Context: The theme of World Mental Health Day (October 10) this year is ‘mental health as a universal human right’. Informal worker and elderly are segments often overlooked when it concerns mental health is the informal worker and elderly.

Mental Health & Work Force

India has a vast informal workforce, which comprises a significant portion of the country’s labor force. This informal sector includes workers in agriculture, construction, domestic work, street vending, and various small-scale enterprises. 

While these workers play a crucial role in the Indian economy, they often face unique challenges related to mental health.

• Lack of Job Security: Informal workers often face a lack of job security, resulting in ongoing stress and anxiety regarding their income and livelihood. This instability in employment can significantly impact their mental well-being.

• Low Wages and Poor Working Conditions: Informal workers often receive low wages and have to endure harsh working conditions. This can lead to feelings of hopelessness and frustration, contributing to mental health issues.

• Lack of Social Safety Nets: The informal sector is often excluded from formal social safety nets, such as health insurance and retirement benefits. This lack of access to healthcare and financial security can result in increased stress and anxiety.

• Long Working Hours: Many informal workers work long hours, sometimes even seven days a week, to make ends meet. This leaves little time for rest and relaxation, which is crucial for mental well-being.

• Stigma Surrounding Mental Health: In India, there is still a significant stigma associated with mental health issues. Informal workers burdened with several deprivations often become more hesitant to seek help due to the fear of discrimination or societal judgment.

• Lack of Awareness and accessibility: Many informal workers may not be aware of mental health services or may not have access to them. Further, shortages in terms of availability of specialists makes the accessibility even more strenuous. 

According to a report by the World Health Organization (WHO), There are only 0.3 psychiatrists, 0.07 psychologists and 0.07 social workers per 100,000 people in India.

All of which further undermine mental health and limit access to mental health care.

Correlation between Informal Work Force and Mental Health

The deteriorated mental health of the informal workforce in India can have significant long-term implications for the country’s demographic dividend, which refers to the economic advantage that arises when the working-age population exceeds the dependent population (children and elderly). 

Here’s how the poor mental health of the informal workforce can impact the demographic dividend in the long run:

• Reduced Productivity and Economic Growth: Poor mental health can lead to decreased productivity among informal workers. This, in turn, can slow down economic growth as these workers are a substantial part of the labor force.
• Increased Healthcare Burden: Mental health issues can result in physical health problems if left unaddressed. The healthcare burden on the country may increase as mental health-related illnesses add to the demand for medical services.
• Higher Dependency Ratio: Workers with deteriorated mental health may become less productive or unable to work altogether, contributing to a higher dependency ratio. A higher ratio of dependents to workers can strain social welfare systems and reduce the savings rate.
• Educational Impact: Informal workers with mental health issues may struggle to provide adequate support for their children’s education and well-being. This can affect the quality of education and future employability of the next generation. The Annual Status of Education Report (ASER) has consistently highlighted issues related to the quality of education in India, with a significant portion of children lacking foundational skills.
• Inter-generational Impact: Poor mental health can be transmitted across generations. Children growing up in households with parents suffering from mental health issues may themselves face challenges in education and employment, further straining the demographic dividend. The National Family Health Survey-5 (NFHS-5) indicates that the prevalence of mental health issues among parents can influence child development outcomes.
• Reduced Entrepreneurship:  Many informal workers are also entrepreneurs running small businesses. Mental health issues can hinder their ability to innovate and grow their enterprises, impacting entrepreneurship and economic dynamism.
• Social Cohesion and Crime: Poor mental health can contribute to social issues and crime rates. Social cohesion may deteriorate, affecting the overall stability of the country.
• According to the United Nations Development Programme(UNDP), unemployment and poor-quality employment have consistently been detrimental to mental health.

With this phase of demographic dividend, where half of India’s population is of working age and projected to remain so for two decades, it is pertinent to think about the quality of employment and long term social security for them.

Mental Health & Elderly:

A study, by the ILO on elderly employment in India, shows high poverty among them, in terms of economic dependency and access to financial assets.

Mental health is a critical aspect of overall well-being, and it becomes even more significant as people age. The elderly population faces unique challenges related to mental health, and addressing these issues is essential to ensuring their quality of life. Here are some key considerations and factors related to mental health in the elderly:

• Prevalence of Mental Health Issues: Elderly individuals are prone to mental health conditions. Depression, anxiety, and cognitive disorders like dementia are common among the elderly population.
• Cognitive Decline: Cognitive decline is a common part of the aging process. Conditions like Alzheimer’s disease can significantly impact an individual’s mental health and well-being.
• Isolation and Loneliness: Many elderly individuals experience social isolation and loneliness, especially if they live alone or have limited social interactions. These feelings can contribute to depression and anxiety.
• Physical Health Impact: Physical health issues such as chronic pain, chronic illnesses, and mobility limitations can exacerbate mental health problems in the elderly. Pain and discomfort can lead to depression and a reduced quality of life.
• Bereavement and Loss: The loss of loved ones and friends is a significant life event for the elderly. Grief and bereavement can trigger or worsen mental health conditions.
• Stigma and Cultural Factors: There can be a stigma associated with mental health issues, particularly in older generations. Some elderly individuals may be reluctant to seek help due to the fear of being labeled as “mentally ill.”
• Access to Healthcare: Access to mental healthcare services can be limited for the elderly, especially in rural areas. Many elderly individuals may not receive timely diagnosis and treatment.
• Medications and Polypharmacy: Elderly individuals often take multiple medications for various health conditions. Polypharmacy can lead to interactions and side effects that affect mental health.
• Financial Stress: Financial concerns, such as inadequate retirement savings or rising healthcare costs, can lead to anxiety and depression among the elderly.
• Caregiver Stress: Caregivers, often family members, may experience mental health challenges themselves while caring for elderly relatives, adding to the overall burden.

The absence of proper financial and healthcare security among the working elderly can severely impact their physical and mental health, aggravating their vulnerability.

What should be done:

• Employment guarantee programmes can indeed improve mental health outcomes. Thus, social security can be: 
  • Promotional –  aiming to augment income
  • Preventive – aiming to forestall economic distress
  • Protective – aiming to ensure relief from external shocks.
• Increase in budgetary allocation and Diversification – As India’s budgetary allocation for mental health (currently under  1% of the total health budget) has overfocused on the digital mental health programme. 
• As the World Mental Health Report 2022 observed, addressing mental health should involve strengthening community based care, and people centred, recovery oriented and human rights oriented care. 

There is an urgent need for proactive policies to improve mental health recognition and action. 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 wellbeing’ and SDG 8 on ‘decent work for all/economic growth’.