Breaking the Silence

Website for the American Mental Health Counselors Association's Breaking the Silence initiative to address mental health stigma.

Addressing Mental Health in the Workplace Is Imperative for Healthier—and More Productive—Employees

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By contributing blogger Joel E. Miller

Five of the 10 leading causes of disability are mental health problems: major depression, schizophrenia, bipolar disorders, alcohol use, and obsessive-compulsive disorders. These disorders—together with anxiety, depression, and stress—have a debilitating impact in the workplace and need to be addressed.

Unfortunately, even though numerous affordable interventions exist, mental health and the stigma that those with mental health disorders still endure are given a low priority in the modern workplace.

Clinical mental health counselors (CMHCs) can play a critically important role in helping companies’ address their needs to make mental health treatment available to employees.

Savvy employers recognize that mental disabilities represent more than a health care issue. Employee performance, rates of illness, absenteeism, accidents, and staff turnover are all affected by employees’ mental health. In the United States, estimates for national spending on depression alone is nearly $40 billion, with an estimated 220 million days lost from work each year.

The impact of mental health problems in the workplace has serious consequences, not only for individuals struggling with mental health issues, but also for the productivity of the enterprise.

The Workplace and Mental Well-being

The workplace is one of the key environments that affects mental well-being and health. There is a growing awareness of the role of work in promoting or hindering mental wellness and its corollary—mental illness. Although determing the impact of work alone on personal identity, self-esteem, and social recognition is difficult, most mental health professionals agree that the workplace environment can have a significant impact on an individual’s mental well-being.

Employment provides five categories of psychological experience that promote mental well-being:

  • Time structure: An absence of time structure can be a major psychological burden;
  • Social contact;
  • Collective effort and purpose: Employment offers a social context outside the family;
  • Social identity: Employment is an important element in how adults define themselves; and
  • Regular activity: Employment provides a means of organizing daily life.

Many large companies now realize that their employees’ productivity is connected to their health and well-being. However, more emphasis has traditionally been placed on physical health than on mental health and well-being.

Several factors at a workplace can promote employees’ psychosocial well-being and mental health. Especially important in this respect is the opportunity to be included in planning and carrying out activities and events in the workplace (e.g. the opportunity to decide and act in one’s chosen way and the potential to predict the consequences of one’s action).

A related feature is the degree to which the environment encourages or inhibits the utilization or development of skills. Physical security, opportunity for interpersonal contact, and equitable pay are also important.

When mental health issues arise and go unaddressed, the employee suffers, as does the employee’s department, and the company’s bottom line.


Barriers to Addressing Mental Health Problems in the Workplace

Among the barriers to solving mental health problems at work are these three: They’re often invisible; people with mental health issues fear their bosses finding out about it (stigma); and low treatment rates can perpetuate mental health conditions and prove costly to the employer’s bottom line.

  • All in a day’s work?: Many mental illnesses aren’t obvious to the casual observer, so those that are evident in the workplace may represent the tip of the iceberg. Researchers analyzing results from the U.S. National Comorbidity Survey, a nationally representative study of Americans ages 15 to 54, reported that 18 percent of those who were employed said they experienced symptoms of a mental health disorder in the previous month.
  • Stigma: Many employees tend to try to hide their mental health problems at work. Further, the stigma attached to having a mental health disorder makes many employees reluctant to seek treatment for fear they could lose their job. Compounding the isolation those with mental challenges face, managers who may want to help often aren’t sure what to do. As a result, mental health disorders often go unrecognized and untreated—not only damaging an individual’s health and career, but also reducing productivity at work. (See more on stigma in the section below.)
  • Low treatment: We know that low treatment rates imperil workers’ careers and companies’ productivity. Adequate treatment, on the other hand, can alleviate symptoms for the employee and improve job performance. But accomplishing these aims requires a shift in attitudes about the nature of mental disorders along with the recognition that such a worthwhile achievement takes time and effort.


Mental Health Problems Cause Employee Disability

Mental health conditions affect working capacity in numerous ways. Depending on the age of onset of a mental health disorder, an individual’s working capacity may be significantly reduced.

Mental health disorders are usually one of the three leading causes of disability, together with cardiovascular disease and musculoskeletal disorders. In fact, mental health disorders are a major reason for granting disability pensions.

Prejudices against those with mental health disorders who remain in the workplace can serve as attitudinal barriers that cause virtual, but harmful, social exclusion. For people with mental illness, social exclusion is often the hardest barrier to overcome and is usually associated with feelings of shame, fear, and rejection.

CMHCs can help validate employees who feel shunned at work because of a mental disorder. And they can be helpful to both organizations and employees by helping employees cope with their mental health challenges in the workplace—and recover from them.


Job Stress—When Work Causes Mental Health Problems

Anyone who has ever held a job has probably experienced job stress from time to time, the harmful physical and emotional response that occurs when the requirements of the job do not match the capabilities, resources, or needs of the worker.

Job stress can cause poor health—both physical and mental—and it can increase rates of work-related injuries and accidents. Some potential causes of work-related stress are overwork, lack of clear instructions, unrealistic deadlines, lack of decision-making, job insecurity, isolated working conditions, surveillance, and inadequate child-care arrangements.

Although sexual harassment and discrimination are often excluded from lists of traditional job stressors, they must be included in any comprehensive analysis of the causes of workplace stress. Sexual harassment is a stressor for women in the workplace, and for ethnic minorities, discrimination is a stronger predictor of health outcomes (including mental ill-health), than traditional job stressors.

Among the many effects of stress are numerous physical ailments as well as mental health conditions such as depression and increased rates of suicide.


Consequences of Mental Health Problems in the Workplace

The consequences of mental health problems in the workplace are numerous, significant, and costly:


  • Increase in overall sickness absence, particularly frequent short periods of absence;
  • Poor health (depression, stress, burnout);
  • Physical conditions (high blood pressure, heart disease, ulcers, sleeping disorders, skin rashes, headache, neck pain and backache, low resistance to infections).


Work Performance

  • Reduction in productivity and output;
  • Increase in error rates;
  • Increase in number of accidents;
  • Poor decision-making;
  • Deterioration in planning and control of work.


Staff Attitude and Behavior

  • Loss of motivation and commitment
  • Burnout


Mental illness imposes a heavy burden in terms of human suffering, social exclusion, and stigmatization of the mentally ill and their families. It’s also economically costly to employers.

Unfortunately, the burden is likely to grow over time as a result of aging of the population and stresses resulting from social problems and unrest, including violence, conflict, and natural disasters.

Yet many mental health issues are treatable. Organizations that encourage employees to seek treatment for mental health issues from licensed mental health professionals—with no resulting negative consequence to their careers—will be investing in a healthy work environment while reducing the negative impact and cost of mental health problems in the workplace,


Preventing Mental Health Problems in the Workplace

While globalization has been a powerful and dynamic force for economic growth and development, work conditions and the labor market have changed dramatically during the last two decades. As a result of the increased automation and the rapid implementation of information technology, workers confront an array of new organizational structures and processes—including downsizing, contingent employment, and increased workload.

Whether or not the workplace causes mental health problems, the prevalence of mental health problems in employees makes mental health a pressing issue in its own right.

The impact of mental health problems on the workplace makes it an appropriate setting in which to educate individuals about mental health problems and treatment—and the likelihood of recovery. For example, the workplace can promote good mental health practices and provide tools for recognition and early identification of mental health problems. Organizations can also establish links with local mental health services for referral, treatment, and rehabilitation.

Local CMHCs can be an important resource for employers, since they are highly skilled professionals who provide flexible, consumer-oriented therapy. They combine traditional psychotherapy with a practical, problem-solving approach that creates a dynamic and efficient path for change and problem resolution.


Stigma and a Fair Chance to Succeed at Work

Sadly, stigma still surrounds those with mental illness, making it crucial for employers and employees to recognize its impact as well as ways to enhance the recovery process for employees with mental health disorders.

Research shows that most people with serious mental disorders are willing and able to work. Stigmatizing views held by employers make it difficult for people with mental disabilities to enter the competitive workforce. Employers are more likely to hire someone with a physical disability than a mental disability, thus raising doubts about the effectiveness of disability quotas as a method of affirmative action for people with mental disorders.

Fears that disclosing a mental health problem to a colleague or supervisor could jeopardize employment are not unfounded. Surveys of U.S. employers show that half of them are reluctant to hire someone who has a past mental health history or who is currently undergoing treatment for depression. Approximately 70 percent are reluctant to hire someone with a history of substance abuse or someone currently taking antipsychotic medication. One half (50%) would rarely employ someone with a psychiatric disability, and almost a quarter would dismiss someone who had not disclosed a mental illness.

It is important to note that these behaviors directly contravene the Americans with Disability Act, which requires employers to make reasonable workplace accommodations for people with physical and mental disabilities.

People with mental health disorders identify employment discrimination as one of their most frequent stigma experiences. In fact, the majority of people with mental disabilities (twice as many compared with individuals with physical disabilities) expect to experience employment-related stigma.

One in three mental health consumers in the United States reports being turned down for a job once their psychiatric status became known, and in some cases, job offers were rescinded when a psychiatric history was revealed. Fear of stigma and rejection by prospective employers may undermine confidence and result in a poorer showing on job interviews. Over time, people with mental disorders may come to view themselves as unemployable and stop seeking work altogether.

Research on mental health and employment shows that people with mental illnesses are likely to be underemployed, working in lower-paying menial jobs or in jobs that are incommensurate with their skills and interests. Likewise, people with mental disabilities are more likely to be hired into the secondary labor market where jobs are unskilled, part-time, and temporary, with high turnover and few benefits.

Economic incentives for people with more serious mental disorders to work full-time in the primary labor market are minimal. The money that they make often displaces or jeopardizes their disability benefits, creating a benefit trap.

Two recent studies confirm that people with mental health disorders who receive disability payments are less likely to be employed competitively and, if employed, are likely to earn less. Participation in the secondary labor market may be a function of a lack of education and training due to illness-related interruptions. If so, greater attention to helping people with mental disabilities advance their education and training, rather than focusing on immediate employment—the goal of most supported employment programs—may reduce underemployment and improve job tenure.

Employees with mental health problems may also experience stigma and discrimination from co-workers once their mental illness becomes known. Workers who return to their jobs after an illness report returning to positions of reduced responsibility with enhanced supervision where they are socially marginalized and become targets for mean-spirited or negative comments from workmates who had previously been supportive and friendly.

In order to avoid workplace stigma and discrimination, employees with mental health problems will usually go to great lengths to ensure that coworkers and managers do not find out about their illness, including avoiding employee assistance programs and shunning effective treatment options. Indeed, the majority of employees who have mental health problems fail to receive appropriate treatment.

Compounding this problem is the fact that few managers have either sufficient knowledge to recognize mental health problems or the skills to effectively manage them at the workplace. Similarly, few organizations have corporate plans to address workplace mental health and employment equity for people with mental disabilities.

To reduce stigma and discrimination associated with mental health disorders and promote employment equity for people with mental disabilities, organizations will need to be proactive in identifying and managing mental health problems among their workers and in fostering an organizational culture that is supportive of mental health, mental health treatment, and psychosocial recovery.


Mental Health at Work: An Imperative Concern

Although our knowledge of mental health issues has increased over the past few decades, employers and enterprises have lagged behind in their understanding and acceptance of the pervasiveness, treatment, and impact of mental health problems on organizational life.

Most human resource management and public administration training programs do not cover adequately the area of mental health and employment. Recognizing mental illness in the workplace is often difficult, because there is often a psychological component to physical symptoms, and physical ailments may be present in some mental disorders. Nevertheless, more and more employers are becoming aware of the importance of developing policies and guidelines to address these issues.

Ultimately, it’s imperative that employers recognize mental health issues as a legitimate workplace concern. As disability costs and absenteeism increase in the workplace due to mental ill-health, addressing mental health problems in the workplace is the way to create healthier employees and improve organizational productivity. When more organizations embrace this solution, which benefits both employers and employees, it will truly be a happy Labor Day.


This article on mental health in the workplace is part of AMHCA’s “Breaking the Silence” campaign, created by AMHCA’s Public Awareness Committee to call attention to the strong social stigma attached to mental illness and to help reduce the stigma and discrimination associated with mental illness.

The main message of the campaign is: “If you are feeling depressed, anxious, having trouble sleeping … don’t wait—get counseling,” said Keith Mobley, PhD, LPCS, ACS, past president of the American Mental Health Counselors Association. “Don’t let the fear of being labeled with a mental illness prevent you from seeking help. Counseling can provide relief by identifying what’s wrong and reducing symptoms that interfere with your work and personal life. … Act sooner than later, and improve your quality of life!”

This article, with a release timed to coincide with Labor Day 2016, notes that organizations that address mental health problems in the workplace save money by helping to foster healthier, more productive employees.

Help AMHCA break the silence! For more information about the “Breaking the Silence” campaign, visit, where you’ll find blogs and articles as well as draft op-eds and letters to the editor that you can edit to reflect your own personal experience and writing style, and then submit to various media outlets.

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