Sound of Silence

Karen Liberman of the Mood Disorders Association of Ontario speaks frankly on the prevalence of mental illness, why we need to talk about it and what employers can do to help.

How common are mood disorders?
They affect one in five [people] around the world. The irony is that by and large, these illnesses—depression, anxiety, bipolar disorder—affect people in their prime working years. Depression will affect one in 10 and twice as many women as men; anxiety, one in eight. And bipolar disorder affects one in 40. We’re not talking about some rare tropical disease.

What role does the Mood Disorders Association of Ontario (MDAO) play for employers and employees?
We see our role as early on in the continuum of mental health, before we can deal with disability management, return to work and accommodation. We can help a company do a Check Your Mental Health week. We have Checkupfromtheneckup.ca and it’s free. Employers can also offer support through employee assistance programs (EAPs). They can take advantage of our capacity to educate them. We have a program called Changing Minds. It’s our effort to educate employers and employees—to raise awareness, to face down the stigma. In the workplace, we’re not even talking about these issues.

Because of the stigma associated with mental illness?
For so long, this issue has been whispered about—not just in the workplace [but] in families. We didn’t talk about Aunt Mary or Uncle Harold. If we did, we talked in whispered tones. There’s lots of subtle but very pervasive bias and prejudice. Companies are getting increasingly used to prevention and early intervention. They’re doing it for diabetes, obesity and cardiovascular disease. Why does it stop at the neck?

What about cultural barriers?
Depression, anxiety, bipolar disorder are equal-opportunity afflictions. They are not a North American conceit; they happen all over the world. The World Health Organization has predicted that next year, depression will be the second greatest cause of disability worldwide.

We do know that in some cultures, the incidence is the same, but it is even more difficult to break through the societal stigma. And there are some cultures in which it’s just not accepted as something that happens to people. So if it’s not accepted, how do you get help?

We know that many cultures in Canada are under enormous stress. People arriving here from war-torn countries, families torn apart, dislocation, stress—is it any wonder why people struggle?

What signs and symptoms should managers watch for?
In the workplace, you see changes in performance—and the operative word is change. You see people who have been reliable, valuable employees and then something starts to change. They don’t seem to have any energy. They’re not focusing. They’re not working well with their co-workers. They’re absent more often.

When managers notice this behaviour change, what should they do about it?
We’re not asking managers to be psychologists. We’re asking them to do what they’re paid to do: get the best performance out of their team. Reflect as to whether there might be something else at play here besides the performance issue. Be aware of the resources that are available to employees. Check your own biases and prejudices. Set up a time to meet [with the employee]. Set a tone of concern and compassion, and resist the temptation to jump in with ‘What’s wrong with you?’

Is there a link between current HR issues such as layoffs or restructuring and mental health issues?
It’s hard to say. One would suppose that there would be more anxiety; I couldn’t tell you if there are more visits to doctor’s offices. We [the MDAO] are always busy. Mood disorders just don’t take a holiday.

You mentioned EAPs and Checkupfromtheneckup.ca. What other resources are available for employers and employees?
We’ve got wonderful fact sheets that we can PDF and send along. We help to produce a guide called Mental Illness at Work: A Go-to Guide for Managers. That’s got a lot of hard copy and Web-based resources. There’s a program out of B.C. called Antidepressant Skills at Work. It’s geared to employees, but there are some very good resources there. Canadian Mental Health Association Ontario has Mental Health Works, which tends to pick up where we leave off in terms of the more in-depth consultation.

Companies are getting increasingly used to prevention and early intervention. They’re doing it for diabetes, obesity and cardiovascular disease—why does it stop at our neck? It’s like our heads aren’t attached to the rest of our bodies. We’re very keen, as employers, in making sure that our people are physically healthy, yet somehow mental health will just take care of itself. It doesn’t make sense when we’re talking about something that’s far more prevalent than diabetes, far more prevalent than cancer. Why aren’t we paying attention?

Watson Wyatt had a survey that indicated that more half of the employers surveyed view mental health claims as a top concern, but only 31% have plans in place. Thirty-five percent have return-to-work processes. Only 27% have a mental health assessment tool—and here we’re giving it to them for free!

How can employers integrate support for mental illness into their HR policies and practices?
When I say ‘accommodation,’ people can recite me line and verse about back injury and the right seats and wheelchair ramps. [But] what kind of accommodations are going to be made for [an employee] coming back from stress leave? If you ask people what they need, it doesn’t cost nearly as much money as retrofitting the entrance to your building. How about [coming in a] little bit later in the morning, because mornings are often difficult for those with mental illness? More access to water because of dry mouth [due to] the medications? We’re not talking about turning a workplace upside down. These things are, in the realm of accommodation, pretty easy.

Are there other countries that Canada could look to for ideas on improving mental health in the workplace?
Australia, New Zealand, the U.K., Scotland—they have just done so much in [terms of] general public awareness, education, anti-stigma work. They’ve spent billions of dollars in helping to educate people like you and me. Whether they’re more advanced in their workplace practices, I’m not sure. I can’t help but think that when the public is more open, there’s going to be some spillover into the workplace.

What one message would you like to get across to employers?
Do not ignore this—the loss in human lives, the human suffering. It’s your bottom line, claims and productivity. Step up to the plate and talk about it. We have to end the silence.

This interview is an extended version of View Point, published in the July 2009 issue of Benefits Canada and available online at: www.benefitscanada.com/issuearchive/july2009

Brooke Smith is associate editor of Benefits Canada.
brooke.smith@rci.rogers.com

> click here for a PDF version of this article