A 33-year-old executive in the travel and hospitality sector had always considered herself a happy person, albeit one who had experienced a bout of depression in her teens when her parents were getting divorced. But her mother’s death last year changed everything.

The executive returned to work after a month’s compassionate leave, but, soon after joining, experienced nightmares and exhaustion due to lack of sleep. She managed to plod on for three more months before having a total breakdown. “Once I joined work, after a month, I was meant to go back to performing as before. I just could not, and that fear made me anxious," she says.

To get more time off work, she got leave notes written by a psychiatrist and started taking anti-anxiety and antidepressant medications, but nothing helped. Finally, fearing that she would eventually be fired, she decided to quit work to focus on her mental health. She moved back in with her family, which meant she could lean on them for emotional and financial support. “That took off a lot of pressure. I finally got the appropriate anti-depression and anti-anxiety medication that worked for me," she says.

The alarming numbers

A 2016 study involving over 6,000 employees in multiple cities conducted by 1to1Help, a Bengaluru-based employee assistance programme provider (EAP), found that 80% of the respondents exhibited symptoms of anxiety while 55% had symptoms of depression. A bigger worry? The study found that between 2008 and 2016, the risk of suicidal behaviour in India nearly quadrupled—from 2.1 out of 10 employees to 8.21. Between 2010 and 2016, more than 2,500 employees with suicidal tendencies reached out to the EAP provider for help, with 70% of them approaching it in the last five years alone. “Mental health is the single most important health issue in the workplace. This is not only because mental health problems, including substance abuse, are a leading cause of lost productivity and sickness, but because workplace practices can worsen or enhance the mental health of workers," says Vikram Patel, professor and research fellow, department of global health and social medicine, Harvard Medical School.

Research by the World Health Organization suggests that for every dollar invested in employee mental health, there’s a 4x return. Yet, according to research by EAP provider Optum Health International , only 10% of the 1.7 million registered companies in India and around 4,500 multinational companies run a formal mental health support programme, says Amber Alam, its vice president and head of business in the Asia-Pacific region.

It is not just that Indian companies are not providing employees with the necessary mental health support. They are also lagging when it comes to designing better human resources policies to reduce workplace-related stress. “According to the World Health Organisation, health is a state of complete physical, mental and social well-being, but all we do is focus on the physical aspect," says Samir Parikh, director, department of mental health and behavioural sciences, Fortis Healthcare.

At the workplace

Sanchana Krishnan, 25, an editor with an education start-up and a mental health advocate, was diagnosed with bipolar disorder and borderline personality disorder in 2013. During a brief period of struggle at work due to her psychiatric medication, she was seen nearly fainting by a senior colleague. When asked about it the next day, Krishnan tried opening up about her mental illness. To her shock, her worries were brushed off. “Don’t say that you are mentally ill! Everyone lives with some psychiatric conditions but no one talks about them."

Dr Parikh believes it may take another 5-7 years for changes in policy, culture and interventions to kick-in for any improvement in mental health outcomes at the Indian workplace. This is likely to be largely driven by MNCs bringing their global best practices to India and the fact that awareness around mental health has increased in the last 2-3 years.

Changing times

Sapient India, one of the few companies to offer mental health-related help, says 50% of its employees have used its mental health services. “We attribute this to more awareness and open communication regarding mental wellness, including regular trainings for managers and supervisors to identify signs of distress, and offer support when needed," says Kameshwari Rao, group vice president, people strategy.

The Mental Healthcare Act, 2017, emphasizes the rights of an employee, warns against discrimination and mandates that all insurance companies offer provisions for treatment of mental health-related illnesses. Royal Bank of Scotland (RBS) India, meanwhile, provides health insurance for its employees and their families that covers treatments relating to psychiatric and psychosomatic disorders. “We are part of initiatives like the ‘Time to Change’ pledge, which is UK’s biggest programme to challenge mental health stigma and discrimination. Additionally, RBS has webinars, a confidential 24/7 helpline, mental health guides, and an app to boost relaxation and de-stress," says Anuranjita Kumar, managing director, human resources, international hubs, RBS.

The former travel and hospitality executive, who is now recovering, set up a content and website design consultancy this year. Reflecting on what her employer could have done, she says: “Employees give so much to organizations. They should support employees in their time of need. If I was an employer I would have given my employee a couple of months off, with some paid component, and would have developed a programme to equip senior managers to be more empathic," she says.

Dr Parikh proposes a three-pronged approach—policy interventions in the company, developing a culture that encourages help-seeking and discourages overwork, and regular screenings. “All of this needs to be low-cost and rights-based where the confidentiality and privacy of employees come first." he says.

After all, as Patel says, there is a bi-directional relationship between mental health and workplace practices. And for any interventions to be effective, companies have to foster an open environment for disclosure of mental health problems, and make mental healthcare accessible.

End the stigma

Follow government mandated regulations or recommendations

■ Leverage global best practices and standards

Protect rights of employees and take their consensus when drafting guidelines

■ Involve key management executives and top leaders

Tie up with a competent EAP provider

■ Train middle managers and line managers to handle interventions and escalations

■ Ensure strong commitment to ending stigma, creating safe spaces for conversations, and awareness among employees on their rights and how to seek help

■ Ensure confidentiality and privacy, create an environment of trust and introduce a strict policy of non-discrimination

■ Have clear redressal systems against bullying or harassment

■ Introduce clear guidelines and rules to ease back into work those returning from a mental health break

■ Have annual health check-ups to screen for mental health issues

Identify an internal champion who will forward the cause. Recognize and reward employees who are mental health advocates

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