Dr. Merv Gilbert and Dr. Joti Samra
The modern Canadian organization is dependent on the psychosocial competencies of its workforce. Whether the task is managing a complex database, serving as a transit operator or acting as a customer service representative, it is necessary to sustain attention, exercise good judgment and interact effectively with others. Correspondingly, forces that threaten these capacities can influence organizational productivity and success.
The impact of this threat is apparent in an increased (and steadily increasing) rate of disability due to mental health problems, with serious implications for employee quality of life, workforce morale, corporate productivity and benefits costs. It is estimated that that depression alone costs the Canadian economy approximately $25 billion per year; the social cost is immeasurable. While one-third of this cost is in direct health care costs, the other two thirds are due to indirect costs such as absences, disability payments and lost productivity. For those who remain at work, impaired functioning – or “presenteeism” – can be particularly insidious as depression frequently affects an individual’s concentration, energy level, confidence and judgment.
As striking as these figures are, they cannot reflect the human side of disorders such as depression and their impact upon individuals, family members and community. Such disorders can also impact morale and team functioning in the workplace, and contribute to recruitment and retention, risk management and human rights concerns. This is particularly tragic as there are increasingly effective treatments which can minimize rates of functional impairment and absenteeism. Unfortunately, less than one in four individuals is correctly diagnosed; of those, only one in four receive treatment consistent with best practice guidelines. These low figures result from a combination of factors, including stigma about seeking help for mental health problems; ignorance about depression on the part of supervisors, co-workers or management; naivety amongst health care providers about the workplace and associated demands; and, general lack of knowledge about mental health disability prevention and management strategies.
In response to the above, organizations are increasingly responding by developing policies and services designed to address and support the mental health of their employees. These include programs such as employee and family assistance, extended health coverage for medications and counselling, and the provision of short and/or long-term disability benefits. Such services are critical ingredients in addressing workplace mental health but are of limited value – and in fact may end up adding unnecessary costs – if they are not accompanied by clear guidance on their effectiveness and use, and careful evaluation and research.
Addressing mental health and addiction issues in the workplace requires cooperation amongst a range of key stakeholders, each with their own sets of responsibilities. These include:
Employer Responsibilities:
Employers have a major role to play. Mental health and addiction awareness programs can help to reduce stigma and promote early detection and intervention, which will help prevent the onset and/or reduce the severity of such disorders. Shaping the work environment can promote a sense of individual control and accomplishment, and reduce stressful demands. Job design and review can be revised to include psychological and cognitive demands. Policies and benefits plans can be structured to allow flexibility in workload and scheduling and to permit access to appropriate services. Employee assistance programs can be an invaluable aid but only if they have the knowledge, skills and opportunity to identify and augment the treatment of disorders. It is critical that an organization have an early return to work process including creative and aggressive case management to identify potential barriers and optimize functioning.
Insurance Provider Responsibilities:
Insurers and disability coordinators need to make efforts to become involved early in the process. When possible, this may include developing, promoting or participating in programs that will prevent the onset and/or severity of disability. They can work with the individual, the employer and the health care provider in order to establish a balanced and realistic picture of the individual’s condition, treatment plan and work situation. This role should be reciprocal, with the insurer providing information about entitlements and responsibilities, specific job demands or extenuating circumstances. If external providers are contracted to provide services, the exact nature and reason for such services should be clarified. In circumstances where leave for mental health reasons is necessary, return to work planning should begin rapidly and needs to specifically address limitations on job tasks and performance, accommodations that are necessary and realistic, and the need for intervention and information for the employee’s supervisors and co-workers. Once a return to work plan is initiated, there should be ongoing supports for the employee with respect to pacing and goal setting, interpersonal issues (e.g., disclosure to colleagues) and the management of stress or relapse. Finally, the plan should be monitored, evaluated and adapted as needed.
Health Care Provider Responsibilities:
Health care providers can play a role by providing assessment, diagnostic and treatment services in line with recommended practice guidelines. Recognizing mental health disorders and making the distinction between disability and impairment is needed. It helps to determine how the individual rates their work in relation to their own sense of self-worth and identity. The provider will need to understand current overwhelming stressors, job requirements or circumstances at the individual’s place of employment. Skills that are focused on coping, mood and lifestyle management, goal setting and activation are necessary augments to pharmacological treatment, both for individuals that are still working but having difficulty, as well as those that may be on leave. If the health care provider is not able to provide support on the above skills, they may be available through outpatient mental health programs or private-sector practitioners. Free psychoeducational workbooks, such as the recently completed Antidepressant Skills at Work guide are also available (www.carmha.ca).
The Individual's Responsibility:
Individuals who may have a mental health problem have a responsibility to obtain the best information and services available. This includes being informed of, and correctly using, employee health, employee assistance or extended benefits options. If workplace circumstances may be causing or contributing to stress and distress, the worker should bring these to the attention of co-workers, supervisors, human resources staff or union stewards. This should include a willingness and opportunity to devise and contribute to possible solutions.
It is clear that the impact of mental health disorders and addiction on the workplace will not go away. What is needed is the co-operation and innovation of all involved. For employers, paying attention to the emotional and psychological well being of their workers is not just a benevolent option but a necessity.
To advance our understanding, collaboration and improved practice, the Canadian Institutes of Health Research (CIHR) are supporting a congress, Workplace Mental Health and Addiction: Research, Knowledge and Action, to be held in Vancouver on May 17 & 18th, 2007. The conference is being co-hosted by the Centre for Applied Research in Mental Health and Addiction (CARMHA), SFU and BC Mental Health and Addictions Services (BCMHAS), an agency of the Provincial Health Services Authority. The conference will bring together local, national and international researchers service providers, employers, unions and businesses. For further information about the program or registration details, visit www.carmha.ca.
About the Authors:
Dr. Merv Gilbert is a consultant and an occupational health psychologist and principal in Gilbert Acton Ltd. www.gilbertacton.com.
Dr. Joti Samra is a clinical psychologist and research scientist at the Centre for Applied Research in Mental Health and Addiction (CARMHA), in the Faculty of Health Sciences at Simon Fraser University.