The numbers tell the story.
Recent studies in North America and Europe indicate that about 25 per cent of the population will struggle with a mental illness at some point in their lives; and that the vast majority of these people will continue to hold jobs.
That makes the workplace the primary battleground for the detection and intervention for people suffering from mental illnesses. Unfortunately, not all employers know how to step up to that responsibility.
The stigma around mental health issues remains firmly rooted in most workplaces. Many managers are still reluctant to begin conversations with their employees about possible mental illness, and co-workers’ first reactions are commonly fear or frustration, not compassion.
According to many respected mental health professionals, the time could not be better to re-think the workplace as the point of first response for those struggling with mental illness.
“Work for adults is like school for kids,” said Dr. Ash Bender, Deputy Clinical Director of the Mood and Anxiety Disorders Program at the Centre for Addiction and Mental Health. “Imagine a school that did not identify and help students that were struggling or had health issues. What we’re talking about for the workplace is really just an extension of that concept.”
Bender said there is a clear motivation for employers to confront mental illness in the workplace: the enormous cost to business and the economy on the whole.
The Organization for Economic Cooperation and Development reports that mental health has become the leading cause of new disability claims worldwide. In some OECD countries, it can be as high as half of all new claims. And the number of sick days attributed to mental health disorders is rising precipitously.
The impact on global economies is enormous. Most developed countries estimate that mental health costs represent a loss in GDP of between three and four per cent. And for many governments, the cost of treating mental illnesses is measured in the tens of billions of dollars.
That does not mean; however, that we’ve completely let go of the stigma that often accompanies the subject of mental illness. Again, OECD data showed that despite the fact that anxiety and mood disorders are the most common forms of mental illness, four in 10 people working in OECD member countries believed that someone with a psychiatric disorder represented a danger to others. And five in 10 Europeans admitted that they believed it was difficult to have a simple conversation with someone diagnosed with a mental health problem.
Dr. Bender said those results are hardly surprising based on the lack of training provided to workplace managers. “The training is not about educating managers to be physicians. It’s really about increasing their skills around having those critical and conversations and responding appropriately to serious things.”
Although effective training and education about mental health is not widely delivered, some of the more progressive organizations are developing a clear methodology around effective intervention. “Often you have to bring the intervention to the person, as opposed to the employee seeking it out,” said Dr. Bender. “We see this with substance use problems as well as depression. There will be many people that seek care themselves, but more often it’s really about being proactive in order to capture the people that really need assistance.”
Paula Allen, Vice President of Research and Integrative Solutions at Morneau Shepell, a leading provider of Employee and Family Assistance Programs (EAP), Health and Disability Programs, and Benefit and Retirement Solutions, said progressive organizations equip managers with the training they need to understand the impact of employee health issues as part of performance management.
In general, radical changes in behavior or performance in someone who has otherwise been a stable employee are usually a sign of something more than a simple morale or motivation problem, said Allen. In situations like this, there are a number of important steps and concepts that managers should consider:
1. You’re not a doctor: Managers are not there to diagnose mental illness. Diagnosis is still the responsibility of medical professionals; managers should be observing employees and making note of marked changes in behavior.
Allen advised that employers “must be clear with managers that it’s really not their role to diagnose. They’ll get too deep into things that are not appropriate for a business relationship.”
2. Observe and discuss: The trigger for effective intervention is observation. If there is a change in behavior or performance, it’s important to meet with the employee and let him or her know the specific change that you have seen. This will be much easier if the manager has put time and effort into developing a trusting and collaborative relationship with their employees where frank conversations are baked into every day interactions as well as performance management.
“Regardless of the reason for a behavior change, the manager’s responsibility is really to communicate what they see,” said Allen. “You’re not making an assumption about the reason behind it, because the manager has no way of knowing. But it is the manager’s responsibility to say very honestly to the employee: ‘this is the way it used to be, this is what I’ve seen in terms of the change, I’m concerned.’ ”
3. Challenge yourself: does the employee know their job? If there is a problem with performance, it’s always important to establish that the employee in question has a clear, unambiguous understanding about what they are expected to do because many performance issues can actually stem from a lack of clear expectations. Eliminating this as the cause of a performance or behavioral issue will help determine whether the employee needs to address a physical or mental health concern.
“If you have a conversation with somebody, the first thing you would want to do as a manager is to be clear about the tasks of the job, the priorities, and the objectives” Allen said. “Very often a lack of clarity is at the root of a performance issue and it has nothing to do with a mental health issue. It is an understandable response to confusion or frustration about a situation.”
4. Offer help: Once change is noted, and the potential for task confusion has been eliminated as the source, the next step is to support the employee in problem solving. Managers should remind employees that EAP is available to deal with a wide range of concerns, everything from a serious mental health crisis to a financial concern.
“It is the same as getting early care for cancer, or a broken leg,” said Allen. “The earlier the intervention, the better the outcome. Many people will ignore their own difficulties until someone like a manager makes note, so managers can help in this respect.”
5. Respect your employees’ privacy: One of the most difficult aspects of dealing with workplace mental health is keeping the details of an individual employee’s struggles from becoming fodder for water-cooler conversations. Allen emphasizes that managers must respect privacy and discourage gossip whenever possible. Specialized training can equip managers with the skills they need to de-stigmatize mental health issues in the workplace.
“People watch what managers do and will often respond as per the example set by their manager. That’s why investing in manager training is so important,” said Allen.
6. Post EAP: the work continues: Far too many organizations believe their involvement in a workplace mental health situation ends with a referral to EAP. However, that reference is just the foundation of a response.
It is essential to maintain contact with employees during disability, and offer ongoing support once they have returned to work. This is a best practice for all types of disability, but it is absolutely critical when dealing with mental health concerns. An absence of supportive contact increases the employee’s anxiety and delay in returning to work.
“When the employee is off work, there should be some contact with that employee, and a process should be developed to get that employee back to work,” Allen said. “A third party can help you and coach you, but when that employee walks through the door it’s up to the workplace.
As Allen emphasized, the responsibility for detecting and responding to mental health concerns falls to line managers, who have the most contact with employees. Not surprisingly, this means tasking managers to build deep, broad relationships with employees. Here are some ways you can go about achieving that:
Get to know your employees. It's very hard to have a conversation about a deeply personal matter if you don't know anything about the people you are managing. You do not have to use formal meetings to get a better picture of the people who work for you; casual "water cooler" conversations can provide great insight into the non-work lives of employees.
Identify values, motivators, and aspirations. Through meetings and conversations, try to identify the things that frustrate and inspire your employees. Everyone has triggers, both positive and negative, that affect their engagement and productivity. As a manager, you need to know what those triggers are.
Talk, but do more listening. When developing a relationship with an employee, it's important to spend only 20 per cent of the time talking, and the remaining 80 per cent listening. Making a concerted effort to listen will build trust, and ultimately forge the kind of relationship you need in order to pick up on potential mental health problems.
Build awareness. One of the great benefits of developing a greater understanding of your employees, and the factors that impact on their work, is being able to pick up on the subtle changes in behavior and attitude. These changes are often the early warning signs of deeply personal problems. However, in order to see these signs, you need to know what is considered normal behavior and what is out of the norm.
Underline accountability. A deeper connection with employees allows managers to emphasize the need for everyone to take responsibility for the personal issues that may be eroding work performance. Ultimately, it is an individual's responsibility to acknowledge a problem, and seek help. Managers can encourage this, and help employees access the help they may need.