For Dr. Stanley Dermer, chief psychiatrist for S.W. Dermer & Associates, mental health in the workplace is associated with two metaphors: an elephant and an iceberg.

The elephant is highly visible and has a large cost, he said, speaking last week at the Employee Assistance Program Association of Toronto’s session on workplace mental health. It’s also the “elephant in the room,” he continued, that forces us to remain silent about absenteeism due to mental health conditions.

Then there’s the iceberg. It’s menacing and mesmerizing, and the threat lies beneath—that’s presenteeism, said Dermer. “We’re going to hear a lot more about presenteeism, which represents the group of employees with mental health problems who continue to work but lack productivity.”

Cost and productivity
About 10% of workers have a mental health condition, and mental health issues represent one-third of all short-term disability (STD) and long-term disability (LTD) claims. They also account for 70% of STD and LTD costs.

According to the Global Business and Economic Roundtable on Addiction and Mental Health, productivity-wise, mental health’s annual toll on Canada is C$50 billion; that’s 4% of GDP, which is equivalent to the output of the mining, oil and gas industries combined, Dermer said.

In terms of cost, presenteeism costs a company about four times more than absenteeism. And, in terms of physical health claims, a physical claim of respiratory disease, for example, lasts 11 days and costs $3,000, whereas a mental health claim can last 65 days and cost $18,000, on average, according to an article in the July 2010 issue of the Journal of Occupational and Environmental Medicine.

By not managing mental health cases properly, there is financial risk to both the employee and the employer, and, from a legal perspective, there are issues of human rights, said Dermer. But evaluation of risks is frequently done through an independent medical examination (IME). However this may not be the ideal route, said Dermer.

The IME is a snapshot in time, Dermer explained, adding that there is little input or information from the workplace or community health providers and that employees typically participate involuntarily.

The union, HR, the employee assistance program, administration, managers—most of these stakeholders should be involved in a mental health case, he said. “When people work together, when you have collaboration, it’s incredible how powerful it is in moving things forward.”

Dermer said he would like to see more collaborative disability management, which would include the following:

  • an emphasis on clarifying the diagnosis and the barriers;
  • facilitation of treatment toward a return to work;
  • early access to treatment; and
  • voluntary participation from the employee.

Dermer would also love to see two changes to the current mental health system. The first is downstream—inserting a psychiatrist into the workplace as a consultant. “You need that kind of firepower,” he said, adding that a psychiatrist in an office removed from the workplace may not be as helpful when it comes to assessing the workplace environment.

The second is upstream. Arm your managers, he said. They are vulnerable and have the least amount of information.

Dr. Dermer and two other colleagues—Dr. Ash Bender and Dr. Anthony Levinson—developed an interactive computer-based training program to assist managers in coping with mental health issues in the workplace (

Copyright © 2020 Transcontinental Media G.P. Originally published on

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