Mental Health: The Hidden Toll of Informal Labor in India

• 12 Oct 2023

This editorial is based on “Mental health and the floundering informal worker” which was published in The Hindu on 09/10/2023. It talks about the mental health issues faced by the informal workers in India and the possible solutions to address them.

For Prelims: National Mental Health Program (NMHP), Mental HealthCare Act 2017, Kiran Helpline, Code on Social Security, 2020, Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS), Sustainable Development Goals (SDGs), MANAS (Mental Health and Normalcy Augmentation System)

For Mains: Mental Health: Impact of informal Work on Mental Health, Impacts of Poor Mental Health, Steps Taken by the Government, steps that can be taken to Improve Mental Health

The theme of World Mental Health Day (October 10) 2023 is ‘mental health as a universal human right’. A segment often overlooked when it concerns mental health is the informal worker. A study by the International Labour Organization (ILO) says that 15% of working-age adults, globally, live with a mental disorder.

On one hand, decent work influences mental health in a positive way while on the other, unemployment, or unstable or precarious employment, workplace discrimination, or poor and particularly unsafe working environments, can all pose a risk to a worker’s mental health. Workers in low-paid, unrewarding or insecure jobs, or working in isolation, are more likely to be exposed to psychosocial risks, thus compromising their mental health.

According to the National Mental Health Survey 2019, about 14% of all adults in India have or will have a mental condition of some kind. Nearly 56 million people in the country are thought to suffer from depression, with another 38 million suffering from anxiety disorders.

What is Mental Health and its Significance?

• Definition: According to WHO, mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.
  • It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in.
• Significance: Mental health is a basic human right and a crucial aspect of personal and community development. It is also a global issue that requires collective action and awareness.
  • That is why every year on October 10, the World Federation for Mental Health (WFMH) organizes World Mental Health Day to promote mental health education, advocacy, and support.

How does Informal Work impact Mental Health?

• Lack of Regulatory Protection: India's informal workers, who make up over 90% of the workforce, often operate without regulatory protection. This means they lack job security, legal rights, and access to benefits, creating a constant sense of vulnerability and stress, which can negatively impact mental health.
• Unsafe Working Environments: Many informal workers toil in unsafe working conditions, which can lead to physical and psychological health problems. The fear of workplace accidents and injuries can contribute to anxiety and stress.
• Long Hours and Uncertainty: Informal workers often endure long working hours and have unpredictable incomes. This instability and uncertainty can lead to chronic stress, anxiety, and depression, as they struggle to make ends meet.
• Limited Access to Social and Financial Protections: Informal workers have limited or no access to social safety nets, such as health insurance or pension schemes. This lack of financial protection can increase feelings of insecurity and contribute to mental health issues.
  • Informal workers face mental distress due to accumulating debt and rising health-care costs, which are intertwined and mutually reinforcing.
    • In India, the share of Out-of-Pocket Expenditure (OOPE) in total Health Expenditure is 47.1%.
  • India will also become an aging society in 20 years, with no apparent social security road map for this rapidly growing group that is especially vulnerable to poor mental health.
    • The Census of India 2011 shows that 33 million elderly people are working post-retirement in informal work.
• Gender Discrimination: Gender disparities are also stark, with over 95% of India’s working women engaged in informal, low-paying, and precarious employment, often without social protection, in addition to suffering patriarchal structures and practices in their social and familial spaces.
• Youth Unemployment: High levels of youth unemployment in India have a significant impact on the mental health of young people. The stigma associated with unemployment can lead to feelings of inadequacy, anxiety, and depression among the youth.
• Shift to Precarious Work: Young workers often accept low-paying and precarious jobs in the informal sector out of desperation, which can negatively impact their mental health. Poor working conditions and low wages contribute to job dissatisfaction and stress.

What are the Impacts of Poor Mental Health?

• Reduced Quality of Life: People with mental health conditions may experience lower levels of well-being, happiness, and satisfaction. They may also face difficulties in coping with stress, fulfilling their potential, and enjoying their relationships.
• Impaired Physical Health: There is a strong connection between mental and physical health. Poor mental health can lead to physical health problems such as chronic stress, sleep disturbances, and increased susceptibility to illness.
• Risk of Self-Harm and Suicide: Poor mental health is a significant risk factor for self-harm and suicide. It's essential to provide appropriate support and intervention for individuals at risk.
  • The National Crime Records Bureau (NCRB) reported that 26% of the people who died by suicide were daily wage earners.
• Work and Productivity: Poor mental health can lead to decreased productivity, absenteeism, and difficulty concentrating at work or school. This can result in job loss, academic underachievement, and financial difficulties.
• Economic burden: People with mental health conditions may incur high costs for treatment, travel, and care. They may also lose income and productivity due to absenteeism, presenteeism, or unemployment. Moreover, poor mental health can affect the economic development and growth of countries and regions.
  • As per the WHO, the economic cost of poor mental health in the country will be over $1.03 trillion between 2012 and 2030.
• Social stigma and discrimination: People with mental health conditions may face negative attitudes, stereotypes, and prejudices from others. They may also encounter barriers and inequalities in accessing education, employment, health care, and social services.

Steps Taken by the Government:

• National Mental Health Program (NMHP): To address the huge burden of mental disorders and shortage of qualified professionals in the field of mental health, the government has been implementing the National Mental Health Program (NMHP) since 1982.
  • The Program was re-strategize in 2003 to include two schemes, viz. Modernization of State Mental Hospitals and Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals.
• Mental HealthCare Act 2017: It guarantees every affected person access to mental healthcare and treatment from services run or funded by the government.
  • It has significantly reduced the scope for the use of Section 309 IPC and made the attempt to commit suicide punishable only as an exception.
• Kiran Helpline: In 2020, the Ministry of Social Justice and Empowerment launched a 24/7 toll-free helpline ‘Kiran’ to provide support to people facing anxiety, stress, depression, suicidal thoughts and other mental health concerns.
• MANAS Mobile App: To promote mental wellbeing across age groups, the Government of India launched MANAS (Mental Health and Normalcy Augmentation System) in 2021.

What Steps can be taken to Improve Mental Health?

• Universalize Social Security: Ensure that social security measures are accessible to all, including informal workers. This could involve expanding the coverage of existing schemes or creating new ones specifically tailored to their needs.
  • Reevaluate and amend the Code on Social Security, 2020 to explicitly include universal social security as a goal. Policy reform is essential to address the specific needs of informal workers.
• Increase Funding for Mental Health: Allocate a higher percentage of the total health budget to mental health services. Given the significant mental health challenges faced by daily wage earners and other vulnerable groups, investing more in mental health infrastructure is crucial.
  • India’s budgetary allocation for mental health is currently under 1% of the total health budget. That too is over-focused on the digital mental health programme.
• Diversify Mental Health Programs: Expand mental health programs beyond just digital initiatives. While digital mental health programs can be valuable, they should be complemented with community-based care and human rights-oriented approaches, as recommended by the World Mental Health Report 2022.
• Promote Awareness and Recognition: Implement proactive policies to improve mental health recognition and awareness, especially among informal workers. This may involve conducting mental health awareness campaigns and training programs to reduce stigma and encourage early intervention.
• Support Economic Stability: Promote employment guarantee programs like the Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS) to provide job security and financial stability to daily wage earners. Economic distress is a significant contributor to mental health issues, and stable employment can help alleviate this.
• Ensure Basic Human Rights: This is critical in upholding the basic human right to good health, including mental health, and in advancing to the Sustainable Development Goals (SDGs), especially SDG 3 on ‘good health and well-being’ and SDG 8 on ‘decent work for all/economic growth’.
• Collaboration and Partnerships: Collaborate with non-governmental organizations (NGOs), healthcare providers, and community organizations to expand mental health services and outreach to marginalized communities.

Drishti Mains Question:

Discuss the impact of informal work on mental healthcare and the steps taken by the government in this regard. Propose additional policy measures to address the mental health needs of informal workers in the country.