Exploring Well-Being among Mental

Health Professionals in India

Pankhuri Aggarwal & Sujata Sriram

Psychological Studies

ISSN 0033-2968

Psychol Stud
DOI 10.1007/s12646-018-0470-x

1 23
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 Author's personal copy
Psychol Stud
https://doi.org/10.1007/s12646-018-0470-x
RESEARCH IN PROGRESS
Exploring Well-Being among Mental Health Professionals in India
Pankhuri Aggarwal1 • Sujata Sriram2
Received: 31 July 2017 / Accepted: 8 October 2018
 National Academy of Psychology (NAOP) India 2018
Abstract An exploratory mixed methods study was
designed to understand the construction and experience of
happiness and well-being among Mental Health Profes-
sionals (MHPs) in India. Through non-probabilistic sam-
pling techniques, 17 MHPs were selected from three
government hospitals in a city in North India. Qualitative
interview data were triangulated with scores from the
Mental Health Continuum-Long Form (MHC-LF). Analy-
sis showed that despite happiness being a desirable and
pleasurable state, participants rarely devoted time thinking
about it. Happiness was a multidimensional phenomenon
which affected personal, interpersonal, social and envi-
ronmental realms. Happiness was synonymous with con-
tentment and satisfaction and was understood as the
opposite of unhappiness. Although recognised as a uni-
versal phenomenon, happiness had a subjective and indi-
vidual-specific understanding, experience and
manifestation. Data from the MHC-LF provided scores on
overall well-being, and emotional, psychological and social
well-being, and indicated that 14 participants had flour-
ishing mental health, and three were moderately mentally
healthy. The personal and professional lives of the MHPs
This paper draws from the first author’s thesis completed at Tata
Institute of Social Sciences (TISS), Mumbai, under the supervision of
the second author.
& Pankhuri Aggarwal
pankhuri.aggarwal@gmail.com
Sujata Sriram
sujatasriram@gmail.com; sujatas@tiss.edu
1
Department of Psychology, Miami University, Oxford, Ohio,
United States of America
2
The School of Human Ecology, Tata Institute of Social
Sciences, Mumbai, Maharashtra, India
were closely intertwined and impacted well-being in mul-
tiple ways. Certain temperamental qualities, personal
insight from the field, supportive interpersonal relations
and management of time, work, thought, behaviour and
affect were protective factors of well-being. Additional
responsibilities at work, negativities in client narratives,
stigma and myths associated with the profession, biases
from other professionals, lack of opportunities for personal
development and growth, insufficient infrastructural and
human resources were threats to well-being. The findings
of the study have implications for policy, education and
training, and practice for mental health practitioners.
Keywords Mental health professionals
Well-being

Happiness
Positive psychology
Introduction
A quest for happiness1 is noticeable today, with a shift of
priorities from economic prosperity to quality of life. Since
the 1960s, the social sciences have made great progress in
the field of well-being research. Statistics about satisfac-
tion, happiness and well-being have been developed for
people across different countries, professions, religions and
social and economic groups. While the field of psychology
has turned its attention towards studying well-being and
happiness since the turn of the century, the construction
and levels of well-being and happiness of Mental Health
Professionals (MHPs) have been largely overlooked
1
The terms happiness and well-being are used interchangeably in
this paper as researchers in the past have seen a parallel between the
two concepts (Biswas-Diener, Tay & Diener, 2012; Singh & Modi,
2011).
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(Pestonjee, 1992; Thara, 1997). This paper examines the
social, psychological and emotional well-being of MHPs in
India and maps the protective and risk factors for their
happiness.
Literature Review
Numerous studies have explored stress and burnout
amongst community mental health teams, especially
focussing on the factors that lead to stress/burnout among
MHPs. However, these studies have failed to integrate their
findings on occupational stress/burnout and the overall
well-being of MHPs in their personal and professional
lives. Further, most of these studies are characterised by
methodological problems such as lack of reliable and valid
measures and small sample sizes, limiting the generalis-
ability of the findings and compromising the ability to draw
significant and meaningful conclusions. Additionally,
because each study uses its own unique instruments to
measure stress/burnout, drawing comparisons across stud-
ies become difficult (Edwards, Burnard, Coyle, Fothergill,
& Hannigan, 2000).
One of the possible reasons why well-being has received
little attention in the field of mental health could be
because it is not regarded as a source of therapeutic con-
cern in the field (Bentall, 1992). The aim of traditional
forms of psychology has almost always been to decrease
distress and suffering rather than enhancing well-being.
Another plausible reason could be the vague nature of the
construct of happiness itself, as well as lack of clarity on
the ways in which it can be measured (Seligman, 2013).
Well-Being and Mental Health
Mental health has been defined as ‘a state of well-being in
which the individual realizes his or her own abilities, can
cope with the normal stresses of life, can work productively
and fruitfully, and is able to make a contribution to his or
her community’ (World Health Organisation, 2005, p. 2).
Keyes and Lopez (2002) proposed the model of com-
plete mental health which conceptualises both mental ill-
ness and mental health consisting of complete and
incomplete states. Complete or flourishing mental health
denotes high level of functioning across social, psycho-
logical and emotional well-being and absence of any recent
mental illness. Flourishing individuals relish their lives and
function positively in all areas, namely personal, profes-
sional and social (Keyes & Haidt, 2003). On the other
hand, incomplete or languishing mental health indicates
low level of functioning across the three types of well-
being as well as the presence of a recently diagnosed/di-
agnosable mental illness. Languishing individuals show
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relatively few signs of mental health (Keyes, 2002) and
may view their lives as stagnant, empty and lacking
meaning (Keyes, 2007). The individuals who are diagnosed
with mental illness but may have moderate or high levels of
social, emotional and psychological well-being may be
classified as struggling (Keyes & Lopez, 2002).
Well-being in the Indian Context
From a review of Hindu philosophical texts, Singh and
Modi (2011) defined well-being as an individual’s ability
to enjoy life and attempt to attain psychological resilience.
When asked to indicate the importance of factors in
determining happiness, poor Indian children rated educa-
tion, security and well-being in life as relatively more
important as compared to health consciousness and psy-
chological well-being (Pandey, 2006). Derne (2008) argued
that, in the Indian context, well-being may be a result of
meeting social expectations, rather than being a match
between personal accomplishments and aspirations.
Taking into consideration variables such as GDP per
capita, life expectancy rate, freedom of making choices and
social support of counting on someone in times of distress,
India is not a happy country. According to the 2018 World
Happiness Report, India is placed at 133 out of 156
countries, ranking below most of its neighbours in the
South Asia region (Helliwell, Layard, & Sachs, 2018).
These figures should call for attention, as the World Hap-
piness Index takes into account economic measures, along
with positive social relations characterised by shared social
identities, trust and benevolence, phenomena which India
is known for. It seems that economic development in India
is not translating into happiness for the citizens.
In contemporary India, although there are some
exploratory studies on the construction of happiness among
children, young adults and the elderly, there is a dearth of
literature on the notions of happiness in adulthood
(Mehrotra & Tripathi, 2011). Camfield, Crivello, and
Woodhead (2008) proposed that qualitative approaches
could further the understanding of the lived experiences of
well-being in developing countries.
‘Mental Health’ Professionals, Stress and Well-
Being
Although India is relatively well placed as far as general
health professionals are concerned, there is a dearth of
trained MHPs in the country. According to the World
Health Organisation (WHO), there are 0.3 psychiatrists,
0.05 psychologists and 0.03 social workers per 100,000
workforce in India (World Health Organisation, 2011).
Further, as compared to other countries, there is a unique
distribution of MHPs in India. In most countries, there are
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about 10–15 times as many social workers, psychiatric
nurses and psychologists as psychiatric consultants; in
India the ratios are reversed; i.e. there are ten times as
many psychiatric consultants as compared to psychiatric
nurses and about 20 times as many psychiatric consultants
as social workers and psychologists (Pathare, 2015). In
addition, these figures are skewed by gender and are
inequitably distributed among different regions and com-
munities across the country (Saxena, Thornicroft, Knapp,
& Whiteford, 2007).
According to the WHO reports, despite the rapid
increase in the need for mental health services, the Indian
government’s expenditure on mental health is about 0.06%
of the total budget of the health ministry, barely adequate
to meet the challenge. Given such a scenario, characterised
by scarce resources, it becomes essential to investigate the
quality of the existing workforce in order to draw conclu-
sions about their effectiveness.
MHPs face an additional work stress as compared to
other health professionals (apart from the common stres-
sors) due to the very nature of their routine work, i.e.
dealing with people and their troubles over an extended
period of time or/and, working in an emotionally
demanding environment (Moore & Cooper, 1996). Fleis-
chman (2005) termed the constant exposure to human
suffering among MHPs as ‘pain of pain’ (p. 53). Resear-
ches done in the past clearly indicate that working in a
mental health set-up is a stressful occupation often char-
acterised by not just high amounts of occupational stress
and burnout, but also a sense of increased vulnerability to
severe emotional exhaustion and psychological tension in
personal life (Hill et al., 2006; Kirkcaldy & Siefen, 1991;
Poojalakshmi & Ghosh, 2015).
Mental health nurses who reported most stress than
others were the ones who generally felt unhappy about
their lives. They had higher caseloads, felt unfulfilled with
their work, took more sick leave and had lower self-esteem,
which impacted their ability to empathise with their clients
and affected the overall quality of client–therapist rela-
tionship (Fagin, Brown, Bartlett, & Carson, 1995; Rao and
Mehrotra, 1998).
Increased stress and lack of job satisfaction were linked
with increased administrative duties, workload and reduced
time for family contact among community psychiatric
nurses and social workers (Parry-Jones et al., 1998).
Additionally, lack of resources (especially funds), inade-
quate supervision, inappropriate referrals, violent clients,
insufficient time for self-study, potential interruptions
when trying to work, role ambiguity and/or conflict, safety
issues and general working conditions have all been linked
to increased stress and burnout among MHPs (Edwards,
Burnard, Coyle, Fothergill, & Hannigan, 2001).
Weiner, Swain, Wolf, and Gottlieb (2001) found that
physicians who engaged in practices which promoted
wellness reported higher scores on psychological well-be-
ing. These practices included practicing mindfulness,
praying, involving oneself in religious activities, main-
taining adequate work–life balance, spending time with
friends, family members or work colleagues or involve-
ment in other community activities, leaving unhealthy
relationships, reading, avoiding substances, getting pro-
fessional counselling/therapy, maintaining healthy diet,
going out for vacation, engaging in exercise (and various
other hobbies) and maintaining a positive outlook.
Obtaining insight into the possible individual factors (both
internal and external) as well as organisational factors
(both controllable and uncontrollable) that may influence
the well-being of MHPs has implications for the betterment
of not just the professionals and their clientele, but society
at large.
The present study was designed to understand the hap-
piness and well-being among MHPs working with clinical
populations in a hospital setting and to determine mental
health and psychosocial functioning. The study sought to
examine the impact of the personal and professional lives
along with protective and risk factors for well-being.
Methods
Research Design
Keeping in mind the objectives of the study, an exploratory
mixed methods approach (Creswell, 2003) was adopted.
The study followed a qualitative dominant embedded
research design (Creswell, Plano Clark, Gutmann, &
Hanson, 2003). The quantitative data were nested within
the qualitative narratives, and triangulation of data took
place during analysis.
Participants
The sample included psychiatrists, clinical psychologists
and psychiatric social workers who worked with clinical
populations in a government/municipal hospital in a North
Indian city and had a minimum work experience of 2 years.
Government hospitals in India have the largest patient load
of all health facilities, and MHPs working in such hospitals
have little control over the number and type of clientele
approaching the hospital for treatment. MHPs in private
practice were not included in the study. With the help of
friends, family, relatives and colleagues, MHPs who ful-
filled the inclusion criteria of the study were approached
through email, phone or face to face.
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Data collection continued till saturation and sufficiency
was obtained. Seventeen MHPs were sampled for the
study, ten females and seven males. The mean age of the
participants was 38.5 years. The MHPs came from three
professional backgrounds—psychiatry (n = 7), clinical
psychology (n = 6) and psychiatric social work (n = 4)—
and had experience in the field ranging from 2 to 20 years.
They were either working as full-time practitioners at their
current place of employment or were engaged in two tasks
simultaneously, i.e. research and practice or teaching and
practice.
Tools Used
Mental Health Continuum-Long Form (Keyes, 2005)
The Mental Health Continuum (Long Form) (MHC-LF)
was used to assess the well-being of each respondent. The
Mental Health Continuum (Keyes, 2005) is a widely used
psychometrically valid and reliable measure of positive
mental health. It provides an overall well-being score,
along with scores on social, psychological and emotional
well-being. The MHC-LF has 40 items in total. Fifteen
items assess social well-being, defined as ‘..general
acceptance of others, a positive outlook on the potential for
people, groups and society to progress, feelings of utility
and belonging in society, and feeling connected, interested,
and a sense of meaning from social life and a larger soci-
ety’ (Fink, 2014, p. 381). Psychological well-being (mea-
sured by 18 items) is derived from Ryff’s (1989) model of
psychological well-being and indicates self-acceptance,
autonomous thinking and acting, an ability to find pur-
poseful direction, meaning in one’s life and motivation to
seek personal development (Fink, 2014). Emotional well-
being reflects an individual’s general satisfaction with life
(one item) and positive affect, (six items) such as peaceful,
cheerful or happy (Fink, 2014).
The MHC-LF classifies individuals into three categories
of mental health: flourishing (presence of mental health),
languishing (absence of mental health) and moderate
mental health. These three categories are viewed on a
continuum of mental health as conceptualised by Keyes
(2002) in his model.
In-Depth Interview
For entering the worldview of the participants and seeing
the reality as they viewed it, an interview guide with open-
ended and non-directive questions was prepared. Inputs
were taken from the interview guide used by Ravi (2013)
and from the review of literature. The detailed demo-
graphic questionnaire used by Rosenberg and Pace (2006)
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was referred to for mapping variables such as years in
practice, average workload, access to supervision.
The interview guide was subdivided into six sections
which addressed the following areas—meaning of happi-
ness/well-being (e.g. How would you describe happiness to
a layman?), expression of happiness/well-being (e.g. How
do you express your happiness?), experience of happiness/
well-being (e.g. Can you describe the happiest or more
rewarding memory you have?), antecedents of happiness/
well-being (e.g. What makes you happy?), the mental
health profession and happiness/well-being (e.g. Do you
think that being a part of mental health profession affects
your happiness/well-being?) and unhappiness/ill-being
(e.g. What do you understand by the term unhappiness?).
Within broader questions, the researcher also sought fur-
ther information: for example, when the participants were
asked, ‘What makes you happy?’, the researcher probed by
asking whether there were any specific people, places,
events, memories or objects that made them happy, if they
had not mentioned the same.
Data Collection
Each participant was given a consent form explaining the
research guidelines, after which a demographic sheet was
given for obtaining information such as name, age, gender,
religion, educational qualification, designation at current
employment, name and place of current employment. The
participants were then asked to complete the MHC-LF. On
completion of the questionnaire, the interview process
began. The average duration of each interview was about
52 min, with the shortest and longest interview durations
being of 22 min and 80 min, respectively.
Data Analysis
The MHC-LF for each participant was scored after the
completion of the qualitative interviews to prevent the
scores from colouring the qualitative interviews. After
familiarisation with the qualitative data by repeated reading
of the transcripts, context-rich codes were formed and data-
driven themes were identified manually. The codes and
themes were discussed by both authors to ensure consen-
sus. Care was taken to not ignore outliers or themes that did
not fit well in the data, but instead attempted to explain the
occurrence of such disparities across participants. After
coding the interviews, the data were triangulated with the
MHC-LF scores.
Ethical Considerations
An informed consent form was given to all participants,
stating the ethical guidelines that the data collection
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process followed and the role expected of them. Partici-
pants were informed about voluntary participation in the
research and the right to withdraw in case of any discom-
fort. They were assured that their responses would remain
confidential and would only be used for academic pur-
poses. Prior consent for using a recording device during the
interview was taken, and queries pertaining to the research
were addressed before data collection.
Results and Discussion
The construction of happiness was explored through the
qualitative interviews. The emotional, psychological and
social well-being of the MHPs was assessed using the
MHC-LF (Keyes, 2005), and the quantitative results were
triangulated with the respective interview narratives. An
attempt was made to understand the impact of the MHPs’
personal and professional lives on their well-being and the
possible factors which affected their mental health.
Exploring Happiness
An initial hesitancy and doubtfulness characterised many
participants’ responses when they were asked to provide
their understanding of happiness, something that has been
reported in the previous literature as well (Lu, 2001; Ravi,
2013). Though happiness was high on everyone’s list of
desires, it was not delved into and understood. Pallavi2
remarked, ‘I never thought that happiness can be defined’.
It seemed that being a MHP impacted participants’
understanding of happiness. Vaidehi used Rogerian con-
cepts, learned in psychology and mentioned that for her,
happiness was the congruence between her real self and
ideal self or what she was in actuality and what she wanted
to become. Anwar narrated the WHO definition of
happiness.
Although happiness was recognised as a universal
human value, the meaning and characteristics ascribed to it
were extremely subjective. For most of the participants, the
terms happiness and contentment were interchangeable.
Happiness was understood as a bigger, more intangible
concept than mere curving of the lips, a phenomenon that
could spread contagiously. Suchi said, ‘happiness is such a
thing that if my colleague starts to laugh, I will also start
laughing, without any reason’.
Despite being recognised as an abstract entity, there was
a consensus about its healing power. Sachin said, ‘Happi-
ness is the cure for all the things which one can have, and
one would have’. Happiness was a fleeting experience,
2
The names of all the participants have been changed in order to
protect anonymity.
which could both arrive and disappear with a flicker of the
eye. Palash often wondered, ‘why is happiness so short
lasting?’ Whenever Adya was extremely happy, she
simultaneously thought ‘this is not going to last for long’,
since happiness for her was an impermanent and momen-
tary state.
Happiness was seen as a result of being at peace with
oneself. Delle Fave et al. (2016) postulated how the
understanding of happiness has evolved over the years
from meaning a fortune earlier to now being used syn-
onymously to refer a positive inner state. In the present
study, while happiness was perceived akin to the absence
of persistent negative emotions for some, others posited
that optimal functioning in the presence of those very
negative states led to happiness. The latter eclectic view
was parallel to Keyes’ (2007) belief that well-being was
more than the absence of ill-being.
Participants strongly believed that though happiness
entailed one overarching feeling, it had different shades
which could be distinguished from one another on the basis
of either its antecedents or intensity. Suchi classified her
happiness into ‘mild, moderate and extreme’ categories,
whereas for Sanjeev and Damayanti, happiness was divi-
ded into two kinds: one was brief and high while the other
was sustained and low key.
The happiest professional memories of the MHPs fell
into two categories. One was related to the satisfaction
attained from treating cases successfully, while the other
included accomplishments in the professional domain, such
as clearing examinations, obtaining degrees, getting
awards, and receiving public appreciation. Happy personal
memories included the birth of children, reconnecting with
friends and family members, meeting a life partner and
achievements of self or family.
Happiness could be verbally expressed (through
increased or decreased verbal output, change of speech
content, etc.), non-verbally expressed (through alteration of
facial expressions, body posture, mannerisms, etc.) or not
expressed at all. Participants used these channels for the
interpretation of others’ happiness. For instance, for
assessing whether other people were happy or not, Sanjeev
used, ‘body posture, way of talking, reaction time, speech
frequency, tone and indirect cues’, Pallavi noticed, ‘their
facial expressions’, Saniya observed, ‘the manner of sit-
ting, and talking’, Umesh and Anwar examined whether
people laughed at jokes or not, whereas Adya banked on
‘vibes’. The expression of happiness was moderated by the
presence of people and the relationship that existed
between them.
Happiness was expressed either in a self-focussed or
other-focussed manner. The self-focussed forms of
expression could be cognitive, affective and behavioural.
The cognitive modes of expression cut across past, present
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and future timelines in the form of re-examining past reached then any piling up of money does not ensure
behaviours, enhanced concentration on tasks in the present happiness. (Damayanti)
moment and looking forward to an optimistic future.
All participants, but one, agreed about illness and well-
Affective modes of expression were reflected through
being, although the effect it had on happiness varied across
increased excitement, joy, cheerfulness and calmness.
individuals. Good physical health was not a guarantee for
Behavioural modes of expression included enhanced cre-
happiness; however, its absence led to a reduction of well-
ativity, work efficiency and increased performance of those
being. On a parallel note, eustress was a functional medi-
behaviours which initially contributed to happiness. The
ator of well-being, and distress or unhealthy stress con-
ability to obtain pleasure from a wide range of activities
tributed negatively. Nelson and Simmons (2005) examined
was enhanced when happy. Other-focussed forms of
a range of sources including laboratory experiments,
expression ranged from increased gratefulness towards
anecdotal evidence and studies of job satisfaction and
God and frequent engaging in altruistic acts, to enhanced
positive life events and reported that eustress had a direct
socialisation and gregariousness. Suchi said, ‘When I’m
effect on health.
happy, that time I feel that everyone is part of my life. And
we will go together somewhere, we will do something’.
Views on Unhappiness
Four important sources of happiness were identified—
personal, interpersonal, work-related and environmental.
Unhappiness was diametrically opposite to happiness with
Happiness was either an involuntary process, occurring due
respect to its quality, meaning, manifestation and experi-
to certain personality traits or achieved through engaging in
ence. Unhappiness was a much broader concept than
voluntary activities.
merely experiencing episodes of crying. It entailed the
I keep telling my patients that emotionally discharg- presence of distress, feelings of frustration, dissatisfaction
ing your tension and conflicts and talking about it, and an inability to cope with internal and external nega-
practicing things that you really like, doing things tivities. Incongruence and lack of internal harmony were
that really make you genuinely happy, and at the end, unconstructive internally, whereas an inability to perform
realizing and never denying the fact that you are also expected duties was an external problem. Unhappiness
a good human being. That defines happiness for me. resulted in the failure to fully relish pleasure from a range
(Vaidehi) of pleasurable activities. Previous literature has contrasted
happiness and unhappiness (Lu, 2001), placed them on two
While certain temperamental factors such as increased
ends on the same continuum (Layard, 2003), and seen as
patience and tolerance were identified as pathways to
two faces of the same coin (Ravi, 2013).
happiness, others believed that engaging in hobbies and
Personal and interpersonal causes of unhappiness were
favourite past times made them happy. A sense of affilia-
mutually overlapping categories. Misunderstanding,
tion, mutual trust and respect, willingness to share and
betrayal, distrust, hurt, manipulation, callousness, dishon-
confide, understanding and transparency in interpersonal
esty, exploitation, loss of loved ones, unsuccessful cases
relations led to happiness. Work-related happiness was
and receiving negative feedback were some of the most
received from finishing work as scheduled and successfully
commonly discussed interpersonal sources of unhappiness.
fulfilling assigned duties and responsibilities.
Similarly, lack of personal growth, rumination of thought,
With respect to external factors, apart from surrounding
mental unrest and lack of optimism were identified as some
oneself with visually appealing stimuli, the absence of
of the personal sources of unhappiness.
danger and control over a situation led to happiness.
Although lack of money contributed to the inability of
Well-Being
carrying out certain happiness-inducing tasks, it was not
seen as a factor which would indefinitely bring about
Prior to conducting the in-depth interviews, the Mental
happiness.
Health Continuum-Long Form (Keyes, 2005) was admin-
I think I can be happy without money; but it becomes istered on all respondents to understand their emotional,
a bit difficult because sometimes money brings you psychological and social well-being.
security, which makes it easier to enjoy all the hap- The scores on well-being for the respondents ranged
piness. It’s always about Maslow’s needs; when your from 160 to 247.3 After obtaining the scores on the three
basic needs are not met, then it’s very difficult to feel domains of well-being, tertiles were calculated for each
the higher level of happiness… To reach one level of category such that each score fell in one of the three score
happiness you need some money but after that level is
3
The minimum possible score on the MHC-LF was 39, and the
maximum was 271.

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types: high, moderate or low. Participants obtained rela-
tively higher scores on psychological and social well-being
as compared to emotional well-being, where they scored
the poorest.
Of the 17 participants, 14 had high well-being scores
and were considered to be flourishing (Keyes, 2005). Three
participants, Damayanti, Palash and Saniya, had moderate
well-being scores, reflective of moderate mental health.
None of the participants had low well-being scores to be
considered as languishing or having incomplete mental
health.
The narratives of the participants who had moderate
scores of well-being revealed stress due to multiple reasons
such as increased work pressure and an inability to cope
and ill-health. They called themselves unhappy. Damayanti
said, ‘It’s just maybe I am not managing well right now, so
that is one sad thing which is going on’. However, all three
participants discussed ways in which they were attempting
to overcome these difficulties, instead of becoming over-
whelmed by the same. Damayanti shared how she had been
successful of late, in bringing about small positive changes
in her daily schedule.
In contrast, the accounts of participants with high well-
being scores were filled with vitality, positivity and zest in
all the arenas of their life—personal, interpersonal, envi-
ronmental and societal. The participants saw themselves as
happy. Raghav said, ‘I feel satisfied with my personal and
professional duties. Despite being 44 years old, I am not
having any major medical issue. My hospital is able to give
me a sense of pride and purpose to move on’.
Impact of Personal and Professional Lives on Well-
Being
A thin line existed between the personal and professional
lives for the respondents. Excelling in both spheres of life
was not considered a necessity, as one seemed to com-
pensate for the other.
Better regulation of emotions, enhanced perspective
taking and acceptance of reality, and becoming a better
human being were some of the changes brought about as a
result of rigorous professional training. Damayanti said,
I used to cry very easily….. I think it comes with
professional training.. you learn how to master your
feelings. Moreover, my way of thinking has changed
drastically. I have more positive thinking because of
all the therapies I have done to my patients.
Clients’ life stories provided an extra lens to the MHPs
for viewing their lives in a nuanced fashion. However, the
same narratives when loaded with negativities were con-
sidered as a source of stress, a finding that has been pre-
viously reported as well (Fleischman, 2005; Hill et al.,
2006; Kirkcaldy & Siefen, 1991). Sanjeev said, ‘We see
many patients commit suicide after stopping medicines
because they have high suicidal tendencies.. So it creates
stress’. Similarly, Damayanti said,
It is stressful because all the time we are hearing the
problems people are having, the struggles they are
going through… A lot of grief, unhappiness, and
anxiety… We are always surrounded by negative
emotions and stories. When the person is coming
with a very dramatic life story, it keeps nagging in
your mind. I think in our job that’s very stressful and
unhealthy for us too.
Inability to maintain adequate work–life balance, losing
the self in the process of daily functioning and facing
ethical dilemmas were also viewed as stress inducing.
Professional work both in the form of tangible tasks and
mental stress was carried back home for some, while others
had consciously decided to not let this happen. Mental
stress from the professional sphere only poured into the
personal lives of these professionals if it was extremely
overwhelming and distasteful. Having pathology-related
concerns for family members was observed. Suchi men-
tioned, ‘Most of the time thoughts are coming ‘‘Is my
husband having problems? Is my child having problems? Is
my parent having some problem?’’’, while Anwar said, ‘We
also start labelling ourselves. If our mood is not alright for
some time, we think whether medicines should be con-
sumed for restoration of the same’.
Participants reported wearing an emotional mask in
front of significant others to whom they did not want to
cause unnecessary trouble. The same was done in front of
clients, as it was assumed that not doing so would act as a
barrier in establishing a healthy therapeutic alliance. They
did not want to be seen by their clients as mentally dis-
tressed individuals, who themselves approached the MHPs
in the dark phases of their lives.
Especially in my profession, I don’t want to be
looked as or seen as a depressed person. I may be
having some sadness inside at times, but I don’t want
others to perceive it on my face. Because I feel that in
the profession we have to share the sadness of others,
and we should try to give more happiness and feel-
ings of peace and calm to others. (Vandita)
Some of the MHPs became active advocates of mental
health to destigmatise the field. They viewed mental ill-
nesses akin to psychiatric illnesses, deserving the same
amount of respect. Some participants also reported
becoming less money oriented and more welfare oriented.
Participants reported having less time to pursue hobbies
and interests as compared to the past. This contributed to
the feelings of exhaustion and stress that could lead to
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burnout. Similarly, due to lack of quality time with family
members, some of the participants reported experiencing
feelings of guilt, which they temporarily dealt by
rescheduling their day so that they were able to spend more
time with family members. Vandita deeply regretted, ‘The
biggest sacrifice I think for my career has been done by my
child. I feel most guilty as during my career, I had to
neglect him when he was small’. This is in sync with
studies that report higher rates of burnout among female
medical professionals in India due to higher familial
expectations, causing a work–life imbalance (Langade
et al., 2016).
Most of the participants regarded their job as being
stressful and accepted burnout as one of the most common
outcomes of being in the field. Not only had participants
seen their fellow colleagues in that unwanted phase, but
also expressed their concerns about experiencing some-
thing similar in future.
Ideally, every therapist should undergo therapy
because they are dealing with human emotions day in
and day out. Burnout is the most common thing that
can occur and let’s just accept that it happens to all of
us. I have seen all my friends, I myself experience
burnout. After a point, there is just a barrier that
comes in between me and my client. That is a chal-
lenge of the profession…We have our issues as well.
(Vaidehi)
While burnout among clinicians has been a well-re-
searched topic in the West, there are few studies in India
that address the same. High levels of burnout and stress
have been measured among doctors, dentists and medical
students (Bhugra, Bhui, & Gupta, 2008; Saini, Agrawal,
Bhasin, Bhatia, & Sharma, 2010). A study by Bhutani,
Bhutani, Balhara, and Kalra (2012) indicated that poor
working conditions with inadequate equipment and poor
doctor–patient ratios in government hospitals in India
contributed to low compassion satisfaction and high
burnout among clinicians. Further, limited specialised
training programs could generate additional stress for some
professionals, often resulting in long working hours and
minimal time for recreation and family life (Langade et al.,
2016). This is a cause of worry as professionals may have
an impaired judgement or might lack empathy towards
their clients.
Protective and Risk Factors for Well-Being
With respect to the functioning of MHPs, multiple factors
seemed to be at play, some of which enhanced their mental
health, while the rest were considered incompatible with
positive functioning.
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Psychol Stud
Adoption of certain measures such as management of
time, work, behaviours, thoughts and affect were reported
as helpful. Optimistic thinking, realistic goal setting,
socialising, emotional distancing and faith in supreme
power were reported as being beneficial. Sangita said, ‘You
need to have your own time, it’s probably the only demand
of this profession, a de-cluttering conscious or subcon-
scious level, at least relaxing, sorting yourself is something
that it demands’. Possessing good observation and listening
skills, cheerfulness, sensitivity, approachability, resource-
fulness, independence, confidence and assertiveness as well
as an ability to empathise, reflect and adapt were seen as
supportive personality traits.
Participants reported that their significant others kept a
check on their well-being. In addition, the nature of the job
acted as a protective factor as it provided MHPs with the
therapeutic tools which could be applied to the self as well.
Damayanti said, ‘When you are saying the same things 90
times, you start believing that too’. Meghana termed this as
‘auto therapy’. The satisfaction received from healing the
problems of others was considered paramount.
Performing multiple expected and assigned responsi-
bilities, increased work pressure and inability to modify
timings resulted in lower well-being of professionals.
Sanjeev felt that ‘being in a government institute there are
some administrative hazards that crop up from time to
time’, which irritated him. For Raghav, involvement in
legal issues comprised additional responsibilities. He said,
‘What your work is, you are not doing that; but you are
stuck in legal matters, going around the court, writing
letters’.
Due to a vague job description for the Ph.D. students in
the organisation, apart from the routine research-related
work, extra responsibilities were handed over to them by
higher authorities, which were reported to be stressful. The
frustration arising from lack of supervision was expressed
in some narratives.
I feel that more supervision was required, which has
not been given. It’s just on my signature, a lot of
things happen, and I really, you know sometimes I
also get scared, that is it right that I am diagnosing
someone with Personality Disorder? So I should get
supervised. (Vaidehi)
Just as too much work was stressful for the individual,
too little work was also found to be stressful, contributing
to boredom and problems of self-worth. Anwar, a psychi-
atric social worker, said, ‘There is not much work honestly.
We just have one or two very difficult cases in the entire
year. Overall responsibility we don’t have. The case
managers don’t give us much. We just get very few referred
cases’.
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Psychol Stud
There was a hierarchy operating among MHPs, with the
psychiatrists at the top of the ladder, with clinical psy-
chologists and psychiatric social workers working under
the supervision of psychiatrists. Uneven distribution of
caseload by profession and by seniority contributed to
frustration and stress. Rajat said, ‘In India, I would not
advice people to be a psychiatric social worker. In my
lifetime I have got one chance and I have not liked it
much’.
Myths/stigma associated with psychiatry as a branch of
medicine, disrespect and biases from other professionals
within and outside the same field, lack of developments
and growth opportunities in the field and a reduced work-
force were also reported as detrimental to well-being.
Sangita mentioned how her parents have been a little tense
lately as, ‘people were still a little apprehensive in offering
their son’s hand in the hand of a psychiatrist or a
psychologist’.
Limitations of the Present Study
The data on MHPs’ well-being were captured using a one-
time self-report measure instead of assessing it over a
period of time. A longitudinal study may better distinguish
the stable from the momentary factors affecting well-being.
Since the data were collected from MHPs, who were
viewed by the public at large as ‘mentally sane’, their
responses on the MHC-LF could have been socially
desirable. Most of the sites of data collection were psy-
chiatric OPDs, and some of the interviews were not given
in one session. Some of the participants reported feeling
fatigued due to the lengthy process of filing the question-
naire and being interviewed. Paucity of time due to
organisational commitments and lack of safety from pos-
sible consequences for the MHPs could have impacted the
quality of the collected data. The MHC-LF that was used
for the study has not been used with large samples in India.
Further research using the tool in India will be necessary
before any generalisable findings can emerge.
Directions for Further Research
There is a paucity of research studies on well-being of
MHPs in the Indian context, and there is a need for further
research on the topic. The dynamics of how the protective
and risk factors impact well-being needs to be further
investigated. It would also be interesting to see whether
these factors differ among the MHPs who are working as
private practitioners through a comparative study. Bhugra
et al. (2008) and Bhutani et al. (2012) report that private
practitioners were less vulnerable to burnout as they had
more control over their job style have better equipment and
salary. It would be interesting to explore whether these
differences extend to the construction of happiness and
professionals’ well-being scores. The relationship between
gender, mental health and well-being could be explored.
The association between the number of years of work
experience and its effect on well-being could be investi-
gated further to see whether, with the advancement of age,
time and experience in a field, mental health enhanced/
deteriorated or remained the same.
Since the sample for the present study consisted of a
mixed group of MHPs (who have different training expe-
riences, theoretical perspectives and practice orientations),
there is a need to involve a sufficient representation of each
of these subgroups in order to better understand these
differences. In a study by Poojalakshmi and Ghosh (2015),
psychiatrists were most likely to experience mental health
problems such as burnout, depersonalisation, depression,
stress and anxiety as compared to clinical and counselling
psychologists. The constant interaction with people in
distress, coupled with inadequate coping mechanisms and
poor working conditions, contributes to poor well-being
among MHPs.
Implications of the Present Study
Despite being an integral part of general health and well-
being, mental health continues to be poorly funded by the
Indian government. Society at large continues to view the
mentally ill, as well as the MHPs with a stigmatised lens;
these biases continue to be internalised and affect their day-
to-day functioning. This was evident in the MHPs’ will-
ingness to recommend therapy for others but not for
themselves. There was a heavy biomedical emphasis
among the participants, and therapy was mentioned as an
afterthought more often than not. MHPs play an important
role in determining their own mental health. They should
hold realistic expectations of themselves as the inability to
do so may lead to frustration, dissatisfaction and stress.
In the current study, many of the younger professionals
felt that they could benefit from supervision, which was not
adequate at present. Additionally, since the nature of the
job itself includes dealing with the adversities of clients’
lives for extended periods of time, it is essential for ther-
apists to regularly engage in self-care activities. Peer
supervision, feedback, regular consultations with seniors
could also be considered. This would help reduce the
chances of burnout, organisational resignations, and
decrease staff turnover figures.
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 Author's personal copy
Conclusion
The findings from the study indicate that the discourse on
happiness is not routine for MHPs. Dealing with mentally
ill clients on a regular basis has implications for the well-
being of MHPs. Having to mask their true emotions in their
personal and professional life was often at the cost of their
own happiness and well-being. This leads to asking the
question: Who will heal the healer, and how?
Research on physicians as patients by Myers and Gab-
bard (2008) indicates that physicians are vulnerable to
stress, burnout and suicide due to the nature of the pro-
fession. The profession requires a precision and perfec-
tionism, which are traits that contribute to feelings of guilt,
self-doubt and responsibility. There are gender differences
seen between male and female physicians, with female
physicians being more likely to suffer from burnout and
stress as compared to their male counterparts. However,
female physicians had better health and personal habits,
which stood them in good stead. For MHPs working in
hospitals, in close proximity with physicians, many similar
patterns can be seen. While professional training may help
in distancing oneself from the stress arising from dealing
with patients, it is important for MHPs to identify personal
factors that could predispose them to burnout. Research in
India has indicated that doctors are at risk of burnout and
stress. The present study corroborates the findings of pre-
vious studies about the vulnerability of MHPs (Bhugra
et al., 2008; Bhutani et al., 2012; Langade et al., 2016;
Saini et al., 2010).
Developing a healthy interface between academia and
practice in the area of mental health will contribute sub-
stantially to the growth of the field in India. A cadre of
MHPs will evolve, who have the necessary knowledge,
skill, attitude and value base to work on the burgeoning
mental health crisis in the country.
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