Maximizing mental health

Gone are the days when employers could pretend that employees’ personal problems didn’t matter. Now more than ever, companies recognize the benefits of investing in their workers’ mental health.

From the pages of In Business magazine.

Years ago, an employee needing a break from the rigors of the workplace — let alone everyday life — might have called in sick.

More recently, workers have opted toward taking “mental health days” to avoid burnout. The phrase may sometimes be used tongue-in-cheek, but the reality is we face numerous stressors in our lives that oftentimes can’t just be checked at the door when we leave for work.

Increasingly, employers also recognize that ignoring an employee’s personal problems is ineffective when trying to promote a healthy, productive workforce. The personal affects the professional, and vice versa, so ensuring workers have the necessary resources available to improve their situation — be it in the form of employee assistance programs (EAPs), counseling services, or even just an impromptu shoulder to lean on — is essential these days.

The Wisconsin Department of Health Services (DHS) conducted a survey in 2009 exploring the link between mental and physical health among Badger State adults, and noted the impacts of mental health on the workplace.

As detailed by HR Playbook, an online resource for Wisconsin human resources professionals, among the key findings in the DHS report were results indicating that Wisconsin adults suffering from serious psychological distress or depression were at least twice as likely to be smokers and were less physically active than those without such mental health issues. Wisconsin adults with serious psychological distress were three to five times more likely to have chronic diseases like asthma and cardiovascular problems, suggesting that behavioral health issues can affect an employer’s health care costs.

When it comes to workplace performance, notes HR Playbook, the DHS study found Wisconsin adults with serious psychological distress or depression were three to six times more likely to have “functional limitations.” That includes being unable to work productively or to show up to work at all. Respondents with serious psychological distress averaged nine days a month that their condition interfered with activities such as their jobs. Compare that to less than one day a month on average for those without serious psychological distress.

Another study conducted by the American Psychological Association estimates that depression alone costs U.S. employers $210 billion in 2010, representing a 21.5% increase from 2005. The study found the average worker with major depression lost the equivalent of 32 workdays a year in productivity due to a phenomenon known as presenteeism, which occurs when an employee is at work but fails to complete responsibilities.

Additionally, people with mental health issues such as depression may be more likely to struggle with substance abuse, which is another behavioral health-related issue, according to HR Playbook. That includes the ongoing opioid abuse epidemic, a major concern for Wisconsin businesses and families alike.

Deep dive into depression and other mental health disorders

Mental health concerns impact both the employee and employer, notes Kayla Smith, communications and development coordinator for NAMI Dane County, the founding chapter of the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization dedicated to improving the lives of people affected by mental illness.

Smith says the four most common mental health concerns in the workplace for employees are:

1. Depression

a. Depression in the workplace presents itself in both emotional and physical forms. For example, low mood is one of the defining emotional symptoms of depression but there are other characteristics that are common. These include nervousness, restlessness, irritability, aches and pains, being more passive, withdrawn or unproductive, and fatigued (partly mood disorder or lack of sleep due to insomnia).

b. One study reports that about 6% of employees experience symptoms of depression in any given year, notes Smith.

c. A World Health Organization (WHO) questionnaire found that workers with depression reported the equivalent of 27 lost days per year — nine due to sick days or other time taken out of work, and 18 reflected in lost productivity.

2. Bipolar disorder

a. In a manic phase, employees with a bipolar disorder may appear highly energetic and creative, but their actual productivity may suffer.

b. During the depressive phase, an employee may exhibit depressive symptoms as outlined above. Although mania may be more noticeable at work, research suggests that the depressive phase of bipolar disorder can impair performance more than the manic phase, explains Smith.

c. According to the WHO questionnaire, it’s estimated that employees with bipolar disorder lost the equivalent of about 28 workdays per year from sick time and other absences, and another 35 in lost productivity.

3. Anxiety disorders

a. Typically manifest in the workplace as restlessness, fatigue, difficulty concentrating, and excess worrying. Employees might also require constant reassurance about performance.

b. Loss of productivity/sick days is similar to that of depression.

4. Attention Deficit Hyperactivity Disorder (ADHD)

a. Symptoms of ADHD typically manifest as disorganization, failure to meet deadlines, inability to manage workloads, problems following instructions from supervisors, and arguments with co-workers.

b. The WHO questionnaire found loss of productivity from ADHD to be about 22 days a year.

c. A not so fun fact: People with ADHD are 18 times more likely to be disciplined for behavior or other work problems, and they are likely to earn 20% to 40% less money than others. They are also two to four times as likely as other employees to be terminated from a job, notes Smith.

The most common ways employers are affected is the sizeable economic consequences of not addressing mental health in the workplace, says Smith. “It’s pretty unanimous that the indirect costs of mental health disorders — particularly lost productivity — actually exceed most companies’ spending on direct costs, such as health insurance contributions and pharmacy expenses.”

Smith says the most costly health condition for workplaces, including direct and indirect costs, is depression. Anxiety ranks fifth while obesity, arthritis, and back and neck pain take up the second through fourth spots.

“Considering the number of sick days and lost productivity attributable to mental illness in the workplace, employers that are able to recognize the most common mental health problems and create a pathway for affected employees to receive needed treatment are making a winning investment,” states Smith, “one that pays off in improved health of employees, and in improved productivity and cost savings for employers.”



Minding our health

According to Tanya Lettman-Shue, chief clinical officer of Madison-based Journey Mental Health Center, depression, anxiety, ADHD, and substance use are all significant issues in today’s workforce. The Centers for Disease Control says half of all Americans will suffer from a significant mental health issue within their life.

Operating since 1948, Journey Mental Health Center runs 25 programs along a continuum of care in five Wisconsin counties. Journey’s nearly 400-plus paid staff and clinical interns work in three program areas — emergency services, community-based services, and clinical services — and Journey serves more than 12,000 individuals each year.

Lettman-Shue says while a worker may be carrying a mental health problem with them from home, there are workplace stressors, and they also can be triggers for conditions like depression or anxiety.

“Individuals can encounter workplace stressors that lead to depression or anxiety when there is difficulty in the supervisor-supervisee relationship as a result of differing expectations,” notes Lettman-Shue. “Those expectations may include the timeframe for completing work, productivity, communication, relationships with co-workers, and work hours, to name a few.”

To combat these stressors, Lettman-Shue says there is a growing trend for people not just to try to achieve a work-life balance, but a work-life blend. The idea is that work is a meaningful and genuine part of our lives, she explains. “While at work the employee is encouraged to be mindful of taking breaks, lunches, and vacations as a means of being a centered and productive employee. The employee is encouraged to make decisions in conjunction with their employer about what makes the most sense for both parties.”

One employee may decide that it is important for them to take a longer lunch in order for them to get out and exercise, knowing that they will come back refreshed and better able to function throughout the remainder of the day, Lettman-Shue says. A parent might benefit from leaving early in a day to take a child to a doctor appointment and work from home to make up the lost time in the evening.

“It is important to recognize that each occupation has its own stressors and that each employee may react differently to those stressors,” notes Lettman-Shue. “Employers can benefit from open and honest conversations with their employees and by inquiring about ways that they can assist in mitigating on-the-job stress. It is equally important for the employees to recognize their stress levels and decide how to manage them as a means of promoting their own health and wellness.”

Colleen Clark Buss, chief human resources officer for Journey Mental Health Center, adds that it’s important that employers let their staff take a mental health “stretch” during the day, and to make sure they take their vacation time.

“American employees are losing out on this time because they simply don’t take it,” explains Clark Buss. “It’s also important to note that research shows that longer work hours result in diminishing returns.”

If an employee is struggling in their attendance or job performance, the issue(s) should be addressed using open-ended questions such as: “Is there a specific reason you are arriving later and later these days,” advises Clark Buss. “Hopefully, the employee will be honest and forthright so you can offer the appropriate help and resources.”

In fact, Journey offers a training program called Mental Health First Aid, where lay people can learn to recognize signs that people are dealing with a mental health issue. Much like first aid or CPR, this one-day course equips people to provide short-term intervention, until professional help can be sought.

Still, it can be difficult to know if the problem is something temporary that’s caused by a specific issue that can resolve itself, or indicative of something greater that requires more intensive help.

Clark Buss says in that case you need to look at key performance indicators to try to make a determination. “Depending on the situation, an employer may offer their EAP or assistance toward a consult with a mental health professional to determine if it’s situational or if more help is needed. If the issue requires a family medical leave, it’s in everyone’s best interest to work with the employee to get the treatment they need. Keep in mind this may be an hour a day or an hour per week, or it may be longer.”

Clark Buss says employers can offer benefits like employee assistance programs (EAPs), short-term disability, and/or family medical leave. Some companies offer paid or unpaid personal leave time.

“It’s a shared responsibility to address these issues,” notes Clark Buss. “Employees need to disclose that they are struggling and that it’s impacting their ability to do their work. Employers can then offer an accommodation to assist with mental health challenges.”

Challenging mental health myths

The stigma associated with mental illness has been around a long time, notes Lettman-Shue. “It is true that there are recent and favorable changes in the way that we talk about mental health; however, we still have a long way to go to get everyone the behavioral health care that they deserve.”

Part of the problem, according to Lettman-Shue, is how the media portrays mental health concerns. Pointing predominantly to mental health issues when there are mass shootings leads people to believe that people living with mental health concerns are dangerous, she says. The reality is that individuals living with mental health issues are 11 times more likely to be the victim than the perpetrator of a crime.

“For its 70 years serving the Dane County community, Journey has been challenging the misconception that those who struggle with mental health concerns are weak,” states Lettman-Shue. “That somehow the person struggling with depression, anxiety, ADHD, or substance use should just pull themselves up by the bootstraps. Very few people will proactively seek out behavioral health care providers to have their mental health care needs addressed. Yet most people will go to the doctor to have their physical health care needs addressed. It’s time we put a different spin on how we talk about mental health because it will ultimately lead us down the path to a healthier life overall.”

Taking a different tack on the mental health discussion can start with how we think about the winter holidays. Singer Andy Williams may have made “It’s the Most Wonderful Time of the Year” a popular holiday tune, but for many people this is not
a season of joy.

“It is important to be honest about the realities of the holiday season,” explains Clark Buss. “Despite what is portrayed on television, the holidays are difficult for people struggling with the loss of loved ones, mental health issues, addiction, financial constraints, and so on. It’s a misconception that the holidays are a happy time for everyone. When we try to bury our feelings or problems, the underlying issues never get addressed and we oftentimes end up feeling worse overall.”

That’s food for thought for the next time someone considers singling out a co-worker who “isn’t in the holiday spirit.”

H-EAPs of help

An employee assistance program is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems, according to the U.S. Office of Personnel Management. EAPs address a broad and complex body of issues affecting mental and emotional well being, such as alcohol and other substance abuse, stress, grief, family problems, and psychological disorders. EAP counselors also work in a consultative role with managers and supervisors to address employee and organizational challenges and needs. Many EAPs are active in helping organizations prevent and cope with workplace violence, trauma, and other emergency response situations.

CUNA Mutual Group in Madison has had an active EAP since July 1999, according to Phil Tschudy, media relations manager.

“Our EAP provides employees with unlimited, 24-hour-a-day phone access for problem assessment and consultation,” says Tschudy. “Employees can also receive up to three hours of face-to-face problem assessment with crisis intervention per case. If the problem is treatable by short-term interventions as determined by the EAP, up to a maximum of six sessions of face-to-face counseling is available.”

Approximately 3% of eligible CUNA Mutual employees use the organization’s EAP services, which are administered by Waukesha-based Empathia, a third-party behavioral health and emergency management program vendor.

For privacy reasons Tschudy says CUNA Mutual does not have insight into which employees have used the EAP, but he acknowledges the organization believes the program has value and hopes employees and their family members use the services when appropriate.

“[The EAP] is one of many programs the organization offers its employees as part of our comprehensive benefits package,” Tschudy explains. “Whenever an employee or their family member is struggling and may not be under the care of a mental health professional, the employee or family member simply calls a toll-free number, available 24/7, that can be found in handouts or on [our] intranet pages.

“The help [the EAP] provides individuals is a necessary piece of our benefit offerings to ensure our employees have complete resources to assist them with various circumstances they may be facing.”



Accommodating workplaces

According to Kayla Smith, communications and development coordinator for NAMI Dane County, employers have to make reasonable accommodations to support employees suffering from a mental illness only if they know about the mental illness.

  • Employers do not have to accommodate disabilities that they don’t know about.
  • If an employee with a known disability is having a hard time doing his or her job, an employer may ask whether the employee is in need of a reasonable accommodation.
  • Also, if the employer has reason to know that the employee has a disability, they may have an obligation to discuss reasonable accommodation. Mostly, however, it is up to the person with the disability to tell the employer that an accommodation is needed.
  • An employer cannot ask questions about a candidate’s medical or psychiatric history during an interview.
  • An employer can ask objective questions to help determine whether a job candidate can perform essential duties of a job. An employer may ask about a candidate’s ability to meet the physical standards for jobs involving physical labor, their ability to get along with people, or their ability to finish tasks on time and to come to work every day.

Examples of reasonable accommodations for people with severe mental illnesses are:

  • Providing self-paced workloads and flexible hours
  • Modifying job responsibilities
  • Allowing leave (paid or unpaid) during periods of hospitalization or incapacity
  • Assigning a supportive and understanding supervisor
  • Modifying work hours to allow people to attend appointments with their psychiatrist
  • Providing easy access to supervision and supports in the workplace
  • Providing frequent guidance and feedback about job performance.

Benefits to business

A mental-health-friendly workplace makes good business sense. It benefits owners, managers, and employees in ways that positively affect the bottom line. Consider the following outcomes:

  • Higher productivity and motivation. Employees feel valued and secure and work more effectively when employers demonstrate a commitment to their well being.
  • Reduced absenteeism. Workplace stress is a major cause of absenteeism. Helping employees manage their stress and overall mental health can boost productivity.
  • Health insurance cost containment. Instituting health and wellness programs can help hold down health insurance rate hikes.
  • Preparedness for disasters. Assisting employees in times of sudden unexpected trauma with counseling, peer support groups, and links to needed community services can help businesses become productive again sooner.
  • Loyalty and retention. Businesses with mental-health-friendly practices have documented remarkably low turnover rates, along with savings in recruitment, new employee orientation, and training.
  • Hiring and promoting the most qualified people. By openly supporting mental-health-friendly policies, employers can increase the pool of qualified applicants.
  • More efficient workplace policies and practices. The process of thinking about mental health can generate helpful internal policy and benefit reviews, and more effective workplace systems and procedures for employees as a whole.
  • Better workplace relations. Awareness of and openness to mental health issues help create a positive climate for understanding, conflict resolution, and support.
  • Diversity, acceptance, and respect in the workplace. Embracing diversity includes people who live with a mental illness. In becoming more inclusive, businesses can both thrive and set a standard for others.

Source: U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA)

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