When an employee becomes mentally ill, where do the employer’s responsibilities begin and end? And what role does the employee play in achieving a successful recovery?

The fourth annual Mental Health Summit in Toronto—presented by Benefits Canada and held at the Sutton Place Hotel on Nov. 10, 2011—sought to address these challenging questions head-on. The theme of this year’s event was Empowering Employees to Take Action.

Presenters uncovered alarming statistics about mental illness in the workplace, shared feedback from employee surveys, presented findings from pilot projects, and outlined cost-effective strategies and tools that employers can use to support their employees through mental illness and facilitate their return to work.

The following report summarizes the presentations and highlights the key themes and top-level insights that emerged from the event.

Stand Up for Mental Health: Using humour to fight stigma
Keynote speaker David Granirer, a Vancouver counsellor and stand-up comic living with depression, gave a rousing description of the Stand Up for Mental Health (SMH) program he founded in 2004. The program consists of stand-up comedy classes and performance opportunities for people with mental illnesses, including schizophrenia. From its modest origins in Vancouver, SMH has now spread to cities across North America and has earned Granirer national acclaim.

Not one to mince words, Granirer began his talk by disclosing his own battle with depression. “When you have a mental illness, one of the biggest barriers is shame,” he admitted, “and shame thrives on secrecy.” Decrying the stigma that still surrounds mental illness, Granirer said he looks forward to the day when “someone at the water cooler can say, ‘You know, the voices in my head are a bit loud today’ and would get the same response as if he’d said, ‘I’ve got a headache. Can I have a Tylenol?’”

Granirer described the SMH program as experiential and immersive, with a minimum of didactic instruction. “I like to get [participants] up in front of the mic right away, so they know it’s okay to take that risk,” he explained. Within three months, his students perform in front of other people. “I don’t censor any of their material—except standard stuff like racism, homophobia, sexism or swearing.”

When he first launched the program, naysayers predicted it would fall flat because his students, being mentally ill, were “unreliable” and wouldn’t show up to class. “Not only did they show up, but they wanted to increase the frequency of the classes,” Granirer said. “And some of them turned out to have real talent, which had never been nurtured.”

Throughout his presentation, Granirer showed several video clips of his students performing. Some of them looked at ease, some looked a little nervous; some had impeccable timing, a couple were a split second off—but every one of them appeared happy and engaged.

According to Granirer, the program helps people with mental illness see themselves in entirely new ways. “They suddenly feel like they have a skill and a use to society, whereas they used to feel worthless,” he said. Even their traumatic pasts now serve a purpose: “The more screwed up you are, the better your comedy is going to be.”

Granirer described the people who take the program as “a group of underdogs who set out to achieve something they were not supposed to do.” As they gain confidence and skill, their self-esteem soars, he said. “Self-esteem rests on two pillars: social support and mastery of something difficult. The program provides both.”

Living and working with mood disorders
In this era of increased openness, depressed people still feel shame about their disease. Dr. Lawrence Martin would like to see such feelings come to an end.

A psychiatrist who heads the Mood and Anxiety Disorders Program at St. Joseph’s Hospital/McMaster University in Hamilton, Ont., Martin cautioned against confusing the disorder with simple sadness. Along with impaired mood, symptoms include decreased concentration, impaired memory, poor sleep and altered eating patterns, he explained. What’s more, “the rates of cardiac disease are substantially higher in depressed individuals.”

A major cause of absenteeism and presenteeism at work, depression often plays out as irritability and erratic performance, said Martin. “If someone has become difficult at work, there’s a reasonably good chance they’re not just overworked but also depressed.”

According to Martin, the goal of modern treatment for depression is complete symptom remission, which, from an employer’s perspective, translates to “cognitive and functional restoration.” Noting that “no one shoe fits all,” Martin described the treatment options for depression as follows:

  • Antidepressant medication or herbal alternatives such as St. John’s wort: Because response to medications varies widely, some patients may need to try a few different drugs before finding one—or a combination—that works.
  • Psychotherapy: There are various forms, including cognitive behavioural therapy (CBT), interpersonal therapy and behavioural activation therapy.
  • Exercise: Two to three hours per week can be as effective as other therapies.
  • Electroconvulsive therapy (viewed as a last resort).
  • Bright light therapy.

While antidepressants can work wonders in some people, they won’t work as a stand-alone therapy for about half of patients. The curative powers of psychotherapy, meanwhile, rest on the duration of treatment. CBT requires 12 to 16 sessions to take effect, whereas employees often receive coverage (through an employee assistance program) for just four or five sessions, said Martin. “There’s no point wasting money on half measures.”

Martin listed employers’ responsibilities toward depressed individuals as access to a variety of medications and psychotherapy, return-to-work measures and workplace accommodations. “For individuals who have been depressed, return to work needs to be gradual,” he maintained. “Patients are battling shame, and the most difficult day for them is the first day back at work.”

What about actually preventing depression in the first place? Here’s where the employer can play a key role, said Martin, noting that “the most effective preventive measure is helping employees manage stress.”

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