By Mark Raderstorf, MA

Principal
Raderstorf Associates

By Katie Connell, PhD

Director of Forensic Services
PsyBar

Most employers have seen their employees, managers, and whole departments struggle when mental health issues strike or linger. Employers often feel at a loss for how to best address mental health issues in the workplace and assist struggling employees. Perhaps you have had an experience with an employee similar to cases seen at PsyBar. Details have been changed to preserve confidentiality.

Imagine John, a 28-year-old, bright, enthusiastic, and efficient employee in your information technology (IT) department who manages security of the organization’s financial documents. He is creative and recognized as a leader. However, lately his mood has been sullen, he has not been meeting deadlines, and he is frequently absent. His manager has attempted to speak with him about his performance, but John has offered no explanation. His behavior continues, and the morale of the department declines.

Another IT employee has shared with management one of John’s Facebook posts, which states, “Life is too tough without her and I don’t want to go on. Looking for an escape…” Management expresses concern to John, and he becomes emotional but denies writing the post. Management is concerned for John’s safety and his ability to do his job, and he is required to undergo a fitness for duty (FFD) examination. The examination recommends that John undergo counseling for a few weeks before he can safely return to work. John completes his counseling and returns to work. The employer has no plan of how to support John or his manager or deal with the morale of the department. The situation remains volatile, and the HR manager calls the mental health provider and asks what they should do now.

Now imagine Mary, a 48-year-old, above-average, dedicated, diligent manufacturing employee of 18 years. In her key coordinator role, a mistake can cause an incorrect product to be produced or create a backlog in the manufacturing process. Mary was recently involved in a car accident and experienced momentary loss of consciousness along with numerous bruises and lacerations. She required a three-day hospital stay. Two weeks after the car accident, she sees her primary care physician and is eager to return to work; she denies cognitive problems, despite family members’ observations to the contrary. She is released to return to work (RTW) on a part-time basis for four hours a day.

Mary returns to work with enthusiasm and relief, but within a few weeks, her coworkers notice that she is a bit off with her number projections. She is also irritable and impatient. Her manager addresses these concerns, but Mary becomes defensive and angry. She rebuffs her manager’s suggestion that she pursue help through the employee assistance program (EAP). Mary’s performance does not improve significantly, and she is becoming worried that she will lose her job. The morale in Mary’s department has reached an all-time low, and even her supervisor is considering changing her job because of the stress of managing Mary. The human resources (HR) manager calls the provider and asks what she should do.

Do these cases sound familiar? It is not uncommon to see these types of scenarios play out with well-meaning employers and a worried, dedicated employee. What could these employers have done differently to avoid a negative impact on the productivity of the company, ensure a safe work environment, and support a dedicated employee? Below are some key recommendations that have emerged based on our extensive experience helping employers manage cognitive and mental health issues in the workplace.

Develop a wellness culture from the start. Clear mental health policies are a must.

The World Health Organization advises that developing a well-designed mental health policy is the first step to addressing mental wellness in any organization. There is an abundance of data to demonstrate the link between poor mental health and reduced productivity and increased costs. Strategies to implement the policy, along with buy-in from top leadership, is critical to sustainability and promoting mental wellness.

Providing readily-available resources and educating employees about these resources before crisis strikes is key. Your fitness for duty procedures are also an important component of a mental health policy. Many employers do not consider a fitness for duty policy until they are in the midst of a volatile situation. Having the policy in place before the need arises allows all personnel to understand this is a resource available to help ensure employees are able to safely perform essential job tasks.

Act boldly early on. Don’t wait to address issues.

Often we find that an employer will refer an employee for a FFD examination when it is too late in the accommodation process. Sometimes FFD examinations will occur as a last step before an employer is preparing to terminate. By that time, an acrimonious relationship usually has developed between the employee, the manager, and HR. A lack of trust has emerged on both sides, and attorneys become part of the RTW equation. Once attorneys become prominent players, the situation can become very expensive on multiple fronts. Stay in tune with your employees, especially after unexpected, potentially life-changing accidents or events. Share your performance concerns in an objective and frank manner. Don’t whitewash or coddle in giving feedback. Acting early to address issues can often prevent the situation from escalating, and at the same time, show support for the employee and reassure other employees. If you determine an FFD examination is appropriate, don’t wait to do this as a last resort before termination. Act early!

Help managers identify markers of poor mental health and learn effective communication strategies.

Behavioral health conditions can wax and wane; that is the nature of psychiatric illness. Many people are uncomfortable around co-workers who have mental health issues and shy away rather than acting in a supportive and candid manner. Secure expert training for your managers so they know the signs of mental ill-health and how to best address mental health issues. Encourage your managers to be observant and stay connected with employees.

Particular areas to pay attention to include: increased absences/tardiness, marked change in mood that persists, increased irritability in communicating with other employees, withdrawal or less social engagement, and rigidity in thought processes. A good manager knows the moods and personalities of employees. If an employee is off-kilter, the manager should address this not in an accusatory way but as an observation. Approach the employee early on about your concerns with compassion and support, not with a disciplinary stick; focus on successful work performance. Managerial communication should always have the intent to be supportive with a shared goal of effective job performance.

Be collaborative and inclusive in your approach.

Managing an employee with a mental health condition should not fall on the shoulders of one individual. The optimum strategy for success involves multiple individuals including the employee, co-workers, health professionals, HR, and supervisors. Confidentiality issues need to be respected. Self-disclosure on the part of an employee is an individual’s decision, but if there is a supportive and trusting relationship between the employee and the supervisor, information regarding an individual’s medical condition may flow more freely. A team effort will convey to the employee that everyone is supportive of a plan for success.

Don’t expect your employees’ treatment providers to have all the answers.

One common mistake is the well-intentioned HR department or manager deferring to an employee’s treating physician regarding restrictions and readiness to return to work. Often, physicians are ill-equipped to handle RTW matters. Physicians undergo very little training on managing disability-related medical conditions. It is not unusual to see a physician merely report what their patient desires, without an objective assessment regarding their capabilities or a real understanding of their job requirements.

If you receive recommendations from a treating physician that are unreasonable, then put on your collaborative hat. Attempt to obtain written permission from the employee so you can speak to the treating physician. Have a dialogue with the treating physician with the intent of crafting an RTW plan that everyone can support, but always remember that treating physicians are not experts in this area. There also may be situations where a physician recommends lower productivity as a way to support a successful transition to work. Be cautious as to how you respond to this request, as lowering job productivity standards can lead to a bad precedent. Lowering job expectations should be done only on a temporary basis, with clear guidelines on when a return to full duties is expected.

Ask for help.

Consider a job coach. Have resources outside of the company ready to engage and support the stay-at-work/RTW process. In addition to EAP counselors and FFD resources, a mental health job coach can be a tremendous asset in addressing accommodation issues and providing support to the employee and management. This job coach is typically not part of your traditional EAP services. This is a skilled mental health professional who has an understanding of mental health diagnosis and treatment as well as workplace accommodation issues.

The job coach can support and guide the employee through the stresses of the RTW process. With proper authorization, the job coach can also keep the treating physician informed of the employee’s process. At the same time, the job coach can advise management about realistic ways to communicate with and support the employee.

Conclusion

Utilizing these principles will help you as an employer to step up and face behavioral issues head on. As you strive to develop best practices in managing employees with mental health issues, remember to create a culture of mental wellness from the start. Don’t wait; address performance issues early on with compassion and support. Develop a team approach that includes the employee’s physician as a resource for the team, but not as the driving decision maker. Consider utilizing a skilled professional job coach who can assist both the employee and employer in managing mental health issues, preserving relationships and keeping a valued employee functioning well in the workplace.