When Madalyn Parker, a web developer from Michigan, took to Twitter in 2017 to share her boss Ben Congleton’s response to a sick leave request, it went viral, sparking a conversation in corporate boardrooms across the world. Parker had asked for a day off to take care of her mental health. Congleton responded by encouraging her on to do so while applauding her honesty. The 16,000 retweets and the reactions to it were telling of the need to have conversations around mental health.

When the CEO responds to your out of the office email about taking sick leave for mental health and reaffirms your decision. ? pic.twitter.com/6BvJVCJJFq — madalyn | ? ? (@madalynrose) June 30, 2017

In the absence of any large-scale study, it is hard to assess how grave the issue is in corporate India. However, a recent survey of 500 people by ASSOCHAM, one of the country’s apex trade associations, provides some clues. The survey found that 14% of respondents experience workplace fatigue and a tenth admitted to sleeping disorders. Some 10% of employees also said that even though they had no diseases, they felt like their health was ‘poor’.

The WHO ran a campaign in 2017 called ‘Depression: Let’s Talk’, calling it the world’s leading cause of disability, affecting 300 million people. “At WHO, we recently led a global study which estimated the cost of depression and anxiety disorders to the global economy to be US$ 1 trillion each year in lost productivity,” Kenneth Carswell of the department of mental health and substance abuse, WHO, said in an email.

Congleton, the CEO of the tech company Olark, admitted that the explosive reaction on social media to his email was not something he expected. “I am so glad I was able to have such a positive impact on so many people,” he wrote in a blog post.

Unorganised sector neglected

The WHO has also called attention to issues of workplace harassment and bullying, something the #MeToo movement also highlighted, saying it is likely to affect the mental health of employees. Closer home, the National Mental Health Survey by the National Institute of Mental Health and Neuroscience, Bengaluru, concluded in 2015 that one in every 20 Indians was depressed. While the survey did not specifically look at workplaces, it did highlight the demand for mental health services. This in a country that has the abysmal ratio of one psychiatrist for every 100,000 people.

“Fall in productivity, anxiety, sleep disorders and a high rate of absenteeism are the presentations of mental health disorders at work,” said Claudina Cayetano, regional advisor on mental health at the Pan American Health Organisation. This segment is also known to be susceptible to a higher rate of physical injuries. The stigma attached to mental disorders makes it harder for employees to seek care. “They (mental health disorders) are considered barriers for equality when looking and keeping a job,” Cayetano said. One in every five employees in the Pan America (North and South America) region is believed to have a mental health disorder.

In India, a crucial sector that is often left out of discussions on mental health in India is the unorganised one. “They are the drivers and domestic workers who are at the mercy of their employers working without any benefits or structure in place,” Dr Lakshmi Vijayakumar, who founded the suicide prevention helpline, Sneha, in Chennai, told The Wire. “The precarious existence causes tension and often leads to a higher rate of alcoholism and domestic violence in this group.”

Stay at home spouses are another category most policymakers completely ignore, she added. “They are undervalued and overworked, with zero benefits.”

Inadequate health and safety policies, inflexible working hours and lack of support are other work-related risk factors that could increase an employee’s stress. “They are partly related to organisational structure [and partly to the] managerial environment,” Carswell said. This puts the spotlight on managers and their colleagues.

Competition and cooperation

Several studies have documented the negative reaction those with mental disorders face from their colleagues. “They were less likely to be offered additional duties and the work delegated to them was not as meaningful,” said Peter Smith, a researcher at the Institute of Work and Health, Canada. “With a physical disease, doctors could give a recovery time, but psychiatrists are often unable to tell employees when they would be fit enough to resume work,” he added, saying that this uncertainty made it especially hard for employees to provide clarity and hold on to jobs.

According to one study published last year, managers could have a significant impact on an employee’s mental health. Just four hours of training given to managers significantly reduced sick leaves taken by their employees. “The condition of someone who is mentally ill can fluctuate from day-to-day and they need more flexibility than just sick leaves,” Smith said, emphasising the role of both managers and supervisors. What this flexibility should look like, however, needs a constant dialogue between the employees and their employers instead of a top-down approach, no matter how well implemented.

So what is the solution? “An ideal office environment is one that manages to strike the perfect balance between competition and cooperation. For the unorganised sector, there has to be minimum wages and a mechanism to fall back on,” Vijayakumar said.

India’s Mental Healthcare Bill aims to provide all citizens with the right to access mental healthcare services. But the answer to making workplaces healthier might not be just be a policy change. “There has to be is openness on behalf of the employers,” said Soumitra Pathare, director of the Centre for Mental Health Law & Policy; he who was involved in the drafting of the bill. “Offering counselling services to all employees and health insurances that cover mental health can be some practical steps employers can take,” he said.

But mental health services and access to them varies significantly between lower and higher income countries. Other factors, such as availability of health services provided by employers, the strength of health and safety legislation and employment protection law, all differ from country to country.

Across the world

“At the national level, policies that support mental health interventions being delivered as part of an integrated health and wellbeing strategy that covers prevention, early identification, support and rehabilitation is beneficial,” Carswell said. This is something that the UK does: it doesn’t just provide free mental health services (on referral of a general practitioner) but those with drug and alcohol problems can refer themselves. It also has a disability discrimination act that protects people’s access to employment, education and access to goods and services.

In the US, workers technology proliferation has ensured that email has become indispensable, and the workday begins much before workers reach the workplace. A concerted effort to change workplaces, however, has been missing. Japan, where work hours began to stretch into the nights after the island nation in the Pacific underwent a rapid period of growth in the 1970s and 1980s, even has a term for workplace depression: shin-gata utsu; it literally translates to “new type of depression”.

The symptoms of employees strangely dissipates once they are outside the work. Battling one of the highest suicide rates in the developing world, the Japanese government is now actively working to reduce stigma and encourage the use of counselling services.

Germany, of course, has a head start. IG Metall, one of the country’s biggest trade unions, is campaigning for a reduction in work hours. Having already won the Germans a 35-hour work week over two decades ago, the union is now rooting for a stronger work-life balance, learning from the mistakes of other industrialised nations. The country’s focus on prevention will hold it in good stead even as the rest of the world looks to firefight the crisis already brewing in their workplaces.

Disha Shetty is a freelance science journalist.