Article: Corporate India's mental health crisis

Corporate Wellness Programs

Corporate India's mental health crisis

This column will seek to explain why the problem of mental illness in corporate India is rapidly growing to crisis proportions and the reasons it is likely to be immune to our existing cures.
Corporate India's mental health crisis

There have been many suicides by managers and employees in corporate India but it took the death of Cafe Coffee Day owner-promoter V G Siddhartha on 29 July 2019 to focus national attention on the pressures and tribulations of business leaders. The press and the public speculated not only on the myriad tensions he experienced but on why he did not seek help from family, friends or mental health professionals to find a less tragic resolution to his problems. While there is no doubt that people at the apex of the corporate pyramid face a unique set of anxieties, there is no reason to believe that employees in less exalted positions find their problems any less terrifying and for many of whom asking for help is as unthinkable as it was for the ill-fated Siddhartha.

"A 2016 study involving over 6,000 employees in multiple cities [in India] … found that 80 percent of the respondents exhibited symptoms of anxiety while 55 percent had symptoms of depression. A bigger worry! The study found that between 2008 and 2016, the risk of suicidal behavior in India nearly quadrupled —from 2.1 out of 10 employees to 8.21…. '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."1

This column will seek to explain why the problem of mental illness in corporate India is rapidly growing to crisis proportions and the reasons it is likely to be immune to our existing cures. We shall then look at some newer tech solutions as well as suggest how a few, long-underutilized remedies can be deployed in new ways to address this growing menace.

A 2016 study involving over 6,000 employees in multiple cities [in India], found that 80 percent of the respondents exhibited symptoms of anxiety while 55 percent had symptoms of depression

Causes and aggravators

Several of the mental health problems associated with work have been with us at least since the time mass production became the preferred technology for high-volume manufacturing and some even go back to the industrial revolution itself. Who can forget the twitching malaise and the nervous breakdown that afflicted the tramp (played by Charlie Chaplin) in Modern Times? The sad fact is that a hundred years later, with all the advances in management theory and work psychology, we have come no closer to finding answers to the mental devastation caused by deadening work. Not only have we continued to allot repetitive work to the majority of the operatives in the remaining non-automated shop floors in India, the other jobs we have created in high numbers (e.g. the delivery staff for e-tailers) are no less routine and even more stressful.2 If we could have ever taken solace in the fact that soul-destroying work was the lot of those who neglected to educate themselves adequately, the last couple of decades have seen unedifying spectacles such as the mass underutilization of hundreds of thousands of people qualified as engineers, being subjected to the drudgery of routine coding by our software majors.3 At forums where HR practitioners need to impress each other, we extensively expound the benefits of 'flow'.4 We would do well to remember that 'anti-flow' is an equal reality: one predominantly caused by repetitive work that uses substantially less than the full potential of a human being.

Going further back, industrialization itself brought many mental maladjustments, some of which are evident even today.5 The crop of mental maladies harvested by the first waves of people moving from the relative self-regulation of agricultural work to the regimen demanded by factory jobs tended to become less acute in a generation or two. On the other hand, psychological ailments brought on by the uncertainties surrounding progression, earnings and even tenure, were hardier plants and have occupied even larger parts of the work landscape in recent times. Impermanency of tenure, in particular, has received a hugely ruinous fillip with the growing contractualization and GIGification of work.

Unlike physical ailments & disabilities, which employees rarely expend too much effort in concealing because they are generally received with sympathy and helpfulness from colleagues and supervisors, mental illnesses are hidden away for the justifiable fear of the reactions they elicit in the workplace

Another causal factor aggravated considerably nowadays is what is frequently referred to as 'burnout', which is supposed to be an acceptable (and sometimes even desirable) term for describing mental health problems at middle and senior levels in organizations. The 70-80 hour workweeks, impossible job demands and terrifying supervisors that are prime predictors of 'burnout' were very much present in the seventies when some of us started our careers. What saved us and our predecessor executives were our spouses, who took on less demanding jobs than they were fully capable of doing and managed domestic affairs so well that we scarcely had had to deal with any significant demands from that front.

Gender opportunities have rightly become more (if not yet fully) equal since those thoughtless days. Not only does this put an additional demand on men to give priority to home and family matters (which people of my generation had blithely ignored), but is even more taxing for women seeking to make careers because (even if their spouses are more understanding) society still puts the prime onus for home management on them. It is not surprising 'burnout' rates have been creeping up steadily. 

Women face one more source of mental stress and consequent trigger for mental illness. Particularly those who break any glass ceiling for the first time have to cope with closed clubs, snide comments and having to deliver twice as much as the dominant population in order to be accepted. Some take solace from comparing the fire they draw to Nelson’s Redoubtable as it revolutionized naval tactics by heading the column of British ships against the Franco-Spanish line at Trafalgar.6 Others are sobered by thoughts of being kissed by Hardy at the end of the proceedings. Jokes apart, women are only the first exemplars of the discriminatory pressures every outgroup faces, particularly when its numbers are too small to find companionship and support from similar others. The tragedy of Payal Tadvi at Nair Hospital in early 2019 is a sad case in point of the mental stress that can be caused by dominant group exclusionary pressures.7

The last major source of mental illness at the workplace, which earlier generations did not have to cope with, is brought on by technology and particularly the social media. "Numerous studies identify connections between social media use and negative outcomes such as increased depression, anxiety, compulsive behavior, loneliness, and narcissism."8 There are many interpretations of the causal linkage between social media use and the form of mental illness it accentuates but no one (other than Zuckerberg, perhaps) doubts the beginning and end point. Particularly in the younger generation, it is not only the aberrations directly caused by social media that can be damaging. It is equally worrisome that a large range of mentally, physically and socially rejuvenating activities are crowded out by the solipsistic, cloud-based confinement imposed by (over)smart devices. 

Another problem that has no name

A single word captures the reason mental illness is among the least tractable problems for corporates to solve or even ameliorate. Stigma. Unlike physical ailments and disabilities, which employees rarely expend too much effort in concealing because they are generally received with sympathy and helpfulness from colleagues and supervisors, mental illnesses are hidden away for the justifiable fear of the reactions they elicit in the workplace. "Persons with mental illness often have to struggle with a double problem. First, they have to cope with the symptoms of the disease itself.…. Second, the misunderstandings of society about the various mental disorders result in stigma…. As a further complication, some people with mental illness may accept the common prejudices about mental illness, turn them against themselves, and lose self-confidence. The latter is referred to as ‘self-stigma’…."9

When persons suffering from anxiety, depression or even more serious mental health problems cannot admit even to themselves that they need help, it is extremely unlikely that they will turn to their friends, leave aside the counselors and other organizational support options provided by progressive corporates.

Before blaming the afflicted with cowardice or worse for not facing up to their problems and seeking readily available help, let us look at the rational reasons that justify such concealment. I personally know cases where supposedly closest friends started distancing themselves from the individuals who made the mistake of revealing their condition or whose symptoms could no longer be concealed. The reactions of those in arm’s length working relationships, with no affect capital to dissipate in the first place, are far crueler. Mentally ill people can, if anything, be even more sensitive to and less capable of coping with the malicious humor that roasts them behind their backs but ultimately trickles back to them through tattlers whose intentions may be bona or mala-fide but whose impact is invariably devastating. Worse still are the unfeeling office comedians who think their innuendos and jibes in the presence of the persons concerned will not be picked up by the latter or who couldn’t care if they are.

What about more senior managers and HR? Surely, they have a more sympathetic and helpful attitude to mental illness. Don’t bet on it. Of course, they pay lip service to progressive views, line up counseling services and sometimes even extend medical insurance cover for mental illness treatments. But ask them (or yourself for that matter), if a choice has to be made between two people for a top role and one of them has been availing of the company’s progressive mental health counseling program, which of the two will be picked for the prized position? Do we seriously expect people to come out with their mental health problems and openly seek help? It ain’t gonna happen.

The only way to crack this nut (poor choice of idiom) is to provide an avenue that guarantees absolute anonymity to the persons who need such assistance.

Tech to the rescue

We have already seen how the ubiquity, round-the-clock presence and self-image seesaws imposed by tech (particularly social media) take a heavy toll on mental health. Fortunately, recent tech breakthroughs also provide the means to break through the Chakravyūha of the stigma that impedes us in tackling mental illness substantively and on a large scale. 

With rapid improvements in Artificial Intelligence, each passing day brings more sophisticated and convenient apps for both diagnosis and preliminary treatment of mental illnesses.10 A considerable body of research is already available in support of the efficacy and ease of dissemination of these delivery modes.11 While lowering of costs and helping to cope with the shortage of mental health specialists are obvious advantages, from our point of view, assured anonymity is the biggest breakthrough bot-based diagnosis and basic therapy brings to employee wellness programs.

Here is one model for putting these technological advances to work. Each organization would need to provide access to a mental health platform for all employees, regardless of level and type of contract. Under conditions of total anonymity, the platform would provide the following five services:

  1. A diagnostics module that would help an employee figure out whether s/he has a mental health issue, how serious it is and its tentative classification.
  2. A preliminary guidance module which would provide AI-based suggestions of simple dos and don’ts as well suggest activities which can give relief to the specific types of disturbance the diagnostic module reveals. The next section suggests the kind of therapeutically useful activities organizations can consider providing.
  3. An interphase bridge to an array of telephonic counseling services from which one or two would be recommended for the individual based on the diagnostic outcome. In terms of sequencing, this may precede or substitute the preliminary guidance module.
  4. An interphase bridge to a panel of clinical psychologists and psychiatrists. While it would theoretically be possible to trigger this bridge immediately after the AI diagnostic, it would more usually be preceded by the telephonic counseling bridge. 
  5. A module for following up therapy sessions and providing on-line exercises for ongoing low-intensity support. 

Apart from the platform itself ensuring anonymity, it is important that the bridges (3 and 4 above) do not yield employee identities or individual diagnoses to the company (collective data could be useful for remedial policy initiation). Hence the algorithm built into the platform would need to be able to assign telephonic counselors or psychotherapists based on the monetary limits and other guidelines adopted by the company for which the individual works. Since most health insurance schemes do not cover mental illnesses, the complication of bringing insurance companies into the workflow would probably be avoided.

Since most health insurance schemes do not cover mental illnesses, the complication of bringing insurance companies into the workflow would probably be avoided

The platform requirement would essentially be the same for all companies, bar the cost parameters that might be differently specified for the bridge interfaces to counselors and therapists. As such, it would be pointless and inefficient to incur the platform development cost separately in each company. Moreover, a platform hosted outside the company would further assure employees that the information they put into it or the treatments they derive through its agency will remain confidential. I have already suggested to one of India’s leading chambers of commerce and industry to develop such a platform for its members. If they choose not to do so, it might be a very viable commercial proposition for health providers or medical insurance firms to consider.

Until Indian industry shakes off its addiction to the excessive use of contract labor, HR managers will have to share the guilt for the inescapable mental trauma suffered by huge swathes of the Indian working population

Promoting mental health

Having signed up for the kind of platform we have described and configuring its linkages and limits with counselors and therapists, can HR wash its hands of the matter? Not by a long shot.

In the first place, we have the concentrically widening set of employment-related stressors, starting from repetitive, distasteful and hazardous work, progressing through toxic supervisors, peers and team members (who are extra-lethal for disadvantaged groups), with a way-point at unreasonably pressured targets with the bell-from-hell to toll the demise of laggards and culminating with zero-privacy (eg fish-bowl open offices) or extremely isolated (including overmuch working from home) working environments. None of these are individually sufficient to disturb the mental balance of all employees – otherwise we would have no sane ones left. However, what is equally incontrovertible is the mental havoc these factors can play in combination with the equanimity of those employees who are already high-strung, anxious, depressed or undergoing familial and other strains. Making substantial improvements in all of these mental health hazards is highly desirable but may not be easy of achievement – at least in the short run. Hence it becomes all the more important to provide a sense of corporate purpose and belongingness, remove the most noxious supervisors and create spaces where social interactions can relieve work-environment handicaps. In the last resort, HR can also seek to doctor recruitment profiles to choose people whose personality-skins are thick enough to withstand the particular malaise which that organization or job particularly causes. There is one super-stressor, however, which no palliative measure can remedy – the one caused by insecure and contingent employment. Until Indian industry shakes off its addiction to the excessive use of contract labor12, HR managers will have to share the guilt for the inescapable mental trauma suffered by huge swathes of the Indian working population.

The greatest benefit of tackling the mental health impairments that have so far been resistant to corporate ministrations may not come simply from making a large number of sub-performers deliver adequately

There are also positive steps HR can take to ameliorate work stress and provide non-stigmatized therapeutic activities. There was a time when most large corporates in the country ran hobby centers, dramatics societies and adventure clubs, without realizing the mental health benefits these provided. In our heedless efforts to prune expenses that could not be convincingly allocated and explained as individual CTC, these fell by the wayside or became ill-funded ghosts of their former selves.13 Many of these will have to be revived in more modern avatars if we are to provide cost-effective and stigma-free therapeutic options on a mass scale. There is now research-based evidence to show how, apart from the activities mentioned earlier, art, dance, meditation, exercise (though there is an unhealthy form of excessive exercise that needs to be guarded against), expressive writing and volunteering can, very economically, prevent mental illness or aid in recovery from it.14 

Freeing beautiful minds

The greatest benefit of tackling the mental health impairments that have so far been resistant to corporate ministrations may not come simply from making a large number of sub-performers deliver adequately. It will be the result of freeing the most brilliant minds that have been shackled by their mental fears and dark moods from giving their best at work. John Nashes may be far and few between but each organization has its share of geniuses, many of whom are held back by some or other kind of mental block for which they are too petrified to seek help. After all, as Aristotle wrote, "No great mind has ever existed without a touch of madness."

The real idea generators and creative geniuses may need just a touch of adjustment and interpersonal capability enhancement to be converted from ridiculed loners to highly valued contributors to the organization's core competencies

I would not hold much hope that leaders who are themselves tinged with a degree of psychopathology15 (and who are responsible for some of the mental strain on the rest of the employee population) will turn to our platform in large numbers. Unless such psychopathic leaders face a major transformative experience or crisis (and perhaps not even then) they are unlikely to think any entity outside of themselves can provide them guidance or succor. If at all they seek counsel, however, it is more likely to be from a source that has no connect with their own company and its people.

On the other hand, the real idea generators and creative geniuses may need just a touch of adjustment and interpersonal capability enhancement to be converted from ridiculed loners to highly valued contributors to the organization’s core competencies. There are some who feel that a tortured mental condition or at least a degree of mental imbalance is essential for truly unique outcomes, particularly in the domains of art and music. A more balanced hypothesis is a shared vulnerability model, the idea that a person's chances of mental illness and of being creative may stem from the same factors (eg high IQ or strong memory) but that neither is the cause of the other.16 If that be so, countering mental illness symptoms should give more play to creative impulses rather than diminish them. An interesting, if anecdotal, substantiation can be found in Ellen Forney’s account of her struggles with bipolar disorder and the preservation of her creativity through it all.17

The platform and adjunct changes described in this column should make it easier for mavericks and potential inventors among employees to contribute their innovative best as their mental health burdens are lightened. Perhaps no words drive home this conclusion better than the ones Rob Siltanen crafted for Apple’s 'Think Different' campaign: "Here's to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do."18

References:

  1. Nelson Vinod Moses, Bosses must take care of employee mental health, The Mint, 6 September 2018.
  2. Amlan Mishra, How Do Zomato, Other Apps Actually Treat Their ‘Informal’ Workers?, The Quint, 20 August 2019.
  3. Visty Banaji, The Golden Lotus under India’s software deities, People Matters, 17th November 2016,
  4. Mihaly Csikszentmihalyi, Flow: The Psychology of Optimal Experience, Harper Perennial Modern Classics, July 2008.
  5. M Obschonka, M Stuetzer,P J Rent-frow, L Shaw-Taylor, M Satchell, R K Silbereisen, J Potter, S D Gosling, In the shadow of coal: How large-scale industries contributed to present-day regional differences in personalit and well-being, Journal of Personality and Social Psychology, November 2018.
  6. David Davies, A Brief History of Fighting Ships, Robinson Publishing, March 2002.
  7. Shah Alam Khan, Payal Tadvi’s suicide highlights, once again, discrimination in medical institutions, Indian Express, 29 May 2019.
  8. Amelia Strickland, Exploring the Effects of Social Media Use on the Mental Health of Young Adults, HIM 1990-2015, 2014.
  9. Nicolas Rüsch, Matthias C Angermeyer, Patrick W Corrigan, Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma, European Psychiatry 20 (2005) 529–539.
  10. Artificial Intelligence In Mental Health Care, The Medical Futurist, 25 June 2019.
  11. John A Naslund, Kelly A Aschbrenner, Ricardo Araya, Lisa A Marsch, Jürgen Unützer, Vikram Patel and Stephen J Bartels, Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature, Lancet Psychiatry. June 2017.
  12. Visty Banaji, Udta Udyog – Industry’s addiction to contract worker, People Matters, 15th September 2016.
  13. Visty Banaji, Imitation is the sincerest flattery - but the worst strategy, People Matters, 5th September 2019.
  14. Luciano L'Abate (Editor), Low-Cost Approaches to Promote Physical and Mental Health: Theory, Research, and Practice, Springer-Verlag, 2007.
  15. Karen Landay, Peter D Harms and Marcus Crede, Shall We Serve the Dark Lords? A Meta-Analytic Review of Psychopathy and Leadership, Journal of Applied Psychology, August 2018.
  16. Shelley H Carson, Creativity and psychopathology: a shared vulnerability model, Canadian Journal of Psychiatry, March 2011.
  17. Ellen Forney, Marbles: Mania, Depression, Michelangelo, and Me: A Graphic Memoir, Avery, 6 November 2012.
  18. Rob Siltanen, The Real Story Behind Apple's 'Think Different' Campaign, Forbes, 14 December 2011.

 

 

Topics: Corporate Wellness Programs, Technology

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