The Paralysis of Depression in the Workplace

​Sadness, difficulty concentrating and making decisions, slowed thoughts. Depression can feel suffocating and never-ending to individuals who have it, and at work it can manifest in missed deadlines, tardiness and poor work quality.

Depression is estimated to cause 200 million lost workdays each year at a cost of $17 billion to $44 billion to employers, according to the Centers for Disease Control and Prevention (CDC). Depression is a major cause of disability, absenteeism, presenteeism and productivity loss among working-age adults.

While the cause of depression is not well-understood, work and nonwork factors play a role, the CDC noted. A number of studies, including one in the October 2018 issue of International Archives of Occupational and Environmental Health, identified several job stressors that can contribute to depression: challenging job demands, low control over one's job, long hours and a lack of friends at work.

More people are talking about mental health in the workplace. On Oct. 23, "CBS This Morning" dedicated an hour of its news broadcast to a live-audience special, "#StoptheStigma," about mental health issues. People shared their stories on Twitter using the same hashtag.

The Society for Human Resource Management (SHRM) addressed mental health at its SHRM Inclusion 2019 event in New Orleans at the end of October, and the U.S. Department of Labor (DOL) hosted a conversation about mental health in the workplace Oct. 30 in Washington, D.C.

"We all know someone who has struggled with a mental health condition," said Secretary of Labor Eugene Scalia at the DOL panel discussion, SHRM Online reported.

The Employer's Role 

"[Depression] can be paralyzing … and is completely all-consuming," said Kristin Tugman, vice president of health and productivity analysis and consulting at Prudential Financial. She spoke recently in a webinar on understanding suicide's impact in the workplace. A 2018 study found that work stress, such as long hours and job strain, is a leading cause of suicide among U.S. workers.

[SHRM members-only toolkit: Employing People with Mental Health Disabilities]

However, with proper care, Tugman said, 80 percent of people with depression will recover and improve.

Employees want a supportive workplace. An online survey conducted with 1,500 full-time workers found that 86 percent said they think it's important that a company's culture supports mental health. The research was conducted by Harvard Business Review and Mind Share Partners, a nonprofit in San Francisco that offers corporate training and advising around mental health.

Ideally, employers should create an environment where people are educated about recognizing high-risk behavior and provide a secure portal where those observations can be submitted, said Tom Miller. He is chief executive officer at ClearForce, a Vienna, Va.-based technology company that helps organizations with early and ongoing discovery of health risks.

"[If] you have somebody you think is a threat to themselves, and you're making decisions on the fly" about how to handle that, "it's really hard at that point to consider all the factors and consistently make all the [right] decisions."

Establish Psychological Safety  

Employers need to create a culture where employees feel safe sharing what they are going through, said Shane Metcalf, co-founder and chief culture officer at San Francisco-based 15Five.

"You don't even have to have an explicit conversation about mental health to begin creating a healthy environment."

Sharing may be as simple as a one-word check-in at the beginning of a meeting: Joe says he is "tired" because he stayed up late watching the World Series. Tanya is "frazzled" because an accident snarled traffic on her drive to the office.

"That establishes psychological safety. Without the cursory level of psychological safety, you can't have the deeper conversations around depression, post-traumatic stress disorder, around trauma-related mental health issues or depression," Metcalf said.

"It's a day-to-day process. So much of this is starting to treat people with kindness. You can hold people accountable and [still] treat people with kindness."

Even changing the language around mental health can make a difference, according to Tugman.

" 'Mental health condition' is less stigmatizing than 'mental illness' or 'mental disorder,' " she said. News accounts of mass shootings, for example, often place the blame on the perpetrator's mental state, "which tends to perpetuate the stigma."

Employee resource groups (ERGs) can help reduce the stigma around depression and other mental health issues and provide support to employees. Johnson & Johnson, for example, launched its ERG program, Mental Health Diplomats, in 2017 for employees with mental illness and those caring for loved ones with mental illness. The ERG offers awareness and training to colleagues to help create a mental health-friendly workplace, and the company's employee assistance program (EAP) includes trained therapists onsite. 

The CDC suggests the following strategies for employers to support their employees' mental health:

Train supervisors in depression recognition. "We are starting to see more and more employers asking the question 'What do we do?' One of our first answers is manager sensitivity training," Tugman said. Ernst & Young instituted an interactive program on the signs and symptoms of and interventions and resources for mental illnesses and addiction. It was developed for company leaders, managers and concerned peers to destigmatize mental illness, addiction and other personal struggles the organization's employees may be facing. Only 25 percent of managers have received training on how to refer employees to mental health resources, according to a report from Unum, an employee benefits provider. More than half of those are unsure how they would help a colleague who came to them with a mental health issue. The findings are from a survey of 1,850 U.S. employed adults, 1,500 of whom had a diagnosed mental health issue. The respondents included 268 HR professionals.

Offer depression-recognition screenings. Unum found that 42 percent of the people surveyed said they had gone to work experiencing suicidal feelings. For employees who seek treatment, Tugman suggested that employers have a return-to-work plan, such as establishing realistic job expectations and modifying the job as the individual returns to functional work capacity.

Use EAPs to promote greater awareness of depression and anxiety. Starbucks announced in 2019 it would provide enhanced mental health benefits through its EAP.
The coffee retailer is partnering with Mental Health First Aid, a national program that teaches people the skills they need to respond to the signs of mental illness and substance use, to offer training to Starbucks managers. By January 2020, Starbucks employees in the U.S. and Canada are expected to have access to subscriptions for the meditation app Headspace.

Provide health insurance benefits that give employees access to psychiatric services. U-Haul International is expanding its benefits to include mental and emotional support for its full- and part-time employees and members of their households. This will include counseling sessions and a concierge service that offers child care help and legal and financial direction. This past summer, Ocean Spray began waiving behavioral health co-pays for its approximately 2,000 employees so that more people could get help for mental health concerns, according to Susan French, senior manager of benefits and wellness.

"We spend so much time in the workplace," Tugman said, "and as employers we have a huge opportunity to recognize [the signs of mental health issues] before people start to spiral downward into depression and suicide."