Executive Summary
For the third consecutive year, Refill Health has surveyed HR leaders and employees across India's mid-market and enterprise sectors to understand the state of workplace mental health. This year, we expected to find the familiar story — stigma remains high, awareness remains low, utilisation remains weak. What we found instead was more specific — and more actionable.
The barrier to mental health support is no longer primarily awareness. Employees know these programmes exist. The barrier is guided access.When we asked the 74% of employees who needed support but never accessed their EAP why they hadn't used it, the top answers were revealing:
38%
"I didn't know how to get started"
The most common barrier — a navigation problem, not a stigma problem
29%
"I was worried about confidentiality"
Vague assurances of "confidential support" are not enough
22%
"I couldn't get an appointment quickly"
The employee's window of motivation closed before help arrived
91%
Organisations with an EAP in place
Yet median utilisation across all surveyed organisations was only 4.8%
These are structural failures, not cultural ones. They are problems that guided care navigation directly solves. Organisations that pair mental health access with an active care navigator achieve utilisation rates 18 times higherthan organisations offering access alone. This is the core finding of this year's report, and we have named it the Guided Care Gap.
Key Concept
The Guided Care Gap
The Guided Care Gap describes the structural failure between having a mental health programme and employees actually using it. In our survey, 91% of organizations reported having some form of EAP or mental health benefit in place. Yet median utilization across all surveyed organizations was 4.8%. The gap between coverage and usage is not a marketing problem. It is a care navigation problem.
Traditional EAPs work on a pull model: the programme exists, communications are sent, and employees are expected to self-initiate contact when they need support. This model fails for three reinforcing reasons — and each failure is structural, not cultural.
Friction at the moment of need
When an employee first recognises they need help, the psychological barrier to taking action is at its highest. The decision to seek mental health support is fragile and time-sensitive. A phone number in the employee handbook is not enough. The employee needs someone to meet them where they are — proactive outreach, a human voice, a concrete next step offered within minutes rather than days.
38% — didn't know how to startConfidentiality anxiety
29% of employees cited fear about who would see their data. Most EAP communications do not address this clearly enough. "Confidential support" is not the same as "your manager and HR will never see what you discussed, only anonymised organisation-level statistics." The specificity of the assurance matters as much as the assurance itself.
29% — worried about confidentialityAppointment friction
22% tried to access support but experienced delays. A two-week wait for a first appointment after a moment of crisis is a programme failure, not an employee failure. The employee's window of motivation — and in acute cases, their window of safety — often closes within days. Speed of first contact is not a quality metric. It is a clinical necessity.
22% — couldn't get an appointment quicklyThe core finding — 2026
Organisations that pair mental health access with an active care navigator achieve utilisation rates 18 times higher than organisations offering access alone. Guided organisations average 68% utilisation. Access-only organisations average under 5%. The difference is not explained by sector, size, or budget — it is explained entirely by the presence or absence of a navigator.
We thought the problem was awareness. We sent emails, put up posters, and held town halls. Utilization didn't move. Then we adapted Refill Health care navigation model. In twelve months, utilization went from 3% to 71%.
Guided care navigation addresses all three structural barriers directly. A care navigator actively reaches out to employees following a screening, contacts those who have expressed interest but not yet booked, and ensures first appointments happen within 24 hours of request. The navigator maintains contact through the programme — checking in after sessions, monitoring engagement, and flagging disengagement for clinical review. This is what closes the Guided Care Gap.
This year's survey included a validated burnout measurement instrument administered to 1,000+ employees across 12 sectors. The table below shows the percentage of employees reporting moderate-to-severe burnout, with year-on-year change.
| Sector | Burnout Prevalence | YoY Change | Primary Driver |
|---|---|---|---|
| IT / Technology | 61% | ↑ from 54% | Always-on culture, role ambiguity |
| BFSI | 54% | ↑ from 48% | Performance pressure, regulatory change |
| Healthcare & Pharma | 49% | ↑ from 43% | Post-pandemic residual strain |
| Professional Services | 44% | ↑ from 39% | Billable hour culture, client intensity |
| Retail | 39% | ↑ from 33% | Frontline pressure, shift work |
| Manufacturing | 31% | ↑ from 23% (+8pp fastest) | Automation anxiety, shift restructuring |
The Manufacturing Alert
The Manufacturing sector deserves particular attention. While burnout prevalence remains the lowest of all sectors surveyed, the 8 percentage-point year-on-year increase is the largest of any sector. Manufacturing organisations have historically invested less in mental health infrastructure than knowledge-economy counterparts. The rapid growth trajectory suggests this is changing — and the gap between emerging need and available support is widening fastest in this sector.
The most significant finding in this year's survey is the relationship between care navigation and utilisation. We segmented the HR leaders surveyed into three groups: organisations with no structured mental health programme, organisations offering access-only EAP, and organisations offering guided mental health programmes.
68%
Guided Care Organisations
Median utilisation — range 42%–81%
4.8%
Access-Only EAP
Median utilisation — range 2%–11%
0%
No Programme
68% could not confirm their utilisation figure
To state it plainly: if you have a mental health programme without guided navigation, you have spent budget to create a programme that approximately 95% of employees who need it will not use.
The 18× utilisation multiple is the largest finding delta in three years of this survey. It is not explained by any demographic, sector, or organisation size factor — it is explained entirely by the presence or absence of guided navigation.
Employees receiving effective, evidence-based mental health care regain up to 4+ hours of productive work time per week — driven by reductions in anxiety, burnout, and overall work impairment. Source: Journal of Occupational and Environmental Medicine (2025), retrospective cohort study on work impairment and productivity outcomes. With the guided care navigation model, it will be increased to 6+ hrs per week per employee.
Productivity cost breakdown
Presenteeism accounts for 68% of the total productivity cost— absenteeism only 32%. This explains why organisations that track absenteeism alone systematically underestimate the true cost. An employee managing untreated anxiety or depression typically operates at 50–65% of normal productive capacity. They're present. They're counted as "in." But their cost to the organisation is real, chronic, and cumulative.
Move from access to guided access
Address confidentiality explicitly and specifically
Train managers with specific scripts, not principles
Measure utilisation and report it to leadership monthly
Address Manufacturing before the need becomes acute
Survey design: 100+ HR leaders and 1,000+ employees across 12 sectors. Burnout measurement used validated Maslach Burnout Inventory short-form (MBI-GS-S, 9 items). All figures from Refill Health's 2025 annual survey. Individual program results will vary.