Mental illness cuts across the workplace hierarchy

Money, power and status do not protect people against mental illness.

Executives are affected by mental illness as often and as severely as other segments of the workforce, said Dr. Samuel Ball, director of psychology and executive programs at Silver Hill Hospital. He specializes in treating executives suffering from mental illness.

Alcoholism is one of the most common afflictions, Ball said, followed by personality disorders and mood disorders such as depression and anxiety. Executives struggling with depression may have difficulties with productivity and have to force themselves to perform their job due to lower energy levels and interpersonal skills, while some people afflicted with alcoholism can drink heavily while often being functional at work.

A group of high achievers may be initially reluctant to admit the problems they’re experiencing, Ball said. They feel a “different kind of shame about the problems they’re struggling with because they’re on a pedestal. So many people rely on them, [and] so many people look up to them at work and in their family.”

They need to feel secure, he added, describing a patient who felt comfortable speaking up because the CEO gave him a clear message that they wanted him back after treatment.

Home Life Versus Work Life

An executive’s spouse and family play a critical role in convincing them to get help.

“In a number of cases, the problem is not as widely known at work as it is at home. And the spouse has gotten to the end of their rope with [their] concerns,” Ball said.

At work, the executive will “put on the best face or a mask of maintaining their competency” because they’re motivated to maintain their career status. But when they get home, it’s different. Their spouse will usually be the one to convince them to get treatment.

If someone has these health issues, it can negatively impact their spouse and children, especially children in their teenage years. According to the Centers for Disease Control and Prevention, growing up in a family with mental health or substance abuse problems is considered an adverse childhood experience — a potentially traumatic event that occurs in childhood and increases people’s risk for health problems as adults.

This group of patients generally have the means to afford outpatient treatment, which is a good first step, Ball said. The patients he sees, though, are often the ones too ill for outpatient treatment. Instead of living at home and regularly seeing a psychiatrist, they need inpatient care. Ball will get a phone call from the spouse, who has done the research to find the ideal place for inpatient care — usually somewhere in a different city that’s nearby enough that family can visit.

How Peers and Employees Can Respond

When an executive’s mental health is severe, employees and peers may notice. But knowing what to do or how to express sympathy or concern is different. For those employees who report to this higher-ranking person, it can be difficult to know what to do, if anything.

Also read: The mental health parity challenge

An exception might be if an executive has a trusted assistant who has been with them for a long time, Ball said. This type of direct report may have some ability to do something about the situation, especially if they play a “work spouse” role in this person’s life. But a majority of direct reports are not in this situation.

Typically, these high-ranking people won’t go to HR or contact an employee assistance program, Ball said.

“These executives report to the most senior people in the organization. And when they do finally admit to having a problem, if they do admit it, it’s not clear to them where to go in the organization to get support,” he said.

Usually it’s the one or two people above them — usually the CEO or COO — telling them to go on leave to get treatment that finally makes them get help, Ball said.

“They’ll say something like, ‘You’re incredibly valuable to us and we want you back, but you’re not well enough to work now. Take a month, two months, but we want you to get into a treatment program,’” he said.

Still, HR has power here. Lower-level employees may bring their concerns to HR, and an HR representative can speak directly with the CEO or COO, who typically are not surprised by the information, Ball said. From there, the CEO or COO can lead the intervention with the sick executive, and the HR person can stay in the meeting as an observer, especially if there’s been any sort of wrongdoing or complaints about the executive’s behavior.

It’s especially helpful if their boss can show sympathy in this discussion, Ball said.

“When this has gone well, their boss is either someone who has struggled with depression or alcohol, or it’s in their family. And they’ll have that discussion with their affected employee and say something like, ‘I know what this is like, and you’ve got to take care of this,’” he said.

Fighting Stigma

A prime reason executives fear coming forward with mental health issues is the fear that their progress at the company will effectively stall and that people will wonder when their next relapse will be.

“Even if they don’t lose their job, the reputational fallout of people knowing they’ve gone off to rehab is significant,” he said.

Some workplace experts encourage leaders to be open about their mental health struggles in order to decrease stigma for employees. However, since even these leaders experience stigma, talking openly about mental health at work is a hard but courageous thing to do, according to Ball.

Still, he said that it does have a positive effect on the workplace when leaders are honest and open about their struggles. He mentioned a patient who, upon preparing to leave soon, plans to go back to work and share broadly with the workforce that he’s been on leave treating his depression. This executive said he wanted people to take better care of themselves and recognize the signs that he did not.

“I think it’s courageous when people do that,” Ball said. “It’s helpful to employees when they send that message.”