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Depression in the Workplace: Can We Do Better?

How can we support productive employees who experience mental health issues?

I recently interviewed a friend and former co-worker who lost a career and a 13-year job due, in large part, to a bout of severe depression and anxiety that was not being managed well by her behavioral health specialist. This friend has depression in her family and had been through several depressive episodes in her life, but had come out of each of them with a combination of medication, support from friends, therapy, and self-exploration. In her 30+ years of working, she had never before lost a job because of her mental heath issues.

Prior to this episode, she had been widely praised at her company for over a decade, and most of the time had received praise, bonuses, and regular raises. Her social security reports showed a steady upward trend to her compensation over the years that she had been in the workforce, the way it was supposed to. She felt she had done well professionally.

But then, things got hard. She had just left an abusive relationship, and the combination of trauma and her genetic predisposition to depression had sent her into a spiral of sometimes-suicidal depression, for which she sought professional help.

Her psychiatrist at Kaiser, which has a notably horrible behavioral health department, had put her on medication, but she often had debilitating panic attacks in the office, could barely get out of bed to get to work on time (though she tried hard to and got there by 10 a.m. if not before, most days), had insomnia, and struggled with focus and motivation. When she tried to get another appointment with her doctor to discuss the continued problems she was having, she was told she would have to wait two months, and when she tried to leave voice messages, the mailbox was always full.

When she told her manager about her depression and that she was in treatment, the manager made vague compassionate noises, but never followed up or even asked my friend how she was doing . Instead, she put my friend on probation at work, threatening her with termination if she didn’t improve her performance.

Naturally, the stress of knowing she was on probation didn’t help my friend’s depression, but she doubled down and tried harder, only missing her work quota by one project despite her struggles, delivering quality projects that were celebrated by her colleagues. However, even though she thought she had performed well enough to be removed from probation, she was still fired and walked out the door by coworkers with boxes of her belongings. She was left sobbing in her car while she got up the energy — and staunched the tears enough — to be able to safely drive home. She said she cried for days and felt numb for nine months.

Because she was not given a letter of reference, she was, in effect, kicked out of a career she had spent 17 years building, and which, up to that point, had been exemplary. All because she encountered serious personal problems and had a genetic predisposition to depression.

She tells me now that, in hindsight, she should have invoked the Americans with Disabilities Act, but at the time, she just thought if she just tried harder, she’d do better.

To make matters worse, her former employer offered her severance, but only if she signed a gag order that included not talking about the gag order, and not being able to sue the employer for compensation. She signed it because she couldn’t afford not to, although she did consider seeking legal advice.

The combination of her depression, lingering trauma from the abuse, and the added trauma of being fired and possibly losing the home she had bought when she thought she had finally “made it,” trying to find health coverage, and looking for work was so overwhelming that she chose to sign the gag order so she could get the money. She says that if she had been financially able to, she would have not signed the agreement and would have talked to a lawyer. She feels her ex-employer discriminated against her because of her depression.

She lost her health insurance and ended up on state-sponsored insurance after 6 months of having no coverage at all, and no access to medication. She finally started to improve when a kind family friend — who is a medical doctor — agreed to see her for free and prescribed a medication she knew had helped her in the past (the Kaiser doctor had heard her say that this medication had worked, but had prescribed another medication instead, which, it turned out, increased her anxiety).

She came through that year of unemployment because she was lucky enough to have some savings, as well as a family members who generously helped her get back on her feet financially. If she hadn't had that, she shudders to think what could have happened.

Though she has righted the sinking ship -- reinventing her career at midlife — she searched for comparable jobs for nine months with no luck, is now earning a quarter of what she was earning, has much worse credit than she had before, and has had to take money out of her IRA in order to pay her bills and launch her business. Again, she's very lucky to have had these resources to lean on, and she knows it.

The medication she is on has helped a lot, and, despite her newly challenging circumstances, she no longer suffers from depression. This means that, if her employer had supported her to get the right treatment, she would have been able to return to being a productive member of the team, as she had once been.

Despite feeling better in relation to her depression, she tells me she feels a deep sense of betrayal and that her confidence as a professional has been crushed.

The people who hired her never even acknowledged her departure, and very few coworkers have reached out, including those she felt were friends. She can’t understand why a community she felt a part of and worked with so long seemingly turned its back on her.

She has a hard time trusting her own skills, and doesn’t trust anyone else unless they’ve been in her life — and supportive — for many years. She has significantly reduced her social life because of the fear of being punished for being who she is, and though she reports being fairly happy anyway, her mind keeps going back to the time when a community she thought valued her almost literally tossed her to the curb.

How can we make the workplace kinder, more compassionate, wiser about mental health struggles, and less punitive towards people who contribute to the workplace but who sometimes struggle, through no fault or choice of their own?

Major depressive disorder is reported to effect 14.8 million American adults (about 6.7%) in a given year (Archives of General Psychiatry, 2005 Jun; 62(6): 617–27). According to the Harvard Mental Health Letter, one survey reported that about 6% of employees experience symptoms of depression in any given year. A 2003 study reported that employers lose an estimated $44 billion every year due to workers with clinical depression (Walter F. Stewart, PhD, MPH, Geisinger Health Systems).

This is clearly a major problem. So why are so many employers treating once-valued employees with mental health issues like criminals to be pushed out of the workplace, rather than seeking ways to support them?

David S. Mandell, director of the University of Pennsylvania’s Center for Mental Health Policy and Services Research, in an article on Knowledge@Wharton says: “… large-scale studies are saying when you treat depression in the workplace, you get a substantial return on investment relatively quickly, so there’s a real economic argument for reducing the stigma, as long as we can provide evidence-based care for [the employees].”

Stew Friedman, who writes on mental health and other issues in the workplace, says, in the same article: “Great managers are always curious about what the needs and interests of their people are, and so we know from my research and others that we have to account for the needs and interests of people in a way that enables them to connect their goals to the goals of the organization, and the only way is through compassionate inquiry about the other. That’s what’s needed — ‘How is it going? What’s happening with you?’”

My friend’s manager inquired once, when her productivity stumbled, but never asked again, even after my friend told her she was in treatment for depression. But after that, my friend said she noticed that people were less friendly to her, even those who used to say hello in the halls. People would look away when she met them in the hallways. And her manager seemingly took opportunities away from her: pulling her off a planned business trip, reassigning work that had been given to her — and which she had completed — to a coworker, without any discussion or critique. She thought she was being paranoid due to trauma from her past relationship, but now she wonders if she was actually seeing the truth: that her admission of her struggles was being used against her.

One reason for this kind of behavior towards people who struggle is clearly the stigma of mental health problems. We are told not to tell anyone at work for fear of reprisals, and, as my friend and others have come to realize: Often, this warning is warranted.

The problem is that if a mental health or other personal issue is interfering with one’s work: how is that person supposed to cope if they can’t be honest about what’s happening? The struggle of trying to pretend everything is normal when it most definitely is not can add to the mental health problems and can make them worse.

Another reason for this treatment is the employer’s fear of workplace violence, which is of course a fair concern, but a 2011 article on the Harvard Mental Health letter reports that “most individuals with psychiatric disorders are not violent.”

So it seems that helping valuable employees with mental health issues rather then firing them is better for business and employee loyalty and retention, yet stigma against employees with mental health concerns is still significantly reducing the life productivity of people who, through no fault of their own, experience mental health problems.

I’m not sure of the answer, except to continue to lobby for robust mental health care in all aspects of community, from institutions of education to the workplace, to the halls of government. We can’t continue to toss valuable people from the workforce because they run up against a personal problem and have a temporary — or treatable — issue. It’s morally reprehensible and doesn’t even make good business sense.

Luckily, Friedman, in the Wharton article, seems to have hope: “I think we are hearing more stories, more openness about the real experiences of actual people who are struggling with how they are different. The more these stories are told and heard, the easier it becomes for you to tell your story. That’s how cultural change happens.”

In my research for this article, I found both evidence that there are workplaces where managers support employees' mental health, and workplaces that still feel that people with mental health issues are a "risk to the company." Yet evidence seems to show that helping formerly productive employees get the help and treatment they need makes more business sense and is healthier in both a financial and psychological sense. It's a shame to me that so many people are punished for having normal life struggles. My friend is, luckily, resilient and resourceful, but she was also lucky enough to have the help she needed. Not all are that lucky.

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