Introduction

Erinda Shah is the Founder and the Managing Director of MHFA India. She has completed her MA in Social Work and has been working since 2000 with various international and national organizations like WHO, UNICEF, ActionAid, The Banyan to mention a few. She is trained as a Psychotherapist by the European Association for Psychotherapy, Vienna. She is a National Accredited Mental Health First Aid Instructor.

Please share your reflections on the evolution of mental health in India. How has this changed in India over the last decade?

A decade ago, and even until 2 to 3 years ago, mental health was typically associated with mental illness, though in reality mental illness and mental health are two completely different concepts. People are now starting to recognize and understand the difference. Mental health is absolutely a part of our day-to-day life. The WHO has defined and conceptualized mental health as a state of well-being. As I reflect on the evolution of mental health, ten years ago there were no conversations on mental health; the conversation was only about mental illness. The change has just started.

Mental health has come to the forefront in India since the COVID-19 pandemic. The pandemic was clearly the one watershed moment that has really changed everyone’s perspective and the overall narrative of mental health. The pandemic has brought significant attention to mental health. It's been a milestone as organizations are investing on well-being too. There is more attention and more investment in mental health now, more than ever before.

We have witnessed a twenty percent rise in the incidence of mental illness cases across the world. It is inappropriate to say that not everyone felt or experienced poor mental health during the pandemic. Persistence of poor mental health post pandemic was a wakeup call that it was not just a momentary need. Now, we witness more people talking about mental health which is emerging as a key component of overall health and well-being, being recognized by all. Our focus on mental health is gradually shifting from reactive management to proactive prevention strategies including self-care.

In the last decade at the macro level, the Mental Health Care Act 2017 was enacted which has brought a huge change in how mental illness is being diagnosed, treated, and managed. The focus has been human rights of people will mental illness. Initiatives with focus prevention and community care are yet to occupy the central attention.  

In recognition of the importance of mental health and well-being, the Government proactively launched the 24x7 Toll-Free Mental Health Rehabilitation Helpline KIRAN in 2020 by the Ministry of Social Justice and Empowerment in 13 languages to provide relief and support to persons with Mental Illness. A good number of tele-calling centers have been announced in the 2022 budget by the Government of India.  

The objectives of the tele-calling services are early screening, first aid, psychological support, distress management, mental well-being, psychological crisis management and referral to mental health experts.

It is also important to mention the efforts being made to regularize the professionals who work in mental health and assure more ethical services through National Commission for Allied Health Care Professions Act 2021.

In your view, why is mental health and well-being becoming a key priority for organizations in India? Do you see any differences based on the profile of companies such as the private sector and the public sector?

Mental health at workplaces reflects the mental health situation in society. Unfortunately, it can be summarized with a high prevalence of mental illness, a high gap of treatment and poor level of mental health literacy that mirrors in form of stigma, misconception, and prejudices.  High level of poor mental health has an impact on business performance, attrition, absenteeism etc. and therefore has a higher cost attached to it, very often silently. There is gradually a shift taking place where organizations are acknowledging that mental well-being is as important as physical well-being. Workplaces in India are an integral component of this transition as mental well-being is becoming a part and parcel of our day-to-day life. This is certainly the right thing to do.                                             

I truly believe that this is the right time for all organizations to spread knowledge and support mental health. There is a need for more awareness about mental health which has resulted in more conversations to address the stigma around mental health and an out-reach for help. Organizations need to preserve the well-being of their people and encourage them to look after each other.

Given the growing incidence of mental illness during the pandemic, mental health experts have been onboarded to help to workplaces resolve the issue or refer to external professional help such as a clinical psychologist/rehabilitation psychologist/psychiatrist.

The public and private sector is working in acknowledging the need to normalize the conversation and access to care in the regard to mental health problems and illnesses. I see the private sectors is working faster and in search of what’s next to introduce in the mental wellbeing domain. While public sector may need more time considering the large number of work force, diversity and spread across the country. For both sectors, it’s important to have their team empowered and involved to assure ownership and progress.  

What is your guidance to organizations to proactively promote mental health at work in India?

As is often discussed, mental health is a continuum which extends from being healthy to being ill across several parameters. Organizations therefore need to put in place resilient systems and forward-looking policies that address stigmas and support employees at work in being comfortable in bringing their authentic selves to work. Organizations should continue to provide employees with access to care including counselling services usually provided through Employee Assistance Programs (EAP).

It is important for organizations to adopt an integrated approach to well-being which includes prevention, treatment, and recovery. Initiatives must be undertaken to promote self-care among employees and as an important step towards a successful and impactful the need for quality mental health education for all.   As part of training programs on mental health, we talk about positive coping as well as negative coping strategies. I believe that organizations should be undertake proactive measures, actions and interventions and ask the key questions - Is it evidence based, does it keep my team safe and finally, is it ethical?  

The business case for mental health is very compelling for organizations to make investments in mental health. In your opinion, what should organizations in India do to prevent mental health conditions arising from work, be it anxiety or depression?

As mentioned earlier, mental illness has been there even pre-pandemic. It is a journey and a continuous process of investment and an ongoing awareness and education about mental health and mental illness. It is important to have regular conversations on mental health and focus on psychological safety. There is a need to emphasize on confidentiality of mental health discussions to build trust among people, to build empathy through skills and knowledge that prepares us on how to support one another.  Employees must be given access to reliable and professional care which may be in various forms. Organizations must be supportive of employees who may need to avail of therapy and medication. Yoga and mindfulness are some of the practices that also help in prevention which companies can easily adapt. While we are yet to have a legislation that protects mental well-being at workplaces, it is important for organizations until then, to provide for reasonable adjustments/ accommodation through leave policies, flexible time schedules and other innovative practices.

How can organizations deal with the stigma associated with mental health?

It is important for organizations to address the stigma around mental health as it has an impact on thoughts and beliefs, which impact actions and behavior and in turn builds the organizational culture. There are several myths around mental health which must be addressed for which people need to be encouraged to participate in awareness and training sessions.

A realistic and implementable well-being strategy is a good tool to be developed by organizations to guide actions and priorities. We have just started this journey and strategies need to be flexible as the awareness and acceptance increases among team members.  All the efforts should reinforce messages that well-being starts with self. Employees should be encouraged to actively participate in such internal initiatives so that they provide support to one another.  Sensitization sessions for line managers and senior leaders are some of the efforts that organizations must undertake, so that their actions and behavior are supportive towards their team members, including those who may be experiencing mental health challenges.

In your view, what should be the role of HR in mental well-being? What are the core skills that HR functionaries should develop to support mental health at work?

HR functionaries have the potential to play a key role in increasing overall confidence of people across the organization that promotes care for all.

HR teams should be equipped with basic skills as mental health first aiders. They should have a basic understanding of mental health and should be able to recognize signs, symptoms, and triggers for various mental health conditions. They should build the capacity to understand people at work, which includes empathy and other soft skills such as non-judgmental listening.

As I said, the journey has just begun and this time we need to all contribute and do it right.