Mental health and work

October 10, 2017

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HK heads a corporate organisation in Islamabad. After his wife suffered from a depressive disorder, he developed a better insight into the illness. At work, he noticed a team member who often looked tired, had started to miss deadlines and was avoiding social contact. As he considered a strategy to broach the subject, another colleague indicated irritability and showed signs of strained relations with others. HK recognised that his team was struggling, but wasn’t sure what he should do to help them become aware of mental health problems and see if they could find a way to prevent these.

For 25 years, the world has observed World Mental Health Day on Oct 10. This year, the theme is ‘Mental Health in
the Workplace’. According to the World Health Organisation, one in five people may experience mental health problems in the workplace. Despite the fact that most mental disorders can be treated successfully, a large number of people delay seeking help or may not access treatment. More than 70 per cent of people with mental illness actively conceal their condition because they fear being discriminated against.

In addition to personal suffering and the heightened burden of care on families, mental disorders exact a huge financial toll. This includes cost of treatment and also the earnings associated with lost productivity. Untreated mental disorders (in employees or their family members) result in diminished productivity at work, significant time off work (absenteeism), far more time needed to achieve targets, increase in workplace accidents/conflicts, higher turnover of staff and reduced opportunity for seeking employment. It is estimated that 10pc of the employed population takes time off work to cope with depression.

Recently, the World Bank identified mental health as a Global Development Priority; that is, an issue that has a critical impact on economic development, and personal and social well-being. Annual global costs of mental health problems are estimated at $2.5 trillion and expected to rise to $6tr by 2030. In India, mental illness is estimated to have cost $1.03tr (22pc of economic output) between 2012 and 2030. A modest estimate for the overall cost of mental disorders in Pakistan has been calculated as running into the millions per annum. These facts are of serious consequence for a country like Pakistan that has a young, growing population with nearly a third living below the national poverty line.

Inequality, harassment and unsafe working conditions can lead to mental illness.

Whilst there is enough knowledge of socioeconomic causes of stress in the workplace, there is still a considerable lack of awareness about mental health issues that contribute to poor performance.

Half of Pakistan’s population comprises women, but we continue to rank second last in the Global Gender Gap Index with the lowest female labour force participation rate in South Asia. For those who do get an opportunity to work, there are glaring discriminations. Three-quarters of women in the workforce have no formal education. Even where there is the same level of education/performance between the two sexes, women earn 38.6pc less than men, and are thereby labelled ‘secondary workers’.

This is not just an economic disadvantage, but also a worrying indicator of poor mental health in women. The rates of common mental disorders in Pakistan, known to be twice as high in women than men, are primarily associated with socioeconomic adversity.

Another concern is that up to 15pc of women experience postnatal depression after childbirth. According to the West Pakistan Maternity Benefit Ordinance, 1958, women are entitled to 12 weeks of paid maternity leave, which too is limited to government service or factories. On the contrary, India has approved a bill to allow a 26-week maternity leave period and nursery facilities to female employees.

The relationship between sexual harassment and subsequent anguish leading to mental disorders is also well established. Victims of sexual harassment range from domestic workers, secretarial staff, doctors, and even lawmakers. For a victim, a sceptical inquiry by men in charge or a sensationalist campaign by social media or the challenges of dealing with male-dominated law-enforcement agencies are strong deterrents that prevent women from coming forward to file complaints.

Headlines like ‘Pakistan — no country for women’ only reinforce the nonchalant, discriminatory attitudes. The Criminal Law (Amendment) Act, 2010, and the Protection against Sexual Harassment of Women at the Workplace Act, 2010, are encouraging but widespread awareness campaigns and effective implementation of these laws is crucial for psychologically safe workplaces.

Unfortunately, sexual harassment is not the only form of bullying, nor are women its only victims. In one study, at least 50pc of medical students reported being verbally abused during their training. In another study, one in six doctors experienced a physical attack and three in five encountered verbal abuse in the emergency department in the previous year. There were significantly high rates of burnout and mental disorders in these doctors. Another relevant example here is that of a recent petition filed by a doctor in the Islamabad High Court against excessive work hours (over 100 hours a week).

Increased workload, role conflict and inadequate compensation are also reported in the higher education sector. At times, signs indicating an unsafe work environment are subtle, for example extreme micromanaging, taking credit for other’s work, exclusionary practices, etc.

Inequality, the gender gap, sexual and other forms of harassment, and poor and unsafe working conditions are consistently associated with mental health problems. The relationship between stress at work and mental health problems is usually bidirectional, which means that compromised mental health further perpetuates stressful conditions.

There are evidence-based, cost-effective workplace interventions to reduce stigma and improve mental health and productivity. Similarly, effective treatments exist for common mental disorders, and employers can facilitate access to care for those who may need it.

Meaningful investments in mental health promotion, and prevention and treatment programmes in the workplace lead to a more productive workforce. It has been established that $1 of investment in treatment for depression and anxiety leads to a return of $4 in better health and ability to work. Positive mental health in individuals eventually contributes to better economies and healthier communities.

The writer is a consultant psychiatrist.

Twitter: Asma Humayun

Published in Dawn, October 10th, 2017