Mental Health in the Workplace

How to foster a resilient workforce

Investing in mental health in the workforce makes dollars and sense. Not only are U.S. companies of all sizes breaking through the stigma of mental illness, but they are also offering employee medical and mental health care at parity, as it is now required by law. ABJ’s editor Antonia McGuire examines why integrative employee health care is a progressive movement to be reckoned with across the nation and worldwide.

Job stress is no stranger to Timothy Collins.* The 31-year old was billing 80 hour-work weeks for the past three years at a medium-sized firm in Washington, D.C. Like so many in high-stress professions, this young lawyer felt the symptoms but the distressing signs sadly, went unnoticed.: upset stomach, problems sleeping, disturbing thoughts, and substance abuse. His unresolved worries reared its ugly head in the form of a mental health issue.

Collins was forced to take a sick leave without pay in order to seek treatment. A year and a half later, he got a handle on his anxiety after some drug treatment and intensive cognitive behavioral therapy sessions. Collins decided not to return back to the firm. Instead, he accepted a new job and now tackles larger cases at a slower pace in public service.

This type of office scenario is all-too familiar, according to Clare Miller, director of the Partnership for Workplace Mental Health, a program delivered by the American Psychiatric Foundation (APF).  In the early stages of development, the Partnership for Workplace Mental Health mostly responded to post-9/11 inquiries by employers who wanted to know what they could do to help distraught workers. Now, she mostly talks with employers about why it’s worth paying attention and investing in mental health programs for workers. “There are a few points to our business case as to why employers should care about mental health. One of them is just the sheer number, high prevalence of mental health issues,” says Miller.

When stress is not addressed, it can affect many parts of your life, including your productivity and performance on the job. In fact, workplace stress causes about 1 million U.S. employees to miss work each day, affecting the company’s bottom line. That’s why an increasing number of employers are starting to pay attention to the taboo subject. After all, 40 percent of the U.S. population will experience a mental health or substance abuse problem at some point in their life. “That’s about 1 in 5 people who have a mental health issue,” says Miller.

Workplace mental health care makes dollars and sense

Job stress in itself comes with a very costly price tag for U.S. industries, estimated at over $300 billion annually as a result of absenteeism, presenteeism and mental health-related medical bills, according the American Institute of Stress. “We know that often times, people wait up to a decade after the onset of their initial problems before seeking help,” says Miller. But there is an incredible cost to the health care system associated with mental health issues that aren’t being treated, she adds. When people do seek treatment, there are obvious, direct cost-savings in medical, pharmacy and therapy bills. Studies have also shown that the treatment of depression can result in a 40 to 60 percent reduction in the cases of absenteeism and presenteeism. The indirect outcomes can be harder to quantify, however.

Current figures according to the Partnership for Workplace Mental Health suggest that mental illness and substance use disorders annually set back employers in indirect costs an estimated $80 to $100 billion. “I’ll be honest, the value proposition of an EAP in this time is not just a dollar and cents computation,” explains Paul Heck, global manager for employee assistance and work-life services at DuPont. “Employee engagement, morale, innovation, presenteeism, etc. are all positively impacted by our work but those are pretty hard to measure in dollar terms, at least as far as I know,” says Heck of DuPont, which is regarded as one of top leading innovators in integrative employee health coverage (both mental and medical). Interestingly, DuPont established the first corporate program for assisting employees suffering from alcoholism in 1942.

The company’s history has many “firsts” in terms of mental health programs, which grew over the years to include concerns related to emotional health and well being. “Our current employee assistance and work life services provide confidential, professional resources to DuPont employees and dependents in 43 countries,” tells Heck. There are other examples.

One Fortune 500 company achieved a 1.7:1 return on investment by conducting a screening program for depression. When care management was instituted at another company, outpatient costs went down by $400,000 in the first year and by $500,000 the next, according to the Partnership for Workplace Mental Health. Another corporate leader attests to a worthwhile ROI in this business case. “When you add in the indirect costs related to presenteeism the picture completely changes. Depression, anxiety and mental health issues are the key cost drivers,” says Lisa Jing, program manager of integrated health at Cisco Systems in San Jose, California. Other cost-saving indicators have increased speed and quality of work when returning to work after a disability or sick leave, which means less turnovers.

Integrative mental health programs put companies well ahead of the curve

With such intangible outcomes however, how does one measure what makes a supportive workforce, like which tools are needed to identify any areas of improvement? That’s what Judy Gosney wants to find out. She works with an arms-length government agency designed to act as a change agent and problem-solver for organizations of all kinds, with the goal to move things from business as usual to addressing long-standing issues. “I think there is still a stigma associated with mental illness, even though it is getting better,” says Gosney of the Mental Health Transformation Project, a division of Washington’s Department of Social and Health Services. Currently, she is asking employers what tools they have set in place when hiring people with mental health illnesses. “What kind of training curriculum is available to these employers who are hiring in a competitive workforce?” she continues. Results are expected by January 2010.

Most companies today offer mental health assistance as a separate service. However, innovative corporate leaders have taken on a more integrative strategy. According the Partnership for Workplace Mental Health, DuPont and Cisco are prime examples of leading innovators in integrative employee health coverage, both of whom have a strong preventative and educational approach. “One way that we identify folks who may need particular education or outreach is through an online personal health assessment tool,” says Jing.

“At Cisco, we have implemented a ‘carve-in,’ meaning that our mental and behavioral health benefits are ‘carved-in’ to the medical, which is kind of counter trend,” says Jing, emphasizing the importance of viewing an employee as a whole person. “Employee health is absolutely essential to engagement; when a person comes to work they bring their whole self,” she says.

DuPont takes a similar holistic perspective. “Much of our work is focused on building emo­tional resiliency, healthy lifestyle choices, organiza­tional psychological health and emotional aware­ness,” says Heck. A mental health problem can be an isolated issue, but it can also manifest if the individual has a medical condition such as, car­diovascular disease or muscular skeletal diseases. “Sometimes we aren’t sure which happens first. Ei­ther way, both need to be treated in order to have sustainable outcomes,” says Jing.

Stressors

There are many complex reasons why a person experiences a mental illness. The more risk factors layered on—family history, substance abuse, chronic diseases, traumatic life events or work-related stress—can increase the chances of someone developing a serious problem, especially if left untreated. In truth, work is not the only stressor in life. “When we see the 24 hour transfer of information in all its myriad forms streaming at us about war, social unrest, natural disasters, pandemic flu, financial uncertainty, nuclear states and all the rest it’s not much of a challenge to see why stress related illnesses and mood disorders are overtaking the traditional physical illnesses in driving lost work days,” points out Heck on the subject. While stress doesn’t necessarily translate to increased number of mental illness incidents, certain combinations of biological, genetic, personality and environmental factors do create a pre-disposition. “The truth is our world of work continues to be a stressful place,” says Heck. Moreover, as life become less predictable, we experience more emotional stress. “Stress is the result of unexpected crisis,” explains Dr. Robert Sapolsky a renowned neuroscientist in his book, Why Zebras Don’t Get Ulcers. More especially, during tough economic times like these when the job landscape is bleak.

Recession breeds a depressed workforce, increasing anxiety

According to the Bureau of Labor Statistics, for every job opening there are six applicants. It is so far the worst ratio since the government be­gan tracking job postings in 2000. With the un­employment numbers at 10.2 percent, the reces­sion is quickly breeding a depressed workforce, anxious job hunters, and as many people wor­ry about their household finances. Even North American dentists are noticing that economic stress is putting exceptional pressure on people’s jaws and molars. According to a New York Times article, dentists are seeing an upwards of 25 per­cent more patients with teeth-grinding symp­toms. While experts say genetics play a large role in bruxism (teeth-grinding), stress has been known to set off clenching and grinding in some people. In comparison to our European counter­parts who seem to have the work-life balance down pat, North Americans have often been per­ceived as workaholics.

Some argue there is some truth to that. Ma­ria Shall agrees that Americans tend to overwork in general. “Our bodies are amazing; they pro­duce energy to do amazing things every day and yet, we tend sit at a computer for hours,” says Shall, an emotional health expert and the direc­tor of Luminific Health in California. Most people choose to revitalize by their own rules, depend­ing on mood or state of our overall health. “We must relax, restore and recharge to produce more energy. Working more and more actually reduces productivity,” says Shall.

New federal mental health parity law marks a ‘mental movement’

This year, Mental Health America (MHA) celebrates its 100 years of advocacy, public education and support. The milestone is marked with its most recent success: the passing of the new federal mental health parity law. “Over the years, we have played crucial roles in passage of legislation that has helped move the mental health system toward a community-based system,” says Steve Vetzner, senior director of media relations at MHA. Notably in Washington state, the parity law, which came into effect in March 2005, regulates equal coverage for both medical and mental health. “Currently, in our public system, the integration of physical, mental and subsidiary health services is just the beginning just ahead of the curve,” says Gosney of the MHTP.

Historically speaking, decision-makers have focused on the biomedical model and then, shifted to the psychodynamic model tailored to the treatment for each individual. Although it has taken years for mental health parity to become a national law, so much has changed in society’s attitudes and treatment of those people with a mental illness. “For one, it has become more patient-focused and considerate of their needs,” says Vetzner of the MHA, adding that research has helped people understand that many conditions are biologically-based and treatable. “We have also focused a great deal on wellness, on steps that can make individuals more resilient,” says Vetzner. He’s referring to developing healthy coping mechanisms—as life skills—combat stressors. Emotional health expert Shall echoes this point, adding the key is to be prepared and be armed with healthy coping skills.

Shifting focus to accommodation in the workplace

Observers say there is also a growing movement in the area of accommodation in relation to workplace mental health. In the past, many Americans secured work for the sake of basic health care coverage. “Now the corporate world is realizing that everyone is equal and if they are overworked, employees become disengaged,” says Shall. With the health care reform sweeping across the state of Washington and in Congress, one still wonders if things are actually greener across the border. With the Canadian province of Ontario and the federal government collaborating with its insurance provider (providing counseling and treatment services not covered by the public system) to launch Great West Life’s Centre for Mental Health in the Workplace. In comparing the two systems of health care however, Shall believes there is a sort of ‘mental revolution’ in America. “While it is true that the Canadians are provided with universal health care that is very separate from business, I think in the U.S. corporations feel they are ahead of the government right now,” says Shall. “But l do think that that relationship between the employer and employee can cause more psychological stress because we don’t have that general sense of stability [of basic health care] if we lose our job,” Shall adds.

Threats to progress

Following on the heels of a new national mental health parity law, which came into effect last month, the Partnership for Workplace Mental Health conducted a survey of employers to gauge their reactions. Most of the companies indicated that they were not considering dropping coverage for mental health (74 percent) or substance abuse disorders (77 percent). Apparently, the new law passed has no negative effect—that is measurable. However, one major airline manufacturer that normally offers workshops on workplace mental health admitted it is currently re-evaluating its employee mental health services. Yet, progressive corporate leaders continue on course with their mental health programming. “Even with the downturn in the economy, Cisco’s commitment to our employees’ health and wellbeing remains very strong and we continue to expand our programs,” says Jing.

Many of the innovative leaders that were interviewed believe there is a huge opportunity to use the workplace as a resource for building emotional health and resiliency. “It makes good business sense to do so,” says Heck. “The competitive edge may well belong to the employer who creates a workplace that offers true alternatives to becoming a victim of excessive stress, with tools and programs that help us control our emotional lives. That’s a goal I keep in mind.”

PEOPLE WHO ARE MOST AT RISK

- 19 percent of lawyers suffer from depression

- Of the 105 professions surveyed, lawyers ranked first in suffering from depression

- 1 in 5 lawyers have a drinking problem

- 25 percent of lawyers experience physical symptoms of anxiety three times a month during a year

- Source: Clare Miller, Partnership for Workplace Men­tal Health, American Psychiatric Foundation

SIGNS TO WATCH OUT FOR

- Unexplained absences

- Problems with deadlines

- Sleeping too much or not enough

- Less engaged in the workplace or in their work.

- “Often times, we see people who are overworking, or having trouble again meeting deadlines,” says Clare Miller of the Partnership for Workplace Men­tal Health. “Another sign is some of these behav­iors is a sudden change in the employee, maybe someone’s performance has declined drastically—all things employers can be cognoscente,” says Miller.

Take the test  at www.depressioncalculator.com

FIVE WAYS TO PROMOTE A MENTALLY HEALTHY WORKSPACE

Read on to find out what steps you can take to prevent unwanted stress on the job

Emotional and mental health is a foundation for produc­tivity on the work place, says Maria Shall, director of Lu­minific Health, an emotional fitness clinic for executives in California. Shall recommends business leaders to take proactive steps to help their company to boost productiv­ity and reduce work-related stress.

- EMPOWER. Busy executives know that any problem can quickly turn into a project, or even a business idea. Take action: Know your power to create change by empowering your employees to be creative problem-solvers. A solution-based mentality is a stress free mentality.

- EDUCATE. Uncertainty often breeds stress. Take action: Provide your employees with as much education, and soft skills training as possible. Relaxation, planning, and hap­piness are the life skills—they are not a luxury but a neces­sity. The moment we learn to ride a bike, it becomes a joy and pleasure. Coping with stress is a learned skill.

- COMMUNICATE. Everyone comes to work with a different set of experiences and belief systems. About 90 percent of conflict is due to misunderstanding. Regardless of your company’s size, develop a culture of collaboration. Good communication turns competition into friendship and a friendship is never stressful.

- BUILD A COMMUNITY. In the information age, we became a global community. Teach your employees to the basics of team building: rely on each other, offer support and ask for help, when needed. Through common action we bond and build a safety net for each other.

- TAKE CARE OF ENVIRONMENT. The world around us is our resource. Teach your employees to take charge of their en­vironment, give them ability to make changes on the work place that suit their physical needs, and work habits.  

If you can promote a mentally healthy environment, it will boost productivity simply because healthy body is productive body.  
Maria Shall, the director of Luminific Health is a cer­tified clinical hypnotherapist and NLP. She is an emo­tional health expert who brings a holistic approach to her sessions and uses many tools known in psychology, art and science.

STARTER TOOLKIT FOR EMPLOYERS

List of resources

- Partnership for Workplace Mental Health: http://www.workplacementalhealth.org

- Case studies of Dupont and Cisco:

http://www.workplacementalhealth.org/Employer.aspx?EmployerId=38
http://www.workplacementalhealth.org/Employer.aspx?EmployerId=3

- The American Institute of Stress: http://www.stress.org/job.htm

- Mental Health America: http://www.mentalhealthamerica.net/go/information/get-info/stress/coping-with-stress-checklist/

* The subject’s name has been changed to protect the privacy of the individual

By Antonia McGuire

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