Tag Archives: stigma

Employers’ Role in Preventing Suicide

American adults working full time spend an average of 47 hours per week at their workplace (Gallup 2013). For those dealing with a mental health issue or thoughts of suicide, employers have an important opportunity to create safeguards to protect those who may be at risk.

There are many reasons why an employee may keep concerns about his or her mental health private. Stigma, fear of losing one’s job, and lack of awareness can prevent an individual from seeking help. It can also prevent someone who is concerned about a co-worker from reaching out when they may be needed most.

Research shows that 70% of those who die by suicide tell someone or give warning signs before taking their own life. Coworkers see each other every day and are more apt to notice changes in mood and behavior. For this reason, they play a key role in identifying potential suicide risk and mental health crises in their peers.

See also: Blueprint for Suicide Prevention  

Mental health education and awareness programs can help to create an environment where employees feel comfortable reaching out for help and should be a primary component of workplace wellness initiatives. Employers can implement the following strategies that not only connect their employees with help but also promote a culture of mental health awareness:

Health Promotion

Health promotion programs enable employees to take action to better their health. While employers often use health promotion to encourage physical health changes, employers can use health promotion to discuss mental health issues and encourage a culture of employee engagement and connection, as well. National Depression Screening Day, held on Oct. 6 this year, raises awareness for depression and related mood and anxiety disorders. The annual campaign provides employers with an opportunity to start the conversation with employees about mental health.

Online Screenings

Anonymous online screenings are a proven way to reach those in need and help direct them to appropriate assistance. Employees can take a screening to determine if the symptoms they are experiencing are consistent with a mental health disorder (i.e., depression, generalized anxiety disorder, bipolar disorder, post-traumatic stress disorder, an eating disorder or a substance use disorder). Upon completion of a screening, employees are provided with immediate results and linked back to employee assistance program or local community resources. If your organization does not currently have an online screening program, a more general anonymous screening can be taken here.

Suicide Prevention Awareness

The Centers for Disease Control and Prevention recently released data showing a 24% increase on average of suicide rates from 1999 to 2014. It is critical that employees learn how to talk with someone about mental health, understand how to recognize warning signs of suicide and know the actions to take to get themselves or a coworker the help they need.

The National Action Alliance for Suicide Prevention’s Workplace Task Force champions suicide prevention as a national priority and cultivates effective programming and resources within the workplace. The task force provides support for employers and motivates them to implement a comprehensive, public health approach to suicide prevention, intervention and “postvention” in the workplace. Programs like the Workplace Task Force are important sources of knowledge and assistance for employers.

See also: 6 Things to Do to Prevent Suicides  

Employers can provide resources such as Stop a Suicide Today, which educates individuals about the warning signs of suicide and steps to take if they are concerned about a coworker or loved one. There are also other lifesaving resources, like the National Suicide Prevention Lifeline (1-800-273-TALK (8255)).

The World Health Organization estimates that depression will be the second leading cause of disability by 2020. Employers have the option to act as catalysts for early detection and prevention when it comes to mental health disorders and suicide, which can lead to improved quality of life for individuals, as well as for the organization itself.

Why Mental Health Matters in Work Comp

At the 2015 Paradigm Innovation Symposium, Renée-Louise Franche, PhD, RPsych, clinical psychologist and consultant in work disability prevention and occupational health, presented a session discussing why mental health issues are so important in workers’ compensation.

Mental health issues in injured workers can no longer be ignored. These conditions are increasingly being recognized as potential risk factors for prolonged work absences, and even for no return to work within the context of workers’ compensation.

Why mental health matters in work disability prevention?

  • One-year prevalence of mental disorders in North America ranges from 12% to 26%. For depression, this is 4% to 7%.
  • Worldwide, mental health conditions are the leading cause of disability in high-income countries, accounting for one-third of new disability claims in Western countries.
  • Mental health-related disability is more frequent in young adults.
  • Workers with mental health conditions have earlier retirements than those without.
  • Studies show that mental health issues have a significant impact on claim duration.
  • Another study showed that, within the first 12 months post-injury, more than 50% of workers experienced clinically relative depressive symptoms at some point during their claim. This is highest during the first month following the accident.
  • There is a significant spillover effect to the families of injured workers. Family members of injured workers are three times more likely to be hospitalized three months after the injury than three months before the injury. It is speculated that the distraction of the injured family member leads to unsafe behaviors.

What works in return-to-work interventions?

  • It is important to focus on ability and function rather than disability. The symptoms and diagnosis need to be deemphasized.
  • Worker expectations of recovery are the single most-determining factor in the ability to return to work. Attitude and state of mind are important.
  • Suitable and safe modified work and return-to-work coordination must be available.
  • A workplace culture of respect and support helps to promote return to work.
  • Claims-related stress/perceived injustices have a very negative impact on return to work.
  • Purely clinical approaches lead to purely clinical outcomes. There needs to be an integrated approach between the physician and the workplace.
  • There must be considerate early contact with the injured worker and continued contact to maintain job attachment.
  • There should be a return-to-work coordinator to facilitate labor/employer cooperation and ensure the healthcare provider understands the return-to-work goals.

What needs to improve for workers with mental health issues?

  • Access to care is a concern. A quarter of Americans have inadequate access to mental health services.
  • Healthcare for mental health conditions is NOT work-focused. There are limited tools and published standards around return to work.
  • Workers feel stigmatized and disrespected, and that there is suspicion about the legitimacy of their condition.

Best practices for return-to-work for workers with mental health conditions:

  • Facilitation of access to clinical treatment for those who need it. Too often, this treatment is delayed. Delays in treatment will, ultimately, delay recovery.
  • Work-focused clinical interventions.
  • Facilitation of navigation of the systems involved.
  • Improved processes, leading to improved sense of fairness.
  • Early identification and screening to identify workers who are high risk for psychosocial complications, and assigning those claims to specialized adjusters.
  • A case manager who plays an important role in humanizing communications, decreasing adversary feelings, clarifying the claim process, decreasing delays and developing more accurate expectations in the worker.
  • Judicious use of independent medical exams. Injured workers view these as a very adversarial experience, which usually leads to litigation.

Best bets for future investments:

  • Perceived justice. Perceived injustice leads to longer disability, higher pain complaints, more depression and increased narcotic use. It is important to fully explain the workers’ compensation system to injured workers, including the benefits that they will receive and the role of the injured worker in his recovery. People need to be treated with respect and receive information that is clear, accurate and timely.
  • Development of soft skills in the front line claims team. This includes communication skills, conflict-resolution skills and training related to identifying potential mental health issues.
  • Early screening for psychosocial issues so that appropriate intervention strategies can be implemented.

Stigma’s Huge Role in Mental Health Care

The role of stigma for people who are in need of mental health treatment is both profound and devastating. According to a 2011 study by the Association for Psychological Science, only 60% of people diagnosed with mental health problems reported receiving treatment. That means 40% of the millions of people in the U.S. who need professional help are getting no treatment whatsoever. Social stigma, myths and stereotypes play a huge role in limiting both access to care and discouraging people from pursuing mental health treatment. The problem is multifaceted and complex and has a wide-reaching effects on people’s education, employment, health, well-being and relationships.

There are many forms of stigma and stereotypes. First, there is a widespread public perception that people with mental illness are dangerous, unpredictable and responsible for their own illness and not deserving of compassion and care. As a result, people in need of help are excluded from jobs, education and much-needed social interaction.

This problem also plays out in the professional medical setting, where negative stereotypes often lead medical providers to be less likely to focus on the patient rather than the disease and to not place the needed focus on recovery and referral for needed consultation and care.

Stigma in society and lack of awareness among medical providers also contributes to what is known as self-stigma. That is: People in need of help believe these stereotypes themselves and develop low self-esteem, which results in denial, attempts to hide problems, alcohol and drug abuse and a sense of hopelessness — they feel they are unable to recover, so why try? These are the people who make up the 40% not seeking treatment and consultation.

Stigma results in a double problem for many people. They have real underlying symptoms, which lead to an actual disability, while myths and misconceptions lead to stereotypes and prejudice. Too often, people turn against themselves. Depression, for example, has been referred to by mental health professionals as “rage turned inward.” This can lead to fear of rejection, isolation and hostile behavior. The result often is that the needed health care system is replaced by the criminal justice system.

How many people incarcerated today have an underlying untreated mental health condition? My guess is most, if not all. These are the people who did not pursue potential life opportunities for themselves but rather pursued illegal drugs or crime out of a sense of low-self-esteem and hopelessness. The overall result is both devastating to them and society as a whole.

Underlying mental health issues also have a huge impact on both healthcare and disability costs for private and public employers, health and disability insurers and both Medicare and Medicaid and the Social Security disability system (SSDI). How many people collecting private or public disability have an underlying, undiagnosed mental health problem? Nobody really knows, but many disability experts believe the number is staggering. The resulting costs to employers, insurers and taxpayers of untreated or undiagnosed mental health issues is in the billions of dollars.

In 2003, I helped conduct an unpublished study for a major U.S. corporation regarding its active employees out of work on full disability with a primary diagnosis of depression. The analysis cross-referenced these employees’ disability claim data with their health insurance data base. It was found that 80% of the primary treating providers in the healthcare benefit side had no mention whatsoever of a primary or secondary diagnosis of depression. This means that their primary treating provider or “family doctor” was either unaware of the underlying mental health issues or failed to acknowledge or consider the possibility.

What was not able to be studied in this research was how many workers out on disability or workers compensation for a “bad back” really had an underlying mental health issue. The study did determine the No. 1 and 2 co-morbidities for employees out on disability for depression was musculoskeletal conditions and gastrointestinal conditions. The overwhelming number of medical providers treating and submitting claims for these co-morbidities (80%) had no mention of an underlying mental health issue despite the fact that their patient was out of work on full disability with a primary diagnosis of depression. The healthcare and disability costs of these employees out on full disability with a primary diagnosis of depression was staggering and in the millions just to this U.S. corporation. Because this large employer was self-insured for healthcare, disability and workers’ compensation these costs go directly to its bottom line. These costs are then indirectly passed on to corporate customers and the general public purchasing the company’s products and needed services.

What needs to be done to address underlying and untreated mental health conditions?

I do not believe any new federal legislation is required at this time. The Affordable Care Act (ACA), the Americans with Disabilities Act (ADA) and the Mental Health Parity Act are all in place to help people receive needed mental healthcare access. There is no reason people should not seek professional help that they need.

As in most complex public health issues, the answer lies in awareness, education, outreach and research dollars. Educating the public is a very difficult task. As we have learned the hard way with overall prejudices, urban myths and misinformation in society, in general educating people can take generations. Medical authorities in leading medical schools and institutions have also stated that documented research and best practices based on evidence-based medicine can take 20 years to filter down to local medical practices, if ever.

People suffering with underlying mental health issues don’t have 20 years to wait for proper referral and treatment. Medical professionals on the front line need to be educated today to ask the right questions with their patients about potential underlying mental health issues and help reassure people that the overwhelming majority of mental health issues can be diagnosed and successfully treated.

As a society we can no longer allow people to hurt themselves or others when treatment is readily available for people who need help because of genetic and other environmental causes that are no fault of their own. How many of our major problems such prejudice and gun violence have a root cause in untreated mental health issues? Maybe all of them.