You are on page 1of 13

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
Your article is protected by copyright and
all rights are held exclusively by National
Academy of Psychology (NAOP) India. This e-
offprint is for personal use only and shall not
be self-archived in electronic repositories. If
you wish to self-archive your article, please
use the accepted manuscript version for
posting on your own website. You may
further deposit the accepted manuscript
version in any repository, provided it is only
made publicly available 12 months after
official publication or later and provided
acknowledgement is given to the original
source of publication and a link is inserted
to the published article on Springer's
website. The link must be accompanied by
the following text: "The final publication is
available at”.

1 23
Author's personal copy
Psychol Stud


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 were closely intertwined and impacted well-being in mul-
designed to understand the construction and experience of tiple ways. Certain temperamental qualities, personal
happiness and well-being among Mental Health Profes- insight from the field, supportive interpersonal relations
sionals (MHPs) in India. Through non-probabilistic sam- and management of time, work, thought, behaviour and
pling techniques, 17 MHPs were selected from three affect were protective factors of well-being. Additional
government hospitals in a city in North India. Qualitative responsibilities at work, negativities in client narratives,
interview data were triangulated with scores from the stigma and myths associated with the profession, biases
Mental Health Continuum-Long Form (MHC-LF). Analy- from other professionals, lack of opportunities for personal
sis showed that despite happiness being a desirable and development and growth, insufficient infrastructural and
pleasurable state, participants rarely devoted time thinking human resources were threats to well-being. The findings
about it. Happiness was a multidimensional phenomenon of the study have implications for policy, education and
which affected personal, interpersonal, social and envi- training, and practice for mental health practitioners.
ronmental realms. Happiness was synonymous with con-
tentment and satisfaction and was understood as the Keywords Mental health professionals  Well-being 
opposite of unhappiness. Although recognised as a uni- Happiness  Positive psychology
versal phenomenon, happiness had a subjective and indi-
vidual-specific understanding, experience and
manifestation. Data from the MHC-LF provided scores on Introduction
overall well-being, and emotional, psychological and social
well-being, and indicated that 14 participants had flour- A quest for happiness1 is noticeable today, with a shift of
ishing mental health, and three were moderately mentally priorities from economic prosperity to quality of life. Since
healthy. The personal and professional lives of the MHPs 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
This paper draws from the first author’s thesis completed at Tata
Institute of Social Sciences (TISS), Mumbai, under the supervision of people across different countries, professions, religions and
the second author. social and economic groups. While the field of psychology
has turned its attention towards studying well-being and
& Pankhuri Aggarwal happiness since the turn of the century, the construction
and levels of well-being and happiness of Mental Health
Sujata Sriram Professionals (MHPs) have been largely overlooked;
Department of Psychology, Miami University, Oxford, Ohio, 1
The terms happiness and well-being are used interchangeably in
United States of America
this paper as researchers in the past have seen a parallel between the
The School of Human Ecology, Tata Institute of Social two concepts (Biswas-Diener, Tay & Diener, 2012; Singh & Modi,
Sciences, Mumbai, Maharashtra, India 2011).

Author's personal copy
Psychol Stud

(Pestonjee, 1992; Thara, 1997). This paper examines the relatively few signs of mental health (Keyes, 2002) and
social, psychological and emotional well-being of MHPs in may view their lives as stagnant, empty and lacking
India and maps the protective and risk factors for their meaning (Keyes, 2007). The individuals who are diagnosed
happiness. 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).
Literature Review
Well-being in the Indian Context
Numerous studies have explored stress and burnout
amongst community mental health teams, especially From a review of Hindu philosophical texts, Singh and
focussing on the factors that lead to stress/burnout among Modi (2011) defined well-being as an individual’s ability
MHPs. However, these studies have failed to integrate their to enjoy life and attempt to attain psychological resilience.
findings on occupational stress/burnout and the overall When asked to indicate the importance of factors in
well-being of MHPs in their personal and professional determining happiness, poor Indian children rated educa-
lives. Further, most of these studies are characterised by tion, security and well-being in life as relatively more
methodological problems such as lack of reliable and valid important as compared to health consciousness and psy-
measures and small sample sizes, limiting the generalis- chological well-being (Pandey, 2006). Derne (2008) argued
ability of the findings and compromising the ability to draw that, in the Indian context, well-being may be a result of
significant and meaningful conclusions. Additionally, meeting social expectations, rather than being a match
because each study uses its own unique instruments to between personal accomplishments and aspirations.
measure stress/burnout, drawing comparisons across stud- Taking into consideration variables such as GDP per
ies become difficult (Edwards, Burnard, Coyle, Fothergill, capita, life expectancy rate, freedom of making choices and
& Hannigan, 2000). social support of counting on someone in times of distress,
One of the possible reasons why well-being has received India is not a happy country. According to the 2018 World
little attention in the field of mental health could be Happiness Report, India is placed at 133 out of 156
because it is not regarded as a source of therapeutic con- countries, ranking below most of its neighbours in the
cern in the field (Bentall, 1992). The aim of traditional South Asia region (Helliwell, Layard, & Sachs, 2018).
forms of psychology has almost always been to decrease These figures should call for attention, as the World Hap-
distress and suffering rather than enhancing well-being. piness Index takes into account economic measures, along
Another plausible reason could be the vague nature of the with positive social relations characterised by shared social
construct of happiness itself, as well as lack of clarity on identities, trust and benevolence, phenomena which India
the ways in which it can be measured (Seligman, 2013). is known for. It seems that economic development in India
is not translating into happiness for the citizens.
Well-Being and Mental Health In contemporary India, although there are some
exploratory studies on the construction of happiness among
Mental health has been defined as ‘a state of well-being in children, young adults and the elderly, there is a dearth of
which the individual realizes his or her own abilities, can literature on the notions of happiness in adulthood
cope with the normal stresses of life, can work productively (Mehrotra & Tripathi, 2011). Camfield, Crivello, and
and fruitfully, and is able to make a contribution to his or Woodhead (2008) proposed that qualitative approaches
her community’ (World Health Organisation, 2005, p. 2). could further the understanding of the lived experiences of
Keyes and Lopez (2002) proposed the model of com- well-being in developing countries.
plete mental health which conceptualises both mental ill-
ness and mental health consisting of complete and ‘Mental Health’ Professionals, Stress and Well-
incomplete states. Complete or flourishing mental health Being
denotes high level of functioning across social, psycho-
logical and emotional well-being and absence of any recent Although India is relatively well placed as far as general
mental illness. Flourishing individuals relish their lives and health professionals are concerned, there is a dearth of
function positively in all areas, namely personal, profes- trained MHPs in the country. According to the World
sional and social (Keyes & Haidt, 2003). On the other Health Organisation (WHO), there are 0.3 psychiatrists,
hand, incomplete or languishing mental health indicates 0.05 psychologists and 0.03 social workers per 100,000
low level of functioning across the three types of well- workforce in India (World Health Organisation, 2011).
being as well as the presence of a recently diagnosed/di- Further, as compared to other countries, there is a unique
agnosable mental illness. Languishing individuals show distribution of MHPs in India. In most countries, there are

Author's personal copy
Psychol Stud

about 10–15 times as many social workers, psychiatric Weiner, Swain, Wolf, and Gottlieb (2001) found that
nurses and psychologists as psychiatric consultants; in physicians who engaged in practices which promoted
India the ratios are reversed; i.e. there are ten times as wellness reported higher scores on psychological well-be-
many psychiatric consultants as compared to psychiatric ing. These practices included practicing mindfulness,
nurses and about 20 times as many psychiatric consultants praying, involving oneself in religious activities, main-
as social workers and psychologists (Pathare, 2015). In taining adequate work–life balance, spending time with
addition, these figures are skewed by gender and are friends, family members or work colleagues or involve-
inequitably distributed among different regions and com- ment in other community activities, leaving unhealthy
munities across the country (Saxena, Thornicroft, Knapp, relationships, reading, avoiding substances, getting pro-
& Whiteford, 2007). fessional counselling/therapy, maintaining healthy diet,
According to the WHO reports, despite the rapid going out for vacation, engaging in exercise (and various
increase in the need for mental health services, the Indian other hobbies) and maintaining a positive outlook.
government’s expenditure on mental health is about 0.06% Obtaining insight into the possible individual factors (both
of the total budget of the health ministry, barely adequate internal and external) as well as organisational factors
to meet the challenge. Given such a scenario, characterised (both controllable and uncontrollable) that may influence
by scarce resources, it becomes essential to investigate the the well-being of MHPs has implications for the betterment
quality of the existing workforce in order to draw conclu- of not just the professionals and their clientele, but society
sions about their effectiveness. at large.
MHPs face an additional work stress as compared to The present study was designed to understand the hap-
other health professionals (apart from the common stres- piness and well-being among MHPs working with clinical
sors) due to the very nature of their routine work, i.e. populations in a hospital setting and to determine mental
dealing with people and their troubles over an extended health and psychosocial functioning. The study sought to
period of time or/and, working in an emotionally examine the impact of the personal and professional lives
demanding environment (Moore & Cooper, 1996). Fleis- along with protective and risk factors for well-being.
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 Methods
mental health set-up is a stressful occupation often char-
acterised by not just high amounts of occupational stress Research Design
and burnout, but also a sense of increased vulnerability to
severe emotional exhaustion and psychological tension in Keeping in mind the objectives of the study, an exploratory
personal life (Hill et al., 2006; Kirkcaldy & Siefen, 1991; mixed methods approach (Creswell, 2003) was adopted.
Poojalakshmi & Ghosh, 2015). The study followed a qualitative dominant embedded
Mental health nurses who reported most stress than research design (Creswell, Plano Clark, Gutmann, &
others were the ones who generally felt unhappy about Hanson, 2003). The quantitative data were nested within
their lives. They had higher caseloads, felt unfulfilled with the qualitative narratives, and triangulation of data took
their work, took more sick leave and had lower self-esteem, place during analysis.
which impacted their ability to empathise with their clients
and affected the overall quality of client–therapist rela- Participants
tionship (Fagin, Brown, Bartlett, & Carson, 1995; Rao and
Mehrotra, 1998). The sample included psychiatrists, clinical psychologists
Increased stress and lack of job satisfaction were linked and psychiatric social workers who worked with clinical
with increased administrative duties, workload and reduced populations in a government/municipal hospital in a North
time for family contact among community psychiatric Indian city and had a minimum work experience of 2 years.
nurses and social workers (Parry-Jones et al., 1998). Government hospitals in India have the largest patient load
Additionally, lack of resources (especially funds), inade- of all health facilities, and MHPs working in such hospitals
quate supervision, inappropriate referrals, violent clients, have little control over the number and type of clientele
insufficient time for self-study, potential interruptions approaching the hospital for treatment. MHPs in private
when trying to work, role ambiguity and/or conflict, safety practice were not included in the study. With the help of
issues and general working conditions have all been linked friends, family, relatives and colleagues, MHPs who ful-
to increased stress and burnout among MHPs (Edwards, filled the inclusion criteria of the study were approached
Burnard, Coyle, Fothergill, & Hannigan, 2001). through email, phone or face to face.

Author's personal copy
Psychol Stud

Data collection continued till saturation and sufficiency was referred to for mapping variables such as years in
was obtained. Seventeen MHPs were sampled for the practice, average workload, access to supervision.
study, ten females and seven males. The mean age of the The interview guide was subdivided into six sections
participants was 38.5 years. The MHPs came from three which addressed the following areas—meaning of happi-
professional backgrounds—psychiatry (n = 7), clinical ness/well-being (e.g. How would you describe happiness to
psychology (n = 6) and psychiatric social work (n = 4)— a layman?), expression of happiness/well-being (e.g. How
and had experience in the field ranging from 2 to 20 years. do you express your happiness?), experience of happiness/
They were either working as full-time practitioners at their well-being (e.g. Can you describe the happiest or more
current place of employment or were engaged in two tasks rewarding memory you have?), antecedents of happiness/
simultaneously, i.e. research and practice or teaching and well-being (e.g. What makes you happy?), the mental
practice. health profession and happiness/well-being (e.g. Do you
think that being a part of mental health profession affects
Tools Used your happiness/well-being?) and unhappiness/ill-being
(e.g. What do you understand by the term unhappiness?).
Mental Health Continuum-Long Form (Keyes, 2005) Within broader questions, the researcher also sought fur-
ther information: for example, when the participants were
The Mental Health Continuum (Long Form) (MHC-LF) asked, ‘What makes you happy?’, the researcher probed by
was used to assess the well-being of each respondent. The asking whether there were any specific people, places,
Mental Health Continuum (Keyes, 2005) is a widely used events, memories or objects that made them happy, if they
psychometrically valid and reliable measure of positive had not mentioned the same.
mental health. It provides an overall well-being score,
along with scores on social, psychological and emotional Data Collection
well-being. The MHC-LF has 40 items in total. Fifteen
items assess social well-being, defined as ‘..general Each participant was given a consent form explaining the
acceptance of others, a positive outlook on the potential for research guidelines, after which a demographic sheet was
people, groups and society to progress, feelings of utility given for obtaining information such as name, age, gender,
and belonging in society, and feeling connected, interested, religion, educational qualification, designation at current
and a sense of meaning from social life and a larger soci- employment, name and place of current employment. The
ety’ (Fink, 2014, p. 381). Psychological well-being (mea- participants were then asked to complete the MHC-LF. On
sured by 18 items) is derived from Ryff’s (1989) model of completion of the questionnaire, the interview process
psychological well-being and indicates self-acceptance, began. The average duration of each interview was about
autonomous thinking and acting, an ability to find pur- 52 min, with the shortest and longest interview durations
poseful direction, meaning in one’s life and motivation to being of 22 min and 80 min, respectively.
seek personal development (Fink, 2014). Emotional well-
being reflects an individual’s general satisfaction with life Data Analysis
(one item) and positive affect, (six items) such as peaceful,
cheerful or happy (Fink, 2014). The MHC-LF for each participant was scored after the
The MHC-LF classifies individuals into three categories completion of the qualitative interviews to prevent the
of mental health: flourishing (presence of mental health), scores from colouring the qualitative interviews. After
languishing (absence of mental health) and moderate familiarisation with the qualitative data by repeated reading
mental health. These three categories are viewed on a of the transcripts, context-rich codes were formed and data-
continuum of mental health as conceptualised by Keyes driven themes were identified manually. The codes and
(2002) in his model. themes were discussed by both authors to ensure consen-
sus. Care was taken to not ignore outliers or themes that did
In-Depth Interview not fit well in the data, but instead attempted to explain the
occurrence of such disparities across participants. After
For entering the worldview of the participants and seeing coding the interviews, the data were triangulated with the
the reality as they viewed it, an interview guide with open- MHC-LF scores.
ended and non-directive questions was prepared. Inputs
were taken from the interview guide used by Ravi (2013) Ethical Considerations
and from the review of literature. The detailed demo-
graphic questionnaire used by Rosenberg and Pace (2006) An informed consent form was given to all participants,
stating the ethical guidelines that the data collection

Author's personal copy
Psychol Stud

process followed and the role expected of them. Partici- which could both arrive and disappear with a flicker of the
pants were informed about voluntary participation in the eye. Palash often wondered, ‘why is happiness so short
research and the right to withdraw in case of any discom- lasting?’ Whenever Adya was extremely happy, she
fort. They were assured that their responses would remain simultaneously thought ‘this is not going to last for long’,
confidential and would only be used for academic pur- since happiness for her was an impermanent and momen-
poses. Prior consent for using a recording device during the tary state.
interview was taken, and queries pertaining to the research Happiness was seen as a result of being at peace with
were addressed before data collection. 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-
Results and Discussion onymously to refer a positive inner state. In the present
study, while happiness was perceived akin to the absence
The construction of happiness was explored through the of persistent negative emotions for some, others posited
qualitative interviews. The emotional, psychological and that optimal functioning in the presence of those very
social well-being of the MHPs was assessed using the negative states led to happiness. The latter eclectic view
MHC-LF (Keyes, 2005), and the quantitative results were was parallel to Keyes’ (2007) belief that well-being was
triangulated with the respective interview narratives. An more than the absence of ill-being.
attempt was made to understand the impact of the MHPs’ Participants strongly believed that though happiness
personal and professional lives on their well-being and the entailed one overarching feeling, it had different shades
possible factors which affected their mental health. which could be distinguished from one another on the basis
of either its antecedents or intensity. Suchi classified her
Exploring Happiness happiness into ‘mild, moderate and extreme’ categories,
whereas for Sanjeev and Damayanti, happiness was divi-
An initial hesitancy and doubtfulness characterised many ded into two kinds: one was brief and high while the other
participants’ responses when they were asked to provide was sustained and low key.
their understanding of happiness, something that has been The happiest professional memories of the MHPs fell
reported in the previous literature as well (Lu, 2001; Ravi, into two categories. One was related to the satisfaction
2013). Though happiness was high on everyone’s list of attained from treating cases successfully, while the other
desires, it was not delved into and understood. Pallavi2 included accomplishments in the professional domain, such
remarked, ‘I never thought that happiness can be defined’. as clearing examinations, obtaining degrees, getting
It seemed that being a MHP impacted participants’ awards, and receiving public appreciation. Happy personal
understanding of happiness. Vaidehi used Rogerian con- memories included the birth of children, reconnecting with
cepts, learned in psychology and mentioned that for her, friends and family members, meeting a life partner and
happiness was the congruence between her real self and achievements of self or family.
ideal self or what she was in actuality and what she wanted Happiness could be verbally expressed (through
to become. Anwar narrated the WHO definition of increased or decreased verbal output, change of speech
happiness. content, etc.), non-verbally expressed (through alteration of
Although happiness was recognised as a universal facial expressions, body posture, mannerisms, etc.) or not
human value, the meaning and characteristics ascribed to it expressed at all. Participants used these channels for the
were extremely subjective. For most of the participants, the interpretation of others’ happiness. For instance, for
terms happiness and contentment were interchangeable. assessing whether other people were happy or not, Sanjeev
Happiness was understood as a bigger, more intangible used, ‘body posture, way of talking, reaction time, speech
concept than mere curving of the lips, a phenomenon that frequency, tone and indirect cues’, Pallavi noticed, ‘their
could spread contagiously. Suchi said, ‘happiness is such a facial expressions’, Saniya observed, ‘the manner of sit-
thing that if my colleague starts to laugh, I will also start ting, and talking’, Umesh and Anwar examined whether
laughing, without any reason’. people laughed at jokes or not, whereas Adya banked on
Despite being recognised as an abstract entity, there was ‘vibes’. The expression of happiness was moderated by the
a consensus about its healing power. Sachin said, ‘Happi- presence of people and the relationship that existed
ness is the cure for all the things which one can have, and between them.
one would have’. Happiness was a fleeting experience, Happiness was expressed either in a self-focussed or
other-focussed manner. The self-focussed forms of
The names of all the participants have been changed in order to expression could be cognitive, affective and behavioural.
protect anonymity. The cognitive modes of expression cut across past, present

Author's personal copy
Psychol Stud

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
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
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
The minimum possible score on the MHC-LF was 39, and the
maximum was 271.

Author's personal copy
Psychol Stud

types: high, moderate or low. Participants obtained rela- 2006; Kirkcaldy & Siefen, 1991). Sanjeev said, ‘We see
tively higher scores on psychological and social well-being many patients commit suicide after stopping medicines
as compared to emotional well-being, where they scored because they have high suicidal tendencies.. So it creates
the poorest. stress’. Similarly, Damayanti said,
Of the 17 participants, 14 had high well-being scores
It is stressful because all the time we are hearing the
and were considered to be flourishing (Keyes, 2005). Three
problems people are having, the struggles they are
participants, Damayanti, Palash and Saniya, had moderate
going through… A lot of grief, unhappiness, and
well-being scores, reflective of moderate mental health.
anxiety… We are always surrounded by negative
None of the participants had low well-being scores to be
emotions and stories. When the person is coming
considered as languishing or having incomplete mental
with a very dramatic life story, it keeps nagging in
your mind. I think in our job that’s very stressful and
The narratives of the participants who had moderate
unhealthy for us too.
scores of well-being revealed stress due to multiple reasons
such as increased work pressure and an inability to cope Inability to maintain adequate work–life balance, losing
and ill-health. They called themselves unhappy. Damayanti the self in the process of daily functioning and facing
said, ‘It’s just maybe I am not managing well right now, so ethical dilemmas were also viewed as stress inducing.
that is one sad thing which is going on’. However, all three Professional work both in the form of tangible tasks and
participants discussed ways in which they were attempting mental stress was carried back home for some, while others
to overcome these difficulties, instead of becoming over- had consciously decided to not let this happen. Mental
whelmed by the same. Damayanti shared how she had been stress from the professional sphere only poured into the
successful of late, in bringing about small positive changes personal lives of these professionals if it was extremely
in her daily schedule. overwhelming and distasteful. Having pathology-related
In contrast, the accounts of participants with high well- concerns for family members was observed. Suchi men-
being scores were filled with vitality, positivity and zest in tioned, ‘Most of the time thoughts are coming ‘‘Is my
all the arenas of their life—personal, interpersonal, envi- husband having problems? Is my child having problems? Is
ronmental and societal. The participants saw themselves as my parent having some problem?’’’, while Anwar said, ‘We
happy. Raghav said, ‘I feel satisfied with my personal and also start labelling ourselves. If our mood is not alright for
professional duties. Despite being 44 years old, I am not some time, we think whether medicines should be con-
having any major medical issue. My hospital is able to give sumed for restoration of the same’.
me a sense of pride and purpose to move on’. Participants reported wearing an emotional mask in
front of significant others to whom they did not want to
Impact of Personal and Professional Lives on Well- cause unnecessary trouble. The same was done in front of
Being clients, as it was assumed that not doing so would act as a
barrier in establishing a healthy therapeutic alliance. They
A thin line existed between the personal and professional did not want to be seen by their clients as mentally dis-
lives for the respondents. Excelling in both spheres of life tressed individuals, who themselves approached the MHPs
was not considered a necessity, as one seemed to com- in the dark phases of their lives.
pensate for the other.
Especially in my profession, I don’t want to be
Better regulation of emotions, enhanced perspective
looked as or seen as a depressed person. I may be
taking and acceptance of reality, and becoming a better
having some sadness inside at times, but I don’t want
human being were some of the changes brought about as a
others to perceive it on my face. Because I feel that in
result of rigorous professional training. Damayanti said,
the profession we have to share the sadness of others,
I used to cry very easily….. I think it comes with and we should try to give more happiness and feel-
professional training.. you learn how to master your ings of peace and calm to others. (Vandita)
feelings. Moreover, my way of thinking has changed
Some of the MHPs became active advocates of mental
drastically. I have more positive thinking because of
health to destigmatise the field. They viewed mental ill-
all the therapies I have done to my patients.
nesses akin to psychiatric illnesses, deserving the same
Clients’ life stories provided an extra lens to the MHPs amount of respect. Some participants also reported
for viewing their lives in a nuanced fashion. However, the becoming less money oriented and more welfare oriented.
same narratives when loaded with negativities were con- Participants reported having less time to pursue hobbies
sidered as a source of stress, a finding that has been pre- and interests as compared to the past. This contributed to
viously reported as well (Fleischman, 2005; Hill et al., the feelings of exhaustion and stress that could lead to

Author's personal copy
Psychol Stud

burnout. Similarly, due to lack of quality time with family Adoption of certain measures such as management of
members, some of the participants reported experiencing time, work, behaviours, thoughts and affect were reported
feelings of guilt, which they temporarily dealt by as helpful. Optimistic thinking, realistic goal setting,
rescheduling their day so that they were able to spend more socialising, emotional distancing and faith in supreme
time with family members. Vandita deeply regretted, ‘The power were reported as being beneficial. Sangita said, ‘You
biggest sacrifice I think for my career has been done by my need to have your own time, it’s probably the only demand
child. I feel most guilty as during my career, I had to of this profession, a de-cluttering conscious or subcon-
neglect him when he was small’. This is in sync with scious level, at least relaxing, sorting yourself is something
studies that report higher rates of burnout among female that it demands’. Possessing good observation and listening
medical professionals in India due to higher familial skills, cheerfulness, sensitivity, approachability, resource-
expectations, causing a work–life imbalance (Langade fulness, independence, confidence and assertiveness as well
et al., 2016). as an ability to empathise, reflect and adapt were seen as
Most of the participants regarded their job as being supportive personality traits.
stressful and accepted burnout as one of the most common Participants reported that their significant others kept a
outcomes of being in the field. Not only had participants check on their well-being. In addition, the nature of the job
seen their fellow colleagues in that unwanted phase, but acted as a protective factor as it provided MHPs with the
also expressed their concerns about experiencing some- therapeutic tools which could be applied to the self as well.
thing similar in future. Damayanti said, ‘When you are saying the same things 90
times, you start believing that too’. Meghana termed this as
Ideally, every therapist should undergo therapy
‘auto therapy’. The satisfaction received from healing the
because they are dealing with human emotions day in
problems of others was considered paramount.
and day out. Burnout is the most common thing that
Performing multiple expected and assigned responsi-
can occur and let’s just accept that it happens to all of
bilities, increased work pressure and inability to modify
us. I have seen all my friends, I myself experience
timings resulted in lower well-being of professionals.
burnout. After a point, there is just a barrier that
Sanjeev felt that ‘being in a government institute there are
comes in between me and my client. That is a chal-
some administrative hazards that crop up from time to
lenge of the profession…We have our issues as well.
time’, which irritated him. For Raghav, involvement in
legal issues comprised additional responsibilities. He said,
While burnout among clinicians has been a well-re- ‘What your work is, you are not doing that; but you are
searched topic in the West, there are few studies in India stuck in legal matters, going around the court, writing
that address the same. High levels of burnout and stress letters’.
have been measured among doctors, dentists and medical Due to a vague job description for the Ph.D. students in
students (Bhugra, Bhui, & Gupta, 2008; Saini, Agrawal, the organisation, apart from the routine research-related
Bhasin, Bhatia, & Sharma, 2010). A study by Bhutani, work, extra responsibilities were handed over to them by
Bhutani, Balhara, and Kalra (2012) indicated that poor higher authorities, which were reported to be stressful. The
working conditions with inadequate equipment and poor frustration arising from lack of supervision was expressed
doctor–patient ratios in government hospitals in India in some narratives.
contributed to low compassion satisfaction and high
I feel that more supervision was required, which has
burnout among clinicians. Further, limited specialised
not been given. It’s just on my signature, a lot of
training programs could generate additional stress for some
things happen, and I really, you know sometimes I
professionals, often resulting in long working hours and
also get scared, that is it right that I am diagnosing
minimal time for recreation and family life (Langade et al.,
someone with Personality Disorder? So I should get
2016). This is a cause of worry as professionals may have
supervised. (Vaidehi)
an impaired judgement or might lack empathy towards
their clients. Just as too much work was stressful for the individual,
too little work was also found to be stressful, contributing
Protective and Risk Factors for Well-Being to boredom and problems of self-worth. Anwar, a psychi-
atric social worker, said, ‘There is not much work honestly.
With respect to the functioning of MHPs, multiple factors We just have one or two very difficult cases in the entire
seemed to be at play, some of which enhanced their mental year. Overall responsibility we don’t have. The case
health, while the rest were considered incompatible with managers don’t give us much. We just get very few referred
positive functioning. cases’.

Author's personal copy
Psychol Stud

There was a hierarchy operating among MHPs, with the salary. It would be interesting to explore whether these
psychiatrists at the top of the ladder, with clinical psy- differences extend to the construction of happiness and
chologists and psychiatric social workers working under professionals’ well-being scores. The relationship between
the supervision of psychiatrists. Uneven distribution of gender, mental health and well-being could be explored.
caseload by profession and by seniority contributed to The association between the number of years of work
frustration and stress. Rajat said, ‘In India, I would not experience and its effect on well-being could be investi-
advice people to be a psychiatric social worker. In my gated further to see whether, with the advancement of age,
lifetime I have got one chance and I have not liked it time and experience in a field, mental health enhanced/
much’. deteriorated or remained the same.
Myths/stigma associated with psychiatry as a branch of Since the sample for the present study consisted of a
medicine, disrespect and biases from other professionals mixed group of MHPs (who have different training expe-
within and outside the same field, lack of developments riences, theoretical perspectives and practice orientations),
and growth opportunities in the field and a reduced work- there is a need to involve a sufficient representation of each
force were also reported as detrimental to well-being. of these subgroups in order to better understand these
Sangita mentioned how her parents have been a little tense differences. In a study by Poojalakshmi and Ghosh (2015),
lately as, ‘people were still a little apprehensive in offering psychiatrists were most likely to experience mental health
their son’s hand in the hand of a psychiatrist or a problems such as burnout, depersonalisation, depression,
psychologist’. stress and anxiety as compared to clinical and counselling
psychologists. The constant interaction with people in
Limitations of the Present Study distress, coupled with inadequate coping mechanisms and
poor working conditions, contributes to poor well-being
The data on MHPs’ well-being were captured using a one- among MHPs.
time self-report measure instead of assessing it over a
period of time. A longitudinal study may better distinguish Implications of the Present Study
the stable from the momentary factors affecting well-being.
Since the data were collected from MHPs, who were Despite being an integral part of general health and well-
viewed by the public at large as ‘mentally sane’, their being, mental health continues to be poorly funded by the
responses on the MHC-LF could have been socially Indian government. Society at large continues to view the
desirable. Most of the sites of data collection were psy- mentally ill, as well as the MHPs with a stigmatised lens;
chiatric OPDs, and some of the interviews were not given these biases continue to be internalised and affect their day-
in one session. Some of the participants reported feeling to-day functioning. This was evident in the MHPs’ will-
fatigued due to the lengthy process of filing the question- ingness to recommend therapy for others but not for
naire and being interviewed. Paucity of time due to themselves. There was a heavy biomedical emphasis
organisational commitments and lack of safety from pos- among the participants, and therapy was mentioned as an
sible consequences for the MHPs could have impacted the afterthought more often than not. MHPs play an important
quality of the collected data. The MHC-LF that was used role in determining their own mental health. They should
for the study has not been used with large samples in India. hold realistic expectations of themselves as the inability to
Further research using the tool in India will be necessary do so may lead to frustration, dissatisfaction and stress.
before any generalisable findings can emerge. 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
Directions for Further Research job itself includes dealing with the adversities of clients’
lives for extended periods of time, it is essential for ther-
There is a paucity of research studies on well-being of apists to regularly engage in self-care activities. Peer
MHPs in the Indian context, and there is a need for further supervision, feedback, regular consultations with seniors
research on the topic. The dynamics of how the protective could also be considered. This would help reduce the
and risk factors impact well-being needs to be further chances of burnout, organisational resignations, and
investigated. It would also be interesting to see whether decrease staff turnover figures.
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

Author's personal copy
Psychol Stud

Conclusion qualitative methods. Social Indicators Research, 90(1), 5–31.
Creswell, J. W. (2003). Research design: Qualitative, quantitative
The findings from the study indicate that the discourse on and mixed methods approaches (2nd ed.). Thousand Oaks: Sage
happiness is not routine for MHPs. Dealing with mentally Publications.
ill clients on a regular basis has implications for the well- Creswell, J. W., Plano Clark, V. L., Gutmann, M. L., & Hanson, W.
E. (2003). Advanced mixed methods research designs. In A.
being of MHPs. Having to mask their true emotions in their
Tashakkori & C. Teddlie (Eds.), Handbook on mixed methods in
personal and professional life was often at the cost of their the behavioral and social sciences (pp. 209–240). Thousand
own happiness and well-being. This leads to asking the Oaks, CA: Sage Publications.
question: Who will heal the healer, and how? Delle Fave, A., Brdar, I., Wissing, M. P., Araujo, U., Castro Solano,
A., Freire, T., et al. (2016). Lay definitions of happiness across
Research on physicians as patients by Myers and Gab-
nations: The primacy of inner harmony and relational connect-
bard (2008) indicates that physicians are vulnerable to edness. Frontiers in Psychology.
stress, burnout and suicide due to the nature of the pro-
fession. The profession requires a precision and perfec- Derne, S. (2008). Well-being: Lessons from India. In G. Mathews &
C. Izquierdo (Eds.), Pursuits of happiness: Well-being in
tionism, which are traits that contribute to feelings of guilt,
anthropological perspective (pp. 127–146). New York City:
self-doubt and responsibility. There are gender differences Berghahn Books.
seen between male and female physicians, with female Edwards, D., Burnard, P., Coyle, D., Fothergill, A., & Hannigan, B.
physicians being more likely to suffer from burnout and (2000). Stress and burnout in community mental health nursing:
A review of the literature. Journal of Psychiatry and Mental
stress as compared to their male counterparts. However,
Health Nursing, 7, 7–14.
female physicians had better health and personal habits,
which stood them in good stead. For MHPs working in Edwards, D., Burnard, P., Coyle, D., Fothergill, A., & Hannigan, B.
hospitals, in close proximity with physicians, many similar (2001). A stepwise multivariate analysis of factors that con-
tribute to stress for mental health nurses working in the
patterns can be seen. While professional training may help
community. Journal of Advanced Nursing, 36(6), 805–813.
in distancing oneself from the stress arising from dealing
with patients, it is important for MHPs to identify personal Fagin, L., Brown, D., Bartlett, H., & Carson, J. (1995). The Claybury
factors that could predispose them to burnout. Research in community psychiatric nurse stress study: Is it more stressful to
work in hospital or the community? Journal of Advanced
India has indicated that doctors are at risk of burnout and
Nursing, 22(2), 347–358.
stress. The present study corroborates the findings of pre-
vious studies about the vulnerability of MHPs (Bhugra Fink, J. E. (2014). Flourishing: Exploring predictors of mental health
et al., 2008; Bhutani et al., 2012; Langade et al., 2016; within the college environment. Journal of American College
Health, 62(6), 380–388.
Saini et al., 2010).
Developing a healthy interface between academia and Fleischman, P. R. (2005). Karma and chaos: New and collected
practice in the area of mental health will contribute sub- essays on Vipassana meditation. Onalaska, WA: Pariyatti
stantially to the growth of the field in India. A cadre of Publishing.
Helliwell, J., Layard, R., & Sachs, J. (2018). World Happiness Report
MHPs will evolve, who have the necessary knowledge,
2018. New York: Sustainable Development Solutions Network.
skill, attitude and value base to work on the burgeoning Hill, R. G., Ryan, P., Hardy, P., Anczewska, M., Kurek, A., Dawson,
mental health crisis in the country. I., Turner, C. (2006). Situational levels of burnout among staff in
six European inpatient and community mental health teams. The
Journal of Mental Health Workforce Development, 1(1), 12–21.
Keyes, C. L. M. (2002). The mental health continuum: From
References languishing to flourishing in life. Journal of Health and Social
Behaviour, 43(2), 207–222. Retrieved from
Bentall, R. P. (1992). A proposal to classify happiness as a psychiatric
disorder. Journal of Medical Ethics, 18(2), 94–98. Keyes, C. L. M. (2005). Mental health and/or mental illness?: Investigating axioms of the complete state model of health.
Bhugra, D., Bhui, K. S., & Gupta, K. R. (2008). Burnout and stress Journal of Consulting and Clinical Psychology, 73(3), 539–548.
among doctors and dentists in North India. International Journal
of Culture and Mental Health, 1(1), 24–29. Keyes, C. L. M. (2007). Promoting and protecting mental health as flourishing: A complementary strategy for improving national
Bhutani, J., Bhutani, S., Balhara, Y. S., & Kalra, S. (2012). mental health. American Psychologist, 62(2), 95–108.
Compassion fatigue and burnout amongst clinicians: A medical
exploratory study. Indian Journal of Psychological Medicine, Keyes, C. L. M., & Haidt, J. (2003). Flourishing: Positive psychology
34, 332–327. Retrieved from and the life well-lived. Washington DC: American Psychological Association.
Camfield, L., Crivello, G., & Woodhead, M. (2008). Well-being Keyes, C. L. M., & Lopez, S. J. (2002). Towards a science of mental
research in developing countries: Reviewing the role of health: Positive directions in diagnosis and interventions. In C.

Author's personal copy
Psychol Stud

R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology psychologists, psychiatrists, and counselling psychologists.
(pp. 45–59). New York: Oxford University Press. Journal of Research: The Bede Athenaeum, 6(1), 168–174.
Kirkcaldy, B. D., & Siefen, G. (1991). Occupational stress among mental
health professionals: The relationship between work and recre- Rao, K., & Mehrotra, S. (1998). Clinical psychologists in India: A
ational pursuits. Social Psychiatry and Psychiatric Epidemiology, time for reflection and action. Indian Journal of Clinical
26(5), 238–244. Psychology, 25(2), 124–135. Retrieved from
Langade, D., Modi, P. D., Sidhwa, Y. F., Hishikar, N. A., Gharpure,
A. S., Wankhade, K., Joshi, K. (2016). Burnout syndrome among Ravi, R. (2013). Understanding lay conceptions of happiness:
medical practitioners across India: A questionnaire-based sur- Emerging adults. (Masters dissertation). Retrieved from DSpace
vey. Cureus, 8(9), e771. Digital Repository. Tata Institute of Social Sciences, Mumbai.
Layard, R. (2003). Has social science a clue?: What is happiness? Rosenberg, T., & Pace, M. (2006). Burnout among mental health
Are we getting happier? [Lecture series]. Retrieved from professionals: Special considerations for the marriage and family therapist. Journal of Marital and Family Therapy, 32(1), 87–99.
Lu, L. (2001). Understanding happiness: A look into the Chinese folk
psychology. Journal of Happiness Studies, 2(4), 407–432. Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality
Mehrotra, S., & Tripathi, R. (2011). Positive psychology research in and Social Psychology, 57(6), 1069–1081.
India: A review and critique. Journal of the Indian Academy of
Applied Psychology, 37(1), 9–26. Saini, N. K., Agrawal, S., Bhasin, S. K., Bhatia, M. S., & Sharma, A.
Moore, K. A., & Cooper, C. L. (1996). Stress in mental health K. (2010). Prevalence of stress among resident doctors working
professionals: A theoretical overview. International Journal of in Medical Colleges of Delhi. Indian Journal of Public Health,
Social Psychiatry, 42(2), 82–89. 54(4), 219–223. Retrieved from
Myers, M. F., & Gabbard, G. O. (2008). The physician as patient: A Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007).
clinical handbook for mental health professionals. Washington Resources for mental health: Scarcity, inequality and ineffi-
DC: American Psychiatric Publishing Inc. ciency. The Lancet, 370(9590), 878–889.
Nelson, D. L., & Simmons, B. L. (2005). Eustress and attitudes at
work: A positive approach. In G. A. Alexander-Stamatios & L. Seligman, M. (2013). Ideas at the house: Martin Seligman—Well-
C. Cary (Eds.), Research companion to organizational health being and happiness [Video file]. Retrieved from
psychology (pp. 102–110). Cheltenham: Edward Elgar.
Pandey, M. (2006). Values profile of the poor. Psychological Studies, Singh, A., & Modi, R. (2011). Indian ancient thought and well-being
51, 161–165. (happiness). Bilingual Journal of Humanities & Social Sciences,
Parry-Jones, B., Grant, G., McGrath, M., Caldock, K., Ramcharan, P., 2(1&2). Retrieved from
& Robinson, C. A. (1998). Stress and job satisfaction among Thara, R. (1997). Stress, burden and satisfaction among mental health
social workers, community nurses and community psychiatric professionals. Indian Journal of Social Psychiatry, 13, 114–118.
nurses: Implications for the care management model. Health and Weiner, E. L., Swain, G. R., Wolf, B., & Gottlieb, M. (2001). A
Social Care in the Community, 6(4), 271–285. qualitative study of physicians’ own wellness-promotion prac- tices. Western Journal of Medicine, 174(1), 19–23.
Pathare, S. (2015). Less than 1% of our health budget is spent on
mental health. Infochange. Retrieved from World Health Organization. (2005). Promoting mental health: Concepts, emerging evidence, practice. Geneva: World Health
Pestonjee, D. M. (1992). Stress and coping: The Indian experience. Organization. Retrieved from
New Delhi: Sage Publications. World Health Organization. (2011). Atlas: Country profiles on mental
Poojalakshmi, M., & Ghosh, C. C. (2015). Comparison of burnout, health resources. Geneva: World Health Organization. Retrieved
depersonalization, anxiety, stress and depression among clinical from