Mental Illness in the Workplace

What is the cost of mental illness? About $14.4 billion annually, according to Health Canada, though the true price is much higher: lives are on the line. With depression forecasted to be the second-most common cause of disability by 2020, businesses of all sizes need to re-examine internal policies and procedures for identifying mental illness in the workplace and dealing with it.

It’s become a cliché: someone in the office is “on stress leave.” In medical terms, there’s no such thing, but the catch-all phrase masks a host of mental-health issues that have become a serious drag on productivity. With employees today expected to be available around the clock, the mounting pressures can quickly evolve from productive stress to a crippling disability.

The Canadian Mental Health Association estimates that half of the sick days in Canada are due to mental health problems. Even in laid-back B.C., where work/life balance is a mantra, depression and anxiety disorders are taking their toll on workplace productivity. It’s a global phenomenon: the World Health Organization has estimated that by 2020 depression will become the second most common cause of disability in the developed world, trailing cardiovascular disease. Health Canada has estimated that the economic burden of serious mental disorders in the public and private sectors amounts to $14.4 billion annually.

To shed light on workplace mental health, we brought together three experts: Jay-Ann Fordy, chief human resources officer at Coast Capital Savings; Margaret Tebbutt, workplace initiatives consultant for the Canadian Mental Health Association; and Dr. Merv Gilbert, psychologist, principal of Gilbert Acton Ltd. and consulting and adjunct professor at SFU.

When talking about workplace depression, do we really need to talk about mental health as a whole?

Margaret Tebbutt: Well, sometimes when we talk only about depression we’re limiting our conversation to one particular kind of mental health concern. And there are many others that can affect people in the workplace, be it anxiety disorders or bipolar disorder – various kinds of common mental disorders.  

What is the most common mental health problem that you see in the workplace?

Jay-Ann Fordy: I think it manifests itself in stress. Whether that’s personal stress or workplace stress, that’s how it starts to manifest itself in the workplace in particular; people are feeling overloaded or they’ve got too much to do. Then the question is: How do you deal with that from a workplace perspective?

How do you recognize when natural, healthy stress turns into a destructive force?

Tebbutt: A lot of it is identifying the difference between occasional acute stress like, “We’re dealing with a deadline, we’ve gotta get the issue out” from chronic, ongoing stress. When every day, 365 days a year, there’s more to do than we can possibly accomplish with the resources we have: that’s a primary reason for good  employees to leave that workplace. So not only may they be suffering some ill effects – physical or mental – from that ongoing chronic stress, but as a business, you may be losing some of your very best employees to more healthy workplaces.

Merv Gilbert: The three most common disorders to hit the workplace are depression, anxiety and risky substance use. Try as we might, whenever we talk about mental health, we end up talking about mental illness.

Is there still a stigma around mental illness that is affecting our ability to address and deal with it?

Tebbutt: Because of the stigma that’s been around mental illness for a long period of time, people will often say, “I’m feeling kind of stressed out,” because it’s kind of the safer language to use. People feel safer saying, “I’m stressed out,” rather than actually saying, “I have been diagnosed with depression” or “I’ve been diagnosed with an anxiety disorder.” If the person doesn’t feel safe in the workplace talking to their manager and seeking the kind of support that ought to be in place – if the language around the workplace is, “Oh, she’s gone to the psycho bin” or “He’s gone mental” – how safe will an employee feel in that regard?

Gilbert: Research suggests that the majority of folks with a diagnosed mental health disorder are not off work; they’re still at work. So where I think we need to put a lot more effort and attention – and this is what progressive organizations do – is helping people to stay at work in a safe and productive manner. And both of those are key words. It’s providing those supports, or what I like to call “small accommodations,” so people can stay at work and be productive. Work’s an important part of who we are; it’s part of our identity and our meaning.

How common is it for people to leave work because of a mental health problem?

Tebbutt: Well, some of the Towers Watson reports [a research company that tracks how Canadian companies handle employee mental health issues] are showing that anywhere up to 80 or 85 per cent of short-term and long-term disability claims are related to mental health concerns. Now that may be the primary reason, but it may also be a secondary reason going along with other kinds of health concerns. We know that if somebody’s dealing with cardiovascular problems, there’s likely to be depression. But we also know that if we’re dealing with depression, we’re more likely to have cardiovascular problems; it’s our whole body that’s engaged.

Fordy: Our research from the Center for Addiction and Mental Health says on any given week at least 500,000 employed Canadians are unable to work due to mental illness, including approximately 355,000 disability cases due to mental and/or behavioural disorders. So, it’s big.

Can an employer be proactive and address these issues with an employee head-on if they think the employee is having trouble?

Fordy: We’re just rolling out a webinar for our managers on how to have the conversation with employees. It could be a productivity issue, it could be feeling distracted, making errors, all the way to something more serious. For us, it’s all about creating that healthy place where people can talk about it. How do we make sure we’ve got managers who are empathetic, who care, who really inspire people to want to do their best and create that environment with the safety of having the conversation? I think that’s important.

Tebbutt: And, for example, through the Canadian Mental Health Association – and others do similar kinds of things – there is training that’s available for front-line
managers, as well as for HR folks in terms of how do you notice a change in behaviour or a change in functioning in the person in the workplace without jumping to assumptions as to what’s going on?

Gilbert: I also think you need to have individual programs. We all have the responsibility to look after our health and our psychological health, so providing programs and supports for individual employees to look after themselves in various ways is important.

We’ve been talking mostly about psychological health in the context of larger businesses that can offer long-term disability coverage. What can we say to small- business owners that don’t have these programs? How can they encourage a healthy workplace and handle potential problems?

Gilbert: It’s a valid point and we frequently hear that. I think small organizations – and we recognize that those are the backbone of the Canadian economy – have some advantages, actually. They can be more nimble, for one thing; they can have more flexibility in those kind of accommodations. “You need to go away at 4 o’clock on Tuesday because you’ve got a doctor’s appointment? Sure, we can cover it.” They’re also often closer to the ground. If I’ve got a staff with 50 people, 20 people, I’m more likely to know it if someone’s struggling. Whereas, in health care, for example, a nurse manager has a scope of 120 people, half of whom she has perhaps never met. . . . So they actually have some merits. [Small businesses] can reach out; they make better connections, in many cases, with the community; they can reach out to local organizations; they can partner together. There are things they can do.

Tebbutt: I would concur with what Merv’s saying in terms of being able to have that closer connection. It can be tough too, as a small business. You’ve got to meet payroll, you’ve got to handle your business and you may not have as much flexibility. So it can be challenging in terms of looking out. Maybe you want to ensure that you’re a member of your local chamber of commerce or some other kind of business association so that you can benefit perhaps from group plans that can help with EAP [employee assistance programs] or EFAP [employee family assistance programs] in a way that’s financially feasible for you.

Gilbert: I think a lot of organizations get it. If they’ve come out of the cave at all, they’re aware that this is a big deal, it’s been a big deal for some time, it’s not going away, it is not flavour-of-the-month in any way, shape or form. It’s going to be with us for some time. It’s a little bit akin to what was formerly the leading cause of disability – and still is in some sectors – musculoskeletal injury during the time when we had to “put our back into it.” Nowadays in the knowledge economy, it’s a different part of the anatomy.

Fordy: You can’t just go out and hire a person and expect what the standards might have been 20, 30, 40, 50 years ago. It is different. And then you’ve got a new workforce, that younger generation who, refreshingly, I think, are going to be a lot more open about what’s going on in their life. And I think if you look at the last 20 years since I’ve been in HR, we’ve been on the defensive on mental health for a lot of years and trying to get into proactivity. But that next generation is coming with expectations that this stuff exists, because they’ve dealt with it in high school. It’s so out there now, it’s so normal and all of the stigma attached with diversity issues and health issues and all that stuff is evaporating before they even get into the workplace. So I think it is time that we look at it from a strategic perspective and build on it.

Gilbert: I also think we need to pay more attention to how we design work: for a small employer or a large employer, to think about the job through a psychological lens, which we haven’t done. Most job descriptions don’t describe what people do for a living, particularly in the context of the psychological demands. The only place that I know of is the City of Toronto. It redesigned all its jobs in terms of psychological demands, the cognitive demands, the interpersonal demands. And that doesn’t mean screening everybody for mental health problems. It means looking at your attributes, what kind of additional training, what kind of additional support you might need to be successful in this position.

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Image: Paul Joseph
(From left) Round Table panellists Jay-Ann Fordy, Dr. Merv Gilbert and Margaret Tebbutt.

A Healthcare Benefit Trust study indicates that the number of people on long-term disability due to mental illness is on the rise. Is that just because we’re better at identifying it or is illness actually on the rise as the nature of work changes?

Gilbert: The nature of work has changed in some areas. I once did some work with a lumber company up north and they were a great company, very proactive, very modern in many ways. The physicians in that town were still writing back-to-work notes on the assumption that the workers were working on the “green chain” – a very dangerous task with an assembly line that can rip limbs off. They weren’t; they were working behind desks. So well-intentioned physicians are thinking about lifting and carrying and strain and so on, when concentration was the primary attribute or skill their patients needed to have.

Fordy: The lines are blurred between personal and work. I’ve got to get my kids all ready for school; they’re behind schedule, I’m behind schedule and now I’m behind schedule on my job. I get here, I’ve got another meeting to go to. That’s everybody. In the knowledge economy, that’s kind of the thing that’s going on that’s different than in previous environments.

We’ve talked about the brain-based nature of the work, but does mental illness affect different industries differently? Is there one that’s harder hit?

Gilbert: No, it affects everybody. There are gender differences in diagnostic patterns, but that’s just because women tend to be more sensitive and likely to actually get help than men. I think Bill 14 is going to be very, very interesting in British Columbia.

Can you quickly sum up the significance of Bill 14?
Tebbutt : It was a bill that was introduced by Minister Margaret MacDiarmid. It got passed in the last sitting of the legislature and came into effect on July 1, 2012. What it does is it amends the Workers Compensation Act. In the past a mental health disorder was only compensable if there was a single traumatic event, for example if you’re a bank teller, the bank gets robbed and it’s an armed robbery. This expanded coverage means it could be a series of significant traumatic stressors, such as bullying, harassment or a cumulative series. The other side of Bill 14, which is still in draft, is a new occupational health and safety policy, which will make it a requirement for employers to actually put in place a policy – a risk-assessment policy and education for managers, supervisors and employees around what is bullying and harassment, what are the complaint mechanisms and what are the things that an employer would do to mitigate those things.

Gilbert: The piece that I think is going to be interesting is the cumulative stress piece. How do you measure it? What’s the baseline? What’s cumulative? What is normative for a particular job? If you work in the call centre for an unpopular Crown corporation, for example, you may get people speaking to you in a strong way that you can’t really respond to – that’s the nature of the work. So that’s going to be tricky.

Fordy: What I hope doesn’t happen is it becomes an adversarial process, where you’ve now got the employer and the employee pitted against each other. So for us it means probably more training for managers, making sure we’re putting the right people into those roles who have the communication skills to address issues of performance in a way that people get. That’s probably the biggest thing that companies are going to have to be a lot more mindful about.

We’ve talked a lot about the beginning of a mental illness. What kinds of things can be done to help people come back to work if they’ve been off?

Tebbutt: There’s really good evidence showing that sometimes we do need to be off work due to a health condition – it’s in an acute stage and we need the treatment. I think when we’re talking about mental health, in the past people would say, “Stay off until you’re 100 per cent.” What we now know is that it’s healthy to return to work; work in a healthy workplace is good for our health as an individual. But it needs to be supported. There needs to be all the various stakeholders involved in terms of a healthy return to work and part of that includes, when a person does go off, not giving them the silent treatment, where there’s no contact whatsoever from the workplace until they show up back at the office or the construction site. Keep up that contact with the workplace: not “Files are piling up, when are you back?” but in a caring, empathetic way.

Gilbert: And what you need beyond that is sustained work return. Conditions such as depression are now viewed for a number of folks as chronic health conditions. If you have a significant depressive episode, odds of a second one go up 50 per cent. What often can happen when people return to work is, “Great. This person’s back to work. Let’s pull all the supports.” There is relapse and people slip. So having a recognition of that at the get-go, having some discussion with the employee coming back, with the employee’s manager saying, “Great, you’re back, let’s talk about a bit of a plan. If things are slipping a bit, I’m going to check in with you. Once a week, I’ll have a drop-in check-in to see how things are going. Let’s have a plan and avoid return to disability.”

Any closing comments?

Gilbert: This is not going to go away and we all need to make meaningful changes if we really do seek collaboration across government and labour; we need to really recognize that this is a national and, frankly, international issue.

Tebbutt: I think it’s important, whether we’re talking about the workplace or we’re talking about Canadian society, that we really encourage the mental health of everybody – babies, little kids, teenagers, people in the workplace or seniors. We’ve all got a role as citizens here.

Fordy: I would echo that we’ve been on the defensive on this for a long time. It’s not unlike when smoking legislation changed; it took us a while to transition through that but now you don’t even think about it; it’s just a common thing. Mental health is the next wave of our world. Take us out of the defensive, take us out of relying on health care to be the be-all and end-all, judge and jury of it and start to move it back into a little bit more common practice and behaviours around mental health, in general, as one component of health.