The cost of mental illness is high. In 2003, mental disorders in Canada cost an estimated $51 billion, not including the cost of prescription medications, of which over one-third is carried by employers. Disability claims related to psychiatric disorders also cost twice the average of all causes ($18,000 vs. $9,027).  Of all mental disorders, depression is the most impactful. Seven out of 10 Canadians with depression are in the workforce. For all of these reasons insight from an bh feature interview with Dr. Ash Bender is likely to have specific relevance to your organization.

Dr. Bender specializes in workplace mental health issues. He is Consultant Psychiatrist – Work, Stress and Health at the Centre for Mental Health (CAMH) in Toronto, Assistant Professor, University of Toronto, and Cofounder – Workplace Insight Ltd, a training company.

Since Dr. Bender’s remarks fall naturally into three areas, bh is offering them in a series of three articles: 

Part I: Prevention  – Understanding the Issues.

Part II: Intervention – Providing Help in the Workplace.

Part III: Recovery – Returning to Work.

These articles will appear here and in the next two e-news issues.  You are encouraged to share them widely, within your organization and beyond.

Part I: Prevention  – Understanding the Issues

bh: What is involved in Prevention?

AB: I look at responses to mental health issues in the workplace using a three-stage model of

Occupational Mental Health Intervention  that begins with Prevention. Within that model, Prevention  includes Leadership, Policy, Education, Training and Resources. Here, I will focus broadly on the issues that shape the context in which preventive activities must occur.

bh:  What are the key mental health issues associated with depression?

AB: If you look at how common or prevalent mental health issues are in the workplace, depressive disorders are certainly the most common and impactful. Why? Some of the key issues that account for its impact include:

• • Early Onset: Depressive disorders often onset in the late teens and early 20s, in contrast to diseases like cancer, diabetes, for example, that begin later in life. It is, therefore, an especially significant issue for organizations with a younger workforce. Persistent high job stress also increases the risk for developing a depressive disorder in all ages.

• • Recurrence: An individual may have multiple experiences of depressive disorders.

• • Chronic Nature: In some individuals, a depressive disorder is chronic and may never be in remission.

• • Co-occurrence: Depressive disorders can occur in the context of physical illness and other mental health problems. Anxiety can reduce the ability to cope with stress, and can be a root cause of substance abuse, for example when alcohol or drugs are used as self-medication. Often the co-occurring condition is treated but the depression is not. As a result, an employee may return from long term disability (LTD) with the physical illness under control but the depression remains undetected.

• • Fatality: Depression can ultimately lead to suicide. For example, research shows that suicide occurs more often in bad economic times. According to one study, approximately 10,000 more Europeans and Americans took their own lives between 2007 and 2010 than in the good economic times of the previous years. And yet, most workplaces are unprepared to help employees struggling with suicide or to provide support to colleagues whose co-worker has died from suicide.

bh: What is the role of the workplace in responding to depressive disorders?

AB:  In spite of the complexity of mental health issues, the workplace must respond. Failure to respond is not an option. Under modern laws, employers must look at all aspects of an employee’s situation.  Human rights legislation protects people with mental health issues from discrimination and harassment under the ground of disability. Employment laws oblige employers to accommodate disabled or impaired workers, unless they can prove that an accommodation is an “undue burden," which is increasingly more difficult to establish.

The relationship between employees and their workplace is also complex. Much depends on individual employees, including their willingness to seek help and to take responsibility for their progress to recovery. As for the workplace, its role is often contradictory and is different in each individual case. On the one hand, the workplace can be a cause of stress; on the other, it is a source of support. When that support includes absence from the workplace on LTD, an employee may be removed from stressors but at the same time, may miss the support the workplace also provides through its structure, routine, and opportunities to interact with colleagues. Employees who are away on LTD may become concerned about the loss of opportunities and wages.

For all of these reasons, managers must look at each employee’s situation individually and respond in ways that are appropriate to that situation. To respond effectively, managers need training – especially in communication skills to transfer information and build trust – so that they can ensure that the employee gets not only the most appropriate type of help but also a return to work (RTW) plan that promotes recovery and prevents relapse.  In so doing, managers must respond in ways that meet the goals of both the organization and the employee.

In Summary

Four themes from our interview with Dr Bender are introduced here:

• • Mental health issues, especially depressive disorders, have a major impact on the workplace.

• • The process of recovery involves reciprocal responsibilities – for employers and employees.

• • The foundation of recovery is a relationship of trust.

• • Attention to depressive disorders is cyclic and moves from Prevention, through Intervention, to Recovery which includes a re-focus on the Prevention of Relapse.

In Part II, Dr Bender will comment on Intervention. Watch for it in December!