Reach Out, Speak Up – Tackling Workplace Depression Starts with Overcoming Stigma

Not all behavioral-health issues are alike — in impact, prevalence, or public perception.
Take substance abuse, which is having its day in the sun in Massachusetts as public and private organizations across the state wage a high-profile fight against what has become, in recent years, an opioid crisis.
Robert Pura says that spotlight has helped people understand that addiction is a disease like any other, one that needs to be treated as candidly and openly as cancer or cardiovascular disease.
But across the spectrum of behavioral health, other issues, such as depression, aren’t always treated the same way.
“The numbers of students who carry with them mental-health issues has increased, so it’s our responsibility to appreciate and understand those struggles, just like when someone struggles with a disease like diabetes or a heart issue or a pulmonary issue,” said Pura, president of Greenfield Community College and one of the most recent signers of the CEOs Against Stigma pledge.
The pledge is a key component of an effort by the National Alliance on Mental Illness of Massachusetts (NAMI Mass) to push back the feelings of shame, stigma, and isolation that keep people from seeking help for mental-health issues. More than 250 leaders of for-profit companies, nonprofit agencies, and municipalities have signed on to date.
“There are treatments and protocols for mental illness with very hopeful indicators of positive outcomes,” Pura told HCN, “but too many struggle in the dark and are less than comfortable talking about it. We send a get-well card to someone with heart issues, but we stay away when someone is struggling with mental-health issues.”
And that’s a serious concern, given the prevalence of such issues in the workplace. Mental-health conditions affect one in five adults and, unlike physical illnesses, carry a stigma that prevents people from discussing them at work, said NAMI Western Mass. President Bernice Drumheller. “That stigma can lead to high turnover, low productivity, and increased employer costs. In fact, mental-health conditions represent the leading cause of workplace disability.”
CEOs Against Stigma seeks to change misconceptions, one company at a time, about mental illness by encouraging people to open up and speak freely about the conditions that affect them and their immediate families — and, importantly, seek treatment without fear of being ostracized or losing their jobs.
Joanne Marqusee, president and CEO of Cooley Dickinson Health Care, signed the pledge about a year ago and has since ramped up communication in the organization to encourage people who are struggling with depression and related issues to seek treatment.
“People might think it’s easier for us, that our staff is sensitized to it, because we’re always giving that message to patients,” she told HCN. “But healthcare workers tend to focus on what the patient needs, not what they need themselves. As a caregiver, they may feel they somehow don’t deserve care.”
However, she continued, “we want to be clear with our employees that they’re human beings and have the same challenges and issues as patients — and they can’t give compassion and support to patients unless they feel compassion and support from us.”
Cooley Dickinson’s initiatives to date include trainings and discussions with managers, directors, vice presidents, and other department leaders, who then reach out to all employees about the resources — such as a robust employee-assistance program — available if they find themselves struggling with depression or any other issue.
“Most people are not going to come to the CEO and say, ‘I’m having challenges with mental-health issues,’” Marqusee said, adding that they need to feel comfortable taking these concerns to their supervisor. Reducing the fear through communication is one way to overcome the stigma of talking about such issues.
“They need to know their supervisor will support them and in no way make them feel uncomfortable,” she said, “but will help them get the resources they need, whether it’s flexibility in their schedule to see a therapist once a week or something else.”

Suffering in Silence
According to NAMI Mass, 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of American adults currently suffer from a depressive illness, yet 71{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults with depression never contact a mental-health professional about it. Meanwhile, employees experiencing depression lose 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of productivity each week.
Most of that lost productivity has nothing to do with missing work, however. The more common culprit is ‘presenteeism,’ an illness-related reduction in work productivity — in other words, showing up for work but getting far less done than a healthy employee would. Among all productivity losses, 81{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} is due to presenteeism.
Yet, individuals with mental-health disorders also experience more absentee days per year than individuals with no conditions — at a ratio of 31 to 1, NAMI Mass reports. Meanwhile, such disorders contribute to workplace accidents. For example, drivers with severe depressive symptoms are 4.5 times more likely than others to experience an accident or a near-miss in the 28 days preceding. Driving with severe depression has been likened to driving with a blood-alcohol content of 0.8 — which, in Massachusetts, is legally impaired.
So employers have plenty of reasons to be interested in the mental health of their employees. But CEOs Against Stigma wants to address the personal toll of depression and other conditions, not just the financial costs.
“In general, there’s more conversation around mental-health issues than there used to be,” said Nina Slovik, a social worker and clinic director for the Center for Human Development. “In some senses, the stigma is diminishing, although we still encounter some amount of misinformation and shame and ignorance about how to recognize signs of significant health problems.”
In the workplace, she noted, people aren’t typically looking for those signs, but the signs do exist. “Typically, when someone becomes clinically depressed, you see changes — reduction in their motivation, which may be manifested in attendance issues or concentration issues. And when people are depressed, they tend to withdraw socially; their interactions may be less friendly. Communication is a casualty of depression.”
Conversely, people might mention some of their stressors at work, such as financial or marriage problems at home, and that can be a sign of depression as well.
“As with any mental-health issue,” Slovik told HCN, “it never hurts to directly ask someone what’s going on — not ‘what’s wrong with you?’ but ‘what’s going on with you?’ — expressing concern from a non-judgmental, dispassionate place, and always avoiding blaming, shaming, or accusing. Ask, ‘what can I do? Let me direct you to some resources.’ The bottom line is beginning a dialogue and letting them know you’re concerned.”
The Center for Human Development’s own CEO, Jim Goodwin, is another signer of the anti-stigma pledge. “Recognizing that something isn’t quite right with our emotional wellness doesn’t indicate a weakness; it indicates a strength,” he said when he joined the movement. “It says you know who you are, you realize something isn’t as it should be, and you are strong enough to ask for help. Or it says you care enough about someone to get help for them.”
One key element of the program is NAMI’s In Our Own Voice presentations into the workplace, which feature two people sharing their personal stories of recovery.
“It’s very powerful,” Marqusee said. “These are very brave, very articulate young people, and you think, ‘that could be my daughter — how would I want her workplace to support her?’”
GCC already has a similar program where students speak openly about mental-health issues, learning disabilities, and other topics, Pura said, so awareness of the need to tackle stigma is already part of the campus culture — but the college can always do more, he added. “It’s not as if we’ve licked it; we want to continue working at it.”

Timely Education
Recognizing that college campuses are just as prone to mental-health issues as workplaces and family settings, the American Medical Assoc. (AMA) recently adopted a new policy to improve mental-health services at colleges and universities. The policy supports strategies to improve accessibility to care and reduce the stigma surrounding mental-health issues. The AMA also urged colleges and universities to emphasize to students and parents the importance, availability, and efficacy of mental-health resources, and to develop mechanisms of care that support timely and affordable access.
“Depression, anxiety, suicidal thoughts, and — sadly — suicide are common among young people at colleges and universities. The lack of resources and stigma associated with seeking help can prevent students from getting the mental health care they need,” said AMA board member Dr. William Kobler. “By improving access to care, colleges and universities will make it easier for young people to focus on their own well-being and give them a greater chance for success on campus.”
It’s a goal Pura certainly shares.
“That’s one of the things that prompted us to sign on — to open a window, open some doors, and light the way for individuals and families who are struggling with mental health.”
While the CEOs who have signed NAMI’s pledge hail from a variety of industries, healthcare is the most widely represented field, encompassing hospitals, health systems, insurers, and public-health agencies, to name a few.
One issue specific to healthcare and a few other professions is known as ‘compassion fatigue,’ Slovik explained. “People in the mental-health or medical environment are seeing terrible things, one story worse than the next, and we’re not inoculated against that. People can experience compassion fatigue and get burned out, triggering a sense of despair. There’s a special onus on mental-health and healthcare professionals to recognize that’s an issue.”
Of course, she went on, “it certainly can be true in other high-stress businesses where people are under constant pressure — they have to perform, have to be ‘on’ all the time, have to be in a good mood, and internally they’re in conflict because they don’t feel good, and that can cause stress in their lives.”
Marqusee hopes Cooley Dickinson’s system-wide focus on reducing mental-health stigma draws the attention of employees who might be feeling that burnout.
“There’s lots more work to do,” she said, noting that, although there has been a marked increase in use of the employee-assistance program, it’s difficult to quantify the effects of the anti-stigma effort. “We have some talented staff in there, and people are feeling comfortable enough to call.
“I feel hopeful the message is getting out,” she continued. “In healthcare, people assume we know this world because we provide patient care, but I don’t think healthcare organizations are immune to how stigma affects a workforce — even if they’ve been successful in helping patients overcome stigma.”
That stigma can affect workplaces of all kinds, which is why NAMI Mass presses on with its outreach to CEOs, and why Slovik continues to encourage people not to ignore the signs that a co-worker might be struggling in isolation.
“It’s not the job of a workplace to address someone’s mental-health issues, but it certainly can’t hurt to say, ‘this workplace wants to support you,’” she told HCN. “Just the little spark of someone else acknowledging you and wondering if you’re OK is a good thing.”