According to National Institute of Mental Health, the average person dealing with depression waits 10 years before seeking professional help. This is due to both the pervasive stigma surrounding mental health and the hidden nature of depression. Future posts will study stigma further, but today we would like to focus on the latter.

Humans are social creatures accustomed to sensing when somebody is sick. Whether someone is coughing loudly or leaning on crutches, we immediately know when something is wrong. However, even the most crippling depression has no outward signals, so strangers rarely realize that anything is amiss. While nobody is at fault for this, the invisible nature of mental health has led many to come to a dangerous conclusion: We believe that mental health is a private matter. And these conversations make us uncomfortable because private matters are not meant to be shared.

Of course, those who are fighting mental illness may choose not to discuss the topic. That is a personal choice, and we at Affect believe that those in recovery should always choose what is best for them. The expectation that mental health issues be kept secret becomes an issue when it prevents the public from talking about it. Often, people will convince themselves that the mental health of others has no effect on their lives.

That belief is an easy way out. While it's more comfortable for the average onlooker to convince himself that the damage is contained to one person, it simply is not true. One person's mental illness can have detrimental effects on their relationships, livelihood, and physical well-being. We will explore more of these consequences in the future, but today we'd like to focus on a little-known fact: Mental disorders are actually bad for the American economy. Especially in the case of depression and anxiety, they actually result in more lost productivity than physical disorders do. 

People struggling with depression face an average job turnover rate that is many times higher than that of their non-depressed counterparts  //    Flickr

People struggling with depression face an average job turnover rate that is many times higher than that of their non-depressed counterparts  //  Flickr

A Vicious Cycle

In 2015, the National Alliance on Mental Illness (NAMI) in Massachusetts launched an initiative called CEOs Against Stigma. The organization describes a cycle that many mentally ill workers fall into.

Let's say Steven starts to develop early signs of depression. However, something prevents him from seeking help. He may have convinced himself that he should "suck it up" or "get over it", or his health benefits might not cover therapy. Perhaps he is afraid of losing his job if somebody finds out he's "crazy." Whatever the reason, he isolates himself and continues to work untreated. Unfortunately, as the NAMI packet states, "the longer any worker goes without treatment, the more likely it becomes that he will slow down, call in sick, and eventually declare disability."

This situation is frustratingly common in the workplace. It likely plays a key role in driving up turnover rates for depressed employees as they reported a 15% job loss rate, compared to 3.5% for non-depressed controls. Read this NAMI piece for more statistics that make the importance of mental health in the workplace crystal clear. 


The Phenomenon of Presenteeism

Much of the research on productivity has focused on absenteeism, or business losses that occur when a medical condition keeps workers at home. However, absenteeism alone cannot address the whole issue. Only employees with the most debilitating conditions will stay home. This is especially true in hard economic times. Additionally, if someone has been struggling for many years, she may have conditioned herself to "push through" and show up anyways. There are plenty of people in a gray area, where they are struggling mightily with chronic illness but still forcing themselves to come to work regularly. 

The study of presenteeism aims to address that group. An article in the Harvard Business Review defines it as "productivity loss resulting from real health problems". Presenteeism losses generally come in two types. Quantitative losses occur when illness prevents a worker from finishing their normal amount of work, and qualitative losses occur when an illness causes them to make frequent or serious mistakes. 

It is important to note that presenteeism is not malingering or being lazy. Rather, it measures the damaging effects that real medical conditions have on concentration and motivation. Nor does it have a small impact. In fact, a study on lost productive time (LPT) found that losses from presenteeism were roughly four times higher than those from absenteeism. 

Presenteeism, a recently defined concept, makes this research much more inclusive. Although 1 in 5 Americans struggles with a mental illness, only 6% of the population has what is defined by the National Institute of Mental Health as a serious mental illness. Now, we can address those with less severe or fluctuating struggles with mental disorders. 

The Americans with Disabilities Act makes it illegal to fire employees because of their mental illness  //    Pixabay

The Americans with Disabilities Act makes it illegal to fire employees because of their mental illness  //  Pixabay

Hiring, not Firing

Reading extensively about how mental disorders interfere with work, some employers may be turned off from hiring those who are mentally ill. From a purely economic perspective, this might seem reasonable. However, there are two key reasons they should not do so. 

  1. It's illegal. Mental illnesses are covered in the Americans with Disabilities Act (ADA). Employees are protected from discrimination and entitled to reasonable accommodations. These might include things like a more flexible work schedule or the option to work from home. There are also some state laws that provide additional regulation. 
  2. It's unfair. Employers who would turn down a qualified applicant with depression should consider whether they would do the same to one who showed up to their interview in a wheelchair. Why does it seem easier to reject somebody with a mental illness than somebody who is physically disabled?

The solution here is not to fire anybody who shows symptoms of mental illness. Rather, the solution is to offer them the help they need. Thankfully, studies show that this pays itself back many times over. 


Proven Return on Investment

An Australian study found that every dollar spent on effective workplace mental health actions can generate $2.30 in benefits. The study is central to the work of Heads Up, an Australian initiative cited as one of the inspirations for NAMI's CEOs Against Stigma campaign. After seeing the moral case for providing preventative care, this proves that it is cost-effective as well. 

Heads Up lists many steps employers can take to make their workplace more inviting, along with a tool to create your own "Action Plan". First, it maps the current level of mental health awareness in the office. Those questions are followed by a list of potentially damaging factors such as "Demanding deadlines and targets" and "Low levels of recognition and reward". Finally, the site produces a set of goals personalized to your company's needs. 

Regardless of the resulting plan, the organization emphasizes on one step in particular: "Speak openly about mental health, just as you would physical well-being." This simple step may hold the key to solving other problems, like derogatory language. As with the example of hiring earlier, joking about physically handicapped coworkers often seems more rude than poking fun at "crazy" people. If employers make it clear that mentally ill employees deserves the same amount of respect, they can go a long way to improving their workplace. 


Banner image courtesy of Flickr