Ground Reports

Helpline Workers Overburdened as Pandemic Anxiety and Panic Grow

India records the highest number of deaths caused by suicide in the world, with it being the leading cause of death in the 15-39 years age group. In 2019 alone, 140,000 people died by suicide, accounting for 17% of global deaths from suicide. While there is little data on COVID-19 related suicide deaths, the NCRB report has shown a 10% rise in deaths caused by suicide in 2020 compared to the previous year. According to experts, fear of isolation, the stigma surrounding testing positive, financial distress, and the displacement of the migrant population might have contributed to the rise in deaths due to it.

By Pritha Bhattacharya, 2 Feb 2022

In the absence of a national suicide prevention policy, helpline workers spread across India’s non-governmental sector are, in many ways, our main line of defence against suicide. However, the disproportionate burden placed on them to manage growing levels of distress has led to widespread burnout among counsellors, driving some to the brink of apathy. 

The Emotional Cost

Ayushi*, 22, joined a reputed Mumbai-based helpline as a counsellor during the pandemic. Although she had never planned on becoming a helpline worker, she accepted the job, thinking it would be an excellent learning opportunity. 

“I had just graduated from college, and I was actively seeking a job. Even under normal circumstances, there are very few jobs in the sector. But due to the pandemic, things were worse than usual. So, when I got an offer to work with a credible organisation whose values align with mine, I was happy to accept it,” she recalls. 

After weeks of extensive training and supervised calls, Ayushi began working independently. However, the constant sense of alarm never left her side. On average, she would receive eight to nine calls daily, the majority of which would be crisis calls, causing her to stay on edge all day. The stress would often lead to tense muscles, frequent headaches, and a high heart rate.  

She observes, “It is normal to have a flight or fight response to someone telling you that they are moments away from taking their own life. But as counselors, we need to contain that emotion to do our job well. The whole process was exhausting; I would have no energy to interact with family or chat with friends after work.”

Working remotely from home, away from colleagues and supervisors, also heightened the sense of isolation and made it difficult for counselors to cool off after work. Many of them reported feeling helpless, scared, and worried for weeks after particularly distressing calls.

Ayushi shares, “Last year, a 12-year-old boy called the helpline from a remote forest with poison in his hands, threatening to end his life. I spoke to him for a few minutes before the call abruptly ended. I tried calling him back, but I could not reach him. The whole incident left me deeply shaken; I could not cope with it. I tried reaching out to my supervisor for help, but she simply asked me to not think about it.”

The inability to preempt the nature of the calls also added to Ayushi’s anxiety. Callers would, at times, lash out at her and speak rudely. “As a counsellor, it is your job to say difficult things and even disagree with your client when required. But some people were not open to it. Male callers, especially, have screamed at me frequently, which made me feel very unsafe at work,” she says.

Within a few months of joining the helpline, Ayushi started feeling burnt out. She left her job at the helpline one year later. “My attention span during calls had waned, and I was finding it harder and harder to empathise with people. It reached the point where I could not receive calls without compromising my mental health,” she tells Mojo.

Harshita*, 24, became a helpline worker to fulfil her dream of making mental health care accessible to all. She joined an NGO that specialises in providing counselling to clients via telephone, email and chat rooms, free of charge. She joined the helpline in 2019, a few months before the pandemic hit India. 

When she first joined the helpline, Harshita would attend three or four calls every day, with one or two crisis calls. But during the pandemic, she started receiving almost ten calls a day, out of which five or six would be crisis calls.

She observes, “Even though our work has always been stressful, before the pandemic, we could at least unwind in the company of colleagues. For instance, our office had a small pantry where we would cook popcorn in between calls and engage in light-hearted banter. But once work from home started, we lost these tiny rituals that used to keep us emotionally afloat on difficult days.”

Besides people struggling with suicidal ideation, Harshita also received calls from individuals stuck in abusive homes or violent marriages seeking a way out. “Stories of violence, abuse and poverty affected me the most. We tried providing people with helpline numbers more suited to their needs, but there was no way of finding out if they had received the help. The level of despair was unbelievable, and it made us all feel extremely helpless,” she recounts.

Lack of Support

Unfortunately, even as helpline workers struggled to cope with the volume of work during the pandemic, the level of support counsellors received from organisations to handle the stress either remained the same or declined.

For instance, it is widely recognised that therapy can help counsellors become better at setting boundaries with clients, preventing burnout and managing their emotions. In light of this, some helplines provide counsellors with a mental health allowance, but the actual amount helpline workers receive as part of this allowance is barely enough to cover one therapy session per month. On average, helplines provide anywhere between Rs 700 and Rs 1,000 per month as a mental health allowance. The amount remained the same even during the pandemic. 

In the absence of adequate emotional support, helpline workers sometimes avoid receiving calls for temporary relief. “I have avoided calls, but it is not easy. I felt guilty for doing that because I knew I had the tools to prevent someone from taking that last step. It took weeks of therapy to realise that I did what I did as an act of self-preservation and not out of malice,” says Ayushi, who is now practising as a therapist with a Delhi-based start-up. 

Further, during the pandemic, supervision, which provides counsellors with the opportunity to discuss their work regularly with someone more experienced, was not as readily available. As a result of the heavy workload, many organisations resorted to weekly group-based supervision instead of individual sessions with counsellors. 

Pragya*, who joined a Mumbai based helpline in 2020, feels that the volume of work increased so much during the pandemic that no matter how much helpline workers exerted, they could not reach everyone. 

“The organisation I was working with pushed us to receive calls non-stop. After each call, we had to finish our documentation in about nine minutes and receive the next call. There was no time to process anything. We had only two options: we could either become apathetic and dole out generic advice to distressed callers or do our job well but lose our sanity,” she recollects. 

Yet, helpline workers feel that the issue of burnout among counsellors cannot be remedied through hiring new staff alone. Pragya, who quit her job as a helpline worker after completing a year, explains, “My organisation did try to hire new people, but because the attrition rate was so high, it did not make a difference. So, unless we find a way to reduce the unfair burden placed on helplines to manage India’s suicide problem, the situation will not improve.”

Need for policy intervention

Public health experts, too, are concerned about the absence of larger policy interventions geared towards suicide prevention, both globally and in India.

A 2021 policy paper titled The National Suicide Prevention Strategy in India: Context and Considerations for Urgent Action by noted suicide prevention expert Lakshmi Vijaykumar and colleagues, hopes to help the Indian government draft a robust suicide prevention strategy that would address some of the root causes of it in India. 

In the review, experts have called for multi-sectoral, multi-level action to decrease the burden of and exposure to risk factors that render people vulnerable to suicidal ideation. Some of the recommended strategies include scaling up user-friendly and accessible alcohol treatment services, bolstering laws and systems that uphold women’s rights, and training journalists in ethical coverage of suicide deaths.

Through such policy insights, experts hope to discard the assumption that suicide is an individual problem and highlight that the source of suicide is often found in unjust structures and systems. The paper also emphasises that suicide prevention measures must be community-based rather than individual-focused. In other words, measures must not only be delivered by mental health experts but also by people from the community. Such a comprehensive approach to suicide prevention can significantly ease the disproportionate burden currently placed on helpline workers and save millions of lives. 

*Some names have been changed

Being a frontline worker, if you’re feeling overwhelmed or if someone you care about or know is experiencing psychosocial distress, reach out for support and help at SWAASTHI. It is an anonymous and confidential service that can be availed free of cost over the telephone by reaching out to the number:9152987824 between Monday and Saturday from 10 am to 6 pm.

If you are struggling emotionally, please feel free to reach out to the helpline number: 022-25521111 (Monday to Saturday, 8 AM to 10 PM) for telephone-based counselling that can be availed free of cost.