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How to Accommodate Employees with Mental Illness

Mental illness leads to more lost workdays than arthritis and back pain—so why are employers reluctant to make similar workplace accommodations for it?


While working for an online educational company in the Washington, D.C., area three years ago, Craig began feeling side effects from a new medication. “I was literally falling asleep at my desk,” he recalls. “I needed to explain to someone why my performance was so subpar.”

So he shared with his two supervisors that he was taking medication to manage bipolar disorder. A few weeks later, his position was eliminated. He was handed two boxes, packed up his belongings and was ushered out the door.

“I was told it was a divisional downsizing,” he says. But he was the only one let go.

The timing was suspicious, says Craig, whose real name has been withheld to protect his current job. And so was the extra work they gave him after he disclosed his illness “even though they knew I couldn’t handle it,” he says.

Needless to say, Craig didn’t disclose his mental illness when he interviewed for his current job.

Each year, more than 41 million Americans—18 percent of the U.S. population—experience some type of mental illness, according to data released by the U.S. Substance Abuse and Mental Health Services Administration in December 2013. Globally, depression and other mental health conditions are on the rise, the World Health Organization has warned. Depression has become the world’s second-leading cause of disability, according to the latest Global Burden of Disease study published online last November in PLOS Medicine, a journal of the Public Library of Science.

The indirect cost of untreated mental illness to employers is estimated to be as high as $100 billion a year in the U.S. alone, according to the National Business Group on Health. More days of work have been lost or disrupted by mental illness than by many chronic conditions, including arthritis, diabetes and heart disease. In certain industries, improperly managed mental conditions also can affect employees’ safety.

A growing number of HR professionals recognize that early detection and treatment of mental illness often can prevent a crisis and reduce employers’ health care costs down the road. They are developing programs and plans to provide more support for their employees with psychiatric disorders—similar to the help they provide those with physical injuries or ailments.

“Employers and HR professionals are in a powerful position to help [reduce] the stigma that often accompanies mental illness,” says Kathy Martinez, assistant secretary of labor for disability employment policy, who is promoting National Disability Employment Awareness Month in October. “After arming themselves with the facts, they can use their knowledge to educate others and reach out to those around them who may have workplace needs related to mental health impairments.”

Finding the Right Words

​What Not to Say
​Try Instead
​"How's your health?"
​"How can we help you do your job?"

​“You seem depressed.”

​“You’re not your usual self.”
​"Snap out of it."
​"Do you want to talk about it?"

​"Think positive."

​"It's always OK to ask for help."

​"I know exactly what you're going through."

​“It’s hard for me to understand exactly what you’re going through, but I can see that it’s distressing for you.”

Fighting Stigma

Some celebrities have talked openly about their struggles with depression and other psychiatric disorders. And the recent suicide of comedian Robin Williams helped remind people that mental illness can affect anyone, regardless of their age, wealth, status or apparent disposition.

Still, stigma remains a major obstacle for employees coping with mental illness. Less than a third of them receive treatment, according to the Partnership for Workplace Mental Health. Some hesitate for fear their supervisors or co-workers will treat them differently.

Popular movies and news coverage of violence committed by people with mental illness help perpetuate negative stereotypes. In reality, less than 5 percent of violent crimes are committed by people who have a mental disorder, according to the American Psychiatric Association.

“Particularly because of the struggle they’ve been through, they’re often extraordinarily dedicated to their company and their work,” says Sita Diehl, director of state policy and advocacy at the National Alliance on Mental Illness.

Bryan Gibb, director of public education for the National Council for Behavioral Health, sums up how awkward workplace reactions can be: “Everybody avoids Dave because Dave is odd, and nobody wants to deal with it. Eventually, there’s a performance issue and Dave’s gone. If Dave had cancer or diabetes, or was having terrible migraines, we’d be bending over backward to help him. We’d be baking him casseroles.”

Creating Awareness

Some companies see value in fighting the stigma and helping employees to get the assistance they need.

DuPont has developed an educational program to encourage employees to reach out to co-workers who appear to be in emotional distress. The company’s ICU campaign (which stands for Identifying, Connecting and Understanding, as well as “I See You”) includes a five-minute video that teaches employees how to ask appropriate questions when someone appears to be struggling.

It suggests nonjudgmental conversation starters such as “You’re not your usual self.” Employees are discouraged from attempting to diagnose peers.

“It’s not a very complicated message. It’s just encouraging people to recognize when another person is in distress and letting them know it’s OK to be a normal, caring person and help them out,” says Paul Heck, DuPont’s global manager of employee assistance and work/life services.

The concept was first presented to DuPont’s workforce in Europe in 2011 and was so successful that it was launched in the U.S. the next year. It has been translated into seven languages and is available to 92 percent of the company’s 68,000 global employees. Team managers often show the video in monthly team meetings where presentations on the company’s core values are required.

A version of the video is being developed to share with other employers through the Partnership for Workplace Mental Health’s website. As part of the organization’s Right Directioninitiative, the website also includes free downloadable material that employers can use to help workers recognize the signs of depression. DuPont screens for depression as part of its health risk appraisal, which is confidential.

“For a long time, there’s been this sense that the workplace is this sterile, emotionless environment where you are supposed to check your emotions at the door,” Heck says. “When I’m carrying something heavy, you don’t think twice about offering to help me. We’re just suggesting that same courtesy can apply to people who are demonstrating distress.”

“When I’m carrying something heavy, you don’t think twice about offering to help me. We’re just suggesting that same courtesy can apply to people who are demonstrating distress.”Paul Heck, DuPont

Education Is Key

Several years ago, Monica Coughlin, PHR, corporate HR manager for The Moore Co., in Westerly, R.I., was working with an individual who had been in and out of treatment for severe depression and openly discussed her suicide attempts with co-workers.

To learn more, Coughlin enrolled in a Mental Health First Aid class developed by the National Council for Behavioral Health. There, she learned the warning signs of mental illness, steps for assessing situations and where to find help.

Afterward, “I felt more confident knowing the right thing to say and certainly was more knowledgeable about resources to direct the person to,” says Coughlin, who helped organize special classes for members of her Rhode Island chapter of the Society for Human Resource Management.

Afterward, “I felt more confident knowing the right thing to say and certainly was more knowledgeable about resources to direct the person to,” says Coughlin, who helped organize special classes for members of her Rhode Island chapter of the Society for Human Resource Management.

“The class walks you through the process so you have a plan,” she says.

It also helped improve her listening skills, enabling her to better understand the employee struggling with depression as well as co-workers worried they might inadvertently trigger a depressive episode. Coughlin told them they didn’t have to deal with the situation alone. Ultimately, the worker resigned when she was unable to consistently follow her treatment regimen.

​Create a Stigma-Free Workplace

​To support employees with mental illnesses, the National Mental Health Association and the National Council for Behavioral Health recommend the following actions:

Educate employees about the signs and symptoms of mental health disorders.

Encourage employees to talk about stress, workload, family commitments and other issues.

Communicate that mental illnesses are real, common and treatable.

Discourage stigmatizing language, including hurtful labels such as “crazy,” “loony” or “nuts.”

Invest in mental health benefits.
Help employees transition back to work after they take leave.

Consult with your employee assistance program.

Rely On Experts

After learning that an employee is experiencing a mental illness, many HR professionals rely heavily on the network of trained professionals available through their employee assistance program (EAP).

“They deal with these kinds of issues all the time,” says Karen G. Fraser, PHR, HR director for the Walton County Board of Commissioners in Monroe, Ga. “I don’t profess to be a psychologist or psychiatrist.”

From 2009 to June 2014, the county has seen a 12.5 percent increase in the use of prescription drugs for mental illness by its 585 employees and their dependents, she says. One-quarter of the 25 new cases opened with the EAP during the first six months of this year were for emotional illness, Fraser says.

The county’s EAP, CorpCare Associates Inc., trains managers to stay alert for performance problems that could reveal a mental health need but to also protect employees’ privacy. When an employee talks openly about personal problems, managers can step in and suggest that he or she call the EAP, Fraser says.

Some EAPs offer telephone consultations, while others refer callers to licensed mental health providers in their community for in-person counseling.

Mental illness causes more lost workdays and impairment than each of the following: arthritis, asthma, back pain, diabetes, hypertension and heart disease. 

Returning to Work

​A common misconception about mental illness is that individuals can’t recover from it. In fact, 65 percent to 80 percent of individuals will improve with appropriate diagnosis, treatment and ongoing monitoring, according to the Partnership for Workplace Mental Health.

In a 2004 study, employees who received high-quality depression care management over two years realized a 28 percent improvement in absenteeism and a 91 percent improvement in presenteeism (when employees are present at work but not productive). That translates to an annual savings of $3,476 per employee (in 2013 dollars), according to Kathryn Rost, a research professor at the University of South Florida. High-quality depression care management involves patient education and monitoring by a mental health professional so that treatment can be adjusted if needed, she says.

More employers are moving toward a formalized return-to-work process rather than depending on the opinion of a direct supervisor alone to assess an employee’s situation, according to a 2012 report by the Disability Management Employer Coalition.

Return-to-work plans might include counseling and accommodations aimed at bringing employees back to work faster.

Work can provide a boost in self-esteem and play an important role in an individual’s recovery.

“When you have a mental illness, you have a sense of being derailed … so getting back to work gives you a sense of getting back on track with life,” says Diehl, with the National Alliance on Mental Illness.

The 8,000-employee Hennepin County, Minn., government has seen promising results from its return-to-work program, which combines medical leave, accommodation management, aggressive use of its EAP and onsite case managers rather than telephone services for short-term disability cases. HR takes on the case management role for the toughest mental health cases. HR guides employees, during their most vulnerable time, to find the right treatment. Combined with mental health screening and manager training, the county program has a $2.50 return for every $1 spent.

“For many employees, I still believe the mental health services are a mystery,” says Jim Ramnaraine, Americans with Disabilities Act (ADA) coordinator with the county’s HR department. “If you’re not seeing the right provider, if you’re not bonding with your therapist, then for goodness’ sake, we’ll help you get another therapist.

“As my boss would say, ‘We’re not social-working these folks.’ We’re trying to get them back to work. We’re trying to help them be productive. And there’s a very fine line in terms of how we do that,” Ramnaraine says.

When an employee recently told his boss about being taken to the hospital and placed on a 72-hour hold because he was suicidal, the HR team could have required a “fitness-for-duty” test, which would have been an adversarial process. Instead, the individual was offered help in contacting the EAP and getting a psychiatric assessment.

“It was a huge success because the guy was cooperative. He was happy to have the support,” Ramnaraine says. “We actually got that person back to work in two-and-a-half weeks. If we’d done a traditional fitness-for-duty test, he probably would have been out six weeks.”

While case managers can’t recommend treatment, they can guide the individual by asking questions, he says.

“You may not change their behavior or the outcome, but you certainly can help them be more attentive to their treatment plan,” he says. “As an employer, that’s about all we do.”

Making Accommodations

Unless it creates an undue hardship on a business to do so, the ADA requires most employers to offer accommodations to an employee with a mental illness—even if it is episodic—if the illness substantially limits a major life activity. Accommodations may include reduced work hours as the employee transitions back to work, permission to work from home or changed duties.

Employers may discipline and even terminate an employee with a mental illness without going through the ADA’s interactive accommodation process if that employee engages in misconduct or presents a threat. But a common mistake that HR and managers make is “confusing a direct threat with something that is just scary,” says employment law attorney Brenda Kasper, a partner with Paul, Plevin, Sullivan & Connaughton LLP in San Diego.

The ADA prohibits discrimination based on the “perception” of a disability, so HR professionals and managers shouldn’t try to diagnose an employee’s condition themselves.

“The person who you think has a mental problem because they’re showing up at work disheveled may not have any mental issue. They may just have decided to let themselves go,” Kasper says.

Another way to invite legal trouble is to ask “How’s your health?”

Instead, she advises, ask “How can we help you do your job?” and let the employee share any health concerns voluntarily.

Finally, HR professionals must be familiar with state law requirements, which can differ from federal law, she says.

Respect All Workers

Employees with mental illnesses just want to do their jobs, says Craig, the employee who was fired after he disclosed his bipolar disorder. He wants “to be treated with dignity and respect with the understanding that bipolar disorder is like any other illness that needs to be treated,” he says. “It can be managed.”

On occasion, when his medication stops working or the side effects cause problems, he may need assistance. But he hopes more HR professionals and managers will someday view his illness as they would any physical injury or ailment.

“If they can understand a broken leg, they can understand bipolar disorder,” Craig says.

As more people understand what mental illness is and is not, it will be easier to have open discussions about it, he says, “but we’re definitely not there yet.”

Dori Meinert is a senior writer for HR Magazine.​