employment and mental illness

where can i find help?

isn't stress just part of my job?

recognizing the problem

talking to other staff

prevention

approaching an employee

rights and responsibilities

reasonable accommodations

resources

people who have mental illnesses make valuable contributions to society

abraham lincoln and winston churchill experienced depression. actress patty duke and musician peter gabriel live with manic depression. nobel laureate john nash lives with schizophrenia. overcoming the stigma associated with a mental illness, seeking and getting treatment, and being part of a support network enable people living with mental illnesses to reclaim their lives and to enjoy meaningful careers.

where can i find help?

if you are distressed (for example, feeling anxious or depressed) and think that you may have a mental health problem, you should seek help. remember that everyone feels stressed or anxious from time to time. if the feelings continue for more than two weeks, prevent you from eating, sleeping or working, interfere with the quality of your relationships, or if you want to harm yourself, you should seek help.

most people seek help from their family doctor. if you have an employee health service, you might want to talk to someone there.

if your family physician thinks that you have a mental illness, such as depression, he or she may treat you with medication, counseling or a combination of both. he or she may also refer you to a psychologist, psychiatrist, or therapist for help.

many employers offer employees help through an employee assistance program (eap). if the organization you work for subscribes to an eap you can get an appointment to see a counselor at no cost to you. when you talk to an eap counselor, your conversation with them is confidential. your employer will not be informed of what you talked about. you can find out about the eap program through the human resources department.

isn't stress just part of any job?

stress is a normal part of any life, and any job. stress can be positive or negative, and how people react to various stressors is highly individual. but excessive negative stress (or distress) can contribute to or even cause serious health problems for employees.

excessive job stress can be caused by many factors, but research over the past 15 years has shown that some stressors are worse than others:

jobs that are highly demanding because they involve constant imposed deadlines over prolonged period, and provide the individual with very little control over the day to day organization of their work (high demand/low control jobs).
jobs with high demand and low control, can lead to more than double the rate of heart and cardiovascular problems. they also lead to significantly higher rates of anxiety, depression, and demoralization.
high demand and low control jobs also lead to significantly higher alcohol, prescription and over-the-counter drug use, and a significantly higher susceptibility to infectious diseases - which in turn lead to increased disability claims.
jobs that require high physical or mental effort but offer little reward in the way of compensation, status, financial gain or career enhancement (high effort/low reward jobs).
jobs that require high effort but offer little reward are associated with triple the rate of cardiovascular problems.
these jobs result in significantly higher rates of depression, anxiety, and conflict-related problems.
an accumulation of home stress and job stress affect overall wellness. a 2002 finnish study that followed 812 employees who were employed for 25 years at one company found that the risk of death from heart disease doubled under high demand/low control and high effort/low reward circumstances. the same factors were also linked to high cholesterol and body mass index.
high demand/low control conditions, combined with high effort/low reward conditions, are associated with higher incidence of back pain (up to three times the rate of high control/high reward conditions) and repetitive stress injuries (excess rates of up to 150% have been reported.)
people experiencing high demand/low control combined with high effort/low reward conditions, along with more general workplace stressors, had over five times the normal rate of colorectal cancer.
distress can lead to accidents on the job, directly and indirectly.
distress can increase conflict amongst co-workers.

the health of workers doesn't have to be compromised by stress, however. changes to the organization of work can make for a more mentally healthy workplace, especially when employees feel adequately rewarded and under greater control of their work.

excessive job stress can be caused by many factors, but research over the past 15 years has shown that some stressors are worse than others.

recognizing the problem

how can i tell if someone is mentally ill?

as an employer, manager, or supervisor, it is not your job or your responsibility to diagnose a mental health problem. however, being aware of the signs that suggest someone might be experiencing a mental illness is important. mental illness includes a broad range of symptoms and behaviors, and it is not easy to determine whether someone is mentally ill. one key indicator is that someone may begin to act uncharacteristically; an energetic person may seem lethargic for a considerable time, or a person who is usually mild may make grandiose claims about their abilities.

behavior changes such as these may reflect personal difficulties that will be resolved quickly. they may be signs that the person is no longer happy in their job. the individual might be going through a particularly stressful time in their life for any number of reasons. these behavior changes might, however, indicate that the person is experiencing a mental health problem that goes beyond being "stressed-out" and that requires professional help.

there are a number of warning signs that can indicate that a person has a mental health problem, such as:

consistent late arrivals or frequent absences
lack of cooperation or a general inability to work with colleagues
decreased productivity
increased accidents or safety problems
frequent complaints of fatigue or unexplained pains
difficulty concentrating, making decisions, or remembering things
making excuses for missed deadlines or poor work
decreased interest or involvement in one's work
working excessive overtime over a prolonged period of time
expressions of strange or grandiose ideas
displays of anger or blaming of others

it is important to emphasize that people behaving in these ways may be simply having a bad day or week, or may be working through a particularly difficult time in their lives that is temporary. a pattern that continues for a longer period, however, may indicate an underlying mental health problem.

talking to other staff

one of my employees has a mental health problem. how can i explain the situation to other employees?

privacy comes first
ask your employee how they want to handle questions
scenario: what should you say?
accommodations aren't "special treatment"

the co-workers of an employee with a mental illness may come to you with their concerns and maybe they're nervous about working with someone they suspect or know has a mental illness. or they may approach you during the return to work of an employee who has been on disability leave for a mental illness, complaining that accommodations for that employee are special treatment. this is often the case if the employee returning to work is given preferential hours, or is offered a private or preferential workspace.

how do i introduce a new employee with a mental health problem, and how do i prepare my staff for his or her arrival?

introduce an employee with a mental health problem just as you would any other employee.

prevention

how can the workplace contribute to or create mental health problems?

a healthy workplace can contribute to the mental health of its employees. when good management practices are in place and employees are valued and respected, the workplace is unlikely to exacerbate, contribute to or create mental health problems.

on the other hand, when poor management practices are the norm and, for example, workplace harassment is tolerated, or employees perceive that they are being treated unfairly or with disrespect - the environment is unlikely to foster mental health or contribute to the mental well-being of employees.

workplaces can have a particularly negative effect on the well-being of employees when they: create an atmosphere in which there is an imbalance between work and life perpetuate harassment, discrimination and stigma.

work/life balance

work/life conflict occurs when employees (and employers) find their roles within the workplace and outside it are overwhelming them, or interfering with one another.

yet many employees are finding that conflict between their work and their lives is leading to strain on the job and in the home. that strain can lead to serious health problems, including mental health problems. while not everyone who has a significant amount of stress in their lives will develop a mental illness, excessive stress can be manifest as depression, anxiety, or anger, and can cause changes in brain chemistry which lead to weakened immune systems. in turn, excessive stress is associated with poor morale, absenteeism, and low productivity.

how can i approach an employee about their mental illness?

you may see behavior or performance signs that suggest an employee has a mental health problem. as an employer (or a manager or supervisor) you have a responsibility both to the individual and the organization to take action if you suspect that this is the case. you may be able to provide the employee with an opportunity to get the supports, professional help, and workplace accommodation they need so that they can continue working productively. in most cases the best approach is to meet with the person privately to talk about your concerns about their work-related performance.

below are suggestions for how you can:

prepare for the meeting
talk with the employee about your concerns
follow-up

preparing for the meeting

broaching the question of an employee's health as it relates to work performance can be a delicate task, especially when mental health problems might be involved. it's important to prepare for your meeting:

find out what resources your organization can offer an employee who is in distress. have this information at hand when you meet with the person.

become familiar with your organization's accommodation policies and processes.

spend some time looking into the basics of mental health and illness before you talk with the employee. misunderstanding and fear are the greatest barriers people face in dealing with a mental health problem; be aware of the possibility that your own misconceptions and fears might interfere with your ability to respond appropriately. your employee might also benefit from good information. they may not understand what is happening or think that mental illness is something they should be able to fix on their own.

think about how you can use your skills as a manager to help make the person feel safe and comfortable in the meeting. if the employee is dealing with a mental health problem you will want to minimize their stress ð not contribute to it. in addressing the performance issues, you can be honest, upfront, professional and caring in your approach.

think about the person's strong points and contributions that they have made. it will be important to talk about the ways in which the employee is valued before raising areas of concern.

consider open questions that will encourage an employee to request support or accommodation. at the same time, remember that your job is not to probe into an employee's personal life, to diagnose a problem, or to act as their counselor. be prepared for the possibility that, while you may be opening a door to offer help, the employee may choose not to walk through the doorway.

talking with the employee

if the situation is serious enough that the loss of a job is imminent, it is important to be clear and document the meeting as a performance issue so there is no confusion.

consider how well you know the employee. some people will feel more comfortable if you treat the meeting as a performance review, focusing first on their strong points as a worker before addressing areas of concern.this format may make some people defensive, though, so you might begin by stating that you are concerned about the employee, then state reasons for your concern.

in either case, assure the employee that you intend to work with them to help them get back on track or get the supports they may need. if you can create an atmosphere in which the person feels safe and comfortable, and let them know that what you discuss with respect to health matters is confidential, they may feel more open to talking to you.

before assuring an employee that their information will be kept confidential, however, make sure you know what the company policy is, who you have to share the information with and in what form. have a copy of the company policy available for the employee.

it is important that you:

approach your concern as a workplace performance issue.
raise the possibility of providing accommodations if needed.
provide access to an employee assistance program or referral to community services.
assure the employee that meetings with an eap provider are confidential.
set a time to meet again to review the employee's performance.
document this meeting fully.

but there are some things you should not say or do:

don't offer a pep talk.
don't be accusatory.
don't say "i've been there" unless you have been there. you may not understand or relate to a mental illness, but that shouldn't stop you from offering help.
don't try to give a name to the underlying issue. even if you suspect a particular illness or problem, focus on how the employee's behavior is concerning you and how you want to help them improve.
if you learn that a specific illness is causing the behavior, don't ask what "caused" the illness.
focus on solutions.

your employee may not know, or may refuse to acknowledge, that they have a mental health problem. in that case, there may be little you can do to help them. at this point, focusing on work performance is the best approach.

follow-up

your organization's involvement doesn't end with this meeting. you'll want to follow-up with the employee, or designate someone who can follow-up on your behalf.

keep your notes on the meeting in a secure location. a locked filing cabinet and password-protected computers are key to maintaining your employee's confidentiality.

to provide appropriate accommodation, you will need to know: if there are any functional limitations that could affect the person's ability to carry out the essential duties of their job. what accommodations would enable them to continue to do their job effectively.

the employee may not disclose a problem to you, but may seek help from the eap provider or from a community service provider (such as a doctor, psychologist, or counselor). after receiving professional help, the employee might decide to put in a request for workplace accommodation.

if the employee's performance has not improved by the time you meet again after the designated period, and there has been no request for accommodation or leave, it would be appropriate only at that point to consider disciplinary action.

be sure you and the employee understand the employer's obligations to provide accommodation. if there is a collective agreement in place, be familiar with the terms of the collective agreement. if it would interfere with accommodation, make sure it is clear what steps can be taken to accommodate the employee.

rights and responsibilities

what are the accommodation rights and responsibilities of employers, employees, and unions?

the employer should:

create an atmosphere in which employees are comfortable asking for accommodations. this means providing employees with information about the organization's accommodation policy, and creating procedures that allow for the request to be made confidentially.
assume that the employee's request is made in good faith.
work with the employee, and experts if necessary, to explore all possible accommodations.
maintain records of the request and steps taken to deal with the request.
respect the confidentiality of the information provided by the employee.
respond to accommodation requests in a timely manner.
require the employee to provide only that information which is necessary to develop an appropriate accommodation.
respond to requests for accommodation even if they are not made in a formal manner or using the term "accommodation."
pay the costs related to accommodation including any medical certificates required.
ensure that managers are aware of their obligation to prevent an employee from being harassed in the workplace because of their disability. accommodation should be done in a way that does not subject the employee to ridicule. the employee should also be assured that the organization will not tolerate any form of harassment.
ensure that progressive performance management processes are in place to identify and assist employees with disabilities prior to their disability leading to a performance issue.

the employee should:

tell the employer that they require accommodation because of a disability and, to the greatest extent possible, set out the type of accommodation needed. the employee does not necessarily have to advise the employer as to the specific nature of the disability, but they do have to provide enough information so that the employer can understand the accommodation needed.
if requested, provide supporting documentation from a health care provider or other person in order to assist the employer in developing an appropriate accommodation.
work with the employer (and union, where applicable) to determine an appropriate accommodation. this includes working with any experts the employer has retained to assist with the accommodation.
meet all relevant job requirements and standards once the accommodation has been provided.
continue to work with the employer to ensure the accommodation remains effective.

unions are required to:

actively participate in the accommodation process.
share responsibility with the employer to develop and implement accommodation.
support accommodation requests even where they are not consistent with the collective agreement unless it would create an undue hardship.

what are reasonable accommodations?

accommodation is a means of removing barriers for someone with a disability so that they can work effectively. in most cases accommodations are inexpensive and involve workplace flexibility rather than capital expenditures.

employers are required by law to provide reasonable accommodation for an employee up to the point where it causes undue hardship to the employer.

undue hardship is determined by factors such as the cost of the accommodation, and whether it affects the health and safety of the employee or others in the organization. it is up to the employer to provide evidence that an accommodation would create an undue hardship.

many people with disabilities -whether psychiatric or other disabilities- don't need accommodations. as more attention is paid to removing and preventing systemic barriers to people with disabilities, the need for individual accommodation may decrease. for example, if an employer has a flex-time program that benefits all employees, an employee with a mental illness who needs to modify their hours of work to coincide with medical treatment can do so without having to ask for an accommodation.

sometimes a short period of accommodation is all that's required while an employee adjusts to medication. while most people think of accommodations as physical changes to the workplace, such as building a ramp for an employee who uses a wheelchair, people with a mental illness require different types of accommodation. for example, someone with depression or an anxiety disorder might find that an accommodation which allows them to work in a private office instead of in a noisy open-space office helps them to work much more happily, productively, and with fewer health and disability costs.

examples of accommodations

the most commonly used accommodations for people with mental health problems include:

flexible scheduling
flexibility in the start or end of working hours to accommodate effects of medication or for medical appointments.
part-time shifts (which may be used to return a worker to a full-time position).
more frequent breaks.
changes in supervision.
modifying the way instructions and feedback are given. for example, written instructions may help an employee focus on tasks.
having weekly meetings between the supervisor and employee may help to deal with problems before they become serious.
changes in training.
allowing extra time to learn tasks.
allowing the person to attend training courses that are individualized.
modifying job duties.
exchanging minor tasks with other employees.
using technology.
allowing the person to use a lamp instead of fluorescent lights to eliminate a flicker which may be irritating or cause a reaction.
providing the employee with a tape recorder to tape instructions from a supervisor, training programs and meetings if they have difficulty with memory.
allowing an employee to use head phones to protect them from loud noises.
modifying work space or changing location allowing an employee to relocate to a quieter area where they will be free from distractions.
allowing an employee to work at home.
job coach assistance in hiring, and on the job.
a job coach may be someone from an outside agency that assists the employee in the workplace. alternately, someone within the workplace, such as a peer or human resources staff person might perform this role.
the job coach can help in a number of ways such as assisting the person to fill out applications, helping them to reduce their anxiety by providing feedback, observing their work and making suggestions about accommodation.