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A global report finds that 18% of global depression cases emanate from India.  (Photo: iStock)
A global report finds that 18% of global depression cases emanate from India. (Photo: iStock)

The corporate hush over mental health can prove costly

India Inc should lift the shroud of silence over it by making it a high-priority concern for chief executives

The covid-19 pandemic seems to have increased attention on mental health issues at workplaces, going by the number of articles in the media. The World Economic Forum had featured mental health as a global challenge. The head of Blackrock, the $6.5 trillion investment firm, has people looking into mental health challenges and their implications for companies and society as a whole. More and more CEOs are turning their focus to mental health, given the big issue that it has become.

A global report finds that 18% of global depression cases emanate from India. Another survey of 200,000 professionals in India found that about half of them suffered extreme stress at work. Adjusted for population size, India may rank first in the incidence of mental disorders.

The workplace is a major source of mental affliction, especially this covid year, with high anxiety being experienced over careers and financial stability. Research suggests that nearly 80% of employees find their jobs no less stressful now than before, and 75% say they don’t have good friends at work. Trillions of dollars could be lost by way of productivity losses. Employers should learn and educate their staff about this problem.

Companies need to stop treating mental afflictions as less important than physical illnesses, and provide more comprehensive coverage as part of their medical benefits, while working to reduce the stigma associated with these. Enterprises and mental healthcare providers need to employ treatments that use the latest findings of neuroscience research. These studies promise effective treatments for conditions such as anxiety and depression.

Unfortunately, many people with serious mental illness do not receive care. About a third of US adults with major depression do not get treatment, and the figures are comparable for other forms of mental disorders. Not many Indian companies and insurance providers cover mental health as part of their policies. They seem not to have realized that they bear a lot of the costs of stress-affected workers. It is imperative that employers address mental health issues, not just by providing medical benefits, but also by fostering a workplace culture of good physical and mental health through management practices that promote well-being.

Employers and governments need to do more. The Indian government should follow the US administration in passing a mental health parity law, mandating equal coverage for mental and physical illness. The big gaps that exist in coverage and access need to be closed. Even in the US, 2015 data shows that bills for behavioural care were 4-6 times more likely to be borne out-of-pocket than medical or surgical care, and insurers paid 20% more for the same types of care than they paid addiction or mental health specialists. Clearly, employees have more difficulty accessing mental healthcare and pay more for it, which deters many from seeking professional help.

Another deterrent is the stigma associated with a loss of mental health. Another difference comes from the sense that a mental affliction is not a “real" illness like cancer, which is completely incorrect. Neuro-imaging studies done at Stanford University show physiological changes in the brain associated with depression.

Keeping mental health issues hushed up and making access to care for it more costly and difficult only leads employees to hide their problems instead of having them addressed, which tends to perpetuate the overall problem and push up eventual costs.

In the current work-from-home era, many companies have sought the help of experts like MHFA-India and Pre2Doc to educate employees on mental suffering, encouraging them to seek help and offer support to colleagues who might be struggling with such issues. More employers should make such moves to get mental health out of the shadows.

Most employers have underemphasized mental health in part because they have not understood the scope of the problem. People hide mental disorders because they don’t think of these as “health" related, and see treatment options as unbounded in scope and even ineffective. That is why recent advances in developing a precision psychiatry approach to the diagnosis and treatment of depression may be vital.

A number of studies relate mood disorders such as anxiety and depression to particular dysfunctions of brain circuitry. When neuroimaging-derived diagnoses are matched with treatments, patient improvement rates are observed to be much higher.

Unfortunately, there remains a large gap between scientific advances and their application in clinical practice. In some sense, this is not surprising. The implementation of clinical guidelines is a significant challenge in all branches of medicine.

In mental health, that problem is compounded by the factors mentioned earlier. Nonetheless, there do exist more and less effective treatment regimens, depending on the specifics of the brain circuit dysfunctions. Companies should join hands with their group insurance providers to push for using the most up-to-date evidence-based protocols in treatment, just as they do with physical health treatment.

Mental illness is enormously costly, both to employers and society. Yet, it remains stigmatized, underinsured and woefully undertreated. Employers and governments should act swiftly on the matter and make lives less depressing for people.

Jeffrey Pfeffer & M. Muneer are, respectively, chair professor of organisational behaviour at Stanford Graduate School of Business, and managing director of CustomerLab.

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