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Returning to work and staying there

section identifier imagethe front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

By Cindy McGlynn

Winter 2005-06, Vol 9 No 2


As the former owner of a brokerage firm, Mary Ann Baynton regularly made accommodations for the special needs of staff – chairs for back problems and flextime to pick up children from school, for example. These are the kinds of workplace accommodations that employers make every day to maximize the potential of their staff.

Baynton also recalls when two employees approached her about their special needs – these ones a result of mental health issues. One staffer with bipolar disorder became very anxious over in-depth policy work, but thrived in interactive situations. The other, diagnosed with panic disorder, found that face-to-face contact triggered panic attacks. The solution? The employees switched tasks and everything returned to business as usual.

Returning to work after weeks, months or even years of disability due to mental health or substance use issues can be difficult. But studies show that people can return successfully to work when they receive the proper accommodation and support at work.

It is an issue that employers cannot afford to ignore. In 1998, Health Canada conservatively estimated that the economic burden of mental health problems was $14.4 billion a year. More recent calculations from the Global Business and Economic Roundtable on Addiction and Mental Health suggest that $30 billion is lost to the Canadian economy annually due to mental health and addiction problems. The Roundtable reports that depression is the fastest growing disability cost nationwide – already weighing in between four to 12 per cent of payroll costs. Global consulting firm Watson Wyatt’s 2005 Staying@Work survey, which polled human resources professionals from 94 large Canadian organizations, confirmed this trend, with mental health problems being identified as the leading cause of short- and long-term disability claims in Canada.

This alarming state of the workplace was the impetus behind the development of the Canadian-led Roundtable: It’s not just that companies have a lot to lose by failing to answer employees’ needs – they have a lot to gain if they do. After all, as Roundtable CEO Bill Wilkerson points out, most people with mental health and substance use issues are in their prime working years.

A 2002 Roundtable report found that employees who get access to treatment can save their employer between $5,000 and $10,000 per employee per year in the cost of prescription drugs, sick leave and average wage replacement. Employees who are diagnosed with depression and take appropriate medication save their employer an average 11 days per year in prevented absenteeism.

Yet the Watson Wyatt study found that only 23 per cent of companies have mental health programs, 36 per cent have stress-management initiatives and 38 per cent run substance abuse programs. Developing such initiatives is crucial to maintaining a healthy workforce – and economy. Work plays an important role for a person recovering from a mental illness, according to the Canadian Psychiatric Association. The workplace provides a social support system and the opportunity for people to regain a sense of self-esteem, control and self-worth on the road to recovery. A supportive workplace can offer a sense of stability that is otherwise hard to find.

Creating a supportive workplace and supporting return to work begins with early detection of mental health or substance use issues. The Depression and Work Function study by the Mental Health Evaluation and Community Consultation Unit at the University of British Columbia says that early detection of depression “has been shown to reduce the severity, duration, complexity and cost of depressive illnesses.” Heading things off early also prevents the migration of a person from a short leave to long-term disability – from which individuals are much less likely to return to work successfully.

“The workplace is a good venue for early detection because of the comparative nature of behaviour,” says Wilkerson. “Behaviours that indicate distress are visible at work. With appropriate training, both managers and co-workers can learn to recognize demonstrable external signs.”

Mary Ann Baynton agrees. She now heads Mental Health Works, an initiative of the Ontario branch of the Canadian Mental Health Association, which helps organizations manage their duty to accommodate employees experiencing mental health issues. “We encourage people to watch for changes in behaviour,” she says. “If it’s an employee you’ve been with for a long time, you notice if they begin to sleep more, or sleep less. They might become more social. It could be that productivity increases rather than decreases. There’s no one single way this happens.”

But even with early detection, return to work can be an uphill battle. “What’s needed is to combat the stigma of mental health and addiction issues, to educate employers and employees about the importance of early detection and to develop a supportive attitude and workplace,” says Wilkerson.

“One complicating factor is that symptoms of depression and anxiety are part of our continuum of normal mental health,” says Baynton. “We’ve all been sad or anxious or upset. When these things become extreme, it can be hard for people experiencing them to realize it’s a problem. And it can be hard for others to accept that it’s a medical situation and not a choice the person is making.”

Mental Health Works combats the stigma and misconceptions of mental health issues in the workplace. The program helps employers respond immediately and appropriately when employees experience mental health problems and effectively manage performance and productivity issues. “Our work is founded on the belief that focusing on solutions around mental health issues in the workplace will benefit employers and employees alike,” says Baynton.

Once a problem is detected, Baynton explains that a good manager can help put an employee in contact with services. It’s not their job to diagnose illness, but it is their job to help accommodate workers who may be struggling. The law says so.

In Canada, employment law, the Canadian Charter of Rights and Freedoms and the provincial and federal human rights codes spell out obligations for employers. Employers have a duty to accommodate employees with disabilities (unless this should cause undue hardship) if the accommodation will allow them to perform the job. Mental illness should be perceived and accommodated in the workplace like any other illness or disability.

One of the most important employment barriers faced by people with mental health issues is lack of flexibility at work, according to the Canadian Psychiatric Association. Flexibility is built on the positive arrangements that organizations need to put in place to promote equality in employment. Accommodation can be as simple as providing a quiet office for a person who is easily distracted, or permitting a person to take an extra break if they are required to eat when taking medication.

Yet some organizations are hesitant to embrace accommodation. The biggest misconception about workplace accommodations, says Baynton, is that they’re expensive. “They don’t cost much money,” she says. “They cost time and committed effort.”

In fact, a 1999 PricewaterhouseCoopers survey found that most accommodations cost less than $500. “Most employers simply don’t know what to do,” says Tim Collins, president of Toronto-based Stafflink Solutions, an employment agency that offers services tailored to individuals with disabilities.

Or employers may misunderstand what is meant by accommodation. “Accommodation is not meant to be a gift or a favour,” says Baynton. “It’s a change that allows a person to do their work. In the accommodations that we come up with, a person does the same amount of work. It’s not about creating a situation where someone does less work for the same pay.”

So, if the legal role of an organization is to accommodate workers, what is the role of staff and management? “What we want them to do is more effective performance management,” says Baynton, who offers a four-point program for managers (see sidebar). “We’re not talking about anything punitive or related to discipline. This has to be a collaborative effort to maximize a person’s potential and performance.”

Wilkerson says that ideally, all managers who deal directly with staff as well as a select number of co-workers would be trained to use appropriate language to break the ice and talk to an employee or co-worker who may have a problem. In a manager’s case, that means learning how to manage the performance of that employee.

A lot of accommodations have to do with communication, says Baynton. “For example, if a person has anxiety issues about not knowing where they stand, they can check in once a week for 10 minutes with their manager for a quick review. For another employee for whom making mistakes on the job became an overwhelming fixation, the accommodation was ‘I will write errors down in objective way and then we’ll let them go.’”

Dr. Lisa Doupe, founder of the Toronto-based Round Table Project on Safe and Timely Return to Function and Return to Work, says that physicians also have an important role to play. She argues that physicians have an ethical imperative, not just to return people to health, but also to return them to work. “What’s the goal of the health care system?” asks Doupe. “Is it just for people to be healthy? Or is it to be back to what they were doing? To be functioning and contributing and being part of their communities?”

Doupe sees health as a two-step process: proper diagnosis and treatment, followed by a return to functioning and working. “The linking of the two is crucial, but there’s very little talk about it,” she says. “I attended a discussion on bipolar disorder, and work was only mentioned in passing. Someone commented that if you have bipolar disorder, your boss might say you are too argumentative. The topic was covered in one sentence. Yet what’s the first thing my patients say to me? ‘I want to function. I want to work.’”


Tips for creating a supportive work environment

Tim Collins, director of Stafflink Solutions, and Mary Ann Baynton, director of Mental Health Works, offer the following tips for accommodating people with mental health or substance use issues:

  • Offer flexible scheduling or self-paced workloads. This is helpful for employees who are on scheduled medication, which can affect focus or energy level at specific times.
  • Offer a meditation or quiet reflection area. This can be a good way for all employees to relieve stress.
  • Offer Alcoholics Anonymous meetings onsite.
  • Offer time off as a reward for good performance.
  • Discuss accommodations that involve changing the workplace with all employees.
  • Welcome a returning employee with a team meeting to update the employee and to give co-workers a chance to make eye contact and conversation and to break the ice.
  • Offer employee information sessions about mental health and addiction. Bring in speakers who have successfully returned to work after addiction or mental health issues.


Fighting stigma in the workplace

Stigma has a large part to play in the struggle to create accommodating workplaces, says Bill Wilkerson, CEO of the Global Business and Economic Roundtable on Addiction and Mental Health. “As a result, people won’t easily or at all ask for assistance or seek out any form of help because they are afraid of conceding what they see as an inherent flaw,” says Wilkerson. “One woman told colleagues she had a brain tumor rather than depression so she wouldn’t suffer from the stigma associated with that diagnosis.”

Stigma also makes it difficult for managers to offer assistance. Mary Ann Baynton at Mental Health Works says managers may feel paralyzed by fear of saying the wrong thing or infringing on someone’s privacy. Through Mental Health Works, Baynton teaches the following four-point process to help managers navigate problems that affect the workplace, stressing that it is a manager’s job to manage, not to diagnose.

1. “I notice.” Listen to and observe employees and ask questions if you notice behavioural changes.

2. “I’m concerned.” Express concern about changes and listen to employees to see what’s going on.

3. “How can I help?” Ask how you can help the employee succeed at work. This may involve linking employees to supports or suggesting a workplace accommodation.

4. “Let’s focus on solutions at work.” Determine what type of assistance the employee needs; for example, new skills or resources, or help or accommodation for a mental or physical health problem. Also determine what the employee can commit to.