Most educational institutions and workplaces in India do not have a robust diversity and inclusion policy that addresses the concerns of employees and students with mental health conditions.
In fact, the concept of mental health and well-being in the workplace is relatively new in India, coming to the forefront only after the Covid pandemic. Educational institutions still haven’t introduced systemic and structural reforms to accommodate students with mental health conditions.
A 2022 report by the World Health Organisation indicates that only 21 percent of countries surveyed report full implementation of policies and plans that completely comply with human rights instruments. Human rights instruments refer to the legal agreements on human rights such as the Charter of the United Nations (1945), Universal Declaration on Human Rights (1948), Convention on the Rights of Persons with Disabilities (2006) and several others. These international treaties outline the basic human rights that every human being is entitled to and the measures that need to be adopted by nation states to ensure that these human rights are safeguarded.
For instance, there are various community mental health services that are compliant with human rights conventions as they follow non-coercive practices, have regard for legal capacity and confidentiality, prioritise community inclusion, promote participation, and are based on a recovery model. Examples of such community mental health services in India include Home Again (Chennai), Atmiyata (Gujarat) and Naya Daur (West Bengal).
While India has a strategic action plan in place, its comprehensive implementation in all spheres is yet to be realised.
The National Mental Health Policy of 2014 recommends non-discrimination and inclusion of those with mental health problems in all aspects to seeking and retaining work, and factoring in mental disorders as a disability while framing appropriate employment policies. The policy defines mental health problems as inclusive of both psycho-social distress as well as mental illness and mental disability. Mental illness refers to specific conditions such as schizophrenia, bipolar disorder, depression and obsessive compulsive disorder. Mental disability is defined as the disability that is resultant of mental illness such as the inability to fully participate in socio-economic activities at par with others.
Additionally, the Mental Healthcare Act of 2017 charts out the rights of persons with mental illness including the right to affordable, accessible, good quality and adequate mental health care and treatment. The act re-affirms the right to dignity of people with mental illness as well as emphasises their “right to live in, be part of and not be segregated from society”.
“Legally, there is no denial of employment opportunities to those with mental conditions,” said Dr Vandana Prakash, a senior consultant clinical psychologist at Fortis hospital, Noida. “The difference in inclusion comes due to the gap between the societal lack of acceptance and what is permissible by law. To bridge the discrepancies between mental health laws and social stigma, psychoeducation of the public is imperative.”
Psychoeducation can be initiated at school level where mental health professionals equip students, school staff and families with the necessary information and resources to understand the students’ emotions, behaviour and well-being. School-level psychoeducation can take place through dissemination of reading resources, individual meetings with families and teachers, and psychoeducational groups that educate on children’s socio-emotional well-being.
Raj Mariwala, the director of the Mariwala Health Initiative, said diversity and inclusion policymaking as a “pigeonholed approach towards invisible diversities such as psychosocial disabilities” – referring to conditions such as anxiety and depression.
“Most companies do not have an inclusive policy and their disability accommodations are mostly surface-level ones such as ramps and gender-neutral washrooms,” he said. “Further, grievance policy needs to accompany disability policy because visibility without protection is a trap for the marginalised.”
Rashi Vidyasagar, the director of the Alternative Story, a Bengaluru-based mental health collective, said, “It is often very difficult to get companies on board to formulate and implement mental health policies as companies don’t consider it important enough. We have the Mental Healthcare Act but it doesn’t mandate every organisation to adopt a mental health policy.”
Additionally, companies are “often in denial of their employees’ well-being”, Vidyasagar said, and “don’t want to incorporate mental health services”. “They argue that their employees are happy and that they don’t need a mental health policy.”
While some companies do have employee assistance programs – which provide counselling services – these may not be effective in ensuring employees’ well-being if the work culture is unhealthy. Work culture can have a significant impact on mental health.
Mental health budgets
The WHO had noted that countries spend only two percent of their health budgets on mental health. In India, it’s even lower – the National Mental Health Survey of 2015-16 indicated that spending on mental health is less than one percent of the total health budget.
Health is a state subject in India. The survey says a “dedicated state level budget for mental health with clear mention of budget lines does not exist as of now, but is necessary for the implementation of mental health programmes.”
But even the budgets allocated are woefully underspent. And, as Mariwala said, “budgeting and services are just one part of the puzzle”.
“Providing full accessibility and affirmativeness through structural and systemic changes in educational institutions is the other side,” he explained. “Providing counselling services and having a disability centre will not solve the entire issue. Systemic reforms such as accommodations for exams and viva need to be introduced for students with psychosocial disabilities.”
Vidyasagar said, “Even in educational institutions where there are counselling services in place, students view it as a punitive measure as the services are called upon by institutions to assist students with either low attendance or behavioural challenges.”
It should be noted that the last union budget had introduced a programme to provide “free tele-mental health services all over the country round the clock” – toll-free, 24/7 helpline numbers with provisions to set up physical or virtual consultations. The tele-mental health service was launched by the Union Health Ministry last year on World Mental Health Day.
What can be done?
At the outset, workplaces and educational institutions need to formulate mental health action plans that are accessible, affirmative and inclusive. There needs to be a strong non-discrimination, equality and confidentiality clause in place along with grievance redressal mechanisms.
In the workplace, specific measures can include flexible leave policies, access to mental health services, flexible working hours, and flexible deadlines. In institutions, these measures include establishing well-functioning disability and well-being centres and disability-related assessment adjustments such as extension of deadlines on coursework and the choice to give assessment in an alternative format, such as written or oral presentation.
But there’s still a long way to go.
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