Creating a Mental-Health-Friendly Workplace



Overview

Abraham Lincoln. Buzz Aldrin. Jimi Hendrix. Jane Pauley. Charles Darwin. Barbara Streisand. Michael Phelps. These are just a few well-known, highly successful individuals who have lived with or are living with mental illness. The value of their work is immeasurable, and not defined by their conditions. With support and understanding from employers, individuals with mental health conditions can thrive in the workplace. 

Mental health has emerged as one of the critical issues of our time and has only been compounded by the renewed visibility of equity and social justice issues and an economic recession.

Every individual has a mental health status, just as every individual has an age or race. Mental health can be viewed as an expansive continuum between good mental health and serious mental illness. Many people will fluctuate on the milder end of the spectrum due to the normal challenges of life, while others will fluctuate or stabilize within the range of mental illness. Most will be able to work successfully, especially when mental health is understood and supported by their employer.

The Centers for Disease Control and Prevention website states, "Although the terms are often used interchangeably, poor mental health and mental illness are not the same. A person can experience poor mental health and not be diagnosed with a mental illness. Likewise, a person diagnosed with a mental illness can experience periods of physical, mental, and social well-being."

The National Institute of Mental Health (NIMH) defines a mental illness as a mental, behavioral or emotional disorder. A serious mental illness is one that results in serious functional impairment that substantially interferes with or limits one or more major life activities.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 20 percent of U.S. adults experience mental illness each year and other studies show that most individuals will experience some degree of mental illness during their lifetime[i]. While some mental illnesses are debilitating and significantly interfere with daily activities, many are minor and even undiagnosed. Regardless, all employees can benefit from mental health support in the workplace.

Failure to support employees' mental health weighs heavily not only on the employees themselves, but also on an organization's bottom line. Investing in workplace mental health and wellness increases retention, recruitment and productivity; lowers absenteeism, disability leave and medical costs; and reduces employee-related risks and potential liabilities. See 5 Common Mental Health Challenges in the Workplace.

The Employer Assistance and Resource Network on Disability Inclusion (EARN) model for cultivating a mental health-friendly workplace is based on four pillars: 

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This toolkit provides a discussion of these pillars and includes resources for employers to better understand mental health in the workplace and support the mental health of their employees. 

See Checklist for Mentally Healthy Workplaces.

Build Awareness and a Supportive Culture

Proven strategies for building a mentally healthy workplace include educating workers on mental health issues and taking actions to foster a supportive workplace culture. Organizations can take the lead in overcoming the stigma of seeking treatment for mental illness.

Through education and advocacy, employers can ensure that employees know the symptoms and causes of mental illness and how to access mental health services. Employees should be encouraged to seek mental health help just as they would seek treatment for physical illnesses or injuries. See How to Encourage Employees to Use Mental Health Benefits.

A September 2021, survey of working Americans by SHRM found that 26 percent of workers hid their mental health struggles from their supervisor. However, when their supervisor was aware that the employee was experiencing mental health issues, the most common responses from the supervisor were to:

• Demonstrate empathy.
• Encourage the employee to take time off.
• Adjust the employee's workload.
  
• Offer remote or flexible work options.

The SHRM survey also found that 15 percent of supervisors did nothing in response to learning about a direct report's mental health struggles, 8 percent removed the employee from an important project and 7 percent denied the employee advancement opportunities.

While these negative actions were uncommon, any adverse action taken solely based on an employee's mental health status is unacceptable. Training supervisors and managers on ways to support employee mental health, the legal obligation to accommodate disabilities, and how to prohibit discrimination and retaliation is essential.

The Job Accommodation Network (JAN) provides a list of workplace mental health awareness training programs employers can access and use in their organizations, including the National Council for Mental Wellbeing's Mental Health First Aid at Work.

The SHRM Foundation is leading the charge toward transformational change by empowering business leaders and HR professionals to eliminate the stigma around employee mental health, invest in innovative wellness strategies and create more supportive work environments.

In addition to workplace mental health and wellness learning resources, a new Workplace Mental Health Ally Certificate program from SHRM and the SHRM Foundation, created in partnership with Psych Hub, offers HR professionals and employers the necessary tools to destigmatize mental health issues in the workplace and implement better workplace cultures. See Workplace Mental Health and Wellness: Accelerating a Movement.

Provide Accommodations

Mental illness can often rise to the level of a disability under the Americans with Disabilities Act (ADA) and thereby require employers to make accommodations for workers with such conditions.

To have employment protection under the ADA, a person with a physical or psychiatric condition must meet two criteria:

1. Be qualified for the job. A qualified employee or applicant is one who, with or without reasonable accommodation for a disability, can perform the essential functions of the job in question.
2. Have a disability as defined by the law. The ADA does not list medical conditions that constitute disabilities; instead, it has a general definition of disability. According to the ADA, a person has a disability if he or she meets one of the following criteria:    

• Has a physical or mental impairment that substantially limits a major life activity (such as walking, talking, seeing, hearing, learning or operation of a major bodily function).
• Has a history of such an impairment(such as cancer that is in remission).
• Is regarded as having such an impairment (even if the individual does not have such an impairment).

See Does the Americans with Disabilities Act (ADA) provide a list of conditions that are covered under the act? and Enforcement Guidance on the ADA and Psychiatric Disabilities.

Possible Accommodations

The following are accommodation suggestions from the U.S. Department of Labor (DOL) that have been found to help employees with mental health impairments perform their jobs more effectively. In reality, these types of accommodations can improve the productivity of most employees, regardless of their mental health status.

It's key to remember and to educate all employees, especially people managers, that accommodations are meant to level the playing field, not to make more work for others or to treat employees unfairly. Messaging around accommodations can make a meaningful difference in how an organization as a whole supports workers experiencing mental illness. See How to Handle an Employee's Request for an ADA Accommodation.

Policies and scheduling:

• Telecommuting, part-time hours, job sharing, adjustments in the start or end of work hours and granting permission to make up missed time for employees struggling with medication side effects, such as drowsiness or lack of energy.
  
• Sick leave for reasons related to mental health, flexible use of vacation time, additional unpaid or administrative leave for treatment or recovery, leaves of absence or use of occasional leave (a few hours at a time) for therapy and related appointments.
• Breaks according to individual needs rather than a fixed schedule, more frequent breaks or greater flexibility in scheduling breaks, provision of backup coverage during breaks, and telephone breaks during work hours to call professionals and others needed for support.
• Permitting beverages and food at workstations, if necessary, to mitigate the side effects of medications.

Work area modifications to help employees concentrate:

• Reduction or removal of distractions in the work area.
• Addition of room dividers, partitions, or other soundproofing or visual barriers between workspaces to reduce noise or visual distractions.
• Private offices or private space enclosures.
• Office/workspace location away from noisy machinery.
• Reduction of workplace noise that can be adjusted (such as telephone volume).
• Increased natural lighting.
• Music (with headset) to block out distractions.

Equipment and technology that helps improve organization, limit distractions and enhance learning:

• Recording devices for recording/reviewing meetings and training sessions.
  
• White noise or environmental sound machines.
  
• Hand-held electronic organizers, software calendars and organizer programs.
• Remote job coaching, laptop computers, personal digital assistants and office computer access via remote locations.
• Software that minimizes computerized distractions, such as pop-up screens.

Job duties:

• Modification or removal of nonessential job duties by swapping tasks with other employees or eliminating unnecessary tasks.
• Division of large assignments into smaller tasks and goals.
• Additional assistance or time for orientation activities, training, and learning job tasks and new responsibilities.
• Additional training or modified training materials.

JAN, a service of the DOL's Office of Disability Employment Policy, has compiled a considerable amount of information on various methods of accommodating employees with mental health conditions. See Accommodation and Compliance: Mental Health Conditions.

Offer Employee Assistance

In addition to providing accommodations to individuals with mental health conditions, employers can support all employees through voluntary programs and actions that can improve employee mental health and wellness. Examples from EARN include:

• Fitness programs to improve employees' physical health, which in turn promotes positive mental health.
• Stress management training to develop relaxation, mindfulness and resiliency skills to manage workplace stressors and enhance mental well-being.
• Work environments that connect with the outside world through natural light, plants, etc., and provide a versatile, flexible range of spaces.
• Employer-sponsored awareness-building and anti-stigma campaigns.

See How can employers help to reduce stress in the workplace?

Many employers also offer employee assistance programs (EAPs) designed to identify and assist employees in resolving personal problems (e.g., marital, financial or emotional problems; family issues; substance/alcohol abuse).

EAP services may include assessments of employees' needs and referrals for diagnosis and treatment of mental health, substance use or other issues. Educational and wellness programs, such as programs informing employees about healthy weight, stress management and smoking cessation, are also staples of many EAPs. See Managing Employee Assistance Programs.

Ensure Access to Treatment

Mental Health Benefits

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires large group health plans to ensure the financial requirements and treatment limitations applied to mental health and substance use disorder benefits and services are no more restrictive than for medical or surgical benefits and services.

The Affordable Care Act builds on MHPAEA and requires coverage of mental health and substance use disorder services as one of ten essential health benefit categories in non-grandfathered individual and small group plans. Over the years, the rules and guidelines have evolved, with modifications from the Affordable Care Act of 2010, the Cures Act in 2016 and the Consolidated Appropriations Act, 2021. See Mental Health Parity Compliance Returns to Forefront for Group Health Plan Sponsors.

Beginning in 2021, plan sponsors must conduct an analysis of their health plan's treatment limitations and provide this information to the DOL or the Department of Health and Human Services upon request. See Appropriations Act Requires Employer Actions to Ensure Mental Health Parity and FAQs About Mental Health and Substance Use Disorder Parity Implementation and the Consolidated Appropriations Act, 2021 Part 45.

The DOL provides an online self-compliance tool that consists of questions and examples to help plan administrators assess whether their plans are in compliance with various MHPAEA requirements, including rules relating to medical management standards, pre-authorization requirements, and coverage exclusions and limits.

Job-Protected Leave

Employers covered by the Family and Medical Leave Act (FMLA) should inform individuals with mental health conditions about the availability of job-protected time off from work to seek medical treatment. Time away from work for mental health treatment is often covered under the FMLA. See How do I know if an employee's medical absence qualifies for FMLA leave? What is considered a serious health condition?

While time off from work can be provided as an accommodation under the ADA, the FMLA provides an employee with additional job and benefit protection and reinstatement rights. Leave that qualifies for protection under both the ADA and the FMLA can run concurrently.

Workplace Practices

Employers can also implement practices to remove barriers, reduce stigmas and encourage individuals to seek treatment for mental illness. The Center for Workplace Mental Health provides a Working Well toolkit to assist employers in fostering a workplace that promotes, supports and improves the mental health of employees and their families. Examples from the Working Well toolkit include the following:

• Regularly provide information about mental health issues and employee benefits to reduce the stigma sometimes associated with seeking help for mental health problems.
• Provide access to valid mental health screening tools.
• Give employees easy access to mental health support and care (e.g., an EAP).
• Provide high-quality outpatient and inpatient coverage for mental health treatment, as well as easily understood descriptions about how to access care, when needed.
• Cover effective prescription medications for mental health conditions at a level that encourages their appropriate regular use.
• Encourage mental health and stress management through a comprehensive wellness and health promotion program.
• Provide training to managers on conflict resolution and management skills to reduce excessive workplace stress.

Enforcing Performance and Conduct Standards

Changes in an employee's behavior, mood or performance may reflect any number of things, including personal difficulties, job dissatisfaction, or physical or mental health conditions that may require treatment. Asking open-ended questions can encourage an employee to request support or accommodation, but it is not the employer's job to probe into an employee's personal life, diagnose a problem or act as the employee's counselor.

Employees with mental health conditions may be disruptive or erratic or may have difficulty controlling their emotions. Employers should clarify to all employees the behaviors that are inappropriate in the workplace and the consequences for engaging in those behaviors.

When a performance-related problem occurs, it remains a performance issue even if the cause is related to the employee's disability. It is not discrimination to approach an employee with a mental health condition to discuss the issue. See Applying Performance and Conduct Standards to Employees with Disabilities.

If an employee's behavior at work becomes a problem, talk to the person privately about how this is impacting the workplace. Focus on the behavior, and do not label the person. For example, do not say, "You are disrespectful." Instead, say, "You are behaving in a disrespectful way" and give examples. If the employee brings up a health-related factor, ask open-ended questions to encourage the individual to request support or accommodation (e.g., "How can we support you in changing these behaviors?").

The employer's involvement does not end with one meeting. HR or a supervisor should follow up with the employee regularly. If the employee's performance has not shown any improvement after the designated period, and he or she has not requested accommodation or leave, considering disciplinary action may be appropriate at that point. If the situation is serious enough that termination of employment is imminent, being clear and documenting the meeting as a performance-related issue is important.

Resources

SHRM Resources

SHRM Foundation Workplace Mental Health and Wellness

SHRM's Mental Health Resource Hub Page

Mental Health Awareness Express Request

Books available in the SHRM Store

Additional Resources

Surgeon General’s Framework for Workplace Mental Health and Well-Being

U.S. Department of Health & Human Services

U.S. Department of Labor Office of Disability Employment Policy

Job Accommodation Network (JAN)

Equal Employment Opportunity Commission (EEOC)

National Alliance on Mental Illness

Substance Abuse and Mental Health Services Administration (SAMHSA)

International Employee Assistance Digital Archive

[i] Centers for Disease Control and Prevention: About Mental Health