© Copyright 2006 Rogers Publishing Ltd. The following article first appeared in the July 2006 edition of BENEFITS CANADA magazine.
Sad company
Managers need to be able to identify—and intercept— their employees’ distress signals. Under new guidelines, they have an integral role in managing mental health in the workplace.
By Alison MacAlpine

An employee running late for his first day of work at VanCity, a network of credit unions headquartered in Vancouver, was flustered and anxious as he approached his branch manager. Every minute he had spent stuck in traffic had raised his stress level until it was almost unbearable. His new supervisor gave him a once-over, frowned, and said, “You must be sweating bullets.” And then, unexpectedly, he laughed. The humour defused the situation.

It’s that type of approach that led VanCity to win the American Psychiatric Association’s Healthy Workplace Award in 2004. The company has also been named the number one place to work in Canada by Canadian Business Magazine and the Great Place to Work Institute of Canada this past spring.

Plan sponsors across the country are becoming more aware of the pivotal role frontline supervisors can play in promoting mental health and managing mental disorders and addiction in the workplace. Supervisors can easily create a safe—or toxic—atmosphere for their staff members. And because they are often in the best position to detect the early symptoms of an emerging problem, frontline managers can be trained to respond and provide referrals to employee assistance programs (EAPs)and medical professionals. Without question, they are also key players in successful return-to-work initiatives.

Yet Dr. Graham Lowe, founder and president of Graham Lowe Group Inc. in Kelowna, B.C., says supervisors are not well-equipped to deliver on their potential. When Lowe’s organization partnered with EKOS Research Associates to conduct a national study of 2,000 workers and 600 employers in Canada in 2004 and 2005, they discovered that only about half of employers give a high priority to developing supervisors’ people skills, with nearly four in 10 providing no training whatsoever in this area in the previous fiscal year. Meanwhile, just one in five employees rated their supervisor as effective or very effective in helping them achieve work-life balance—while one in three supervisors agreed or strongly agreed that they need more training in order to be effective managers.

There’s clearly a tremendous opportunity for employers to provide additional support to supervisors on the front line so they are trained and motivated to nurture a mentally healthy workplace. The question for many plan sponsors is, where do I start?

Bill Wilkerson, co-founder and chief executive officer of the Global Business and Economic Roundtable on Addiction and Mental Health, headquartered in Toronto, says that a plan sponsor’s first step must be to conduct an audit to assess their current disability experience when it comes to mental disorders. He suggests in the Roundtable’s 2006 Business and Economic Plan for Mental Health and Productivity that CEOs, CFOs and department heads examine existing disability rates, why some cases have lingered, patterns of return to work and the incidence of long-term disability.

“The business case for mental health is made,” he adds. “Employers are certainly aware in great numbers of the predominance of depression, mostly, as a source of disability leave and salary continuance, and secondly the prevalence of antidepressant use in their group drug plans. Plan sponsors need to get a clearer understanding of what to do about this without resorting to a wrong-headed approach—that is, reducing eligibility for benefits.”

One right-headed approach, according to Wilkerson, is to dedicate resources to improving early detection and appropriate intervention among frontline supervisors. The good news, says Ramona Steacy, a senior consultant at Watson Wyatt Canada in Toronto, is that in many cases, employers don’t have to start from scratch.

“Most organizations, especially the Fortune 500 companies that we deal with, have sophisticated systems for their occupational injuries, and frontline managers have clear guidelines about what they should ask and what they shouldn’t, and what the staff person’s functional abilities are for returning to work,” she says. That existing structure, she argues, is a good starting point for a comprehensive mental health disability management program that includes training for supervisors.

That said, some companies simply aren’t in what Sue Reibel, vice-president of Group Life and Disability at Manulife Financial in Waterloo, Ont., calls a “state of readiness” to step up to the challenge and start improving the way mental disorders are handled within an organization. “You have to have a champion within the company that works alongside the insurer to make this work,” she says.

Wilkerson believes that many people in managerial positions already have the common sense and innate empathy required to approach employees who may be experiencing difficulties “privately, quietly, without asking probing questions, and in a non-judgmental way.” However, what they need to add to this, he says, is an understanding that they have a significant accountability for promoting and maintaining mental health in the workplace, and that this important role is something they can learn and perform as part of their management function.

Wilkerson’s 2006 Business and Economic Plan (available at www.mentalhealthroundtable.ca)and a Conference Board of Canada brochure entitled What You Need to Know About Mental Health: A Tool for Managers(available in the e- Library at www.conferenceboard.ca)are two readily accessible resources that can help plan sponsors begin to communicate these messages. The first document makes a clear case for the need for programs to address mental health in the workplace and provides guidance for supervisors, including important questions they should ask of their organization to define their mental health management responsibilities.

The Conference Board of Canada brochure, for its part, outlines the workplace costs of mental disorders and describes specific strategies managers can use to:
• prevent issues by building a healthy environment for employees;
• recognize the signs and symptoms of an emerging problem;
• guide staff members towards the help they need; and
• engage themselves in the return-to- work process.

Building on this universal information, Reibel says companies need to design customized education programs that take into account “what makes an organization tick and where the stressors are coming from.” Each company needs to establish its own benchmarks, based on current employee satisfaction, productivity, short-term and longterm disability and drug utilization rates, she says. Reibel also emphasizes that before supervisors are advised to intervene, sponsors must ensure the necessary external support structures are in place—from EAPs to constructive doctor-insurerpatient relationships.

Frontline supervisors have told Steacy that one of the reasons they are reluctant to approach staff members who appear distressed is a fear of what the employee will tell them and a lack of confidence in their ability to respond appropriately. To confront this issue, Steacy leads roleplaying workshops so supervisors can practice potential conversations and prepare for the “worst case scenario:” the reactions of employees that might take them off guard.

And if hesitation is one barrier plan sponsors must help supervisors overcome, too much enthusiasm may be another. Any training program must clearly identify at what point a supervisor may be stepping over the line, says Robert Wilson, president of Wilson Banwell in Vancouver.

“We emphasize that middle managers not become diagnosticians,” he insists, “but that they at least become aware of the fact that causes of some work performance problems can be related to personal issues and personal distress. And that there are a variety of ways to detect that this may be part of the process that’s occurring, and how they then can refer them on to proper resources where they can get the care they need.”

Wilson says the key is for supervisors to focus on workplace evidence: in the form of performance issues, absenteeism and presenteeism—not rumour or innuendo.

Incentives are always important when you’re implementing a program that hopes to change behaviour, and frontline supervisor training is no exception.

“Most managers I’ve run into, and most managers I’ve worked with, including me in past lives, look at disability management as something that is not their responsibility at all, and they treat the person out of sight, out of mind, and turn disability management over to the so-called professionals,” says Wilkerson. “One of the good audits that should be routinely done in companies is the disability rates in individual departments, plants, factories, worksites and companies. That will tell you an awful lot about the protectiveness of the management in place at that location.”

If supervisors are doing a good job, Wilkerson advises, reward them— perhaps with a financial incentive such as a mental health bonus. The expense will pale in comparison to the skyrocketing costs of caring for people whose mental disorder escalates.

Of course, no amount of frontline supervisor training is going to eliminate mental disorders and addiction from the workplace—or shield your organization completely. However, as the staff at VanCity have discovered, the intangible benefits are just as important.

Building a mentally healthy workplace

The Provincial Health Services Authority(PHSA)in British Columbia has developed a four-phase plan, informed by research and best practice, to improve the way it addresses mental disorders and addiction among employees. Implementation started at the beginning of this fiscal year, in March 2006, and programs will be rolled out in stages over the next several years.

1. Organizational culture
To create an environment of respect and two-way communication, the PHSA is establishing people-centred policies, delivering management and leadership training among executive directors and managers, and conducting an employee health survey with the goal of developing an organizational health profile.

2. Primary prevention
In the area of primary prevention, staff will receive internally and externally produced communication materials, tools and education sessions related to mental health. This phase will also see resilience training workshops for executive directors and managers, and the formation of a workplace mental health working group to engage staff at all levels of the organization.

3. Secondary prevention
To support employees who are experiencing mild symptoms related to mental health, the PHSA will develop a workplace self-care manual, complemented by an organization-wide early intervention program. Also being considered for future implementation are depression screening for highrisk cases and periodic health monitoring for high-risk occupational groups.

4. Tertiary prevention
For people with more serious disorders, the organization will develop comprehensive return-to- work processes and relapse prevention strategies, to be implemented starting next fiscal year. “Dealing with workplace mental health and addictions is a journey. There’s not a quick fix,” emphasizes Peter Coleridge, senior advisor of B.C. Mental Health and Addiction Services, a PHSA agency in Coquitlam, B.C. “The focus here is really about improving understanding of mental health and addiction programs in the workplace, trying to reduce the stigma, and ensuring employees understand why we’re doing this as part of a healthy workplace strategy.”

Break the cycle

Excerpted from the Global Business and Economic Roundtable on Addiction and Mental Health’s 2006 Business and Economic Plan for Mental Health and Productivity.

1. Strike up a conversation.
“Jack, we value you here but we need to discuss some aspects of your performance lately. But I’d like you to consider something first. I’ve noticed, Jack, that you seem to be under a lot of pressure. We all go through that from time to time; and sometimes, it takes a toll. Would you care to take a bit of time to talk to our EAP people? I would certainly support you doing that and we can talk about the job later.”

2. Use your body language strategically.
• Sit, don’t stand; avoid a desk between you;
• Managers should make eye contact, but don’t stare or glare;
• Look away easily from time to time, then return back to the subject; and
• Don’t lean back in your chair: stay in a relaxed neutral position or lean forward a bit just to make the conversation seem more personal.

3. It’s all about the delivery.
• Get to the point quickly, no big lead-up;
• The construct of your statements should be a series of brief, short sentences and transitional phrases. This allows you to pause and yet complete the message in a single thought.

4. Take an empathetic tone.
Balance genuine concern, empathy and clarity.

5. Be a good listener.
Patience breeds listening and listening breeds patience; take an interest in the employee’s viewpoint and/or feelings. Give them the gift of listening.

6. Be clear on future steps.
Don’t end the conversation in a fog. If need be, adjourn and make an appointment to talk again. Give the employee time to think about things but don’t end the meeting on a vague basis. Establish, exactly, what the next steps are.

Alison MacAlpine is a freelance writer in Toronto. alison@amcommunications.ca