Edited transcript of the episode:
Smarinita: Since the launch of the World Happiness Report nine years ago, India’s ranking on this index has slipped every year. It has gone from 111 in 2013 to as low as 139 last year, which is a drop of 25 percent.
There is a strong correlation between happiness and mental health. Research done by renowned economist Richard Layard, who is also the co-editor of the World Happiness Report, has shown that eliminating mental health issues such as depression and anxiety will increase happiness by 20 percent.
Given this, the stigma around mental health in India isn’t helping us as a nation. Moreover, the never-ending lockdowns and blurring work–life boundaries during the pandemic seem to have further aggravated issues of loneliness and isolation.
So the one thing that has become clear over the past two years of living with COVID-19 is that conversations around mental health need to take centre stage. We must take a hard look at how mental health is viewed and addressed in the country, especially in the workplace. There is a need to move beyond the current tokenistic approach, beyond wellness and yoga retreats and workshops, and to think of mental health as a person’s right. Organisations need to expand their understanding of mental health and create a safe space for dialogue among employees, especially as the office-work landscape continues to change due to the pandemic.
But does the onus lie entirely on the organisation? Where does the organisation’s responsibility end and the individual’s begin? At what point should the organisation step in when it comes to the well-being of its employees?
Answering these questions and more will be our two guests, Dr Santrupt Misra and Raj Mariwala.
Dr Santrupt Misra is an industry stalwart when it comes to people management and HR and a business leader with more than three decades of experience. He is currently the group director at Carbon Black and the director for Chemicals as well as the director for Group Human Resources at the Aditya Birla Group. Santrupt has various academic qualifications across political science, management, industrial relations, and public administration.
Our second guest is Raj Mariwala, a director at Mariwala Health Initiative (MHI). MHI is an organisation that works on various mental health initiatives, with a focus on creating awareness about mental health for marginalised communities. Raj also serves on the boards of the Global Mental Health Action Network, the Lancet Commission on Stigma and Discrimination, and the nonprofit Parcham that serves adolescent girls through sports.
Welcome, Raj and Santrupt, to this episode of ‘On the Contrary’.
Smarinita: So Raj, what are the structural issues that impact how mental health is looked at and addressed in the country? And how do you think we can seek to change this?
Raj: So mental health within the country is largely seen in a dominantly biomedical paradigm. Now, what that means is that just like physical health, mental health is assumed to be a set of symptoms. Then there’s a certain kind of treatment given, which could be allopathic medication or talk therapy at the most. And then what is expected is a reduction in symptoms, and then the person is cured. Now, this is a very limiting narrative, because what it ends up doing is focusing on only a symptom reduction approach. And, moreover, when you look at the way that persons with mental illness have been discriminated against, you’ll see that people aren’t actually willing to take support or help for this simply because they are then shunted out of spheres of life—such as employment, school, or maybe even transport. Now what we’ve seen in COVID is that people are coming to realise that mental health is also very deeply connected to our lives, the environments we inhabit, and our contexts. So it’s not enough for me to say, “I will provide maybe a psychiatrist or I would provide a counsellor,” especially when it comes to workplace mental health. It’s a piecemeal approach, which affects how we look at workplace mental health as well. Rather than saying “let’s look at our workplace” or “let’s look at a school”, we could see what the stressors borne out of this environment are. So, in a structural sense, that’s how mental health has been looked at. And there are definitely some alternative paradigms one should really consider if we are to look at addressing mental health issues.
Smarinita: You touched upon mental health issues and organisations. So, Santrupt, when you run a company, there are business compulsions of revenues, targets, deadlines…but you also have to factor in employee well-being and their mental health. As a business, how do you manage this and other trade-offs? And does this work differently if you’re a larger, well-resourced organisation versus, say, smaller organisations that might have more resource constraints?
Santrupt: First of all, I think all well-run organisations that are truly productive do realise and understand that they are productive because their people are in a state of equanimity—where they are able to bring their best on the job. Because an organisation’s performance would always be unsustainable and short-term if people are not at ease with the organisation and the work context in which they are. And I think all enlightened, evolved organisations do realise that, so I don’t think there is a dichotomy between the two. Yes, in the short term, there will always be tension between the two in terms of how much you account for an employee’s state of health—mental health, in particular, in this case—and how much you need to meet your obligation to other stakeholders, including the customers, shareholders, and others. But the moment you see the phenomenon of interdependence and integration between employees’ well-being and mental health, and the need to be productive and competitive and the rest of it…the moment you start seeing that as two sides of the same coin and not as two parallel lines, I think a lot of issues start.
The challenge is that for far too long, we have refused to recognise mental health as an issue.
The challenge is that for far too long, we have refused to recognise mental health as an issue. And often we see mental health as an issue with people who are weak and need help and not necessarily that mental health could be an issue with anybody for that matter. I think the issue boils down to the realisation and understanding by the management and the leadership and the organisation about mental health as an issue. As Raj very rightly mentioned, yes, you can always provide a yoga instructor, a counsellor, and supportive infrastructure. But those can be the icing on the cake; they cannot be the cake. The cake has to be the commitment of the management, the willingness to understand this as a phenomenon and accept it, and empathy and a supportive environment to connect with the fundamental issue. I think there’s no difference between large and small organisations—there should not be because both are equally capable. The reality is that large organisations have more resources. But the very largeness also creates isolation, anonymity, impersonality. And a large organisation should be more cognizant of it—that you can feel lonely even in a crowd of a large number of employees or people. So resources in everything can help, and I cannot undermine the role of resources. But banking on financial resources or infrastructure alone would be a wrong thing to do. I believe that large and small organisations are on equal footing as far as the leadership willingness to address the issue goes. And I think those have to come from the heart, from the realisation and sensitivity to people.
Smarinita: Raj, if I can segue from that, we are already seeing individuals manage their well-being to the extent that they can. But the onus also falls on companies, like both of you have said, to ensure a safe space where mental health can be talked about and solutions thought out. So where in this sphere does the organisation’s responsibility and that of individuals begin? In the past, you’ve spoken about the concept of reasonable accommodation. So could you also explain that a bit?
Raj: I’m going to first talk a little bit about a shift in the organisational view. And this really has to be that the organisation needs to look at mental health as an issue of disability rights. And so the organisation’s responsibility is to look at the environment; it’s to address the structural barriers in society that exclude persons with disabilities. Now, what that means in a larger sense, of course, is that then your whole workplace or your whole work ecosystem is actually accessible for everyone, because you’re not building it just for persons with disabilities. But it’s a very critical shift to make, because then you’re not looking at it as a privilege, you’re not looking at it as, as Santrupt said, icing on the cake; you’re looking at it as a right. And this could be anything from changes that need to be in the workplace environment, change in work processes, change in location, so that the person who is maybe undergoing some sort of health issue will be able to work—this then moves to the biomedical model. It’s a very expert-led model of mental health. The second model, the psychosocial model, essentially says that mental health is affected by what is in the head; it is affected by our thoughts, feelings, and emotions. And what plays an influencing role is the experiences we have, the contexts we live in, and our own lives. What also plays a role is larger society, because that’s the space that we inhabit. And so, for example, a psychosocial model would say that if you are marginalised, there is a greater likelihood of you being vulnerable to mental health concerns.
So, in that case, the onus is to provide what we call reasonable accommodation. Now, the term ‘reasonable accommodation’ is pretty well-defined in the United Nations Convention on the Rights of Persons with Disability; it’s called UN CRPD. And this principle essentially says that necessary and appropriate modification and adjustments be made that don’t impose a disproportionate burden on the organisation and on the ecosystem, so that a person will be able to enjoy or exercise their responsibilities and their privileges with others in that space.
So that’s essentially what reasonable accommodation is. Now, if we look at it historically, there was and maybe still is discrimination, where employers or workspaces wouldn’t hire women, because they didn’t want to give pregnancy leave. Now due to advocacy that has shifted, pregnancy and maternity leave is considered an employee’s right. Even parenting leave is considered an employee’s right. So what’s stopping us from giving similarly related mental health accommodation? It’s just because now society has come to see this as routine. And that’s an example of the environment or the environment change to allow maternity leave. So it’s very important to see this as a person’s right. Similarly, if an employee breaks a leg, either you’re going to make some other adjustments, you’re going to ensure the lift is working, maybe get a nicer chair if the employee has to sit in the chair for long periods. So that’s what reasonable accommodation is. And in terms of mental health, it can take quite a few different forms. So extra leave, aids or appliances for facilitating work, opportunities to use advanced leave or maybe unpaid leave—that’s what reasonable accommodation is. Now, the employee also has a responsibility in this. I would say the first responsibility is to communicate to the supervisor or to the organisation that you will require an accommodation. This is easier said than done. But ideally, as you mentioned, a safe space has to be made in order to communicate that.
Everyone who wants reasonable accommodation still needs to give proper accountability to their work.
I think the other kind of fear that most people think of is “will we have to have a trade-off with performance?” And that is not reasonable accommodation. Everyone who wants reasonable accommodation still needs to give proper accountability to their work. And that’s as per your negotiations and communication. Now, you can change that around, if that’s part of reasonable accommodation—for example, maybe decreasing daily work hours but working more days in a week. But there is no trade-off per se in terms of performance. Also, the employee must realise that if they’re unable to do certain things, it’s likely that another team member would have to do it for them, especially once some sort of arrangement is being made to provide reasonable accommodation. So responsibility for the employee is to communicate very clearly, and many employees do not actually communicate clearly for a variety of reasons. I won’t get into those now.
Smarinita: I think that’s a great way to frame both rights and responsibilities when it comes to the organisation as well as the individual. Santrupt, if I can take off from where Raj left, what do you think is a change that needs to happen within organisations to make multiple levels of leadership understand and incorporate mental health policies and practice? Usually, there will be commitment at the top, there’ll be an understanding at the top, but how do you take it down multiple levels, because in many cases, companies might be willing to accommodate the mental health needs of star performers. But what can be done to make policies and practice more equitable and applicable to all employees, whether they are stars in the company or not? And particularly in maybe traditional industries—manufacturing, logistics, retail—where some of these conversations might not even happen.
Santrupt: I think at a policy level when it comes to healthcare, or people’s well-being concerns, I don’t think there’s a distinction between star performers and others, because business is a collective operation. If you could run an organisation with only a handful of star performers, you don’t need the rest of the people. So one thing is very clear that for the health of an employee—mental or physical—the primary responsibility has to be that of the employee. You cannot suddenly become a paternalistic state or company to take over everything. But having said that, given the fact that you have a larger responsibility to society and your employees are also part of the larger society, if you find that there are issues there, you have a responsibility to help them both for reasons of your own narrow self-interest as a business organisation and also self-interest.
Even in the course of working, even if you do not have a pre-established mental condition, you can develop paranoia, anxiety.
Raj talked about the rights of people. I look at it slightly differently. The one issue about the disability rights, which is very important as people enter into the organisation, is if they have pre-existing disabilities, particularly in the mental area. But even in the course of working, even if you do not have a pre-established mental condition, you can develop paranoia, anxiety, or any other kind (of mental illness) caused by many things. Many years ago, if I may give an example, there was an outstanding worker in a factory in India, in Mumbai. He used to go to the factory every day at eight o’clock, taking his tiffin box and saying bye to his wife and everything. And some days later, when he was not at home, a colleague dropped in and said, “Why has he not been coming to work?” His wife said, “I’m surprised! Every day he carries his usual dabba, goes out…he comes back every day at six o’clock or seven o’clock. I have no clue that he’s not at work.” So this co-worker started following him as this guy left home for the next few days. And he used to leave his home and go to another place and sit with people and play cards and come back. Some days he will go to the railway station to take the train, the train comes, people get off, get in, the train leaves. He doesn’t get in; next train, people get off, get in, he doesn’t get in. After a few moments, he’ll walk away and go and play cards with friends and come back home at seven o’clock, as if he had gone to his workplace.
When he was taken out by colleagues—who trusted him and were friendly—and had a conversation with him, the amazing thing they discovered was that suddenly this employee had developed a crowd phobia about getting into that train during rush hour and getting out. So he would watch the train coming, people get in and get out, but could not muster the courage to get in or even try to get in. And after two, three attempts, he just walked away and played, and could never share this with anyone. As Raj was saying, a lot of people don’t share for very many reasons. Now, what I’m saying is that during the course of work, people can develop many kinds of problems. And I think employers do have a responsibility to find ways to notice that and help create a sensitive culture or managers. And if you can create more awareness about mental health issues that are there, how they impact people and how people notice them…I think that is one thing that organisations can do.
The second is a little bit of role modelling. In a hypercompetitive world, most often senior managers, successful people, seem to believe there is a compulsion to always show that you are invincible, you are macho, you are great. If senior leadership can display authenticity and vulnerability or talk about their personal issues and anxieties or the challenges they face, it makes the people around more comfortable to come out and share without feeling that it is something abnormal or it is humiliating or inferior to go through similar emotions and experiences. So I always encourage people, my colleagues at a senior level and everyone, that there is a need and merit in being more authentic and expressing your own vulnerability.
Smarinita: Raj, if I can ask you the same question: What needs to change within organisations?
Raj: One is, and I’ve already said this, that the organisation needs to adopt a disability rights approach. And this is not just for those who come in as persons with disability, but for everyone, because it applies to everyone, right? I think the second point is the leader of the enterprise. Now, about one and a half years ago, we did a research on leaders, the entrepreneurs, the heads of different growth-ready businesses. And we found that obviously, as anyone else, they face certain unique life stressors. But I think the critical point here is that they never shared this with either their co-workers, their top management teams, or their peers, and so any sort of help or support they needed was only inward-looking. So I would agree with Santrupt and say that there definitely needs to be some role modelling. If the head of the organisation or the senior leadership of the organisation doesn’t feel safe enough to talk about this, how are you going to expect your employees to talk about it? So there does need to be this very visible commitment and articulation from the top management that there are mental health concerns or that they may be undergoing distress—simply because mental illness is a hard word for many people to grapple with; distress is a much easier term to look at.
Mental health is not just looking at your mental health work; it’s also looking at having other comprehensive anti-discrimination policies and safeguards.
Also, because—I’m going to borrow from a colleague of mine, these are her words—“Visibility without protection is a trap.” So it’s very important that policies are in place. And the top leadership makes sure that everyone knows. Part of this is also looking at your workspace and recognising that workspaces actually mirror the larger prejudices of society. And I’m going to now switch to distress and say that workspaces are largely engineered in a way that may be more distressing to women, to LGBTQ persons, to Dalit and Adivasi persons, to Muslim persons. And so, does this mean when we look at mental health, when we look at distress, are we going to be able to treat everyone equally? And if the answer is, “We are not sure,” we need to look at our different policies. One is a mental health policy, of course, which looks at reasonable accommodation. But mental health is not just looking at your mental health work; it’s also looking at having other comprehensive anti-discrimination policies and safeguards. It’s also looking at having grievance mechanisms up and running and in place, and other than the policy fit, having supportive spaces at work. And again, those are not going to come up; people are not going to feel supported if they aren’t visibilised and if the dynamics aren’t really looked at. And what are the ways in which to do that? We break it down into three categories: What’s happening in the ecosystem when it comes to workplace mental health, what’s happening in the industry, and then what’s happening to the individual. So if I look at job-related distress in different sectors, there’s job distress related to job insecurity, it could be about salary, it could be the work hours, it could be due to a toxic supervisor.
It could be due to toxic peers. For example, what would it be like for a trans woman to worry every day about using the bathroom? Or, for example, high-pressure targets. So this is looking at the actual organisation and the individual who may be having to deal with these. So it’s very important to look at what the organisational culture is and the individual themselves. If there’s an individual who undergoes anxiety and the job all of a sudden requires, say, public speaking, what sort of accommodations are you going to put in place? And then, of course, looking at the ecosystem. Now, for example, certain ecosystems employ a large percentage of migrant labour or informal labour. What are you doing about your workforce there? What are you doing as a larger ecosystem in terms of policy, in terms of collective negotiation with unions? As maybe an industry, how about pushing mental health within insurance policies? How about tying up with an insurance provider who would also provide mental health as part of the insurance package for employees?
Smarinita: Santrupt, you spoke about having a culture and a sense of awareness within an organisation that enables some of these conversations. And Raj spoke about having a supportive space at work to enable some of these conversations around mental health, some of these practices and policies. At the Aditya Birla Group you wear multiple hats, as group head of HR, and you run multiple businesses. So what are some of the good practices that work well, and that companies can follow?
Santrupt: First of all, I don’t want to make it an advertorial for the Aditya Birla Group, though I’m very proud of all the work that we have done during my existence in the last two and half decades with the company. Our engagement with mental health issues goes back to the year 2000. It’s not a fad of today. Recognising this as a subject and partnering with some expert organisations to access trained counsellors to have conversations has been a long-standing practice of ours—since the year 2000. And the good news is that a stable number of people have stayed with that engagement; it has not grown exponentially, even including at the time of COVID. Now, the interesting aspect of this is that even during the time of COVID, the number of people reaching out to our counsellors didn’t go very high, which means that the network of informal culture has worked very well. We have a very strong informal culture in the organisation, where the employee network brings the problems of employees to other people during COVID times; people have joined informal parties on digital, you know, called people to stay in touch. We have managed to prevent suicide during the pandemic, because informal network information has come about somebody being stressed.
So, when you talk about impact, there is external research that talks about the fact that for every dollar you spend on the well-being of your employees, the healthcare cost goes up by 3.2 or so dollars and absenteeism goes down by 2.7 dollars. And, interestingly, Raj was talking about senior leaders…We created an exclusive programme during the pandemic called ‘Lonely at the Top’. It was designed with the Mpower mental health expertise organisation, which is a sister organisation of ours. We designed it for senior people to deal with their own emotions and challenges in the time of the pandemic because they were responsible for other people, including their own family. Our listening culture through surveys, focus groups and segmented employees… you know, Raj talked about women and different segments of employees. We increasingly do not do mass-scale surveys. We do niche surveys to find out issues of young people, single people, people living alone in urban cities, because these are all unique problems of loneliness, engagement, anonymity, and a sense of significance. In one of my reviews with larger HR teams recently, somebody talked about their loneliness and I invited the person—an open invitation to anybody who’s feeling lonely—to come and have dinner with me. And the person came down and we had lunch one day. I think the informal network and the culture in the organisation helps people to really connect with colleagues, to feel comfortable and share, etc.
Infrastructure, resources are important. But I believe in the training that you give to your leadership, how you hold your managers accountable.
And I believe that’s the best gift any employer or any organisation can give to its employees. Infrastructure, resources are important. But I believe in the training that you give to your leadership, how you hold your managers accountable. We last talked about obnoxious targets and obnoxious managers. I think one of the major things that we have done is to notice team engagement scores— when we get low scores about a manager, we have a conversation with the manager, we dig for deeper feedback and have a discussion with the manager on how to improve. Some people sometimes put down statements, for example, in public. Great humiliation, and humiliation creates an inferiority. I think our organisation is very trained to be clued into these kinds of root causes or factors in the context and we try to address it. Now, I do not like the idea of best practice because best practices can be many; whatever works in your context is a best practice, honestly speaking. I would always urge organisations to experiment in their own context on what works rather than simply copy paste somebody else’s practice.
Smarinita: Coming to the last question, and this is again addressed to both of you: For a long time in the world of business, and elsewhere, productivity has been a key measure to figure out how employees are faring. But as we’re seeing workforces get younger, we are beginning to question this. So in order to bridge the gap between where companies are today and what younger people want them to be, is there a need to completely reimagine the existing constructs of work and jobs? How have you been thinking about this?
Santrupt: I would somewhat question the assumption behind your question. I don’t think young people are against productivity. What they have inbuilt is a temperament of questioning. They are seeking flexibility; they are seeking balance between life and work and work and life in many permutations and combinations. What they’re seeking is choice. So I think as long as an organisation is sensitive and clued into the contemporary generations—it understands their psyche, doesn’t judge it, tries not to stretch and bend to meet every requirement of everybody but understands the broad trends and patterns and creates opportunities—that will go a long way. And I believe that younger people do not like bureaucracy, and I think all bureaucracy is anti-productivity. And I don’t think productivity alone reflects what employers are doing. I believe the engagement of employees captured through whether it is attrition and the way they feel about their managers, the way they feel about policies, etc., are all very important indicators as to how well we understand younger people.
For example, I remember 20 years ago, or maybe a little more than that, we ran a competition in the group called ‘Oh Not So Smart’, where we invited our employees to say what are the not-so-smart things we are doing, what could be a smarter alternative. That was a way of reaching out to every employee to say, “We are open enough to hearing from you what’s not such a smart thing we’re doing.” I think when you keep on doing activities like that, you convey a sense of openness. So I think productivity is an outcome of many things. One of which is how well you understand your employees’ needs segmentally. There are obviously some generic needs of everyone. But I think of focusing on segments, and that we often do not recognise segments of employees as unique cohorts. The time has come for segmenting instead of doing a commodity approach to employees. I think we have been doing that in most progressive organisations where the workforce population is relatively young. In my case, over 40 percent are below 35 years of age, given several of our, you know, new-age businesses.
Raj: I want to acknowledge first the atmosphere that we are talking about work and productivity in. And, you know, COVID is part of it. I think what isn’t spoken about as much is that the work and leisure boundaries have gotten even more blurred. And that’s a problem. I was reading some work again, where about 60 percent of the people who were surveyed in a research said that their mental health has gotten worse, because they don’t really get time off from work due to work from home. And then it just becomes a vicious cycle, because then, of course, that affects work productivity. So if I am to talk about it right now, I think COVID, again, has brought that to the forefront—to really challenge the prevailing narrow biomedical discourse.
We definitely need to look at different ways in which to figure out productivity to figure out outcomes.
Now, the moment I look at this narrow thing, I’m going to look at piecemeal and tokenistic solutions, like awareness programmes or employer system programmes, and then look at counselling or something else. There does need to be a change. And maybe it’s in how we define productivity. In the Indian cultural context, I’m going to say that the problem is with presenteeism, rather than productivity. And by presenteeism, I mean actually being there. I know that it’s been observed in the American context as well, which is someone who is present on the job or, for example, someone who’s logging in those keystrokes on the computer but they are not able to fully contribute due to an underlying health condition. I do find that younger people are very invested in having a work–life balance, more so than at least previous generations. A part of that is a value judgement on leisure. “We used to spend all evening in our office, we spend until 8 pm in office”—this sort of stuff is lionised, and there is a problem with that. And so I feel we definitely need to look at different ways in which to figure out productivity to figure out outcomes. I mean, look at the health sector. It’s been immensely productive—because, well, they have no choice—but there is immense burnout; there’s immense compassion fatigue that they’re facing. And so it’s important to also look at productivity a little more carefully. Because in the end it’s—and I, unfortunately, have no other way of saying this—diminishing marginal utility. There’s this whole idea, again, that if you live with a mental illness, or if you’re facing distress, you may not be as productive. And that could be very true for quite a few people. And if I have to take a very personal example, I live with a mental illness. And that actually drives me to do two jobs at one time. I will not feel all right if I’m not doing multiple things. And so I do have two jobs. And I do largely work seven days a week. But unless someone puts the brakes on me now and then, I will stop doing even the most basic tasks because there is burnout. So it’s very important to look at productivity to look at balance like that.
Smarinita: Thank you both for shedding light on just how important it is for mental health conversations to be woven into our everyday lives, especially at work.
Dialogue and conversations within the workspace are then perhaps the first critical step organisations must take towards addressing their employees’ mental health. Organisations need to create an environment that enables these conversations, not only between the HR department and the employees, but also between peers and top management and their teams.
At the same time, as organisations make space and put in place both systems and a culture for a more inclusive workspace, the onus also lies with the individual to ensure they communicate their needs clearly for a more equitable working environment.
Thank you so much, Raj; thank you, Santrupt.
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- Who is ‘self-improvement’ for?
- The problem with resilience as we know it
- Are our cities making us lonely?
- Why we need to take a systemic approach to suicide prevention