Real Voices, Healthier Systems: Health Workers’ Lived Experience as a Path to Better Mental Health Support

... mental health initiatives are not always designed with enough input from the people expected to use them.

By Dr. Arshi Ahad is a Dentist & currently a Research Scientist at the Model Rural Health Research Unit (MRHRU), India

The hidden mental health burden of care

In public health, we spend a lot of time thinking about the people who need care. We discuss how to reach them, improve services and ensure that programmes work. But how often do we think about the people responsible for making all of this happen?

Community health workers, nurses, doctors, researchers and support staff carry responsibilities that are not always visible in reports. Their work involves more than completing tasks. It requires patience, coordination, problem-solving and, often, finding ways around difficulties they cannot control. The expectation to keep going can make it difficult to acknowledge when the work begins to affect their own wellbeing.

There is also the fear of being misunderstood. In professions built around caring for others, admitting that we are struggling can feel like admitting that we cannot cope. So we continue with our responsibilities, even when we feel mentally exhausted.

Lived experience as a form of expertise

I believe that the people doing the work understand some of its challenges better than anyone else. They know what makes a task difficult, where support is missing and what could make their working lives easier.

Yet mental health initiatives are not always designed with enough input from the people expected to use them. We may offer counselling, awareness sessions or advice on managing stress, but do we ask whether workers have the time to access these services? Do they feel safe speaking about their difficulties? Are they involved in deciding what support would actually help?

The World Health Organization's 2026 World Mental Health Day theme, “Lived experiences heard: real voices, real change,” reminds us that listening must go beyond inviting people to share their stories. Their experiences must help shape decisions, policies and services.[1]

Stories reveal system challenges

I experienced this pressure during a particularly demanding period of community-based work. There were administrative and coordination difficulties at different stages, and resolving one problem sometimes meant following up on another. I was expected to keep the work moving, even when some of the obstacles were beyond my control.

What worried me most was the possibility that the effort already invested might go to waste. Community members had given their time and agreed to participate, and local health workers had supported the process alongside their other responsibilities. Gaining people's trust and willingness to participate takes time. When something goes wrong later, you cannot always ask them to start again.

I kept trying to find solutions, but the pressure followed me beyond working hours. I felt mentally drained and irritable, with very little time to myself. I managed the situation, but I remember thinking that getting the work done should not have to come at such a cost.

Then I thought about the ASHAs and other community health workers. They, too, have to maintain relationships with people, manage competing responsibilities and deal with circumstances beyond their control. What happens when they feel overwhelmed? Do they have someone they can turn to, or are they simply expected to manage?

That question stayed with me. Sometimes, what appears to be an individual's difficulty in coping is also a sign that the way work is organised needs attention.

What real change looks like

We need workplaces where health workers can speak openly about their difficulties without fearing judgement. They should have a say in decisions affecting their workload and working conditions, access to supportive supervision, opportunities for peer support, and mental health services that are practical to use.

Their wellbeing must matter alongside the number of activities completed or people reached. A programme may meet its targets, but that does not tell us whether the people delivering it felt supported.

International guidance from the World Health Organization and the International Labour Organization similarly emphasises the importance of addressing workplace risks and protecting mental health at work.[2]

As public health professionals, we understand that programmes work better when they reflect people's actual needs. The same must apply to health workers themselves.

We often praise people for managing difficult situations. Perhaps it is time to ask what would make those situations less difficult in the first place. A health system should not measure success only by the work completed, but also by whether the people doing that work are able to remain well. Listening to their experiences is a good place to start. Allowing those experiences to change the way we work is what will make the difference.

References

1. World Health Organization. World Mental Health Day 2026: lived experiences heard, real voices, real change [Internet]. Geneva: World Health Organization; 2026 [cited 2026 Oct 26]. Available from: https://www.who.int/campaigns/world-mental-health-day/2026
2. World Health Organization, International Labour Organization. Mental health at work: policy brief [Internet]. Geneva: World Health Organization; 2022 [cited 2026 Oct 26]. Available from: Mental health at work: policy brief
3. World Health Organization. WHO guidelines on mental health at work [Internet]. Geneva: World Health Organization; 2022 [cited 2026 Oct 26]. Available from: Guidelines on mental health at work

About the Author

Dr. Arshi Ahad is a Project Research Scientist II (Medical) at the Model Rural Health Research Unit (MRHRU), Jarmundi, Jharkhand, under the Department of Health Research (DHR), Ministry of Health and Family Welfare, Government of India. Her work focuses on implementation research, health systems strengthening and community-centred approaches to improving health outcomes, with an emphasis on generating evidence that informs public health programmes and practice.