Stop mental health from becoming an epidemic

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A short conversation about mental health.

Arvind Passey
02 July 2019

The biggest and the most formidable asset for any country is neither its geography nor its history. No, it isn’t GDP as well. The history, geography, economics, politics, and everything else that matters remains at best a sub-set of people who reside in a country. It is people who build and maintain this corpus of power. Quite obviously, their mental health is what can undo every good work that everyone from politicians to bureaucrats and from professionals to its skilled workforce painstakingly construct. The unskilled and those who stay at home and do what must be done are equally vital when any discussion on mental health is approached. In short, the attack of mental oscillations includes everyone with no barriers to age, gender, beliefs and economic status.

William Styron, author of ‘Darkness Visible: A Memoir of Madness’ writes that ‘the pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne. The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.’ What is playing with the mind are undefined chunks of ‘emotional abuse, the insults, insinuations, criticism, and accusations slowly eat away at the victim’s self-esteem until he or she is incapable of judging a situation realistically’, to quote Beverly Engel, and the final outcome is that the victim generally begin to blame themselves for what the world perceives as abuse.

Sumedha Jaggi

Since graduating with a Masters in Industrial/Organizational Psychology from University College London (UCL), Sumedha has been working with Mercer Mettl in the field of Psychometrics and Behavioral Assessments. She designs, develops and delivers behavioral competency-based assessment solutions for corporate hiring and L&D. Outside of work, Sumedha remains closely involved with non-profits geared towards education and mental health, and in her free time, she enjoys experimenting with different fitness routines.

Mental Health and Well Being at Work

In every organisation, there exist implicit ‘display rules’ regarding what is considered appropriate behavioural conduct. These rules are generally reinforced through socialization, becoming a part of the professional ethos over time. However, over the course of a work day, employees feel many different emotions, some of which may conflict with display rules. Take, for instance, working with a demanding or an angry client, or getting into an argument with a co-worker. Such situations force us to engage in ‘emotional labour,’ a phenomenon that entails faking emotions that are not felt, or suppressing those which are.
Literature shows that employees who engage in emotional labour are likely to experience burnout. ‘Burnout’ is an occupational phenomenon that is defined as, “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” (ICD-11). It is characterized by three dimensions- feelings of energy depletion or exhaustion, increased mental distance from one’s job, and reduced professional efficacy.
The growing knowledge on burnout and its impact on mental health and well being enables organizations to identify and reduce workplace stressors. To begin with, organisations should set clear role-based expectations and ensure easy access to resources required to meet those expectations. Organizations should also encourage social support within teams in a bid to create a healthy work atmosphere. Lastly, managers should be aware of the signs and symptoms of burnout and immediately ensure interventions are sought (e.g. personal counselling and training) for those who may need them.

Statistics say it all

Studies point out that serious mental disorder doesn’t differentiate much between the urban and rural divide and isn’t ever bothered about age, gender or economic differences. One WHO study reports ‘at least 6.5 percent of the Indian population’ being more than threatened. The appalling part of this study is that it reported an extreme shortage of mental health workers and the ratio was as low as ‘one in 100,000 people’ in 2014. As a result of this, we in India we have a high suicide rate that is 10.9 for every 100,000 and a majority of these are reported from the less than 44 years of age group.

A report published in IndianPsychiatry.org mentions nearly 50 million Indian children suffering from mental disorders and this is just one part of the entire statistical data. The same report states that major illnesses affecting both kids and adults, include depressive disorders, agoraphobia, disabilities affecting intellectual status, autism spectrum disorders, psychotic disorders, anxiety disorders, depression, schizophrenia, substance abuse, and seizure disorders.

An article published in Economic Times mentions that ‘42.5% of the employees in the private sector of corporate India suffer from depression or some form anxiety disorder. That’s almost every second person. Studies indicate that

Its ok to not be okay

According to WHO, about 450 million people worldwide suffering from mental or behavioral disorder. Shocking as it may sound but 1 person commits suicide every 40 seconds. These numbers are scary but the talk about mental health is still a taboo among the masses.
There is now a more than ever need to incorporate mental fitness in our daily routine. While Yoga and meditation are being promoted and can be helpful, one must understand that only when one opens up and talks about these issues with their friends, family or goes ahead to seek medical advice will alternatives like yoga serve as a viable catalyst.
Understand this. Its ok to not be okay. Talk it out. It helps.

Dr. Aakanksha Mehrotra

Aakanksha is a public health
professional who loves to
learn new things via reading
& travel. Strongly believes
that meeting new people
provides the best education.

Shivani Khera Khanna

Shivani Khera Khanna is a founding member and the Chief Marketing Officer at MeeHappy Wellness. MeeHappy offers employee wellness programs that focus on holistic wellness with a special emphasis on mental health.

Women and mental health

Today’s educated, urban woman wants it all! The number of opportunities created by economic liberalization and coupled with the desire to contribute equally towards the financial security of her family is making the woman of today go all out. She is establishing herself at the work front and is, at the same time managing the disproportionately large share of the responsibility of the house and kids. While women are breaking grounds by handling both fronts pretty well, the truth is that domestic and office work does take a toll on them – not just physically, but more so mentally. Add to these issues specific to women like gender inequality, bullying, undue expectations from family, inability to question some set patriarchal norms, no discourse to help and so on, women are twice as likely as men to develop common mental disorders like anxiety and depression and research substantiates the same. A study by Lancet* puts suicide as the number one cause for death in women and teenage girls in India, surpassing maternal mortality.

two-thirds of people who have suffered from depression face prejudice at work or while applying for new jobs. The World Health Organization estimates that India will suffer economic losses amounting to a staggering 1.03 trillion dollars from mental health conditions between 2012 and 2030.’ If you think that our politicians are not aware of this, think again. Ram Nath Kovind, the President of India has talked about the ‘mental health epidemic’ and said that ‘our National Mental Health Survey, 2016 found that close to 14 percent of India’s population required

active mental health interventions. About two percent suffered
from severe mental disorders’. However, there is still a severe
lack of nationwide data which means that mental health issues
need to be taken on a war footing. This is the only way work on
viable solutions will be possible. It is obvious that solutions include
the availability of medications as well as professionals trained to
address these issues.
What is more serious is that studies point out the use of
damning terminology like ‘stigma’, ‘retard’, and ‘mad’ and the
overwhelming dominance of an unfounded prejudice among nearly
71 percent of Indians. One of the contributing factors could be a
woeful absence of professionals to deal with mental health issues.
A report published in one of the dailies says that ‘mental health
workforce in India (per 100,000 population) include psychiatrists
(0.3), nurses (0.12), psychologists (0.07) and social workers (0.07)’.

Rimli Bhattacharya

Rimli Bhattacharya is a gold medalist in Mechanical Engineering from National Institute of Technology, and also holds an MBA in supply chain management. Her essay on mental illness in the anthology “Book of Light” published by Speaking Tiger Publications caught much attention in literary circles. Her writings have appeared in several magazines. She is also a trained classical dancer (Kathak & Odissi forms).

Mental health and suicides

So often we get to hear stories of suicides committed by young students of the prestigious IIT’s. While getting an admission in one of those premier institutions is a herculean feat achieved by only a handful then the eternal question arises – What made them take their life in spite of such a promising future ahead?
Time we acknowledge the importance of proper mental health among students. The research data reveals that students in these eminent institutes top the list when it comes to mental ill health. The constant need for good performance, tough syllabus, and parental expectations attributes largely to the mental maladies like depression, bi polar, schizophrenia, anxiety, obsession and suicidal tendencies in the young adults. The students are like pressure cookers without a safety valve.
We must realize that it’s a crime to keep high aspirations on a student to constantly excel in studies. We fail to realize the amount of stress we as adults are exerting on them. Introduction of mental health literacy courses among students and teachers both in the schools and colleges must be made mandatory. Rope in professional counselors for better advice. This will help in changing attitude towards studies and also in seeking help. Remember good performance among students is directly proportional to good mental health. This is only possible once we make studies a fun filled activity rather than a stressful affair.

What do these statistics mean?

Imagine 57 million individuals in India going about their daily work without even knowing how to deal with their ‘depression’. They do not know if it is some maverick biochemical imbalance causing their trauma or if it is related to their income not matching

their ambitions or just the fact that one of their loved ones is being missed. This is reason enough to believe that trained psychiatric staff is the need of the hour as most of these cases need customized solutions and answers.

Why hide subliminal voices?

Mental health doesn’t denote the absence of mental illness. Being mentally healthy simply means having positive characteristics to navigate all ups and downs in life. We all face disappointments, sadness, and anxiety at some point in life… and tend to ignore the emotional signs and messages that say that something is wrong. We then go ahead to bottle these vital issues in the hope that not talking or thinking about them will make them disappear. When a person runs a fever, he immediately takes medicine and proper rest and doesn’t push away corrective action in the assumption that fever unattended is fever gone. Similarly, seeking help for mental health issues is important. There is a need to set up counseling centers at schools, colleges and workplaces. A comfortable place free from biases provides support to grow as an individual and talk about mental health issues openly. This will help in catering to the developmental and emotional needs of students and also provide emotional support to employees at the workplace leading to resilience and consequently, healthier professionals and individuals.

Roohi Kapoor

Roohi is a Counselor at Rajiv Gandhi Cancer Institute and Research Centre. She holds a M a s t e r s i n A p p l i e d Psychology from Tata I n s t i t u t e o f S o c i a l Sciences. She enjoys painting and music.

Another shocking revelation that stats point out is that by 2020 around 70 percent of the world’s population aged sixty and above will be living in developing countries and 14.2 percent of them in India. This brings in issues related to loneliness and the utter lack of professional care for the elderly. We’ve already been reading about farmer suicides in the country and this is yet another serious issue related to mental health. More than 36,000 farmer suicides happened between 2014 and 2016. Talking of suicides, one must mention that the rate is fairly high even amongst students in India and this crisis is projected to become the biggest in the world by 2025. Are we prepared for all these issues?

All these add up to a sheer loss of productive involvement and if we are planning to be a force in the economic strata we must understand that mental health conditions are the second biggest cause of absences from work and a study pointed out that in the UK this led to a loss of 15.4 million work days annually. By the way, if figures from other countries matter, the estimated cost to the global economy due to depression and anxiety is US$ 1 trillion

Mental health in India - websites

• https://www.nhp.gov.in/world-mental-health-day_pg
• https://indspireme.in/2018/06/07/mental-health-websites-india-online-portals-resources-counselling/
• https://services.india.gov.in/service/listing?cat_id=50&ln=en
• https://www.india.gov.in/information-about-national-mental-health-programme
• https://hetv.org/india/health-medical-web-sites.htm
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479084/
• https://mohfw.gov.in/about-us/departments/departments-health-and-family-welfare/mental-health-division
• http://www.indiahealthcaretourism.com/
• https://en.wikipedia.org/wiki/Ministry_of_Health_and_Family_Welfare
• http://www.indiaenvironmentportal.org.in/content/447691/draft-rules-and-regulations-under-mental-healthcare-act-2017/
• http://icallhelpline.org/ten-mental-health-apps-and-resources-to-help-you-destress/
• https://www.whiteswanfoundation.org/
• https://www.who.int/features/2015/mental-health-care-india/en/
• https://www.downtoearth.org.in/news/health/here-are-the-top-10-things-weshould-do-to-improve-our-mental-health-61729
• http://www.amritahospitals.org/MediaGalleries/Mental-health-problems-on-therise-among-Indian-ad
• http://www.amritahospitals.org/MediaGalleries/Mental-health-problems-on-therise-among-Indian-ad
• https://happyaging.in/tag/mental-health/
• https://www.thebetterindia.com/139913/depression-websites-connect-talk-help/
• https://www.indianweb2.com/2013/07/10/30-health-wellness-websites-india/
• http://healthyindiachronicle.in/national-health-portal-transforming-health-sector/
• http://ihbas.delhigovt.nic.in/wps/wcm/connect/DOIT_IHBAS1/ihbas/home

per year in lost productivity. The answer to every issue dealing with mental health lies in not just changes in laws and regulations but also in the way each of us responds to those around us who have been touched by any of the issues mentioned. There are a number of people who believe that it is the therapist who matters but then there are others who may try to discover any of the myriad other solutions. I know of people who find solace and comfort in long heart-to-heart conversations and all they need is a listener. This may sound a bit frivolous but if going out to have a pint or two of a tippler soothes the brain, go for it.

Make sense out of the chaos

Glenn Close writes that mental health needs ‘more sunlight, more candor, and more unashamed conversation’. The truth is

that simply because a lot of people do not understand the right perspective, the journey within tends to get murkier until only darkness prevails. It is thus paramount that people talk about their feelings to make them less upsetting and less scary. let me add here that the hashtag with two simple sounding words #MeToo were as much about a form of protest as they were about dealing with a continually overwhelming struggle to persist and survive. All those in the throes of debilitating mental health terror must stand up and assert their needs, diffuse arguments and conflicts, and protect themselves as well as others from behavior that hurts and traumatizes. This is done better if one is surrounded by others who have equipped themselves with a better understanding of the issues that are at play. Yes, reading helps. So does the right consultation. I have known a lot of people who were living with guilt, besieged by hostile behavior, subjected

to unhealthy criticism, and were
drowning in low self-esteem. These
are the ones who need to feel good
every day and must be slowly
brought back to a position where
they are able to bounce out of their
universe of negativity. Friends and
family of those who have problems
dealing with mental issues must
proactively learn to be great
listeners, be ready to assess the
worsening situation and intervene
with compassion. Someone rightly
remarked that when voices in the
head become your enemy, the
pain that emanates can lead to
anger, misery, and sometimes, even
suicidal tendencies. We are talking
of people who need to exchange the
voices in their head with real-time
conversations with real people.
Conversations directed towards
them are one form of comfort that
such people seek without actually
asking or demanding them. Such
friendly interventions happen
spontaneously when people are
well-read. So yes, reading helps

‘ABC of Mental Health’ by Rachana Awatramani.
‘Feeling Good: The New Mood Therapy’ by David D Burns.
‘Understanding Mental Illness’ by Atul Kakar, Nundy M Chir, and Samiran
‘Think Like a Monk’ by Jay Shetty.
‘I Hate You – Don’t Leave Me: Understanding the Borderline
Personality’ by Jerold J Kreisman and Hal Straus.
‘Stop Walking On Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder’ by Kreger Randy and Paul T Mason.
‘Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy’ by Blaise Aguirre.
‘Let Him Not Sink – The First Steps to Mental Health:
A Manual for Adults Who Work Closely with Children and Adolescents’ by Samir Parikh and Kamna Chhibber.

Reading helps

One of the correct things to do, besides consulting a professional and besides browsing the net to read up on relevant issues bordering mental health and how to cope with it, is to read books. Reading clarifies and removes cobwebs of misunderstood notions and helps a person deal with issues in a pragmatic way. Those who suffer need people around them who are well read. A few books recommended by some of the experts that I talked to are listed here:
‘Side Effects of Living: An Anthology of Voices on Mental Health’ by Jhilmil Breckenridge and Namarita Kathait.

‘Shhh! Don’t Talk about Mental Health: Why Being Quiet Is No Longer an Option’ by Arjun Gupta.

There is hope even when the brain says NO

There is no standard normal. There can be as many ‘normal’ as there are people on this planet. Same is the case with brains that have decided to not to remain normal. What this means is that there are no set answers or solutions to mental health that needs intervention. Only one thing is certain… there is hope even when the brain says NO. 

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