A Monumental Problem

John Binns knew something was wrong when he found himself sitting in front of his home computer at 2 a.m. struggling to compose an email to his supervisors.

He had been staring at the screen for three hours, but the words weren’t coming. He was in a mental fog, unable to focus, dreading the thought of sending the email that could sink his career.

'I had gotten to the point where I couldn’t face coming in tomorrow as I couldn’t function like I normally could.'

—John Binns

Binns, a successful executive at consulting and accounting firm Deloitte in London, eventually composed his email, explaining to his bosses that he was unable to work the next day and perhaps the one after. In fact, Binns had no idea when he could return to work. Binns added in his note that he was struggling with “some kind of stress-related condition,” that his marriage was in trouble and that he could no longer perform his job well.

“I had gotten to the point where I couldn’t face coming in tomorrow as I couldn’t function like I normally could,” Binns said. “I initially felt relief at telling them but quickly followed by despair as I thought I had now ruined my career.”

Binns, 57, was clinically depressed, a condition that’s becoming increasingly prevalent in the workplace.

More workers miss work because of mental illness than any physical condition like cancer and heart disease, according to Employers Health, a national employer coalition based in Dublin, Ohio. And the organization says it’s costing employers between $80 billion and $100 billion in lost productivity each year.

While this takes a huge toll on workers who are struggling to manage their conditions and their careers, companies are also paying a price in higher health care and disability costs. Mental illness accounts for 30 percent of disability costs, and that figure is growing by 10 percent a year.

And yet these disorders usually fly under the radar in the workplace with employees suffering in silence, afraid to risk their careers by speaking out, and employers afraid to ask.

But it doesn’t have to be this way, according to former Rhode Island congressman Patrick Kennedy, who has made it his life’s mission to educate others about mental illness and battle the stigma surrounding it. Depression, bipolar disorder and other mental disorders are highly treatable, and those who suffer from them can lead successful lives and careers. Kennedy illustrates the point.

The son of late U.S. Sen. Ted Kennedy has spoken publicly about his bouts with drug addiction, alcoholism and bipolar disorder, and is writing a memoir about his struggles. He is also the leading sponsor of the Mental Health Parity Act of 2008 that requires health insurance plans to provide equal coverage for physical and mental illnesses.

Mental Health: Evaluation Is the First Step

While most employers make the connection between mental health and the bottom line, figuring out how to address the issue can be challenging. To help companies develop mental health programs that offer support to employees struggling with depression and other mental disorders, the Partnership for Workplace Mental Health offers guidelines for every phase of the progress, beginning with the first step: evaluation.

1. Evaluate your current mental health benefits and health services. Even the best plans vary greatly in the mental health benefits they offer.

2. Ask your health plan or behavioral vendor detailed questions about their mental health programs, like what educational tools and referral programs are offered, how employees access the plan, what conditions are covered, and if the vendor can integrate its services with your employee assistance program and self-screening tools, among other offerings.

3. Review how your pharmacy benefits manager handles issues like requests for medications that are not on its formulary.

4. If your company doesn’t have an EAP, consider getting one.

5. Calculate the cost of depression and alcoholism using free online tools available at www.workplacemen talhealth.org/Business-Case.aspx.

6. Develop a business case for company leaders.

—Rita Pyrillis

“We’re entering into a new phase in the workplace because the parity law really requires a whole new mindset and a whole new approach and commitment to making sure that mental health and substance abuse disorders are no longer the ugly stepchild of health care but are on par with the rest of the health care system,” he said.

In order to help employers step up to that challenge, Kennedy is working with a group of large employers in New York to create a “CEOs round table on mental health” that gives business leaders a place to share ideas on how to change the way companies deal with mental illness in the workplace.

“What HR leaders and those who are purchasing health care need to know is the experiences of other employers when it comes to mental health, like workplace disability and other issues,” Kennedy said. “A lot of companies and HR folks are going through the same set of challenges, but in isolation. It would behoove companies to band together and begin to share best practices, like what kinds of benefits have the best evidence- and outcomes-based research behind them.”

Kennedy has been working with business leaders such as Michael Thompson, a principal at PricewaterhouseCoopers in New York, the Northeast Business Group on Health and the National Alliance on Mental Illness of New York City, or NAMI-NYC, to get companies on board.

Employers Building Awareness

Thompson, who had an older brother who committed suicide, said that most employers care about the issue and understand its impact on health care and disability costs and productivity, but they don’t know how to address it.

 “What they don’t understand is what are the key barriers to breakthroughs,” he said. “It requires more assertive action to overcome the legacy of stigma and discrimination. We are living in a ‘don’t ask, don’t tell’ society, but the irony is that when you open up to others who you trust, you’re going to find that [mental illness] is not uncommon, it’s very common. From a pure business standpoint, getting this right matters.”

Last year, Thompson, the business coalition and NAMI-NYC launched a series of gatherings called the Workplace Mental Health Summit, which brings together human resources professionals, employee assistance program, or EAP, providers and benefits executives. About 30 organizations are involved, according to Thompson, including American Express, Deloitte, Deutsche Bank and global advertising agency JWT. All have hosted the gatherings at their headquarters. 

 Chemical company DuPont is one step ahead with its mental health awareness campaign dubbed “I.C.U.,” which was launched in 2012. It centers on a five-minute video presentation that helps workers identify the signs of depression and encourages them to reach out to co-workers who need emotional support. Signs of depression include low energy, difficulty concentrating, indecisiveness, forgetfulness and missing work, according to mental health experts.

“It’s a simple message about recognizing when an employeeis distressed,” said Paul Heck, global manager of employee assistance and work-life services at DuPont. “It’s used to help break down the stigma of approaching a colleague who is obviously in distress and expressing concern. We’re not saying that you should know the symptoms. It’s just about breaking through hesitancy to express human concern.”

The name of the I.C.U. initiative is a play on the words “intensive care unit” and “I see you,” Heck said. It also stands for “identify, connect and understand.” The program is now offered at DuPont offices in Europe, the Middle East and Africa. Heck said that the program is well-received by employees, but its impact can only be measured through feedback.

“Everyone would love to see a metric, but we can’t say 8.2 percent more call the EAP now,” Heck said. “I have seen an increase in management referrals to the EAP, but you just don’t know if that’s due to I.C.U. What we do is intuitively valued.”

While attitudes about mental illness have softened in the past few decades, some stereotypes persist, like the idea that people with depression are weak, unpredictable or even dangerous.

Few employers are ready to address these issues, and few employees are willing to risk their careers by admitting that they suffer from mental illness. Many fear being viewed as weak and are concerned about being passed over for opportunities or even losing their jobs, said Allen Doederlein, president of the Depression and Bipolar Support Alliance.

“There is a perception that people with bipolar disorder and depression will be unreliable, absent a lot and difficult to work with,” said Doederlein, who has struggled with depression himself. “There is this idea that people will suddenly look at you in a different way.”

Another obstacle is addressing the legal implications for employers and employees when it comes to mental illness. The Americans with Disabilities Act prohibits discrimination in recruitment, hiring, promotions and terminations against employees with physical or mental disabilities. It also requires employers to make reasonable accommodation as long as the person can perform the essential job functions. While employees are not required to disclose their condition under the ADA, once they do it’s in the employer’s best interest to obtain the medical information needed to determine if a reasonable accommodation for the employee can be made, said Alec Beck, a partner in the law firm Ford & Harrison in Minneapolis.

“They have to work with the employee to get all the information on the table as soon as possible so each side can make an informed decision. People are afraid to ask for medical information, but after an employee self-identifies, you not only have the right to get that info, you must get it. Employers can’t assume anything.”

Starting With Education

While U.S. companies are starting to focus on mental illness, other countries, like the United Kingdom, Australia and Canada, seem to be further along.

In January, Canada’s first university-certified program to train employees on how to manage mental health issues in the workplace was launched by Bell Canada and HR consulting firm Morneau Shepell. The Mental Health@WorkTraining Program teaches about mental illness and its impact on businesses and helps participants develop management skills to address these issues. More than 4,000 supervisors from the Canadian telecommunications and media company have completed a test pilot of the program, which was expanded and is now open to employees from all companies. The program is offered through Queen’s University in Ontario.

“We’re not trying to train employees to be clinicians, we’re trying to educate them on how to manage performance and how to get employees the resources that they need,” said Michelle Steinowicz, vice president of client strategy at Morneau Shepell in Toronto. “It’s easy to jump to the conclusion that it’s a performance issue when someone is missing deadlines or their productivity has really gone down, but it could be depression.”

The program, which is offered online and in the classroom, focuses on teaching empathetic coaching skills and management practices to help employees manage their illness and return to work, she said.

Canadian journalist Jan Wong would likely have benefited from such a program. Her ongoing battle with her former employer, the Toronto Globe and Mail, over her mental health issues made headlines in Canada. 

A highly respected reporter for more than 20 years, in 2010 Wong seemed to fall off the radar, with her byline suddenly disappearing from the newspaper. What few people knew was that she was suffering from a debilitating depression triggered in the aftermath of a controversial story she wrote in 2006 about a mass shooting on a college campus in Montreal. She used a term considered discriminatory by the province’s French-speaking residents that provoked readers to send her hate mail and death threats.

But rather than get support from her employers, they questioned her diagnosis, accused her of malingering, cut her sick pay and fired her, according to Wong, who sued them for wrongful dismissal and won. 

She blames her employer’s actions on ignorance about depression and urged companies to train their HR departments on how to handle employees who struggle with mental illness.

“I don’t know if I was dealing with people who were being deliberately venal or just ignorant,” said Wong, who is a university journalism professor. “HR professionals need to know what mental illness is. You’re not supposed to fire someone because they lost their hearing; you’re supposed to accommodate them. We’re still in the dark ages when it comes to mental illness.”

The Toronto Globe did not respond to requests for comment.

Depression Is Not for the Weak

In fact, employees with mental illness can have flourishing careers, according to Tom Wootton, author and CEO of Bipolar Advantage, a consulting firm that offers courses and workshops on managing the disorder to companies and individuals. They just need to learn how to manage their condition and get support from their employer.

“If a company could teach their employees how to understand their condition through an employee assistance program, those employees could become their biggest assets,” Wootton said. “Bipolar disorder is very prevalent in creative departments, sales departments and in top management.”

Deloitte’s Binns said that he was lucky to have the support of his employer and colleagues. After three months at a psychiatric hospital where he was treated for severe depression and anxiety, he returned to work stronger than ever.

“I was a successful leader for the next seven years, possibly even more successful than I was before,” he said. “I was given a strong message, that, ‘John, you’ve been a very valuable guy.’ Getting that positive reinforcement sped up my recovery substantially, and I paid the firm back in spades for doing that.”

He cautions that employers overlook the signs of mental illness among their high performers by focusing on their weakest links.

“If you look at the traits of a lot of the highfliers, like having a tremendous sense of responsibility, really caring about the outcome of something, being highly ambitious, caring too much about what others say and think, these represent a whole range of risks,” he said. “There is this fear of being seen as weak and not being able to cope, but what’s become very obvious to me is that it’s often quite the opposite.”

If employers care about keeping their strongest workers, then they must help them cope when they are at their weakest, he added.