The Unseen Struggle

Employers are increasingly taking a more proactive, multi-pronged approach to managing the costly and often overlooked issue of mental health.

Monday, June 5, 2017
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Roughly 20 years ago, Keris Myrick was diagnosed with a serious mental illness. Throughout her career, she says, some supervisors and coworkers treated her differently after learning of her illness. 

Myrick, who now serves as the director for the office of consumer affairs at the Substance Abuse and Mental Health Services Administration in Rockville, Md., recalls how one employer mandated that an onsite nurse distribute her medications even though it was not being done for other employees who required medicine for physical conditions such as diabetes or high blood pressure. When Myrick was placed on short-term disability due to her condition, co-workers never called or sent get-well cards like they did with her peers who were physically sick or hospitalized. Assuming her workload was also perceived as a staff burden, something she says is an "incredibly common experience" for employees with mental illness.

So when Myrick landed a new administrative job at a university, she avoided telling anyone about her illness. But her strategy backfired.

"I lost a lot of weight because I was very anxious," recalls Myrick. "I was working all of these extra hours, trying to keep up and make what I was doing perfect. But the more anxious I got, the worse my performance was. After four years, I was let go."

Nearly one in five adults (18.1 percent) suffer from mental illness, according to the National Alliance on Mental Illness in Arlington, Va. Although many companies support a holistic approach to wellness that offers everything from budgeting workshops to yoga classes, such benefits barely touch the surface of mental illness, which is typically treated through a combination of medication and therapy.

Some employers have begun treating mental illness like any other serious health issue. Instead of shunning and hiding it, they're taking a proactive approach toward understanding and managing it. They're raising awareness about such conditions and making it OK for employees to step forward so they can get the assistance they need.

Road Map

Depression and anxiety disorders are among the most common mental health issues. An estimated 16 million American adults -- almost 7 percent of the population -- had at least one major depressive episode last year, reports NAMI. Even more disturbing: Anxiety disorders affect 40 million adults or 18 percent of the U.S. population, which costs the U.S. more than $42 billion a year and reflects almost one-third of the country's estimated $148 billion total mental health bill, according to the Anxiety and Depression Association of America.

Back in 2007, Prudential Financial, which supports 45,000 employees globally and 19,000 in the U.S., conducted its first annual health assessment. After analyzing the data, it discovered that roughly 25 percent of its workforce was at risk for depression, says Andrew Crighton, the company's chief medical officer.

"In the mid-2000s, we really started understanding that the work environment was a big driver in a lot of things we were trying to focus on from a health perspective," he says, adding that the plan was to train supervisors on helping people with such conditions. "A lot of times, they wanted to back away and give an individual more space when they really needed more structure."

Crighton's strategy included expanding the company's mental-health offerings, bringing mental-health issues out in the open through various methods such as weekly news videos and educating employees about such illnesses. This, in turn, has helped decrease the stigma that has been tied to mental illness for so many years, he adds.

Formalized in 2010, the mental-health strategy at Newark, N.J.-based Prudential gave managers a road map for addressing mental illness in the workplace. For example, when employees take a leave of absence due to mental illness, Prudential's return-to-work team of nurses manage the process early in the absence and will offer a behavioral health professional to assist them through the transition.

At the very least, Crighton says, hundreds of managers have been coached and received training in workshops on subjects such as ethics or diversity that also include a component on mental illness. Managers learn how to spot warning signs, approach staff and become familiar with the multiple pathways for help, such as the company's onsite clinic and HR leaders.

Employees suffering from depression have also spoken about their illness on Prutube, the company's weekly news video. The daily email newsletter featured a series of articles on depression. Employees addressed their post-traumatic stress disorder, substance abuse and domestic violence experiences on Prudential TV. Over the past several years, the company has also held workday seminars such as "Navigating Our Troubled Times," which are videotaped and replayed on demand.

Collectively, Crighton says, all of these efforts have helped drive down the number of employees at risk for depression by 8 percentage points over the past decade, to 15 percent. For its efforts, the company won the 2017 Organizational Excellence Award from the American Psychological Association.

Meanwhile, in-house data revealed that psychotropics -- anti-depressant or anti-anxiety drugs -- were being prescribed to more than half of the company's workforce without a mental-health diagnosis. Crighton believes they were possibly being mistreated or misdiagnosed. Either way, he says, these individuals tend to experience high numbers of medical visits and are the company's next area of focus.

HR can play a big role in this process, he says, explaining that this is not something that can be outsourced. HR must own it by training and collaborating with managers who serve as the linchpin to identify and guide employees with potential mental health concerns.

"Have the courage to tackle . . . depression, stress or anxiety," says Crighton, adding that the work environment can contribute to mental illness by triggering positive or negative employee responses. Quoting the title from an April 2016 article published in the Harvard Business Review, he adds: "Good bosses create more wellness than wellness plans do."

Focus on Work Behaviors

As conversations about mental illness in the workplace become more prevalent, Myrick says supervisors must target worker behavior. Is she coming in late every day? Is he exhibiting new behaviors? Did she miss a project deadline?

"First look at behaviors of concern," she says. "Then ask open-ended questions to elicit responses about how you can help them in their work. Say, 'John, I'm noticing you're coming in late every day. How can I help out?' "

HR can also encourage employees to share their personal stories about living with mental illness. Myrick says this approach is often effective since it enhances understanding about such conditions, builds positive interactions and personal relationships between workers, and decreases negative attitudes often associated with such disorders.

The "r u Ok?" program at Ernst & Young was designed with similar goals in mind. Launched last September in more than 90 EY offices nationwide, the program's 90-minute in-person presentations include two short videos featuring personal stories of employees who have mental illness; four short videos on how to identify colleagues who may be struggling with it; tips for conversing with colleagues with such conditions; internal and external resources to recommend to them; and a question-and-answer session.

The voluntary program is currently offered to the company's 45,000 U.S. employees. So far, nearly 1,000 workers have participated, according to Carolyn Slaski, EY Americas vice chair of talent in New York. Managed through HR, the program also offers a 24/7 hotline. Since its introduction, the number of mental-health-related calls has increased by 30 percent.

"When one person struggles, it can affect the whole team," says Slaski. "EY wanted to foster a culture of kindness where its people can support one another so they can each do their personal best and the teams they work on can perform at the highest levels."

Tools and Tips

According to a white paper by BDA | Morneau Shepell, a provider of employee assistance programs, the age group reporting the highest rate of depression were millennials (20 percent), compared to 16 percent each for baby boomers and GenXers. Depression can often lead to absenteeism, presenteeism, employee conflicts and disciplinary action.

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But perhaps the reason why millennials rank highest is because they may be more willing to address personal issues or reach out for help, says Clare Miller, director of the Partnership for Workplace Mental Health at the American Psychiatric Association Foundation in Arlington, Va.

"Mental health issues affect everyone across the board, people at all ages," she says. "Research is still evolving with respect to millennials."

Roughly five years ago, DuPont developed an employee program called ICU, which compares mental-health services to those products in an intensive-care unit. Miller says the initiative was so successful that the global science and engineering organization made it available to the Partnership for Workplace Mental Health to share with other employers.

At the heart of the free program is a short video that addresses emotional distress, which can be embedded within any company's EAP. She says it teaches employees some of the common symptoms or behavioral changes that co-workers with mental-health conditions may demonstrate, such as distancing themselves from others, and gives them "permission" to offer direction or guidance to co-workers.

"It's designed to avoid potentially problematic interactions between a manager and an employee," Miller says. "If you don't have a robust program that's training managers on how to intervene and reach out to employees, this circumvents that by being peer-to-peer."

Employers also receive a poster they can customize or brand, a PowerPoint presentation that can be used to solicit senior-level support for programs aimed at helping employees with mental illness, and pre- and post-survey tools to measure the program's impact.

So far, she says, at least a dozen employers have implemented the program, while several large employers are in the midst of piloting it.

Another free program being offered is Mental Health First Aid, an eight-hour course that teaches a five-step strategy that helps people identify, understand and respond to signs of addictions and mental illnesses. Up to now, more than 1 million people have been trained.

But awareness and education is just half the battle. The other half is access to care.

Based on Aon Hewitt's 2016 Consumer Health Mindset Study, 74 percent of the 2,503 responses from employees or dependents with employer-sponsored coverage faced one or more barriers to access to support, says Rod Hart, vice president of the national health transformation team at the global consulting firm.

"Oftentimes, people get a referral list, but the individual has to call the referral," he says. "If you're already struggling with depression, you don't have a lot of self-motivation to do that. That becomes a challenge for a lot of people, because they don't have the energy."

Hart, who works out of Aon Hewitt's Portland, Ore., office, says effective workplace strategies focus on ABLE: Advocate to break down the barriers to support; build awareness and create a sense of belonging in the workplace; lift the curtain on the stigma of emotional health disorders; and establish a total well-being and an emotional-fitness approach to your health and well-being program.

Likewise, he advises, HR should rename its EAP to eliminate associated stigmas. Focus more on the work/life components of what the EAP offers and reframe emotional struggles as being part of the normal human condition, he says.

In the past, Hart says, many employers compared addressing mental-health issues in the workplace to opening a Pandora's box. But more employers are straying from that perception and implementing anti-stigma campaigns, such as Stamp Out Stigma. Some are even pressing their EAP vendors for more access channels such as digitized, cognitive behavior therapy delivered via mobile devices and tablets, which removes one more barrier to counseling.

"The most important piece is seeing emotional health as something that's just a normal part of life," says Hart. "Focus on restorative practices -- anything from talking about emotional health and relationships to how people are overwhelmed in today's society . . . . By talking about it and bringing it to the surface, you allow that dialogue to be much more real, start to establish trust and build competence within your culture."

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