By Chad A. Buck, Ph.D.
According to data released by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), more than 41 million Americans experience some type of mental illness. In addition, data from the National Institute of Mental Health suggest that 26 out of every 100 U.S. employees are in need of mental health services, and one out of every two people will need mental health care in their lifetime. Employees can experience a range of mental health disorders, including, but not limited to depression, anxiety, bipolar disorder, ADHD, OCD, eating disorders, post-traumatic stress, personality disorders, and substance abuse. The encouraging news is that support and intervention for these and other mental health disorders can prevent worsening symptoms, offer relief, enhance overall well-being increase productivity, reduce absenteeism, and improve overall engagement in the workplace.
Barriers to Talking About Mental Health in the Workplace
The stigma associated with talking about mental health is a primary barrier and is even more pronounced in the workplace. Employers fear that learning about an employee's mental health condition could open the door to discrimination lawsuits if the employee is disciplined later on. Employees fear being ostracized, held back from promotions, or even fired. Rather than risk negative outcomes, employees may isolate or avoid work altogether. This behavior, however, can result in the very things employees fear most. In addition to fearing lawsuits, co-workers and/or managers may suspect a problem and want to help, but they are unsure of what to say or how or when to say it.
Most employees have a reasonable concern about talking about mental illness in the workplace, and some work environments are not conducive to this type of talk. The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities, including psychiatric disabilities in employment settings. ADA confidentiality provisions prohibit any disclosure of medical information to employees about another employee's disability or accommodations for that employee. Unfortunately, there is a tendency for people to talk about co-workers and to theorize about the nature of their problems. Employees even fear seeking out available resources, such as Employee Assistance Programs, due to a belief that information is not private. The reality is that employee assistance programs follow ethical guidelines as well as legal statutes that protect employee information. The only limits to this would be if a person were: actively suicidal or homicidal; a threat to the health and safety of patients, students, customers, or co-workers; reporting that an elder or child is being abused; or if the person signs a release of information permitting the sharing of information with specific parties.
Fear of Violence
There are those who consider mental illness a risk factor for violence. Contrary to depictions in the media, people with mental health problems are no more likely to be violent than anyone else. According to data from the U.S. Department of Health and Human Services, most people with mental illness are not violent. They are, in fact, more than 10 times more likely to be victims of violent crime than the general population. People with mental health issues are less often the scary stereotype and more often productive and active members of the community and workplace.
People with mental health issues are often considered vulnerable or fragile. The truth is that people are typically only as fragile as you treat them. Someone who has a mental health issue deserves compassion and support, but it is not necessary to tiptoe around them or to treat them as if they may break. Information gathered by the U.S. Department of Health and Human Services suggests that employers who hire people with mental health disorders who have engaged in some form of treatment have good attendance, punctuality, motivation, and productivity, and job tenure on par or greater than other employees.
Cultural and Spiritual Factors
Cultural and spiritual differences can influence how problems are defined, whether or not a person will seek help, what type of help is sought, what coping styles and supports are available, and what treatments might be the best options for relief. Unfortunately, people may also fear talking about mental health issues out of fears of judgment or misunderstanding due to biases, beliefs, and/or real or imagined agendas.
How to Talk About Mental Health in the Workplace
While not an exhaustive list of barriers to talking about mental health in the workplace, it is easy to see how fostering awareness of resources, making suggestions for support, and increasing willingness to pursue support can be complicated for both employees and employers. The following are some suggestions for how to discuss mental health concerns or experiences in the workplace that may help co-workers and managers navigate some of those barriers:
- DO NOT DIAGNOSE. Focus on observed or reported behaviors. Do not speculate whether or not the person has ADHD, OCD, Bipolar or any other condition, even in a joking way. This is very difficult not to do in academic and health care settings as people are trained to diagnose or solve problems. In the workplace, however, it can open an employer up to legal consequences and increases stigma and fear about mental health issues. Instead, express concerns about tardiness, absenteeism, productivity issues, workplace engagement, or any other observable and clear performance issues. Stick to the facts while conveying concern and empathy.
- Set a private time and place to talk. No one wants personal issues dissected in front of a crowd. Make sure that conversations about concerns are private and free of potential interruptions. If the problem is serious enough to call for a discussion, then it is serious enough to protect the individual and create a safer space for them to explain what is happening. Be thoughtful, keep the goal of the conversation in mind, and be ready to offer resources to help the person. Also, maintain the employee or co-worker's privacy. If not out of consideration for the employee, do it because it is the law.
- Do not promise more than you can provide. Our tendency is to tell a person who is hurting that we are available at any time, that the person can trust us, that we consider a person as part of the family, etc. There are a few problems with this approach. 1) You set the person up to be disappointed when you cannot offer what they need. 2) You take on more than you bargain for and end up overwhelmed. 3) It is a workplace and not a family reunion. You may care a great deal about a person, but crossing boundaries or giving perceived differential treatment can cause problems within the overall work environment.
- Know what to notice. You should never make assumptions about someone's mental health. If you know what to notice, however, you are able to describe what you see and not try to label it. Here some clues that there may be a problem:
- Changes in behavior or mood or how they interact with colleagues
- Changes in work output, motivation levels, and focus
- Increased difficulty getting organized, making decisions, and/or finding solutions to problems
- Appearing tired, overwhelmed, or withdrawn.
- Consult with your Employee Assistance Program. When deciding to approach a co-worker or employee about mental health concerns, it may be helpful to get some guidance on how to do so from people who are trained in how to talk about mental health issues within the workplace. EAP professionals consult on workplace concerns, assess situations, make recommendations/referrals to providers, and offer short-term, solution-focused support for employees. An EAP is the gateway for employees in need of resources, and they do so under private and confidential conditions.
Vanderbilt offers Work/Life Connections – EAP is an internal EAP through the Department of Health and Wellness. Services are part of university and medical center employee benefits, so there is no cost to use Vanderbilt's WLC-EAP. While it does not offer ongoing treatment, WLC-EAP does offer private and confidential support, consultation, assessment, and referral. There are also unique services offered to nurses, faculty, and physicians through the Nurse Wellness Program and Faculty and Physician Wellness Program. Workshops, lectures, and critical incident response services are also part of WLC-EAP. For more information, please call 615-936-1327 or visit the WLC website.