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This article is part of the essay series “World Mental Health Day 2024”
Frontline workers are hailed as heroes, yet we have failed them in ways that are far from heroic. While they shoulder the responsibility of keeping society functional through the dark days, they are left to grapple with crippling mental health issues—often in silence. This hidden crisis requires urgent attention, not just from the viewpoint of individual well-being but from the economic future and security of the nation. In 2019, the World Health Organization (WHO) estimated that 12 billion working days are lost annually due to depression and anxiety, meaning a cost of US$1 trillion in productivity losses worldwide. How many years can India afford to ignore the mental health of those who keep it running?
Essential but overlooked
Across India, frontline workers face unrelenting pressure. A study by the Postgraduate Institute of Medical Education and Research reported that nearly 30 percent of doctors were depressed, with 17 percent admitting to having suicidal thoughts. Another systematic review showed that burnout among healthcare professionals in India is around a staggering 25 percent, a grim reminder of the widespread nature of the mental health crisis. This brings to the fore a dismal picture for India's frontline workers, worsened by the stigma that is often overlooked in discussions about mental health and safety."
A study by the Postgraduate Institute of Medical Education and Research reported that nearly 30 percent of doctors were depressed, with 17 percent admitting to having suicidal thoughts.
Overworked and burnt out
An important reason for the frontline workers' mental health crisis is simply the number of hours they work. Long and unsociable working hours are key risk factors for mental health disorders identified by the WHO. In the Indian context, this becomes very pertinent as healthcare workers, particularly postgraduate doctors and resident physicians, have been observed to work consecutive shifts, sometimes over 12-36 hours. They often forego sleep and go without proper meals. India also has a serious shortage of healthcare professionals (HCPs). There was only one allopathic doctor for every 1,511 people in 2021 and if one adds AYUSH doctors to the mix, the figure stood at one doctor for every 834 people in 2023. The situation for nursing professionals is similarly concerning, with one nurse available for every 476 people in 2023. This dearth of professionals could be one of the reasons for an all-time high level of burnout in the medical profession. These ratios are based on the assumption that 80 percent of the total HCPs are practising, which may not necessarily be the case. Human and financial costs abound: India's reliance on burnt-out healthcare professionals runs far beyond pain and suffering for the individual to higher rates of absenteeism and staff turnover; much worse still, error rates in medical care being affected.
The right to disconnect: Far from reality
Countries like France and Spain have already been proactive over the mental health of workers by implementing “Right to Disconnect” legislation, that governs after-hours work communication. The legislation was first implemented in France in 2017, followed by its adoption in Spain, Italy, and Belgium, which have now guarded their federal public sector workers against after-hour communication. In Ireland, a Code of Practice has been developed to safeguard employees' rest time to encourage work-life balance but it remains only a code of practice, not formal law. India, however, marks a stark contrast. Even though the need for such laws is growing day by day, legislation like the Right to Disconnect continues to remain on paper. Member of Parliament Supriya Sule’s 2018 Right to Disconnect Bill failed to gain traction. Additionally, states like Tamil Nadu and Karnataka have proposed increasing work hours, further worsening the situation for essential workers.
In Ireland, a Code of Practice has been developed to safeguard employees' rest time to encourage work-life balance but it remains only a code of practice, not formal law.
Essential workers in India, particularly in healthcare and law enforcement, frequently work more than the stipulated hours. A 2020 report found that Indians worked an average of 2,117 hours annually in 2017—significantly higher than the OECD average of 1,749 hours. During the pandemic, frontline workers were stretched to their limits, with long hours becoming the norm. The absence of laws like the Right to Disconnect has left workers vulnerable to burnout and mental health crises. Even when such laws are enacted, as in Ontario, Canada, critics argue that such legislation is relatively unenforceable, usually with vague rules and minimal penalties for violation. This will perhaps illustrate the problem that would arise if India were eventually to consider such legislation.
Work culture and mental health
India’s work culture, particularly in high-pressure fields like healthcare and law enforcement, is notoriously hierarchical. Junior doctors and police officers are expected to endure long, gruelling hours as a form of professional initiation. This “rite of passage” normalises suffering and contributes to high levels of burnout and mental health disorders.
A report issued by the Indian Medical Association conveys that more than 75 percent of doctors face verbal or physical violence at some stage in their professional lifecycle, which increases stress. Such a hierarchical culture along with lengthened working hours and a lack of support leads to absenteeism, including loss of productivity. According to the National Mental Health Survey (NMHS 2015-16), 10.6 percent of the population suffers from a mental health condition; however, the prevalence in frontline workers must be much higher because of the extreme stresses they bear.
During the pandemic, frontline workers were stretched to their limits, with long hours becoming the norm.
Systemic change
Addressing the mental health crisis among India’s frontline workers requires more than token gestures. India’s current labour laws, while reformed, still fall short in addressing the mental health needs of its workforce, particularly in high-stress sectors like healthcare and emergency services. The Mental Healthcare Act 2017, too, provides legal safeguards in the form of confidentiality and immunity from termination due to mental illness. What is lacking is some level of enforcement of these safeguards. Not only that, but the lack of strengthened workplace policies hinders their cause. Debates over the increase in working hours to 70 hours a week or discussions of amending the Factories Act, reveal how employers reap output from overworked employees but do not consider the long-term implications. Without legal frameworks enforcing labour laws, such as those seen in Europe, the mental and economic toll on India’s essential workforce will only escalate. India should transition from a piece-meal approach, and scale up the National Mental Health Programme to focus on frontline workers, strictly enforce work hours, and destigmatise regular mental health protocols as an accepted workplace requirement.
India must move beyond paper policies like the Right to Disconnect or dreams of a four-day work week. It needs to ensure that work-life balance becomes a real, actionable priority, rather than a Don Quixote-like pursuit.
KS Uplabdh Gopal is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
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