India's workplaces have failed to protect their employees from suicide risk
To ease the precariousness of daily wage work, individuals need to be guaranteed financial protections, quality healthcare and access to their rights and entitlements.
The workplace is where most adults are likely to spend a significant amount of their time and energy. Research across the world has shown the work environment and culture impact employees' mental health and well-being. The workplace is also quite distressingly a contributing factor in some cases to suicide deaths and attempts. In India, given the demarcation of the labour market into the formal and informal sectors, there is an added layer of complexity to unpacking the relationship between suicides and the workplace.
A look into the data on suicides in India provides a startling revelation. According to the National Crimes Record Bureau (NCRB), one-fourth of all suicides in the country were among daily wage workers in 2021 – a number that has alarmingly increased by 11% from the previous year. This troubling occupational pattern brings to the forefront the precarity of unregulated informal work in India and the cautionary consequences of such jobs.
Suicide risk in the informal employment sector
The onset of the COVID-19 lockdown exposed the glaring social inequality within the informal sector. The nationwide lockdown forced several daily wage migrant workers from urban centres in India to embark on long journeys, in many cases by foot, to their home villages.
While the media’s attention and the public focus on their plight was short-lived, stories from the field and recent data from the NCRB highlight the potentially fatal impact of acute financial insecurity that many workers experienced during this period. While research in India is limited, we do know that socio-economic factors largely influence suicidality among such groups.
Daily wage workers rely on cash wages to support themselves as well as their families. The wages they receive are consistently low without access to any benefits such as health insurance. Their savings are either non-existent or minimal. In such situations, a healthcare emergency is very likely to leave them in debt or in penury.
These problems, while seemingly personal, stem from structural irregularities in the informal sector. The sector constitutes nearly 90% of the workforce in the country. Jobs in the sector are plagued by long working hours, no paid leave, absence of legal protections, or any social security. Employers are barely regulated or held accountable by the state for appalling work practices. Disconcertingly, the division of labour and participation in the sector, many a times mirrors and perpetuate class and social inequalities in society. Caste lines still define who is engaged in menial custodial work or in dangerous professions such as manual scavenging. Such jobs are characterised by deplorable working conditions, mistreatment by employers and rampant discrimination and harassment.
Employment in these jobs is dependent on the whims of the employer or the fluctuating state of the economy. With a contracting economy, jobs within manufacturing and services are few and far between. Such economic precarity and social inequality have serious psychological and social repercussions Many men engaged in daily wage work are the sole earners in their large families. The misplaced cultural notions associated with being the ‘breadwinner’ affects their identity in situations where they are bereft of work and are unable to support their family members. The constant discrimination and shame associated with certain jobs also take a toll on individuals and chip away at their dignity. Against this backdrop, stories of hopelessness, spousal abuse, alcohol dependence, and suicide, the brutal consequence of being in a state of constant insecurity, are far too ubiquitous.
This narrative is also very common among another professional group, the farmer. For over a decade, reports on suicides among farmers dominated discussions on suicide in the country. The often-politicised issue drew mass attention to the state of the agricultural sector in India. State policies and practices were blamed for high input prices, declining market rates and the push toward commercialisation. Without state support, and help from the formal banking system, subsistence farmers were left to fend for themselves at the mercy of predatory moneylenders and unpredictable climate patterns.
In the sector, where systems and institutions fail to keep individuals financially afloat, suicides have been a bitter outcome of poor action by the state and employer. In the absence of tangible institutions in the informal sector, it is the role of the state to step in to plug these systemic gaps. To ease the precariousness of daily wage work, individuals need to be guaranteed financial protections, quality healthcare and access to their rights and entitlements. Moreover, efforts should be made to restore the dignity of labour by legislating for anti-discriminatory practices in the workplace.
Suicide risk within formal institutions and workplaces
Beyond the informal sector, institutions in the organized sector suffer from practices that are associated with suicide risk. Occupations that are hyper-competitive and involve high stakes tend to aggravate stresses owing to the nature of work and professional practices. COVID-19 exposed one such profession that was prone to suicide risk – healthcare professionals. During the peak of the pandemic, doctors, nurses, ASHA workers and other medical staff were overburdened and under intense pressure to provide quality care in healthcare facilities that were inundated with patients, with limited resources and support. Healthcare workers were isolated from their families with no time off. They were often the ones to bear the vitriol and harassment from caregivers for the unavailability of services.
While there is no reliable data on the deaths by suicide among this group, there are several news reports of healthcare workers taking their lives during this period. Globally the risk of suicide among doctors is over two times higher as compared to the general population. In India, it was reported that over 350 doctors died by suicide between 2010 to 2019, most of them early career residents. The intense training that young doctors are required to undertake is gruelling. Long working hours and fierce competition contribute to burnout, depression and psychological strain. These environments are not conducive to seeking help and healthcare institutions are yet to prioritize mental health support.
Another institution afflicted with a high burden of suicides is the armed forces. The Centre recently reported that over 800 army personnel died by suicides in the past five years. Most reports of suicides among this group take place in Kashmir or North-Eastern states, where army personnel are on active duty. The stress and trauma of prolonged deployment in counter-insurgent operations coupled with institutional problems such as indifference and mistreatment among leadership and senior officials, inadequate leave and extended isolation are some of the possible reasons behind these suicides.
The crux of the problem of suicides in the workplace as illustrated by both the examples in the military and healthcare arise from deep-rooted institutional apathy and stigma. At its core, institutional reform is required to address the problem. The challenge is to prevail upon such institutions be it in healthcare, armed forces, or other industries to realise that they play a crucial role in preventing suicides. Structural changes have to be made to create work environments where individuals are valued and respected beyond their productivity. Leaders ought to be sensitive to their employee’s mental wellness. And policies that prevent discrimination at work as well as for paid leave and regulated work hours need to be adopted.
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Workplaces should not be spaces that exacerbate stress and suicide risk. Rather, they should guarantee economic security, be free of discrimination, encourage individual autonomy, and enable people to develop meaningful connections and purpose. Despite the diversity of workplaces in India, they can be transformed into spaces where individuals thrive with impetus from decision-makers to prioritize their employees in both policy and practice.
(Tanya Nicole Fernandes is a Research Associate; and Soumitra Pathare is a Consultant Psychiatrist and Director; at the Centre for Mental Health Law & Policy, Indian Law Society, Pune.)
Discussing suicides can be triggering for some. However, suicides are preventable. In case you feel distressed by the content or know someone in distress, call Sneha Foundation - 04424640050 (available 24x7).