That will make the employers sit up and take notice.
    Trade Unions have a role to play too.

    Don’t talk about our dowry system. It makes steam come out of my ears.

    Comment by little indian — July 9, 2007 @ 8:08 pm

  15. Mohan Singh: Thanks for sharing your views. Stress is an important contributor to mental health issues, so that is a key issue in the workplace. Thanks.

    Little Indian: A successful litigation will require a case to come to court. I would not like even to begin to talk of the backlog in the Indian judicial system! Just like the dowry system :-/ Many ‘manager’ like jobs are not covered by trade unions though. Thanks again for reading.

    Comment by Shefaly — July 9, 2007 @ 8:47 pm

  16. Everyone seems to say the same thing. But I am not sure what one would do if you were that manager or a colleague dealing with this issue.

    And it’s not just Indians, it’s others – Asians, Westerners, Africans and you name it – who doesn’t have stake in that sick person’s life, that discriminate. I think we achieve little by blaming tradition and illiteracy (in these matters). Learning about and being informed is more important. I still don’t know what to do when someone goes into seizure (saw it at least twice when I was in school many years ago) other than getting a doctor.

    Depression, whether working hard or not, is probably one of most wide spread sickness for most people at some point their life. Family and friends do come to aid, after initial confusion, for most Indians at least. What about drugs? Are they widely available?

    Comment by Chandra — July 16, 2007 @ 12:15 am

  17. Chandra: As you rightly point out, awareness is the first step. As that old prayer goes \’tamasoma jyotirgamaya\’, from the darkness of ignorance to the light of wisdom..

    Awareness hopefully addresses prejudice of the kind that assumes that every mental health patient is dangerous, that they cannot carry on a normal life at work and outside work, that they somehow are different.

    If prejudice can be reduced, hopefully a better relationship can be built between a mental health patient and his/ her colleagues, friends and family. Even patients of paranoia have some strong relationships in their lives – for some it is the therapist, for others it is a friend or a family member. A strong support system can help societal rehabilitation of such a patient and resumption of near-normalcy in life.

    In action terms, this means:

    * Not being passive about prejudice. When I see prejudice, I address it. Admittedly it makes me \’difficult\’ for some people but sowing a seed of doubt in such people\’s heads about their views is what I aim to accomplish.

    * If you are a manager or a leader, you may want to initiate an awareness programme for other managers and non-managers on how to deal with such issues.

    As for drugs, yes, they are available. But in my observation in India, many health insurers do not cover mental health incidents and treatment. Good psychiatrists are few and far in between, and being like \’gold dust\’ charge accordingly too! Behavioural therapists are even rarer. Malpractice is common with general practitioners with no psychiatric training sometimes prescribing anti-psychotic drugs which is wholly inappropriate. Patients have no recourse, of course. Stigma prevents people and their families from seeking periodic reviews which means that despite 2nd generation drugs being available, some old patients are still on 1st generation medicines. Such periodic reviews are also very expensive and thanks to a melange of health insurance industry practices and societal stigma, the patient needs to fork the cash out him/ her self. Not good, is it?

    My consumption of Indian media leaves me very disappointed. We do not discuss important things related to health at all. When we do, either they are in abstractions (such as cinema) or they are about reinforcing common, often wrong, beliefs and impressions. May be that is why people believe all sorts about seizures too! I am considering an on-the-ground initiative which is shaping up in my head right now but not enough to share yet.

    Thanks again.

    Comment by Shefaly — July 16, 2007 @ 3:37 pm

  18. [...] Posted by as Uncategorized social isolation, increasing economic disparities and such inevitable joys of globalisation and industrialisation, the numbers of Indians with chronic depression, anxiety, mood and personality disorders, and eating disorders are only … article continues at Shefaly brought to you by Depression and Clinical Trials [...]

    Pingback by   Mental health in the workplace: Food for thought by depression.vahalo.com — August 3, 2007 @ 7:53 am

  19. A very well written article. Unfortunately mental health isn’t openly discussed as much as it should be. Maybe one day it will be.

    Comment by Bobby Capps — January 22, 2008 @ 4:52 am

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