Introduction
The National Institute of Mental Health reported that in 2012 an estimated 18.6 percent of all US adults age eighteen and older had some form of mental illness (besides substance abuse or developmental disorders). The World Health Organization also estimated that in 2010, 13.6 percent of all disability adjusted life years (DALYs) worldwide were caused by mental and behavioral disorders. According to many employers, mental illness is the condition with the highest indirect cost to their companies. Substance use disorder, bipolar disorders, major depression (major depressive disorder), obsessive-compulsive disorder, and schizophrenia, coupled with anxiety, stress, and nonmajor depression, present a growing problem in the workforce. These disorders may lead to productivity loss, employee turnover, and long-term disability in employees. Depression is often reported as the mental health disorder that has the greatest effect in the workplace, leading to approximately 200 million days of lost work annually in the United States, according to 2001 and 2003 reports cited by the Centers for Disease Control and Prevention in 2013.
Globalization has resulted in workers in the United States and other developed nations losing their jobs due to downsizing, outsourcing, and factory closings; those who remain employed experience increased workloads, pressure to perform, and uncertainty about their futures. In economic downturns, falling purchasing power and the decreased demand for goods can lead to a rise in drug and alcohol abuse as well as in stress and domestic violence, according to the International Labor Organization.
Historically, employers have viewed mental health disorders in applicants and workers in a negative manner. The stigma attached to mental illness has affected both hiring and retention of individuals perceived to have mental health issues. By the twenty-first century, however, efforts at educating employers regarding mental health issues have ameliorated some of the stigma associated with mental illness and allowed workers with mental illnesses to receive appropriate treatment. In addition, companies have altered their hiring practices to comply with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination against people with disabilities, including psychiatric disabilities, in employment and other activities. Studies have shown that employees either entering or returning to the workplace after successful treatment for mental health issues are as productive as their coworkers.
To provide a healthful workplace and decrease employee turnover, many companies have begun educating employees and managers to recognize the signs and symptoms of mental health disorders, enabling them to identity early indications of problems and to refer individuals to the appropriate course of treatment. Many companies have also found that providing an environment conducive to good mental health in employees enhances productivity and product quality.
Recognizing Signs of Mental Health Disorders
Employers are encouraged to consider hiring individuals with managed mental health disorders.Research has shown that employees with select psychiatric disorders can be stable, functional, and productive employees. Understanding the pathology of mental illness can assist managers in providing an environment that encourages success for employees. When employers are aware of mental health disorders affecting employees, accommodations can be made to better meet their needs.
Both managers and employees should be educated to recognize the early signs of mental health disorders. Early recognition of signs indicating a problem in an employee will lead to early intervention, prompt referral for treatment, and better outcomes of therapy. Employees may also be able to recognize their developing problems if mental health education has been provided in the workplace. Education also creates the opportunity to remove the stigma surrounding mental health issues and encourages both managers and employees to feel comfortable acknowledging a need for assistance.
The most visible sign of a potential mental health issue with an employee is absenteeism. If an employee calls in sick several times a month for a few days at a time, this should alert the individual’s supervisor to a potential problem. Employees who exhibit sadness, irritability, or make inappropriate comments should also be observed carefully. Employees may also complain of burnout or their frustration with assigned tasks and, in extreme cases, may even make comments about violence or suicide. General poor health—including high blood pressure, skin rashes, sleeping disorders, and frequent infections—is often associated with mental health disorders. Lethargy, abnormally slow movements, or periods of hyperactivity may indicate substance abuse, and slurred speech, confusion, clumsiness, and the smell of alcohol on the breath may indicate alcohol abuse.
Changes in work performance are often noted in mental health disorders. Decreased productivity and work output, and increased errors and accidents are indicators that should be carefully evaluated. An inability to prioritize work, poor decision making, and a loss of commitment and motivation are also signs that an employee may have a problem. If staff in an area demonstrate a poor attitude or there is a high rate of turnover, it may indicate a problem with the supervisor or the workplace environment.
Poor relationships at work with colleagues or clients may also be an indication that an employee is experiencing difficulties. Visible tension or conflicts, an increase in actions requiring discipline, or avoidance of an employee by colleagues are also warning signs for employers. Social support from colleagues is important to mental health and work productivity.
Although absenteeism, changes in work performance, and deteriorating relationships may indicate a problem with an individual, the diagnosis of a mental health disorder must be made by a mental health professional. Educating individuals about warning signs of a potential issue is the first step in determining if an employee or manager needs professional intervention.
Common Psychiatric Conditions
Many employees with diagnosed psychiatric conditions are capable of working and being productive members of society when given the opportunity. Understanding the definition of common mental health disorders is important for managers of employees with a diagnosed condition, and managers are encouraged to research known diagnoses in more depth to increase understanding of a specific disease.
Bipolar disorders, also known as manic-depressive disorders, cause changes in mood, function, and energy levels. Manic phases with hyperactivity, lack of impulse control, and irritability, alternating with depressive phases of sad, anxious, or hopeless moods are the hallmarks of bipolar disorders. Often the disease is not recognized in a timely manner, but when diagnosed, the disease is treatable, and patients can lead full and productive lives.
Major depression is a disorder that interferes with the ability to carry on a normal life and should not be confused with mild episodes of sadness or a blue mood. Depressive disorders are evidenced by persistent sadness, feelings of hopelessness, decreased energy levels, thoughts of death or suicide, loss of interest in pleasurable activities or work, difficulty concentrating, or trouble making decisions. Depression may be treated with psychotherapy and medication, and individuals are capable of leading a productive life after intervention.
Substance use disorder remains a growing problem in the workplace. A compulsion to drink; being unable to limit drinking; the development of withdrawal symptoms such as nausea, sweating, and anxiety; and an increasing need for greater amounts of alcohol all indicate a problem. The
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013; DSM-5) eliminates the distinction between drug abuse and drug dependence. Prior to DSM-5 drug abuse was defined as repeated use of harmful agents but did not include tolerance or compulsive use. Drug dependence was also known as addiction and implied an inability to do without an agent. Substance use disorders and other mental health conditions often occur together. Behavioral therapies and medication may be used to treat addictions, and positive responses may occur with continued support and the individual’s commitment to staying sober.
An individual with obsessive-compulsive disorder, an anxiety disorder, has unwanted thoughts or demonstrates repetitive behaviors such as hand washing or counting in attempt to control unwanted thoughts. Medication, psychotherapy, and self-help groups may be effective in managing this disorder.
Schizophrenia is a severe and disabling disorder that, according to DSM-5, may cause individuals to hear voices, hallucinate, suffer delusions, or exhibit disorganized speech. Depending on the type of schizophrenia, individuals may also experience paranoia, or withdraw. Antipsychotic medications and long-term psychosocial interventions may allow the individual to manage the chronic disorder, but recovery does not occur. Entry into the workforce for more complex mental disorders is possible in a carefully selected and managed setting.
Anxiety, stress, and nonmajor depression may be evident in individuals who are in the workplace. Stressors such as life events (divorce, death, or other loss) may lead to nonmajor depressions and anxiety disorders such as post-traumatic stress disorder (PTSD). Cognitive behavioral therapy and medications may be used to treat anxiety disorders.
Hiring an individual with a diagnosed mental health disorder requires a commitment to providing accommodations based on the needs of the individual. There may be funding available to assist companies in providing a job opportunity for individuals entering or returning to the workforce after therapy for mental illness.
Intervention Programs
The most commonly implemented intervention program related to mental health in the workplace is the Employee Assistance Program (EAP), offered by 77 percent of companies in the United States, according to the Society for Human Resource Management in 2013. The EAP provides a confidential resource for employees to seek help with mental health issues and is a nonthreatening option for managers to suggest to employees. Although the EAP was originally designed to assist with drug and alcohol use disorders, its programs have expanded to cover a variety of issues, including depression, stress management, marital problems, or legal and financial problems. Many plans also allow limited care for employees’ family members. The program is conducted by an outside third party, and confidentiality is assured.
Many employers have implemented disease management programs for mental illness. Disease management programs generally assign a case manager to monitor the care of an employee undergoing therapy to be sure that timely and appropriate care is provided. An additional focus of disease management programs is to facilitate the employee’s reentry into the workplace.
Supporting Employees with Mental Health Problems
Individuals with mental health disorders benefit from work during their treatment and recovery. Having a purposeful and supportive place to go on a daily basis provides structure and financial security to individuals experiencing mental illness. Often job-related health benefits are needed to pay for therapy and medications that lead to recovery. Colleagues and friends are an important part of recovery. Individuals receiving care may share their issues and concerns with coworkers.
If the workplace provides education about good mental health, employees have a foundation from which to support the colleague with a mental health issue. Some more formal work reentry programs allow a therapist to come to the workplace and provide an orientation to coworkers to ease the employee’s return. This program must be conducted without violating patient confidentiality and with the individual’s written, legal permission. Recovery is more likely in a supportive environment, and a workplace that is accepting and supportive is important.
Promoting Good Mental Health
Employers have a responsibility to create a work environment that promotes good mental health. An assessment of physical conditions, such as lighting, temperature, cleanliness, and noise level, may indicate that the physical environment needs attention. A safe and secure work environment is the first step in promoting good mental health in the workplace.
Managers are also critical to a positive work experience, leading to a less stressful and healthy workplace. Providing management training for newly promoted supervisors and ongoing education for all managers is important. Understanding how to manage and motivate employees to achieve their potential in a positive and supportive manner may contribute to good employee mental health. Measuring employee morale and satisfaction in the workplace is also important to track measures that affect good mental health and to determine if managers are meeting the needs of their employees.
Some companies provide screening programs to detect mental health risk factors in employees. Mental health screenings must be confidential and should be interpreted by a mental health professional. Employees may feel threatened by the findings of a mental health screening and its relationship to continued employment or advancement within the company. Some mental health screening questionnaires allow individuals to self-evaluate using a set of indicators, and if the individual crosses a certain threshold of response, the person is advised to seek additional assistance from a mental health professional. These are similar to cancer or heart disease screening questionnaires, which are used to refer individuals who possibly have problems to their doctors. Most general health screening questionnaires include some mental-health-related questions. Many employers also have pre-employment drug testing or, depending on the industry, may have a policy of ongoing, random drug testing. In some instances, this may be a deterrent to substance abuse in the workplace.
Companies should provide education that assists individuals in learning how to deal with stress, anxiety, and substance use disorders both in and out of the workplace. Learning stress relief measures, such as meditation, guided imagery, and relaxation, helps employees deal with day-to-day issues. Learned coping mechanisms may also improve employees’ personal lives, leading to less stress at home and improved performance at work. It may also lead to less reliance on drugs and alcohol as coping mechanisms. Educating employees may also be effective in preventing the development of drug or substance use disorders.
Proactive measures designed to enhance employee health contribute to positive mental health and may decrease behaviorally related mental health disorders. Wellness programs such as smoking cessation, weight loss, and grief recovery programs are used to enhance employee health and self-esteem. Allowing community agencies or twelve-step programs such as Alcoholics Anonymous to use meeting space at a company is a way to provide cost-effective intervention programs. Educational programs such as on-site literacy programs, high school completion programs, and special training or college courses all contribute to a positive self-image and may inhibit development of some mental health disorders.
Companies should provide their employees with health insurance with equivalent coverage of physical and mental health problems. If employees have access to inpatient or outpatient care, those with recognized signs of mental health issues may be referred for care more easily.
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