Mental Health

- Varsha Aithala and Eklavya Vasudev


The pointers in this Primer enhance the details of some of the issues we covered in our earlier posts in this section.


Overall Concept


It is a complicated time with stress affecting people rampantly, both as individuals and as professionals. There are several triggers such as the fear of COVID, prevalence of disease in the family, uncertainty at work and economic distress and job losses. Meanwhile, work culture and methods have changed to online and web-based apps where possible. There is also a general dread of feeling cooped at home, which brings forth concerns such as lack of privacy, failure / difficulty to maintain work-life balance, domestic violence and threat of abuse. A holistic understanding of mental wellness as well as access to mental health resources is urgently needed for professionals and organizations to effectively deal with mental health issues as they arise. This can be a two pronged approach (a) first, we attempt to break down into simple steps the most common mental health issues and contextualise techniques to handle these plus deal with the new normal for working professionals (b) second, we have curated a list of reliable resources and helplines set up by governmental and civil society organisations which professionals can access to seek support for mental well being.


Please note that this primer is not professional advice and you should immediately seek a professional’s help if you experience any of the symptoms we’ve described below:


(i) Sub Topic: Stress Triggers


1. Context:

Stakeholders in the work environment include actors ranging from employers, employees, informal workers, gig workers, commercial organisations and almost anyone interested in the economy. Several stress triggers exist in the Covid scenario - uncertainty in hiring practices, changed labour laws, adjusting to a new format of the work environment and technology as well as financial worries. The first step is self-awareness and identification of issues. Once you recognize the particular stressor relevant to you, you can move to contextualise it, acquire knowledge to deal with it through open resources and get professional help. The other part of the solution is to recognize the “normalcy” of mental health issues, especially in a pandemic. This will help destigmatize the myth of a mental health ‘crisis’ as an anathema to normalcy. This can help deal with mental health problems, in the same way that one deals with physical ailments which affect our health.


2. Key Issues:

If you are an employee: Job Uncertainty, change in work routine, domestic issues, grappling with new technology, work conflicts and lack of professional support , financial worries, anxiety and depression.


If you are an employer/owner: declining revenues, product delivery and invoicing issues, payment mismanagement, low team morale, loan repayment pressures, investment in new technology and effects of legal fictions like force majeure in contracts.


If you work in the informal economy/ are a gig worker: Added to the above, the constant stress of no formal work guarantees, effects of lockdowns and social distancing on employment, wage cuts, difficulties adapting to new technology.


3. Action Points:

Use of simple techniques such as the wellness workbook to self assess stressful situations, seeking medical and therapeutic interventions as necessary.


4. Related Documents:

You may wish to use the following worksheets to understand your stressors better, list them out and construct an adequate action plan to deal with them:

(a) https://www.beyondblue.org.au/the-facts/anxiety-and-depression-checklist-k10

(b)https://thewellnesssociety.org/wp-content/uploads/2020/04/Coronavirus-Anxiety-Workbook.pdf

(c) https://pib.gov.in/PressReleasePage.aspx?PRID=1624148


5. Digital Tools:

(a)https://www.thehindu.com/news/national/mental-health-tool-available-free/article31297628.ece

(b) https://www.theinnerhour.com/


6. Keywords: Depression, Anxiety, Stress, Uncertainty, Conflicts, Economic difficulties


(ii) Sub Topic: Dealing with Suicidal Thoughts


1. Context:

As per the World Health Organization (WHO), 800,000 people die due to suicide each year. Thoughts about suicide are fairly common and are exacerbated in times of distress and social isolation such as the current COVID pandemic. Experts believe that life events like financial loss or job loss are some of the major risk factors leading to suicidal thoughts. This can be prevented through timely intervention, seeking professional help and adopting certain self help techniques.


2. Key Issues:

Timely intervention, anonymity and confidentiality, privacy, dealing with societal stigma, understanding and managing shame.


3. Action Points:

We provide the context of the problems, summarise key techniques available around us to deal with suicidal thoughts in moments of distress, and document useful resources for persons in distress or their family/friends to adopt.


The following questions can be used by persons feeling extremely stressed and/or dealing with morbid or suicidal thoughts.


Ask yourself the following questions:

Q 1 Do you identify with any of these? (a) thoughts of feeling listless, (b) low self esteem, (c) desire to self harm, (d) sudden emotional outbursts, struggle regularly to report to and attend work.

Q 2. Have you spoken about these thoughts to anyone around you?

Q 3. What has their response been?

Q 4: Are you using any drugs, medicines or other substances to help you during the times you get these thoughts?


See, if the following steps help you deal with your situation better.


If you are suffering from suicidal or self-harming thoughts:

  • Talk about your feelings with someone

  • Maintain an active lifestyle and healthy diet

  • Ask for assistance from your family, friends and at your workplace

If you suspect that your friend/colleague/family member is dealing with thoughts of suicide or self harm

  • Stay alert for warning signs like talking about suicide, morbid ideation, speaking about self harm, withdrawal from friends, family and work.

  • Talk to the person to understand their feelings and emotions

  • Convince him/her to speak to a professional therapist/counsellor

  • Comfort the person that you will support her/him through the treatment/therapy

  • Make sure that the person is in a safe environment


Source:https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20045943


4. Related Documents:

a) Preventing Suicide - Resource for General Physicians available at: https://www.who.int/mental_health/media/en/56.pdf


b) Towards a National strategy to reduce suicides in India by the National Medical Journal of India:

http://archive.nmji.in/archives/Volume_18-3_May_June2005/editorial/EDL18-3.pdf


5. Some Relevant Resources:

  • The Tata Institute of Social Sciences (TISS) in Mumbai has set up a psychosocial helpline called iCall which can be reached at icall@tiss.edu or 9152987821 (Monday to Saturday, 10 AM to 8 PM).

  • Sneha, a suicide prevention organization in Chennai can be reached at help@snehaindia.org and the helpline at 044-24640050 (10 am to 4 pm) on all days.

6. Key words: Suicide, Suicidal Ideation, Suicidal Impulse, Mental Illness, Distress.


(iii) Sub Topic: Helping colleagues, friends and family cope with mental illness of someone close


1. Context:

Effective support to a family member or friend who is experiencing mental health issues is critical. If your employee, colleague or co-worker is experiencing lack of mental well being, it is highly likely that their personal relationships as well as work performance are suffering. It can be tough for the person suffering to talk about what they are going through. So, here are a number of things that you can do to support such persons. It is important that you listen, stay calm and reassure them that they do not have to deal with such distressing feelings alone. At the same time, you must remember that you cannot force someone to talk about their suffering if they choose not to. Listening, without judging can itself help. You can refer them to seek professional help and direct them to relevant organizations.


2. Key issues:

Recognition, timely intervention, sensitivity, empathy, guidance towards adept resources/personnel


3. Action points:


STEP 1: Identify if your friend, colleague or family member is showing any one or more of these symptoms that the Mayo Clinic guide lists out:

  • feelings of sorrow, tearfulness, emptiness or hopelessness

  • angry outbursts, irritability or frustration

  • loss of interest or pleasure in most or all normal activities

  • insomnia or sleeping too much

  • tiredness and lack of energy

  • changes in appetite - reduced appetite and weight loss or increased cravings for food and weight gain

  • Anxiety, agitation or restlessness

  • Slowed thinking, speaking or body movements

  • Feelings of worthlessness or guilt, fixating on past failures or blaming oneself for things that aren't one’s responsibility

  • Trouble thinking, concentrating, making decisions and remembering things

  • Frequent or recurrent mention of death, suicidal thoughts, suicide attempts or suicide

  • Unexplained physical problems, such as back pain or headaches

Source:https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression/art-20045943


STEP 2: If the answer to any (one or more) of these symptoms is a YES, then you may consider the following actions:


A. If the person is a friend or family member:

  • Talk to the person to understand the issues troubling them

  • Encourage treatment and help from a counsellor

  • Offer to help them with the process

B. If the person is your colleague:

  • Talk to the person to understand the issues

  • Offer to help prepare a list of questions for diagnosis

  • Encourage him/her to approach your in house counsellor or, if there isn’t one, a professional counsellor

  • Work with your team members to create a low stress and less anxious working environment

C. If you are an employer:

  • Create a positive team culture

  • Make it clear that there is zero tolerance for workplace bullying and discriminatory behaviour

  • Implement a supportive work performance management system which can do an initial screening for early warning signals of mental health issues of your employees. This could include ongoing dialogues with employees, consistent feedback and regular interactions.

  • Ensure that the employee is aware of resources available to support their mental wellness needs such as counselling support (internal or external) or other employee well being programmes which need to be confidential.

  • Ensure that people are not stigmatised and punished if they choose to reveal they have mental health issues.

4. Related documents:

(a)https://www.verywellmind.com/how-to-help-someone-with-depression-1065117

(b) https://www.healthline.com/health/how-to-help-a-depressed-friend#educate-yourself

(c) https://www.mentalhealth.org.uk/publications/how-support-mental-health-work


5. Resources:

Helplines:

(a) https://www.vandrevalafoundation.com/

(b) https://www.nhs.uk/oneyou/every-mind-matters/helping-others/


NIMHANS (National Institute of Mental Health and Neurosciences), Bangalore is the leading institute in the field of mental health and neurosciences in India. NIMHANS offers a host of therapeutic services depending on your specific need. The Institute can be reached at :

Phone: 080-26995000, email: ms@nimhans.ac.in, Enquiry: 080-26995530


There are several organisations which provide online counselling. Further details can be found at: https://www.opencounseling.com/hotlines-in


In addition, most private hospitals like Fortis, Max, Apollo and Sitaram Bharatia among others have psychologists on call who offer services including online sessions.


Key words: empathy, recognition, patience, concern, reassurance, practical help


(iv)Sub Topic: Dealing with substance or alcohol addiction in friends, family or colleagues


1. Context:

According to a household survey conducted by the National Drug Dependence Treatment Centre of AIIMS, New Delhi, in 2019, there were 5.7 crore alcohol addicts and more than 3 crore substance abusers. Unfortunately, only 1 in 38 alcohol addicts reported getting any treatment and 1 in 180 addicts reported receiving inpatient treatment (for alcoholism) at a hospital. For drug addiction, 1 in 20 addicts received hospitalisation or in patient treatment (Source: Financial Express, February 18, 2019). This is concerning because substance abuse does not occur in a vacuum. It is usually a response to overbearing stress, anxiety, depression and unwanted thoughts which a person tries to escape from by using substances to dull their senses.


2. Key Issues:

Substance abuse might be triggered by an underlying event. Once you identify signs of any substance dependence or abuse, in order to assist yourself, a friend, family member or colleague, you should seek professional advice or where a friend, family member or co-worker is affected, encourage them to approach a professional urgently. If you are an employer or co-worker, value mental health and wellbeing as critical assets of your organisation.


3. Action Points:

  • Never assume but always ask if they would like to talk about their problem. If yes, offer them help in a sincere, friendly, empathetic way. Similarly if you think you have a substance abuse issue yourself, try to look at yourself non-judgmentally and look for solutions.

  • Discuss their thoughts about substance abuse openly and in a non-judgemental manner. Similarly dissect your own thoughts if you are struggling with a similar issue.

  • If they are unable or unwilling to attend therapy or treatment sessions, offer to call their doctor, counsellor, therapist on their behalf to seek professional support or accompany them on these sessions. For oneself, remind yourself that this is a health issue and immediately remove the stigma and shame around it. Substance abuse often requires medical intervention, similar to seeking treatment for a flu, virus, or any bodily ailment.


If you are an employer, and your employee is indicating signs of substance use,

  • If you notice a subtle dip in performance or signs of emotional distress in the employee, organise a confidential meeting to discuss this with the employee.

  • Suggest that the employee takes time off from work and seeks professional help urgently.

  • Permit their phased return to work following treatment or therapy or flexible working conditions. During this time, provide for relaxed performance appraisal and balanced feedback. This can allow the employee to return to their earlier work routine in an unrushed and stress free manner.

  • Make sure that you keep the information confidential and do not share it with anyone.


4. Related documents:


5. Resources:

Helplines:

  1. https://rehabs.in/

  2. https://hopetrustindia.com/blog/drug-addiction-treatment/

  3. http://www.aagsoindia.org/

6. Key Words: addiction, substance abuse, depression, alcoholism, drug use


Varsha is Business and Legal Regulation Lead at Justice Adda and Eklavya is a Senior Consultant, Climate and Health at Justice Adda