Every 10 October, India performs the same ritual. Companies post a lotus-pose graphic, a minister tweets a helpline number, and HR schedules a wellness webinar for Friday afternoon, squeezed between two deadlines. On Saturday night, a manager sends the 10 pm email. By Monday, the ritual is forgotten.

This year I want to break the pattern. I was recently invited on a podcast to talk about the economics of mental health, and the conversation changed how I frame the subject. For years I wrote about mental health as a cultural and moral failure. The podcast forced me to count it as an economic failure too, and the numbers are brutal.

You can hear the full conversation through the Spotify link here:

https://open.spotify.com/episode/5SKomXkCIRNcZxLDVQy17k?si=dSmINov4T3-BiFuKnn1KZA

We usually ask how much it costs to treat a mental health condition. That is the wrong question. The right question is what it costs when we do not treat it.

The National Mental Health Survey says nearly 150 million Indians need care, yet fewer than 30 million seek it. The other 120 million do not vanish. They reappear as lost workdays, weak performance, relatives who quit jobs to become caregivers, and, in the worst cases, funerals. India records over 170,000 suicides every year. That is 1 person every 3 minutes.

Now look at what we spend.

Public health spending hovers around 1 to 2% of GDP, and less than 1% of the health budget goes to mental health. India has roughly 9,000 psychiatrists and needs about 30,000 more. The Indian Journal of Psychiatry estimates it would take 42 years to close the gap for psychiatrists and 76 years for clinical psychologists and psychiatric social workers. That is not a plan. That is a delay with a government logo on it.

Treatment is cheap compared to the damage. A WHO-backed study found that every dollar invested in treating depression and anxiety returns about four dollars in better health and productivity. Harvard and the World Economic Forum estimated that India could lose about USD 1.03 trillion between 2012 and 2030 because of mental disorders. We are not saving money by neglecting this. We are paying a far higher price, just not on a hospital bill.

The Employee Who Is Present and Absent

Absence is visible. Presenteeism is not. The person sits at the desk, but the mind is somewhere else.

A 2023 ASSOCHAM study found that 89% of Indian employees suffer from work-related stress, yet only 27% feel comfortable telling their supervisor. So, most people stay quiet and keep showing up. Quiet does not mean fine. It means slower decisions, more errors, less creativity and less risk taking. The anxious employee stops volunteering for the stretch project. The burnt-out employee stops asking for the promotion. A career stalls and nobody records why.

For the individual, this is a ceiling on potential. A talented person works below capacity for years and is then told she lacks ambition. For the economy, it is a hidden tax. Deloitte estimated in 2022 that poor mental health costs Indian employers about USD 14 billion a year, and global employer studies keep finding that presenteeism costs more than absence, because the loss is spread across every task done at half strength.

12 Hours Is Not Productivity. It Is Theft From Tomorrow

Take the Big 4 as the extreme case. Audit staff have been reported working 12 to 16 hour days, and surveys show over 70% say the pressure is damaging their mental health. Does a longer day mean more output? No.

Economist John Pencavel studied this and found that output rises with hours only up to about 49 hours a week. After that, output per hour falls sharply. Someone working 70 hours produces almost nothing more than someone working 55. The extra hours are wasted, and the worker pays for them with health.

The health cost is documented. The WHO and the ILO found that working 55 hours or more a week raises the risk of stroke by 35% and the risk of dying from heart disease by 17%, compared with a 35 to 40 hour week. They linked 745,000 deaths in 2016 to long working hours.

The firm pays too, through attrition, errors and weaker audits. Replacing a single manager costs roughly 12 to 15 lakh rupees. And audit quality is a public good: a tired auditor is more likely to miss a red flag, and then investors, banks and taxpayers settle the bill. In July 2024, a 26-year-old EY employee in Pune died, and her mother wrote publicly that overwork played a part. That case forced India to look at what these hours really cost.

It is not only a Big 4 problem. In Indian startups and corporates, 70 to 80 hour weeks are celebrated, and prominent business leaders have argued for 70-hour and even 90-hour weeks. The evidence says they are wrong. Long hours borrow from tomorrow, and fatigue always collects the debt.

Hustle Culture Converts the People Who Resist It

Hustle culture turned exhaustion into a badge of honour. The person who keeps a boundary is labelled “not committed” or “lacking passion.” Busy has become a personality, and rest has become a weakness.

It also changed how we talk about mental health. Hustle culture says stress is your personal problem: meditate more, wake up earlier, build resilience. It moves the blame from the system to the individual. A company can run a wellness webinar on Friday and send a 10 pm email on Saturday. Women carry a triple burden of work, home and social expectation, and a 2022 survey found that 76% of working women in India report anxiety from balancing work and family.

The young are not choosing this freely. Gen Z employees, facing a tough job market and heavy debt, show 23% higher tolerance for toxic behaviour than millennials at the same career stage. When you carry 15 lakh rupees in education debt and 200 candidates are chasing one job, you smile through abuse. That is not a mindset. That is economic pressure.

Then the cycle feeds itself. A five-year study of 1,000 Indian professionals found that in year one, 89% said toxic managers should be fired. By year five, 34% had become toxic managers themselves. Hustle culture does not merely survive resistance. It recruits the resisters.

Why 92 Percent of Toxic Managers Keep Their Jobs?

According to the figures I used on the podcast, 67% of Indian employees have worked under a toxic manager, and only 8% of such managers are ever fired. Managers with the highest employee complaint ratios had a 43% higher chance of promotion. In the same research, 78% of surveyed C-suite executives admit they know toxic managers exist in their organisations, and 92% believe removing all of them would hurt short-term profit.

Read that again. Reported research suggests toxic managers can save a company about 45 lakh rupees a year and deliver 23% higher short-term productivity. The benefit lands in the quarterly result. The cost lands on the employee, and on the health insurance claim two years later. When the boss is part of the problem, showing up sick becomes a survival strategy. The problem is not only overwork. It is the toxic combination of unrealistic targets, job insecurity and a cultural acceptance of workplace abuse.

The Poverty Trap Inside the Mind

If financial stress worsens mental health, and poor mental health makes it harder to earn and manage money, we are not looking at two problems. We are looking at one trap.

A major review in Science in 2020 found that the link runs both ways: poverty raises the risk of mental illness, and mental illness pushes people deeper into poverty. Picture a father who loses income. Stress builds. He sleeps badly, decides poorly, misses work. Income falls further. The family borrows, and debt adds stress. Now he needs care, but a private therapy session in a metro can cost 1,500 rupees or more. With per capita income around 2 lakh rupees a year, weekly sessions would eat nearly 40 percent of a person’s annual income. That is an illustration, but it explains why care stays out of reach. By my estimate, not more than 10 percent of Indians can afford mental health assistance.

Stress also changes the arithmetic of decisions. Sendhil Mullainathan and Eldar Shafir showed that scarcity taxes the mind. In a study of sugarcane farmers in Tamil Nadu, the same farmers scored far lower on thinking tests before harvest, when money was tight, than after it. The gap resembled losing about 13 IQ points. Same person, same brain, different financial stress.

So, households respond in opposite directions. Some hoard cash and gold out of fear and refuse to invest. Others spend impulsively and stop opening bills. Both are rational reactions to an irrational amount of pressure. Borrowing is where the damage peaks: a stressed household takes the fastest loan, not the cheapest, and in India that often means a moneylender. With close to 40% of health spending paid out of pocket, one mental health episode can push a family straight into debt.

The state is supposed to break this cycle. Section 18 of the Mental Healthcare Act 2017 gives every person the right to mental health care from government-run or funded services and says the government must reimburse treatment costs if it fails to provide it. The Act also says insurers must cover mental illness on the same terms as physical illness. Yet on 16 May 2020, the Supreme Court had to issue a notice to the insurance regulator IRDAI because insurers were still refusing cover. We have a law that promises care, a market that declines to provide it, and a public system with too few professionals. The family is left alone with the cycle. That is a policy failure, not a personal one.

Two Families, Same Salary, Different Lives

Take two Mumbai families, both earning 8 lakh rupees a year. In the first, someone can talk about stress, and a relative with depression is treated early. In the second, the same illness is hidden behind shame. The family says “pagal hai kya” or “sab dimag mein hai,” and money goes to rituals and spiritual healers first. In one documented case, a family spent two years on religious remedies for a son with schizophrenia before accepting medical treatment, and by then his condition had badly deteriorated.

Compare the outcomes.

The first family keeps its earner working, its savings intact and its children stable.

The second loses workdays, takes on debt, and has a caregiver who cannot work.

The illness may even shadow marriage prospects and social standing.

The joint family once acted as an emotional buffer, but urbanisation and migration have weakened it, so many households now face illness alone.

This is why income is a weak measure of welfare. Amartya Sen made the point with his capability approach: what matters is what people can do and be. Mental health is one of the biggest drivers of that ability, and stigma, family structure and access to care spread it unevenly. Religion deserves a hard work here. Faith can comfort, but when someone with severe depression is told to “just have faith,” comfort becomes a delay. Religious and community leaders need training on when prayer must be paired with medicine.

When the Person Is the Firm?

My own research lives in informal markets, so the podcast question I enjoyed most was about entrepreneurs. Nearly 90% of India’s workers are in the informal economy. There is no HR department, no sick leave, no insurance and no manager to cover for you. If a street vendor, small trader or gig worker has a bad week mentally, the shop shuts, the delivery does not happen, and income stops that day.

That makes mental health a direct business risk. Stress narrows decisions. A stressed entrepreneur avoids risk, skips investing in stock or equipment, and takes short-term credit at a high rate because it is fast and needs no paperwork. Household and business finances are mixed, so a family crisis becomes a business crisis, and the reverse. Delivery workers, cab drivers and freelancers face income uncertainty, no benefits and social stigma, and their distress stay invisible to policymakers.

But informal markets also teach something formal workplaces forgot. Traders rely on peer networks, rotating savings groups and informal credit from people who know their family. Someone covers your stall for an afternoon. That is insurance built from trust. Formal employers can borrow three lessons: flexibility, community and trust. Offer results-based schedules without treating them as a favour. Build peer support circles and emergency salary advances so one bad month does not become a debt trap. Let teams cover each other without fear. One warning, though: do not romanticise the informal sector. It has almost no safety net. The goal is to combine its flexibility with the protection only formal systems can give.

The Invisible Ledger

Why do we underestimate all this?

Because GDP counts what is produced, not what is lost. It counts a hospital bill as growth, and it does not count the person who worked at half strength for ten years. It ignores presenteeism, the unpaid care work done mostly by women, informal workers who never appear in company data, and the lifetime earnings lost to suicide.

Consider the scale.

The OECD estimates that mental ill health could reduce GDP by 1.7% annually in OECD countries. As a benchmark for India, whose GDP is around USD 4 trillion, even 1.7% is about USD 68 billion a year, more than 5 lakh crore rupees, every year and compounding. It would hit growth, shrink labour supply, raise healthcare spending and weaken government finances at once, because fewer people pay tax while more need support. A country that wants to be developed by 2047 cannot run its workforce at partial capacity.

What gets measured gets managed. So, measure it. Add mental health indicators to corporate reporting such as BRSR, track attrition and complaints by manager, and include mental health in national statistics. Until then, we will keep calling a slow budget crisis a private problem.

The Dividend That Could Become a Liability

India’s median age is around 28, and the window of a large working-age share is expected to stay open only until the early 2040s. A young workforce is an advantage only if it is healthy. The WHO estimates that 56 million Indians live with depression and 38 million with anxiety disorders. The National Crime Records Bureau recorded over 13,000 student suicides in 2022.

At the current pace, closing the gap in professionals will take 42 to 76 years. A 25-year-old today will be retired by then. The dividend will be over before the doctors arrive. Early burnout means shorter careers, lower incomes, lower savings and, eventually, an older India that is poorer and sicker. The best talent will also leave for countries and employers that treat them better.

Instagram Is Not Your Psychiatrist

Into this vacuum of care has marched a new profession: the influencer therapist. In my Medium essay on this, I opened with a 19-year-old in Mumbai at 2 a.m. who watches a 47-second reel about “high-functioning depression,” ticks off every “symptom,” and goes to bed convinced she has a clinical disorder. The qualification of the person who diagnosed her was 1.4 million followers.

This is not a hypothetical. A licensed clinical psychologist needs six to eight years of education and supervised practice. An influencer needs a phone and Wi-Fi. A 2023 study in JAMA Network Open found that more than half of the 100 most popular TikTok ADHD videos contained inaccurate or misleading information. Then comes the more dangerous genre: the anti-medication narrative, “I healed myself naturally, you don’t need pills,” which can push someone with severe illness to stop treatment without supervision. That is a medical emergency dressed in motivational aesthetics.

India is especially exposed. The WHO estimates a treatment gap of over 80 percent for common mental disorders, and a wave of Hindi and regional-language creators has rushed in, offering astrology-based emotional advice, morning routines that supposedly cure depression, and breathwork as a substitute for psychiatry. I am not against lay conversation. Peer support and shared experience have helped millions feel less alone. The problem is not the conversation. The problem is the costume. “This is what it felt like for me” is honesty. “Here is what is wrong with you” is the practice of a clinical profession.

Fix the Environment, Not the Flower

There is a quieter lesson underneath all of this, and I learned it the hard way. A Mumbai counsellor once told me, “When you give space to the saplings, they grow. When you regulate them more frequently, they will never become a tree.” We are inured to fixing the person, not the environment. The speaker Alexander Den Heijer put it well: when a flower does not bloom, you fix the environment in which it grows, not the flower.

That is why a resilience workshop cannot cure a toxic office. It is also why India’s families, workplaces and religious spaces matter more than any app. Your environment, your colleagues, your feed and your habits shape your mind more than you realise. Walking out of an environment that keeps you stagnant is not selfishness. Sometimes it is treatment.

The same logic applies to helpers. For years I suffered from what psychologists call a savior complex, trying to rescue every struggling student and colleague. A Japanese monk in Worli, Bhikku Morita, told me, “Kindness without boundaries becomes a burden.” He was right. Listen without absorbing. Encourage professional help. Set time limits. Protect your own peace. You cannot heal everyone, and the system should not rely on exhausted volunteers to do its job.

What India Must Do Before the Next 10 October

I will start with policymakers, because employers will not move alone.

First, fund it. Mental health should be a non-negotiable line in the budget, with clear targets and public reporting. Less than 1% of the health budget is not serious.

Second, enforce the law we already have. Section 18 gives a right to care, and insurers must offer parity cover.

Third, build people. We cannot wait 42 to 76 years for specialists. Train community health workers and lay counsellors for basic care, expand tele-services such as Tele-MANAS, teach mental health in schools from primary level, and push the media to report responsibly.

For employers, my advice is direct. Cap working hours and mean it. Offer real mental health leave without penalty. Cover outpatient therapy in health insurance, not just hospitalisation. And fix the managers: put people management into promotion and bonus criteria, provide safe anonymous reporting, and attach real consequences. If a manager hits targets by breaking teams, that should count against them.

For platforms and influencers, the ask is not silence. It is honesty. Disclose your qualifications. Stop selling diagnoses. Advertisers should refuse to sponsor unqualified mental health advice.

And for the rest of us, the ask is smaller and harder: have the uncomfortable conversation at home. Drop the “pagal hai kya.” Ask the quiet colleague how they are and wait for the real answer.

The Question That Remains?

Mental health is not a cost. It is an investment we refuse to make while paying for the refusal in lost workdays, ruined households, stalled careers and lives.

The question is not whether India can afford to address this. It is whether India can afford not to.

If you are struggling, please speak to a licensed professional or a trusted person.

If this article stirred something, listen to the full podcast conversation here:

https://open.spotify.com/episode/5SKomXkCIRNcZxLDVQy17k?si=dSmINov4T3-BiFuKnn1KZA

“Thank you very much!”

Views of the author are personal and do not necessarily represent the website’s views.

Dr. Jaimine Vaishnav is a faculty of geopolitics and world economy and other liberal arts subjects, a researcher with publications in SCI and ABDC journals, and an author of 6 books specializing in informal economies, mass media, and street entrepreneurship. With over a decade of experience as an academic and options trader, he is keen on bridging the grassroots business practices with global economic thought. His work emphasizes resilience, innovation, and human action in everyday human life. He can be contacted on jaiminism@hotmail.co.in for further communication.

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