If you work in an office of 10 or more, one of these people could be your co-worker.
She used to be a team player, but you can’t count on her anymore to hold up her end of the workload. Her sick days are mounting. She has lost a lot of weight. Just last week, she flew into a tirade with a customer.
He has always been a decisive manager. Suddenly he’s vacillating. He forgets the details of conversations. The office buzz is that he’s lost the assurance he once had.
Burnout? Lack of interest? Perhaps. But employers are beginning to realise these symptoms also describe someone suffering from depression, one of the most frequently misdiagnosed illnesses and one of the most costly to business.
Private insurance costs for treatment of mental illness and substance abuse rose 27% between 1990 and 1994. But the true costs of depression are likely to be found in physical complaints, lost time and productivity, experts say. A benchmark study published in 1993 by researchers at the Massachusetts Institute of Technology estimated depression’s cost to employers at $23.8 billion annually in absenteeism and lost productivity. Direct medical bills are $12.4 billion more, and mortality costs – lost earnings as a result of depression-related suicides – add $7.5 billion, the study said.
Recent research indicates that depression at work is more pervasive than thought earlier. The toll is estimated at 10% of all employees. Moved by the human as well as the financial costs, some employers are beginning to view depression and its treatment differently from past years, when treatment dollars were limited and funneled toward inpatient care. Instead, businesses such as Southwest Airlines and First Chicago Corp. are educating managers and employees to spot symptoms of the disease. Others, such as GTE Corp. and Delta Air Lines, have revised health care plans to favor earlier, preventive treatment.
“We’re seeing softening attitudes. Mental health is going to be realised as a legitimate health concern,” says Daniel J. Conti, a psychologist who heads an internal employee assistance programme at First Chicago.
In a study of its own medical records for instance, First Chicago found that its employees were taking as much disability leave for depression as for coronary heart disease, almost 40 days. After placing mental health care management under the control of an internal employee assistance programme in 1989, the bank was able to cut lost work time due to depression. Treatment costs didn’t decline, however, because more employees were treated, Dr. Conti said. Among other innovations, the bank began helping employees return gradually to work after being absent for depression.
Depression is actually a blanket term for a variety of related disorders – from severe major depression and bipolar (manic depressive) disorder, to a chronic but milder form known as dysthymia. Depression sometimes accompanies physical disorders such as thyroid diseases that affect hormones. Normal grief from a divorce or from the death of a loved one can linger and turn into clinical depression.
Current treatment ranges from psychotherapy to medication, depending on the character and severity of the depression. If untreated, though, the condition can create havoc with an individual’s career and an office’s productivity.
“Low self-esteem is universal in depression, and low self-esteem can have lifelong impact on a person’s performance,” said John Herman, a Dallas psychologist who specialises in treating professionals.
Dr. Conti describes a typical case this way: “An employee has been working in an acceptable way for a period of time. Then their performance seems to go into the tank. The individual seems mopey or apathetic. They’ve lost the will to complete assignments. They often then fall into the disciplinary route.”
Ellen Szalinski was a receptionist at a Chicago real estate company when her depression deepened so badly that she lost her temper one day with a visitor, something she had never done before.
“I had been useless on the job for a long time. My body was still there, but nobody knew what to do about me,” she said. Co-workers had been picking up the slack, she said. “It’s a pretty typical story, because it’s undramatic,” Ms Szalinski said. Still, by the time she blew up at the customer, Ms. Szalinski, who is 5-foot-2, weighed 88 pounds. “I had a constant lump in my throat that I would massage, to make the food go down. I was so sad – over nothing, really.”
She might have committed suicide, she says, had it not been for the intervention of the firm’s CEO, who had suffered from depression himself. Recognising the symptoms, he suggested treatment. It worked, said Ms Szalinski, now a spokeswoman for the National Depressive and Manic-Depressive Association.
Privacy issues can make such referrals a particularly tricky issue for managers, said Libby Sartain, a vice president at Southwest Airlines who manages the company’s personnel matters. Like First Chicago, Southwest trains its managers to recognise symptoms of mental health disorders.
“Our goal is to get the work performance where it needs to be – not to mess in our employees’ personal lives,” Ms. Sartain said. If depression begins to hurt performance, supervisors are trained to confront the issue but are careful to focus on performance.
The conversation might go something like this, said Dr. Conti of First Chicago: “You were functioning at this level in the past, and now you’re here. These are the goals we need you to reach.”
At some point in the discussion, you shift focus and let the employee know there are resources available to help performance, and that one includes an employee assistance programme, which is confidential.
The best corporate mental health benefit plans make help easy to get, said Robin Weiner, who advises companies for the consulting firm Foster Higgins.
“It’s not the kind of thing you ask the guy sitting next to you. ‘Hey, I’m feeling suicidal. Who should I call?’” she said. That is why many employers offer confidential 1-800 numbers that workers can call for help with personal difficulties. A telephone help-line service is now available in South Africa through the Depression and Anxiety Support Group who operate an 8 a.m. to 8 p.m. service. Free brochures, help and referrals are all available by calling (011) 884-1797 or (011) 783-1474.
In the managed-care plans that many employers are implementing for mental health benefits, the next step is having someone interview the caller, usually in person. “Someone might say, I just haven’t been feeling well, or I have financial problems. That is one of the ways employee assistance hotlines get at it. People whose financial problems are bad enough that they are calling this hotline may in fact have a substance abuse problem,” Ms. Weiner said.
The last step is finding the right treatment. Managed-care approaches haven’t been without controversy. Critics charge that the systems can lead health care providers – under pressure to reduce costs – to cut back needed treatment.
“Concern exists about whether ‘care’ is being managed… or ‘cost’ is being managed, and access to necessary care is actually being restricted,” the Washington Business Group on health noted in a report on Depression: Corporate Experiences and Innovations. Still, the report said employers have to find some way to manage mental health care in order to spend benefit dollars where it makes the most sense.
What doesn’t work, Ms. Weiner said, is for employers to think they can save costs by simply “capping” mental health expenditures – still a common practice, particularly among smaller firms.
Untreated mental health problems bounce around in families or show up as physical complaints, Ms. Weiner said. Several studies have shown that once the mentally ill person is treated, total treatment costs for the family – including physical ailments and substance abuse – decline.