Tag Archives: ptsd

Impact of PTSD on Workers’ Comp Costs

Mental health disorders have emerged as a potentially significant factor in workers’ compensation. This article focuses on potential impacts that post-traumatic stress disorder (PTSD), a mental health condition that some people develop after they experience a shocking, scary, or dangerous event, may have on WC system costs.

In recent years, there has been an increase in legislative activity across the country to broaden or establish eligibility for WC benefits for PTSD. The momentum of such measures has grown, and could be accelerated somewhat, given the spotlight the COVID-19 pandemic has cast on the potential for workers to contract PTSD from their employment—particularly in the healthcare field. In this paper, we review examples of WC benefit eligibility criteria for PTSD, available data and the potential impact of PTSD on overall WC costs, including possible effects stemming from the pandemic and other stressors.

How Do WC Benefit Eligibility Criteria for PTSD Vary by State?

There is much variation in WC benefit eligibility requirements for PTSD between states. The first question we reviewed is whether PTSD—without a corresponding physical injury—is explicitly addressed as being a compensable injury or occupational disease under WC statutes.

  • Statutes may generally address WC for a mental injury or illness in a variety of ways, explicitly exclude mental injuries not accompanied by physical injuries (a mental injury or disability that arises without a physical injury is also known as a “mental-mental” injury) or limit mental-mental injuries to certain situations such as crimes of violence.
  • If PTSD is compensable as a covered injury or occupational disease under a state’s WC statutes, it may be compensable for all occupations or only for some subset of occupations such as “first responders” (e.g., law enforcement officers, firefighters and emergency medical technicians).
  • In the case of first responders, statutes typically reference the PTSD subset of mental injuries.

If a state provides WC benefits for PTSD without a physical injury, what conditions need to be satisfied for it to be a compensable claim?

  • Must the condition result from a specific incident, or can it arise over time as a result of cumulative exposure to several events? (When the condition is brought about by repeated traumatic events, it may also be referred to as continuous traumatic stress disorder, or CTSD.)
  • Must the nature of the traumatic event preceding the PTSD be extraordinary in relation to the average worker’s job experiences, or in relation to other employees in the same occupation?
  • What is the burden of proof required to establish eligibility for WC benefits? For example, must PTSD be proven with clear and convincing evidence or with a preponderance of evidence? Is PTSD associated with a presumption that it arose out of and in the course and scope of employment?
  • What type of healthcare professional may make the diagnosis, and what standards can they use?

Some states have legislative proposals that consider establishing or expanding eligibility for WC benefits resulting from PTSD to first responders or a broader group of occupations. Some others have considered increasing coverage to all occupations under certain conditions. Several states where mental injuries may already be eligible for WC benefits have introduced legislation to provide a presumption that PTSD in first responders occurred in the course of employment.

In jurisdictions where NCCI provides ratemaking services, first responder classes only account for approximately 1.6% of privately insured costs, with most states ranging from 0.5% to 3.0%. Therefore, legislation focusing on first responders may have a relatively small impact on overall privately insured WC costs. But it may have a significant impact for the affected classifications. On the other hand, legislation affecting all classes could have a significant statewide impact.

What WC Data Is Available on PTSD?

WC data on PTSD is limited due to both the relative scarcity of PTSD claim data, in general, and limited data reporting for first responder employer groups. If legislation is enacted making PTSD more readily compensable under WC, the subsequently reported additional data could be used in future PTSD cost impact analyses. Until a significant volume of credible WC PTSD data becomes available, non-WC data may be leveraged.

What Are the Incidence Rates of PTSD?

We can get a general idea of PTSD frequency in the workplace by analyzing incidence rates from published PTSD studies and meta-studies of the general population, first responders, veterans and those in other occupations.

For the general population, a 2016 epidemiological study indicated that 6.1% of American adults experienced PTSD in their lifetime, while 4.7% had it as a condition during the most recent year. The presence of PTSD in the “most recent” year does not indicate when the event or events occurred that led to the condition. So, care must be taken if these prevalence rates are extrapolated to estimate annual WC claim frequency, which is the likelihood that a worker will file a PTSD claim in a particular year and that the claim is accepted.

See also: Workers Comp Trends for Technology in 2021

There have been numerous PTSD studies on first responders. One worldwide meta-analysis estimates a 10% average PTSD rate for first responders overall, where the average rates vary by occupation.

Care is needed when comparing the results of studies that were conducted in varying locations and time periods, and that use differing methods to identify and analyze the incidence of PTSD. Further, it is possible that reported mental illness from traumatic events in the workplace may be increasing relative to levels reflected in past studies.

What About the COVID-19 Pandemic?

While some employees have been working from home, many employees classified as “essential workers” have continued to work at their usual place of employment. This latter group may have faced a higher risk of contracting COVID-19 and possibly experienced more fears and anxiety about becoming infected themselves or infecting their loved ones. In particular, early data suggests that first responders and healthcare workers may have been disproportionately affected by COVID-19—accounting for almost 75% of all COVID-19 claims reported to NCCI as of year-end 2020. Some of these workers have provided direct care to people with the virus, often in overburdened areas. As a result, they may experience significant physical and psychological strain. For example, a sample of 571 frontline workers in the Rocky Mountain region surveyed between April and May 2020 showed 15% to 30% reported traumatic stress.

The myriad of issues faced by first responders and those on the front lines of the pandemic have been well-documented. For example, one writer opines: “Over the last year, there has been the psychological trauma of overworked intensive care doctors forced to ration care, the crushing sense of guilt for nurses who unknowingly infected patients or family members and the struggles of medical personnel who survived COVID-19 but are still hobbled by the fatigue and brain fog that hamper their ability to work.” Extended periods of stressful conditions resulting from the COVID-19 pandemic could mean that these workers may suffer trauma not necessarily from a specific extraordinary event, but perhaps from continuous stress.

Mental health was reported as a significant concern for healthcare workers before the COVID-19 pandemic, and COVID-19 appears to have increased the stress, with 37% reporting “mental health issues” in 2019 versus 41% in 2020. And 58% of healthcare workers say mental health issues have affected their work more since the COVID-19 pandemic began. If any resulting emotional impact persists, it could increase the prevalence of PTSD and CTSD among healthcare workers after the pandemic.

Some other workers, such as nursing home staff, have also disproportionately suffered from COVID-19-related stress. One survey taken between May and June 2020 revealed some of the same adverse conditions for these workers as noted above for healthcare workers.

At this writing, it remains to be seen how COVID-19 will affect the propensity to file PTSD claims in those states that have chosen or will choose to make PTSD or other mental-mental claims eligible for WC benefits.

What About Other Stressors?

The COVID-19 pandemic is an example of a potential large-scale stressor on the WC system because it may contribute to an influx of claims involving not only physical injuries but also mental trauma. However, this is not the only potential source of escalation in mental trauma claims. Other types of events could have similar impacts at a state or local level, such as shootings, natural disasters and domestic terrorism.

Events involving mass injuries or casualties could lead to spikes in reported PTSD cases, which would present a challenge when projecting future PTSD incidence rates.

Understanding How PTSD May Affect WC System Costs

In all situations, one must account for how state law treats physical-mental, mental-physical and mental-mental events when assessing their potential impact on WC system costs.

When analyzing how proposed PTSD legislation may affect a state’s WC system, one must first consider issues related to estimating the number of compensable claims, including:

  • Nuances in current and proposed WC statutes—What are the eligibility requirements, and how are they changing?
  • Studies of PTSD prevalence rates—Are the prevalence rates for the lifetime or a recent period? What were the exact occupations of the participants in these studies? What DSM (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) standard was used? Did the study use clinical reporting or self-reporting? If the latter, what cutoff point of scores was used to determine the presence of PTSD? Were the participants selected at random or by convenience? What was the sample size? When was the study conducted? What country did the participants live in?
  • Other factors that might cause actual claim frequency to be different than otherwise expected—Will frequency be lower due to any potential perceived stigma associated with reporting a mental injury claim? Conversely, will frequency be higher if there are financial incentives for being diagnosed with PTSD?

WC benefits available to workers with PTSD may vary significantly by state and by occupation. Considerations when estimating the average WC cost of a PTSD claim include:

  • Types of medical treatment provided—Beyond the cost of counseling sessions and primary care office visits, what medicines may be prescribed to sufferers of PTSD? What health issues may arise directly related to PTSD or related to the treatment provided, such as side effects of prescription drugs? Might there be cases of self-harm?
  • Temporary versus permanent disability—How might healthcare professionals determine when a worker has reached maximum medical improvement? How likely is it that a worker will be found to have a permanent total disability due to PTSD? How will benefits be determined in cases where the worker has a permanent partial disability? How will statutory time limitations affect expected costs?

See also: Addressing PTSD in the Workplace

Conclusion

Mental health conditions in the workplace are receiving greater attention, whether they arise from a single event or continual exposure to an unusually traumatic work environment. Many state legislatures have been considering establishing or expanding the eligibility for WC benefits to those suffering from work-related PTSD. And COVID-19 could intensify this trend.

To gauge the impact of PTSD claims by occupational group and on overall costs, one needs to estimate the number and average cost of such claims. Recognizing the scarcity of WC-specific PTSD claims data, a projection of the potential impact that PTSD claims may have on WC costs may result from analyzing available literature and incorporating key considerations. These considerations include the extrapolation of prevalence rates to estimate annual WC claim frequency and the applicability of historical studies to the current situation, given the locations, time periods and methodologies underlying such studies.

Addressing PTSD in the Workplace

The occurrence of school shootings, store robberies and job-related fatalities have all contributed to the increase in cases of post-traumatic stress syndrome (PTSD) in the workplace. This session at the RIMS 2019 Annual Conference and Exhibition discussed the need to address the issue on a broader basis.

Speakers included:

  • Dr. Teresa Bartlett, senior vice president, medical quality, Sedgwick
  • Denise Algire, director, risk initiatives, and national medical director, Albertsons
  • Dr. Steve Wiesner, on-the-job medical director, workers’ compensation service, Kaiser Permanente

Post-Traumatic Stress Disorder (PTSD) is a complex disorder that affects the memory and emotional responses of a person who has experienced or witnessed an event that involved actual or threatened death or serious injury. The worse the trauma, the more likely it is that a person will develop PTSD and the worse the symptoms. The most severely affected patients are unable to work, have trouble with relationships and have great difficulty parenting their children.

See also: The Need to Be Open on Mental Illness  

MRI and PET scans show changes in the way memories are stored in the brain for patients who suffer from PTSD. The disorder actually changes the portions of the brain that regulate the fight or flight response and the area where memories are coded and stored. Symptoms are generally grouped into three types: intrusive memories, increased anxiety and avoidance/numbing. Prognosis depends on the patient’s health prior to developing the disorder but is improved with early treatment, preferably within the first 12 months. Patients with PTSD are more likely to have amplified pain and stress reactivity when they are injured, leading to longer-tail claims.

Major life-threatening events that can lead to PTSD:

  • Combat or military exposure
  • Sexual or physical assault
  • Childhood sexual or physical abuse
  • Serious accidents, such as a car wreck
  • Terrorist attacks
  • Natural disasters, such as fire, tornado, hurricane, flood or earthquake

When PTSD occurs in the workplace, an employer’s program should address early intervention, specific functional limitations, treatment consistent with care and time away from work as part of the treatment plan. Clinical involvement early in the claim process is critical.

A successful employer program should include critical incident response as well as continuing guidance and counseling. Critical incident response gives the employee a chance to express feelings or reduce stress and gives management an opportunity to show concern for colleagues, both of which can help the employee re-acclimate when the person returns to work.

See also: How to Help Veterans on Mental Health  

There are many work accommodation considerations to take into account for employees suffering from PTSD. Modifying specific environments that trigger memories of the original stressor can be very helpful. For example, an employee who was present for an armed robbery could be transferred to a different location, if possible. Allowing work-at-home or flexible scheduling opportunities can also be effective, to allow the employee ample time for mental health treatment. There are an extraordinary number of other possible accommodations that may be needed, addressing alertness/concentration, decreased stamina, memory loss and stress intolerance. If an employer is committed to safely reintroducing the employee into the work environment, the employer will need a clear and actionable plan.

Fascinating Patent Filing by State Farm

Sometimes other drivers can make you crazy. Maybe you’ve gestured to boneheaded motorists, safe in the anonymity of your car and the flow of traffic. Perhaps you’ve let your anger at other drivers get the best of you at times because there’s no one else in the car to judge.

But State Farm is on the case. It has developed plans to monitor your every move while you’re driving, measure your emotions, detect angry behavior and deliver stimuli such as music to calm you down.

The plans, as revealed in a patent application, would combine biometric measurements with automotive data to create a “total impairment score” that could be used to set customized car insurance rates.

“Every year, many vehicle accidents are caused by impaired vehicle operation,” State Farm says in its application, recently filed with the U.S. Patent and Trademark Office. “One common kind of impaired vehicle operation is agitated, anxious or aggressive driving.”

Are you sweating, yelling or waving your arms while you drive? State Farm’s “emotion management system” would use a variety of sensors and cameras to monitor your biometrics, including:

  • Heart rate
  • Grip pressure on the steering wheel
  • Body temperature
  • Arm movement
  • Head direction and movement
  • Vocal amplitude and pattern
  • Respiration rate

The system could use “infrared optical brain imaging data” to get deeper inside your head. State Farm might even know if you’re giving the evil eye to another driver: Measurements include gaze direction and duration, eyelid opening and blink rate.

And impaired driving is not confined to angry and aggressive drivers. State Farm also would consider nervousness, distraction and drowsiness. Other sensors would keep track of your vehicle: Are you swerving, accelerating or driving too close to other objects?

[Compare car insurance quotes through NerdWallet’s Car Insurance Comparison Tool.]

Smell this and calm down

If you are “emotionally impaired” – as measured by State Farm, not your spouse – the patent-pending system would select and deliver stimuli to change your behavior. The patent application outlines a variety of options, including relaxing music, a recorded message, sounds of nature, fragrance or a blast of cold air. The system might even suggest you stop at a coffee shop or scenic overlook.

Robert Nemerovski, a licensed clinical psychologist in the San Francisco area and an expert on anger management and road rage, was skeptical about State Farm’s patent. He questioned whether an automated system could be sophisticated enough to account for the unique characteristics of individual drivers.

“I would be concerned about individual differences: people on medication, the elderly vs. the young,” he said. “Maybe they have PTSD, or they’re in recovery from a heart attack. [State Farm] would need to know nuances of human behavior and human bodies.”

In addition, “People don’t want someone patronizing you or telling you to calm down. I’m not sure it would be successful psychologically because it would be rather annoying,” he says.

state farm patent

State Farm’s depiction of an emotional impairment score on a mobile device, from its patent application.

State Farm envisions an “emotion management system” that goes beyond just monitoring behavior. The system would store profiles for each driver so, for example, it would learn which music might reduce your hard braking or persuade you to stop tailing the car in front of you. This might spell an end to your loud music.

Each time you end a trip, the State Farm system would analyze the data and update your impairment score, which you could check on your mobile device.

Because the purpose of the patent application is only to describe the system, it leaves many unanswered questions, including:

  • How much would it cost per vehicle?
  • Who would pay?
  • How often would you have to refill your fragrance containers?

State Farm, the nation’s largest car insurance provider, declined to comment on specifics of the patent application but provided this statement to NerdWallet: “State Farm is actively innovating in a number of areas that are important to improving how we meet the needs of our customers. The patent  . . . is just one example of State Farm’s innovation. Because of the nature of our innovation work and patent program, we are unable to provide further comments at this time.”

Angry about car insurance bills, too?

According to the application, State Farm is considering applying the “comprehensive impairment level” to car insurance in several ways, including:

  • Adjusting your insurance rate, up or down.
  • Requiring you to buy a minimum amount of auto insurance, or limiting how much it will sell you.
  • Offering you a discount for using the system.
  • Flagging your policy for possible cancellation.

While State Farm’s plans may never be implemented, the carrier clearly has many ambitious ideas about monitoring customer behavior, such as its previously described ideas to price car insurance by the trip and deliver targeted ads based on where you drive.

Many consumers aren’t aware that auto insurers are preparing to unleash a tsunami of such services based on telematics, systems that track your car and driving habits. Progressive was the first to enter the space and dominated it for a while with its Snapshot usage-based insurance program.

“Other big auto insurers don’t want to be in second or third place again,” says Donald Light, director of North America property/casualty insurance for Celent, a research and consulting firm that focuses on information technology in financial services.

“I believe in about five years it will be a standard part of an auto insurance policy,” Light says.  “Insurers will say, ‘If you don’t want to use it that’s fine, too, but we’ll charge you based on not having it.’”

Light sees one large hurdle to State Farm’s emotion-management plan: The company will have to convince state insurance regulators that the emotional impairment scores accurately reflect risk.

“The key qualifier is that these kinds of data have to make actuarial significant difference in the ‘risk’ of different drivers,” Light says. For example, if State Farm wants to charge more based on driver agitation, the company will have to prove that agitation causes crashes.

Nemerovski says State Farm’s emotional management system might appeal to millennials, who are comfortable with the idea of measuring physical and other metrics so they can be improved.

“But I don’t think people would want it to be shoved down their throats,” he says.

How to Help Veterans on Mental Health

The constant beat of the major media drum often paints a grim picture of veterans and suicide. Sometimes, we wonder if these messages become a self-fulfilling prophecy. Consistent headlines include data such as:

MRE

  • Approximately 22 veterans die by suicide each day (about one every 65 minutes).
  • In 2012, suicide deaths outpaced combat deaths, with 349 active-duty suicides; on average about one per day.
  • The suicide rate among veterans (30 per 100,000) is double the civilian rate.

Listening to this regular narrative, a collective concern and urgency emerges on how best to support our veterans who are making the transition back to civilian jobs and communities. Many veterans have a number of risk factors for suicide, contributing to the dire suicide statistics, including:

  • A strong identity in a fearless, stoic, risk-taking and macho culture
  • Exposure to trauma and possible traumatic brain injury
  • Self-medication through substance abuse
  • Stigmatizing views of mental illness
  • Access to and familiarity with lethal means (firearms)

Veterans show incredible resilience and resourcefulness when facing daunting challenges and learn how to cope, but employers and others who would like to support veterans are not always clear on how to be a “military-friendly community.”

The Carson J Spencer Foundation and our Man Therapy partners Cactus and Colorado’s Office of Suicide Prevention conducted a six-month needs and strengths assessment involving two in-person focus groups and two national focus groups with representation from Army, Air Force, Navy and Marine Corps and family perspectives.

When asked how we could best reach them, what issues they’d like to see addressed and what resources they need, here is what veterans and their advocates told us:

  • “I think that when you reach out to the vets, do it with humor and compassion…Give them something to talk about in the humor; they will come back when no one is looking for the compassion.” People often mentioned they preferred a straightforward approach that wasn’t overly statistical, clinical or wordy.
  • Make seeking help easy. A few veterans mentioned they liked an anonymous opportunity to check out their mental health from the privacy of their own home. Additionally, a concern exists among veterans, who assume some other service member would need a resource more. They hesitate to seek help, in part, because they don’t want to take away a resource from “someone who may really need it.” Having universal access through the Internet gets around this issue.
  • “We need to honor the warrior in transition. The loss of identity is a big deal, along with camaraderie and cohesion. Who I was, who I am now, who I am going to be…” The top request for content was about how to manage the transition from military life to civilian life. The loss of identity and not knowing who “has your back” is significant. Several veterans were incredibly concerned about being judged for PTS (no “D,” for disorder – as the stress they experience is a normal response to an abnormal situation). Veterans also requested content about: post-traumatic stress and growth, traumatic brain injury, military sexual trauma and fatherhood and relationships, especially during deployment.
  • The best ways to reach veterans: trusted peers, family members and leaders with “vicarious credibility.”

Because of these needs and suggestions, an innovative online tool called “Man Therapy” now offers male military/veterans a new way to self-assess for mental health challenges and link to resources.

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In addition to mental health support, many other things can be done to support veterans:

We owe it to our service members to provide them with resources and support and to listen carefully to the challenges and barriers that prevent them from fully thriving. Learn how you can be part of the solution instead of just focusing on the problem.

The Need to Be Open on Mental Illness

Hoarding. Depression. Two instances of attention deficit disorder. These are personality characteristics of different people whom I have reported to over the years. Executives with titles like CEO, president, director or founder. I’m here to tell you that people in the executive suite, just like the rest of society, live with mental illness.

I know this because I’ve worked for them and, more importantly, because I am one of them.

I have lived with chronic depression since I was eight years old. I also, by many measures, have had a rewarding and successful career in consulting and financial services.

I want to share my thoughts on three vital issues: first, why senior executives should lead more conversations in the workplace about mental illness, including suicidal behaviors and suicide prevention; second, why I think it is important; and third, some ways we might be able to start more meaningful dialogue.

In the past, we’ve often treated mental health as a personal issue that individuals must overcome on their own or with a healthcare provider. But addressing mental health conditions such as depression, substance-related disorders, personality disorders and suicidal behaviors is just as important as addressing any other public health issue. Mental health problems are just as critical as childhood obesity, cancer, hypertension, heart disease, stroke or HIV/AIDS.

Over the past few decades, medical science has had great success bringing the death rates down in many diseases. There has been no significant reduction in suicide in more than 50 years. Just as we have  handled other public health issues, we must tackle mental health problems like suicide together in an organized fashion as a total community. Suicide and suicidal behaviors (or SSBs) are complex heterogeneous behaviors commonly manifested in the presence of mental illnesses. They are multifactorial and complex because not all SSBs have the same underlying etiologic factors.

I want to approach mental health from the perspective of my personal story. It is a story about one strategy I believe we can all support to improve mental health in the workplace by reducing stigma and increasing awareness and support, thereby lowering the number of suicides.

While a change of culture has happened with many illnesses that were previously taboo, there is still a silence around mental illness and suicide. This is even more noticeable in the workplace. So, how do we break the silence?

I think there are a number of strategies, many of which we see today: public service campaigns, mental health parity in insurance coverage and workplace programs that provide employee assistance, just to name a few. These are all important components to raising awareness, providing support and changing attitudes. However, I think one of the most effective ways to break the silence is for business leaders who have experience with mental illness and suicide – either personally or through someone close to them – to start talking about it.

I have worked in places where we talked about religion, politics and even gun control. We talked about our physical health. We talked about our families and what we did over the weekend. We talked about our dreams and aspirations. So why in the world wouldn’t we talk about our mental health in the workplace?

We don’t because the stigma is so strong that the topic is buried. Yet when leaders remain silent about mental illness, there is a discernable and substantial cost to the rest of society. Such silence contributes to the misperception that successful people do not get depressed. It keeps people from seeing that treatment allows many individuals to continue in or return to successful professional lives. Silence also contributes to the myth that people who are brilliant or full of life cannot possibly have so much despair as to kill themselves.

They do.  Every day.

Just look at Robin Williams. Most people I know were shocked at the news of his recent death. Honestly, I was shocked that everyone was so surprised. I didn’t know Robin other than as a fan, but I did know he had a history of depression and substance abuse. As a celebrity, this was both the fodder of tabloids as well as the legitimate press. He was very open about his challenges. And, as someone who has lived with depression all his life, I know that frequently depressed people use humor to hide the pain they feel – to keep people from seeing the dark inside that no one wants to see. Like many of us who live with the condition, I believe Robin Williams wore a brighter self in public to distract from the darkness that settled over him behind closed doors.

Most people don’t see depression in others, and that’s by design. We depressed people simply hide ourselves away when we’ve dimmed so as not to shade those who live in the sun.

So the fact that Robin Williams died by suicide was not surprising to me at all. It certainly is a tragic loss of a great entertainer. But watching the mass reaction highlighted to me how little people know about depression and suicide. I even sensed a restraint at first to report his cause of death as suicide. Then, when it became known he had Parkinson’s, it was almost a sigh of relief, as though that, instead of depression, was the real cause. It almost allowed the suicide to be explained away and silenced.

It is this silence that helps perpetuate the stigma of mental illness. The notion is that successful people don’t get depressed and that depressed people are not successful. We know neither of those statements is true. But the stigma perpetuates the myths.

These myths pervade all facets of society, and business leaders are the community gatekeepers. It does not matter whether you are speaking about mega-corporations or small business. Leadership is likely to come into contact with those at risk for suicide or mental health problems. However, these business leaders ordinarily are not trained to be influential.

From the public health perspective, the reduction of stigmatization of mental illness including suicide must be a first step at prevention efforts on a large scale.

There is a difference between those exhibiting a diagnosable mental health issue and those who are able to have access to proper mental health care. This, too, is part of the challenge. Business leaders and those in the public arena have a unique opportunity to lessen this stigma, to mobilize research efforts, to raise money and to educate others who do not have the same financial and educational advantages.

Where I work, we do talk about mental health, depression and suicide. We talk about it because I talk about it.

People look to me to set the tone of the workplace. More than anyone, I am responsible for establishing what is okay and what is not okay to say and do in the office. Whether I like it or not. Whether I recognize it or not. As the senior person in the office, setting the tone and defining what is acceptable is one of the most important roles I play.

There are forward-thinking companies out there providing programs and assistance to employees. Prudential offers an employee assistance program, training for managers to spot distress among employees and health clinics that screen for mood instability and more. Still, the company recommends employees stop short of telling managers about their diagnoses, according to Ken Dolan-Del Vecchio, vice president of health and wellness. The reason he gives is, “We don’t want managers to be acting as surrogate counselors.” No company would say the same thing about heart disease or cancer.

Dupont trains managers to identify signs of distress in workers. However, Paul W. Heck, global manager of employee assistance and WorkLife services, says conversations with a boss about a diagnosis “would never be encouraged.” Managers at Dupont who do identify distress are asked to remind employees of the assistance program, which offers free counseling. While these efforts are laudable and provide valuable services to employees, it’s obvious that corporate America still views mental health as something not to be discussed.

It is not just a matter of confidentiality concerns for the firm. The message is to keep silent. But there is no way to break the stigma if we keep silent. And the reality is that the fear is unwarranted, and, if discussion starts at the top, it can easily change attitudes and behaviors.

There is much that business leaders can do. While leaders are more likely to be committed and indeed supportive if they understand what’s in it for the company, the most effective way to gain leadership support is if they personally relate to it. Senior executives like to have a cause, whether it’s cancer, homelessness, youth or any number of issues; business leaders frequently are champions. They use their position and influence to engage the staff, corporate communications, HR and other resources, including the community, to work together to address social needs. Their ability to effect change is vast and untapped when it comes to mental health and suicide. We just need to get them talking about it.

Two years ago, I had wrist problems and had to get physical therapy for several months. In the beginning, I went to a see a therapist twice a week. Everyone knew about my wrist problem. They knew where I went twice a week, and they were sympathetic to what I was experiencing. Today, I no longer need physical therapy, but I do go to a doctor every week. I go to see a different kind of therapist. The kind you talk to and get advice from. In the beginning, I told people I was going to see my psychiatrist. Now, I don’t feel the need to re-enforce the point every time I go to see my therapist, because everyone already knows. Seeing this therapist is just like seeing my physical therapist. I have declared it okay to leave the office to see your doctor, even if that doctor is focused on mental health. I’ve set an example that it’s okay to talk about this at work, and, more importantly that mental health should be treated no differently than any other health concern.

This openness definitely has an impact.  A while back, we were in the office on a Monday morning talking about the weekend. One person had been at the family house on the lake with the extended family – grandparents, aunts, uncles. One of his aunts was going through another depressive episode. The employee admitted that in the past when his aunt was depressed he tended to leave her alone and felt she should “just get over it.” But this weekend, he spent time talking to her, listening to her and reassuring her. His exposure to someone living with depression in a different setting allowed him to be more sympathetic and understanding. I’m sure if friends or co-workers exhibited signs of depression, he would be able to be more supportive of them, too. Getting to know a co-worker living with a mental illness changed his attitude.

While I would never have chosen to be born with depression, I have learned to appreciate what it has given me. True, it has presented some significant challenges and difficult times. But these challenges have also given me a tremendous amount of strength and resilience.

I draw on this both in my personal and my professional life. Having been in financial services for much of my career, I have experienced significant work challenges. I led the effort to keep a major financial service provider funded and operating as it went through a downsizing from more than 14,000 to fewer than 4,000 employees. Back in 2007, during the early stages of the financial crisis, I was at a major financial services company when an industry analyst used the “bankruptcy” word speaking about the company. The press descended in droves, customers were concerned and a year later the company was acquired by another bank. In all these situations and many more, I have been counted on as a leader during substantial adversity. Yet these challenges cannot compare to the difficulties I have faced with depression. It is through the struggles with depression that I learned how to attack really difficult situations and how to get through the tough times at work.

Depression has also given me an increased empathy toward others. While I think this manifests itself daily in the way I manage, it certainly helps in those situations when it is most needed.

Once, as soon as I had started a new job, an employee whom I had not met did not show up for work for several days. No one knew what happened until we heard through one of his friends that he was in the hospital psychiatric ward after attempting suicide. He had served in Afghanistan and had post-traumatic stress disorder (PTSD). He had just bought a house that he and his fiancée were going to move into. But, before moving in, his fiancée broke up with him.

When he got out of the hospital, he contacted another executive he knew. This person knew my background with mental illness and suggested the two of us meet. When we met, it was clear he wasn’t ready to come back to work, so I got him to agree to meet me for coffee twice a week. This was my way of making sure he got out of the house and allowed me to help him with referrals for things like therapists and support groups. I talked with him about being in therapy and how it had helped me. Because the people who hired me knew of my advocacy around mental health, I was brought into the conversation and was able to provide support as this young man started down the road to recovery. I’m happy to say he got the help he needed and now, years later, is thriving.

In the alpha-male-dominated, type A, adrenalin-charged executive suites of corporate America, admitting to weakness of any sort is viewed as taboo and a job-killer. The prevailing view is that people at the top get paid a lot of money and should be able to handle whatever their job throws at them. It is incredibly difficult to find examples in the press of senior executives who have taken a leave or resigned for mental health reasons. And we know death by suicide is often attributed to other causes.

However, we are seeing mental health in the press more and more. Last year, Barclay’s compliance chief resigned after taking a leave of absence for stress and exhaustion. In 2011, the new Lloyd’s chief executive took a leave of absence after eight months on the job for stress-related problems. Last year, the CEO and the CFO of two different companies in Switzerland died by suicide, and their deaths were reported in the press. And I’m sure you are all aware of the recent string of Wall Street suicides. So, while the perception is that people at the top can and should handle anything, the reality is somewhat different.

Clearly, there are people at the top who are experiencing mental health problems. People in the highest offices of corporate America do live with mental illness. Personally, I think depression is a much more common affliction with executives, entrepreneurs and leaders than society is willing to admit.  And, just going by the numbers, many, many more have a family member, relative or friend living with a mental illness. There have to be senior executives who have been affected by suicide.

It seems to me depression is the family secret we all share. Frequently, a bereavement leads to depression, which, in turn leads to suicide of a family member, which can lead to another period of bereavement, depression and suicide. It can be an evil circle.

So how do we create awareness and a sense of urgency around mental health in corporate America? How do we make sure suicide-prevention efforts are supported and sustained? There are many strategies. I’ve already mentioned things like anti-stigma campaigns, health care parity, wellness clinics and employee assistance programs. Together with mass media and extensive research into the causes and treatment of mental illness, we should see a change in corporate cultures. These are critical efforts, and we should continue supporting them.

I’d like to propose one more strategy. That is a concerted campaign targeting senior executive leaders to become mental health and suicide prevention advocates.

How do we accomplish that? Let’s reach out to senior executives in a number of ways. Above all, we have to make talking about, and then communicating about, mental health concerns acceptable in their rarified sphere of influence. Only then can we create support groups, arm them with thorough training about mental health and suicidal behaviors, create speakers bureaus of senior leaders who are open and sharing and teach them to become knowledgeable advocates.

First, let’s provide support for the leaders themselves. Clearly, there are people at the top are who are experiencing mental health problems. Why not create a support network for these individuals? Let’s provide a safe environment for senior executives to talk with their peers about what they are going through – personally and professionally.

Philip Burguieres was the youngest CEO of a Fortune 500 company. In 1996, this self-described workaholic had to leave his job because of depression. It was several years before he returned to work. Today, he is a vice chairman of the Houston Texans football team. He is actively sought by CEOs with similar stories. He has been rather public about his very private support of a secret network of CEOs with depression. We could extend Philip’s example to create a safe community for senior executives challenged by mental illness to talk, share, and find support. It could even be positioned as an extension of the increasingly popular executive coach strategy.

Let me give you another example. Last year, the UK arm of Deloitte, the international business advisory firm, appointed a British senior partner, John Binns, as its mental health and personal resilience advisor. Deloitte is one of the most forward-thinking companies with respect to human resources of all the places I have worked. After taking a leave for depression, John created a group of nine mental health champions at Deloitte UK, partners in the firm who were trained to discuss and support mental health in the workplace. He provides one-on-one advice for individuals in the firm who want to speak about mental health issues affecting them or their family. He also provides mental health awareness and advisory services to other businesses across the UK.

We know that most deaths by suicide are by individuals with a diagnosable mental health issue, but only a minority those individuals receive any mental health service. Confronting mental health in the workplace should be an effective method of reducing deaths by suicide. As the stigma is reduced and more people get the care they need to recover, efforts like zero suicides among people who are receiving care become more significant. Moreover, to the degree benefits like employee assistance programs, wellness programs and general awareness and prevention programs are used in the workplace, advocacy by senior management is the best way to make these efforts a sustainable and core part of the organizational culture.

So why do I think this will work? Why should corporate leadership become a major force in mental health efforts including suicide prevention? Why will it make a difference for people with mental illness and suicide attempt survivors to be open in the workplace?

For me, the answer is simple. I’ve been through this before. Coming out of the mental illness closet is not the first closet I’ve come out of. Twenty-three years ago, when I was accepted into business school, I made the decision to be open and honest about being gay. It may not have been a revolutionary act at the time, but it was a time when almost everyone in corporate America still was in the closet. I decided that I didn’t want the next generation to experience the same prejudice, ignorance and stigma that I experienced. I told myself that if I were someplace that didn’t want me because I’m gay, I could take my Stanford bachelor and Kellogg MBA degrees and go somewhere else.

This spring marked my Kellogg 20th anniversary. I ran into someone I knew quite well during school but had lost touch with over the years. While re-connecting at the reunion, he mentioned that he was against my being open while at business school. But now he sees what’s happening with gay marriage and thinks my being open must have made a difference. I look back at the past 25 years, and I know the important role every out and open gay person has played by simply being honest about who they are. And one important lesson we have learned is that to ask others to accept us means we have to accept ourselves.

I think the people living with mental illness and suicide attempt survivors at the corporate level need to come out of the closet. We are the best positioned to shatter the silence. If we can combine this openness with change in the business world driven from the top down, I know we can make a significant impact on the stigma around mental illness and suicide.

I talk about mental health in the workplace because it’s the best way I know to break down the stigma. I want to make a difference, and I can afford to take the risk in an effort to effect change. As the senior executive in charge, setting the tone and defining the organization’s core values is one of the most important roles I play.

Living with depression has not always been easy. However, in many ways it has made me a better person, a better manager and a better business leader. Living with depression has been challenging, but it has not kept me from succeeding.