The theme of World Mental Health Day (October 10) this year 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.
The Indian experience
India’s informal workforce accounts for more than 90% of the working population. These workers often operate without regulatory protection, work in unsafe working environments, endure long hours, have little access to social or financial protections, suffer high uncertainty and deep precarity, and face discrimination — all of which further undermine mental health and limit access to mental health care. 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.
According to the United Nations Development Programme (UNDP), unemployment and poor-quality employment have consistently been detrimental to mental health. The Lokniti group within the Centre for the Study of Developing Societies, which interviewed 9,316 youth aged between 15 to 34 years across 18 States in India, has shown that they are highly susceptible to negative emotions. Youth unemployment is one of the highest in India which, along with the stigma around unemployment, significantly impacts their mental health. Moreover, an ILO report highlights how young workers are shifting to more precarious and informal work, accepting less pay and poorer working conditions, out of desperation, and, sometimes, giving up and exiting the labour force altogether. The State of Inequality in India Report 2022 observes that the unemployment rate actually increases with educational levels, particularly for educated young women who show an unemployment rate of 42%. 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.
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. Another study, by the ILO on elderly employment in India, shows high poverty among them, in terms of economic dependency and access to financial assets. The absence of proper financial and health-care security among the working elderly can severely impact their physical and mental health, aggravating their vulnerability.
On social security
Informal workers face mental distress due to accumulating debt and rising health-care costs, which are intertwined and mutually reinforcing. A study by Women in Informal Employment: Globalizing and Organizing (WIEGO) among informal workers in Delhi, mostly migrants, indicates that recovery post COVID-19 remains uneven among informal worker cohorts. Many still report food insecurity, skipped meals, or reduced consumption. As observed by the Keshav Desiraju India Mental Health Observatory, mental health and well-being are impacted by factors such as food security, access to livelihood and financial stability. While certain schemes have received a higher allocation this year, others such as the Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS) have seen their funding slashed. In 2021, the National Crime Records Bureau (NCRB) reported that 26% of the people who died by suicide were daily wage earners. 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 and protective, aiming to ensure relief from external shocks.
A relook at the Code on Social Security 2020 shows how glaring issues concerning the social security of India’s informal workforce still remain unheeded. While India should universalise social security, the current Code does not state this as a goal.
Care needs drastic improvement
Informal workers, despite their significant contribution to national income, are perennially exposed to various economic, physical, and mental vulnerabilities. India’s budgetary allocation for mental health (currently under 1% of the total health budget) has over-focused on the digital mental health programme. As the World Mental Health Report 2022 observed, addressing mental health involves 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 well-being’ and SDG 8 on ‘decent work for all/economic growth’.
Neethi P. is a senior researcher at the Indian Institute for Human Settlements, Bengaluru. Her work focuses on the broader themes of urban employment, informality and women’s work. The views expressed are personal
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