Out of the Darkness
More employers are recognizing the destructive footprint of depression on their workforce and bottom line, and are taking direct aim at the illness.
By Carol Patton
Several years ago, Bhawna Provenzano was writing a research paper on wellness programs while working on her master's degree in HR and employment relations at Penn State University. The deeper she delved, the more she realized that the culprit behind many employee illnesses and increases in pharmacy spend was an often misunderstood and overlooked mental illness -- depression.
As senior manager of benefits and wellness at Zappos in Las Vegas, she wasn't fully convinced that this was a universal trend. Would it apply to the rather young 1,500 employees at the online retailer, whose average age was 34? Provenzano, along with the company's employee-assistance-program vendor -- ComPsych -- and pharmacy benefit manager, reviewed utilization and medical-claims data. As her research suggested, depression ranked among the company's top 10 worker illnesses.
Depression affects approximately one in 10 adults, according to the Centers for Disease Control and Prevention. As the No. 1 contributor to disability in the United States and Canada, it's one of the most costly conditions for American employers, according to the University of Michigan Depression Center, and is associated with more than $44 billion in lost workplace productivity due to absenteeism and presenteeism.
Despite its profound effects in the workplace, depression rarely gets addressed beyond the office walls of counselors. Some HR professionals believe it's simply too sensitive a topic to discuss. Unlike chronic conditions such as heart disease or diabetes, depression is often perceived as a sign of weakness, not a real condition, even though it's linked to biochemical, environmental and genetic factors, reports the U-M Depression Center.
However, some HR professionals have taken notice and are tackling the illness head-on through employee-awareness campaigns and training programs that help managers motivate employees to seek help when needed before sinking too deep.
Back in 2012, Provenzano began searching for community resources that dealt with depression and discovered a free program called Right Direction (rightdirectionforme.com) that was developed by Employers Health, a national employers coalition in Ohio, and the Partnership for Workplace Mental Health, a program of the American Psychiatric Foundation. She invited Marcas Miles, the coalition's senior director of marketing and communications, to distribute information about the program at Zappos' on-site wellness fair.
Weeks later, Provenzano says, there was a small uptick in EAP utilization, but because of federal privacy laws, there's no way to tell if more people are seeking help specifically for depression.
Still, she believes it's a positive sign that more employees are, at the very least, taking the most difficult step -- asking for help. They may want to learn the reasons behind their fatigue or insomnia, not realizing those are symptoms of depression.
Since then, HR has worked with ComPsych to develop and deliver an optional annual, 90-minute leadership-training program for managers during the workday that is designed to help managers identify symptoms of depression and employ useful strategies that encourage staff to seek help.
In 2013, HR placed a lollipop, stuffed stress bear (the mascot for the Right Direction program) and two fliers on all employees' desks that promoted its EAP services and Right Direction program. She says HR will probably do something similar this year so the topic stays fresh in everyone's mind.
"I want depression to be less of a stigma in the workplace," Provenzano says. "Hopefully, through our strategy this year, we will be able to make it a topic that everyone feels comfortable talking about."
At this point, not many do, says Miles at Employers Health, adding that Right Direction offers free materials about depression to employers, such as posters, newsletters, slides for TV screens in employee breakrooms and a template for a PowerPoint presentation.
He says the catalyst behind its development involved several factors: rising pharmacy costs among member employers and dismal EAP utilization by their employees, typically less than 3 percent. One member company also experienced a 300-percent increase in disability claims over the past three years that were tied to depression.
"More times than not, anti-depressants [and] anti-anxiety medications were in the top three with diabetes drugs and cholesterol medication," he says. "And there's a disconnect between taking medications and getting therapy treatment [since] anti-depressants can be prescribed by anyone -- from primary care [physicians] to OB/GYNs."
Filling In the Gaps
There's no shortage of bad news involving depression. Consider these results from The Impact of Depression at Work Audit that surveyed 1,000 employees in June: Nearly one quarter (23 percent) of the respondents had been diagnosed with depression during their lifetime, almost 40 percent reported taking an average of 10 days off work a year due to their illness and 64 percent experienced cognitive-related challenges, such as difficulty concentrating, indecisiveness and/or forgetfulness.
After discovering that depression ranked among the top five health issues faced by the Columbus, Ohio-based Online Computer Library Center's 950 U.S. employees (the others were cardiovascular disease, diabetes, cancer and high blood pressure), Susan Marsico didn't waste any time.
As the director of corporate benefits and HR systems at the library cooperative, Marsico says HR's first step was to select a new EAP vendor that was fully equipped to handle depression and other mental-health conditions. Then it increased its wellness benefits from three to six free counseling sessions a year and began distributing materials about depression to employees at annual biometric screenings.
"A number of employees sent me emails afterward and said, 'I'm very glad OCLC is addressing this, because depression is a real issue,' " she recalls.
Still, Marsico wanted to do more. During new-manager orientations, she now introduces the EAP vendor and Right Direction program. HR also conducts several educational sessions throughout the year on emotional health, which covers depression. She says the hour-long workshops are held on-site during the workday and typically attract up to 100 employees.
While employee productivity and job satisfaction are likely targets of depression, she says, it's too premature to report hard results. However, she adds, employers also need to pay attention to employee family members with depression who can drive up costs and negatively impact the employee's concentration, productivity or absenteeism.
"I hope we will see a difference, whether it's in the harder costs or the way employees are receptive to the topic of depression, that the stigma around depression is not as prevalent . . . and that people are getting the care they need early enough . . . ," Marsico says. "Helping the whole family ultimately helps our business as well."
Most employers would agree, yet many still don't offer mental-health services.
According to the results of a national survey conducted by Public Policy Polling in September for Workplace Options, an employee well-being provider, 42 percent of the 609 working Americans who responded said their employer had no support structure or programs to help employees deal with mental-health issues such as stress, anxiety or depression. Eleven percent had no idea what their employer offered.
To be fair, EAPs can only go so far, especially if employees resist seeking help because they're fearful of losing that promotion or being labeled mentally ill by co-workers. Others may not be aware that depression is the root cause of their health issues.
Some companies have adopted a collaborative approach to mental health by requesting that their health-insurance provider assign a social worker to coordinate the care of employees diagnosed with depression, says Kathleen Mahieu, leader of behavioral-health consulting at Aon Hewitt in Norwalk, Conn.
In this type of arrangement, social workers monitor employees, encouraging them to follow through on their treatment plans by taking their prescribed medications or attending therapy.
Mahieu also suggests positioning EAP professionals on-site as "well-being coaches," not counselors, which may encourage employees to seek help, or establishing a confidential network of volunteer employees with some clinical training or direct experience in dealing with depression who can help guide struggling employees to appropriate resources.
But there's one contributor that's frequently overlooked: the workplace. Is it a breeding ground for depression? Does the environment adversely affect employee stress levels?
"[HR] can focus on the workplace environment, ensuring that people have a voice in the workplace, camaraderie and a social network, and work alongside people who are respectful and understanding of each individual's skills and capabilities," says Mahieu. " . . . That's a really significant component of addressing depression and mental health in general in the workplace."
Managers need to be equipped with the right skills to create a "nice playground" and manage employees from a behavioral perspective, adds Solange Charas, president of Charas Consulting in New York, which focuses on human capital deployment.
"Feeling useless and worthless, feeling like you don't make a difference, you don't have control or are left out, are things we can experience in the workplace . . . ," she says. "Those are key indicators of depression."
But managers tend to focus more on the productivity of workers and less on their psychological states, she says. HR can train them in how to converse with employees at risk for depression so they don't feel threatened or shift into panic mode. For example, Charas says, instead of accusing employees of underperforming, they could ask: "Is there something I can do to help you? Is there something we can do together to help you address whatever issues and concerns you have?"
Last year, Kent State University offered 36 educational sessions about depression across eight campuses for its 4,000 benefits-eligible employees and conducted separate training programs for managers and supervisors that introduced the illness, identified its symptoms, addressed its impact in the workplace and presented tips on how they could refer employees to its EAP (Impact Solutions). Roughly 400 employees attended the optional sessions.
"We wanted our supervisors to embrace this awareness program we were rolling out, try to reduce the stigma of depression, let them know it's increasingly common, to be sensitive to it and share resources with employees," says Mark McLeod, manager of university benefits at KSU.
He says depression is one of the school's leading chronic illnesses among its workforce, along with diabetes and hypertension.
There, HR also takes advantage of Right Direction to keep the topic in front of employees on an ongoing basis. It incorporates some of the program's branded materials on its website and into its quarterly wellness newsletters, hangs its posters in common employee areas, distributes information at its open-enrollment fairs, and hands out 1,500 stress-reducing teddy bears during an employee appreciation event last September.
Recently, HR developed metrics to track how many employees were seeking help for depression. While there already has been a slight increase in usage, says McLeod, HR will need to continue tracking over the next year to realistically evaluate the campaign's success.
Meanwhile, people diagnosed with depression increases by approximately 20 percent each year, with more than 80 percent of them not receiving treatment, reports Healthline.com. By raising awareness of the illness, encouraging workers to talk openly about it without fear or judgment, and offering effective treatment, HR can better equip employees to battle an illness that's been around for centuries.