Many alcoholics avoid talking about their problem, even with close friends. Robert Tyndall came out about it to 20,000 of his coworkers.
Tyndall, a senior vice president at Prudential Financial, was forced to confront his years of daily drinking at a performance review in 2010. After some bad behavior at company functions, his boss warned him never to drink at a work event again. Mortified, Tyndall listened—for a while. But soon he slipped at another gathering. His second conversation with his boss was more blunt: "‘You need to get help, but I’ll have to fire you if you don’t,’" Tyndall recalls she said.
"Back in the day," Tyndall says, he likely wouldn’t have gotten a second chance. Instead, that conversation—along with an ultimatum from his family—was a wakeup call. Tyndall contacted Prudential’s behavioral health services group, a unique part of the company’s health and wellness division consisting of two full-time employees and eight on-site consultants who offer confidential counseling and coaching, in which about 6.5% of employees partake each year. They helped him get admitted to a rehab program, for which he went on medical leave. Later, he joined AA, and as he recovered, a realization hit him: Other coworkers might be suffering in the same way. "If I could tell others they aren't alone, they could be more likely to feel they can reach out for help," he remembers.
Stigma is one of the biggest reasons mental health is not addressed adequately at work. And there is no question that it is not addressed adequately: In recent years, companies and entire industries have been confronted with consequences for their high-stress, poor mental health cultures—see the high-profile suicides on Wall Street and the string of deaths among tech entrepreneurs.
"There is a reluctance on the part of many workplaces to have open discussions about mental health on par with other physical health issues," says Wendy Brennan, executive director of the National Alliance on Mental Illness of New York City. "We don’t generally recommend that anyone discloses in the workplace. There’s still a huge stigma attached." In one study of 600 people with disabilities reported in the New York Times, about half involving mental health, 25% reported receiving negative responses to their problems, including bullying and being passed up for promotions. The U.S. Department of Health itself warns that discrimination can be a cost of disclosing. Brennan says she’s seen people still fired after they reveal their issues.
It is strange that many workers feel they can’t ask their employers for help, because mental health is discussed more than ever before in today’s workplace. As everyday stress and overwork plague the American workforce, mindfulness meditation sessions and yoga practices have spread from the halls of Google to the back offices at Target and the cubicles of Goldman Sachs. Automated apps that offer therapy on your smartphone are in vogue. And at most mid- to large-sized companies, workplace wellness programs exist to promote the benefits of exercise, sleep, and a healthy diet to improve bodily health—but also to boost mood and focus. Corporate wellness is an $8 billion industry, and in some offices, things like cholesterol and blood pressure testing are becoming mandatory, raising Big Brother concerns for employees.
Sleep trackers and meditation programs may be truly beneficial to some workers, even if perhaps more often, employees ignore wellness offerings or don't stick with them. But they also address just a tiny sliver of employees' true mental health issues. Most employers still aren’t like Prudential, where explicit programs exist to end stigma, support mental health for both employees and their families, and create a balanced and flexible workplace culture. Many companies fail to address the root causes of workplace angst, whether it is the long hours or poor job security that exacerbate stress and health problems for all employees or the mental health challenges—including depression, anxiety, and substance abuse—that affect a smaller but growing subset of them.
"It’s easier to go and do 20 minutes of exercise or get your 10,000 steps than to have hours of costly therapy," says Andre Spicer, a professor at the City University of London and critic of wellness programs. "Or say you have an asshole boss. You psychologize that. It’s not that you have an asshole boss—it’s your problem. It’s not dealing with the underlying organization of the workplace." In other words, workplace wellness programs often miss both the more serious mental health issues and the everyday structural stresses that affect all employees.
Mental illness is extremely common in the workplace, even if it often remains hidden. In a given year, according to the National Institute of Mental Health, 1 in 5 U.S. adults experience some form of mental illness, including 6.7% with a major depressive episode and 18% who experience an anxiety disorder; there are 20 million workers with a substance abuse issue. In the last 12 months, more than 1 in 10 workers skipped at least one day of work because they were too depressed or anxious.
Of course, work is not fully responsible for these issue. But it does help create some: A 2015 study from Harvard and Stanford University business schools found that health problems stemming directly from job-related stress—ranging from long hours to the burdens of having no insurance and doing shift work—likely contribute to about 120,000 deaths a year and $190 billion a year in health care costs. By examining more than 200 separate studies, the research concluded that job insecurity increased the odds of reporting poor health by 50% and long work hours increased mortality by almost 20%.
Employers are slowly coming to terms with all of this. "As a society, I think we are talking about mental health and mental illness more. But that’s translating much slower in the workplace—the workplace is sort of the last frontier of these conversations," says Clare Miller, director of the nonprofit Partnership for Workplace Mental Health, which works directly advising employers. She has seen the change during her 15 year career, especially recently as companies recognize the costs of not doing enough. Depression alone is estimated to cost the U.S. $210 billion a year, half of which are workplace costs including missed days and reduced productivity. More generally, research studies showing how mental health affects productivity and performance are piling up. By 2020, the World Health Organization estimates, depression will be the second leading cause of disability worldwide.
Progressive firms—both Miller and Brennan cite Prudential as one example—are now very proactive about breaking down stigma and changing workplace culture. The company has focused on health and wellness for decades, but its programs became more expansive in 2007 when a health risk assessment taken by 77% of employees showed that stress, depression, and obesity were some of the key areas of concern among its staff. Today, Prudential has held employee forums about "ending the myth and stigma" where senior executives like Tyndall speak about addiction, depression, and PTSD. It also does things like offer a 24-hour a day referral service to help employees manage problems like elder care, funerals, and sick pets. The majority of its employees have a flexible work arrangement.
No one else at work officially knew Tyndall had been to rehab. But in 2013, he decided he wanted to share his story. It was hard, but first, he spoke on a panel about mental health troubles, and then he and his boss talked about it together on a video circulated widely inside Prudential. Now he is just starting to talk about stigma and outside firms and conferences. "Companies need to not shy away," he says. "Supervisors need to have these conversations."
Workplace design is another important factor because many work environments are designed for anxiety today. Spicer notes that people are most "mindful" and happy in the course of doing their jobs when they can work without too much interruption and accomplish goals every day, rather than flitting between 1,000 tasks and not getting anything done. Designing job roles and teams that allow employees to focus on goals, accomplish tasks every day, and feel in control of their time could go much further to improve mental health than a meditation program, he says. So could HR policies that do more to weed out horrible managers, he says.
Leadership trainings at Prudential involve discussions of these issues. "We train supervisors to have the courage to argue up the chain of command when priorities and deadlines are unreasonable," says Kenneth R. Dolan-Delvecchio, head of the company's behavioral health services group. "We need to be respectful of human limits."
U.S. employers are also, of course, the primary purchaser of health insurance—and that’s another area where they have yet to exert enough influence.
For example, a law passed in 2008 required health insurance plans to cover mental health services equally with medical care, but what that looks like is not well defined or enforced yet. For example, in many regions, a health insurer might provide in-network benefits to see a psychiatrist or psychologist, but there are so few providers that none are taking new patients. Or the next appointment is in eight months. As a result, many people don’t get the help they need, and when they do, the co-pay costs might be high, says Miller.
"If big employers got together and put pressure on the insurance companies, access would have to improve," says Brennan. (There is also an overall shortage of mental health specialists).
New tech tools are also becoming available to help employers offer their workers access to anonymous mental health screenings. For example, Castlight Health product chief Dena Bravata and Facebook’s former chief financial officer, David Ebersman, came together last year to launch a startup called Lyra Health to do just this. According to Bravata, part of the reason Ebersman came on board was because he saw first-hand the financial toll of depression and anxiety on both Facebook and his previous employer, the Silicon Valley biotech firm Genentech. Lyra Health is now building an app-based questionnaire that screens for mental health red flags and, then using an algorithmic matching system, recommends a doctor or course of action and offers live support. The app is a more convenient, data-based, millennial-friendly extension of the underutilized employee assistance programs many large employers already have. They are in the piloting phase right now.
"Any patient who comes to us has immediate access to a mental health professional, via text, email, phone, or video," says Bravata. "We save those precious few local providers for those folks who really need it."
Workplace wellness programs that encourage meditation aren't a bad thing, especially when nothing is mandatory for all employees. It’s just, says Spicer, that they are not enough. They give companies an excuse to stop at the cheaper, more superficial mental health solutions.
Tyndall, for his part, says he will feel forever grateful to his employer for the supportive intervention. "My bottom was very high," he says. "I feel very very fortunate to try to slay my demons at the time I did."