What is the Incidence and Cost Impact of Depression and Anxiety in America?
According to the CDC, 1 in 5 Americans will experience a mental illness in a given year, and more than 50% of us will be diagnosed with a mental illness or disorder at some point in our lifetime.
Prior to the pandemic, mental health researchers calculated that depression and anxiety disorders alone were responsible for $210 billion in added costs to the economy every year.
As you might expect, the pandemic has made things worse.
The number of workers who report dealing with one or more mental health conditions (including anxiety, depression, or PTSD) doubled from 20% to 40% between 2020 and 2021, according to a survey by Lyra Health.
The Covid Pandemic has Dramatically Increased Stress Levels
The pandemic has increased our overall stress levels considerably – and this, in turn, will have a major negative effect on our collective mental health.
If we make a scorecard of the typical external factors that contribute to stress and anxiety, Covid is hitting all the marks, with many Americans experiencing one or more of the following:
- Income Instability, Increased Poverty due to Job Losses, Business Closures
- Political Arguments Leading to Family or Friend Estrangement, Divorce
- Lockdown Loneliness and Social Isolation from Friends, Family, Co-Workers
- Lack of Timely, Affordable Access to Medical Care
- Increase in Significant Health Conditions, including Covid and Long Covid
- Grief due to Illness and Death
- Increased Levels of General Anxiety and Fear of the Unknown
- Sleep Disorders and Fatigue
- Job Burnout, Concern over Workplace Safety
- Poor Eating Habits, Decreased Exercise and Fitness, Increased Alcohol Use
- Increased Incidence of News Doomscrolling and Catastrophizing
- Public Outbursts, Online Bullying and Trolling,
- Negative Impact of Social Media on Self-Esteem
We might assume that older workers would bear the brunt of this stress, but researchers from AP and the University of Chicago’s NORC found that members of the Gen Z generation (currently aged 13-24) have been especially hard hit by the stress of the pandemic.
The Case for Investment in Improved Mental Health
According to a survey conducted by the human resources company Paycor, 86% of business leaders are concerned about mental health in the workplace as a result of the pandemic.
One piece of good news is that investing in better treatment for depression and anxiety could save significant money over the long run, according to a 2016 World Health Organization (WHO) study.
WHO found that, on a global basis, every dollar spent on treating the most common forms of mental illness results in a $4 return on investment, thanks to improved worker health and increased capacity to work.
Ways to Help: Create a Healthy Work Environment that Focuses on Mental Health Wellbeing
American business leaders seem to be getting the message.
Companies across the country are making larger investments in “holistic” employee wellbeing programs that not only focus on the physical health of workers but on their mental health as well.
One reason for this is the tight labor market, which is encouraging employers to look for ways to improve their recruiting and retention efforts while at the same time reducing worker absenteeism and job turnover/separations.
Many of these programs are based on common sense approaches:
- Workers have anxiety about coming to the office? Then allow employees to continue working from home and/or make the work environment feel safer and more inviting – with a greater emphasis on sanitation, fresh air ventilation, more open workspaces, and the addition of calming biophilic design elements inspired by nature (such as natural light, indoor plants, and views to the outside).
- Workers are stressed out and not getting enough exercise? Create guided meditation spaces and gym workout rooms in the workplace. Conduct similar online programs for those working from home.
- Workers concerned about Covid when visiting crowded restaurants during the lunch hour? Offer nutritious on-site food options, including delivery to the desk or open cafeterias with grab-and-go meal solutions.
- Workers suffering from lack of social interaction? Be the catalyst and encourage people to meet face-to-face, even if it’s a social meeting on Zoom. Encourage employees to help others by participating in volunteer programs in their community.
- Workers feeling burned out on the job? Create more liberal time off policies that recognize workers may need a break to handle increased stress from the pandemic or to assist others in need.
- Workers feeling anxious about or disconnected from their job? Go the extra mile in communicating with employees (especially those working from home) to reassure them and provide fair, honest, clear information and actionable feedback to avoid unnecessary anxiety – and quash any toxic workplace rumors.
Ways to Help: Streamline Access to Mental Health Counseling and Treatment
In addition to investing in wellbeing programs, many companies are also expanding their mental health counseling and treatment program offerings for their employees.
However, you may want to review if there are still hidden barriers in place that would discourage employees who might benefit from these programs from taking advantage of them.
What should you look for, and what actions can you take?
- Increase Awareness of Available Benefits
According to 2018 research by the National Council for Behavioral Health and surveys by Lyra Health, 40% of employees said they didn’t know about available mental health benefits offered by their employer or that they found them hard to access.
- Simplify the Presentation of Benefits
Employment law and HR departments have created a confusing soup of acronyms that may intimidate employees looking for help. As proof of this, take a look at this Thomson Reuters primer on HR and employee law acronyms!
- Normalize Healthy Behavior at the Workplace
As managers, we’re probably all familiar with psychologist Bruce Tuckman’s famous phrase “forming, storming, norming, and performing.” Take the time to “normalize” and destigmatize issues of mental health by demonstrating best practices for wellness in the workplace.
- Reduce the Employee’s Cost for Accessing Benefits
With the increased need for mental health counseling services increasing, review your co-pay and paid time off policies to see if you can reduce the financial barriers for employees who need help.
- Online Counseling is Convenient and Helps Ensure Privacy
Many healthcare plans now offer online counseling options which can increase employee access to mental health services while also reassuring them that their privacy will be maintained.
How Should Managers Handle Individual Suspected Cases of Depression?
Let’s look at a common scenario.
You want to be a good manager, and you sense that one of your employees seems to be feeling down, or their performance on the job has taken an out-of-character nose dive.
You’ve invested a lot in developing a cohesive team, so your natural instinct is to investigate the problem and find out what’s happening. After all, employees often become work friends, so it’s natural to want to help.
You might be asking yourself some of these questions:
- Is this a simple case of the January “blues”? Perhaps it’s a middle-age crisis?
- Could it be a problem with a relationship at home?
- Should I say something? I really need to know what’s going on so I can help.
What should the manager do next?
The answer is to stop right there.
You are not a doctor in this scenario. Even if you are a doctor, it’s not your job to diagnose a potential healthcare or mental health condition among your employees.
Even if you are friends with the employee, you need to maintain a business-like, professional relationship that avoids crossing the line into inadvertently learning about your worker’s private medical information (PMI).
· Avoid Sharing or Receiving Personal Health Information (PHI)
Before we look at what the manager should do next, let’s take a minute to review the importance of PHI compliance under HIPAA.
Generally speaking, most businesses will fall under HIPAA regulations that help protect an individual’s private “personal health information” or PHI.
(We’ll briefly address the exceptions to the HIPAA compliance rules in the next section, but it’s generally good practice to assume they apply even if they don’t.)
Here is a brief list of the type of information that is considered Personal Health Information (PHI) by HHS and must be protected:
- Health status, including medical conditions (physical and mental illness)
- Medical history, including medical records, genetic information, test results, diagnoses
- Insurance records, evidence of insurability, receipt of healthcare, past medical claims, billing information
- Prescription information
- Disability status and claims
- Any other health status-related factor as determined by HHS
Receiving and/or disclosing this information can lead to some hefty penalties if you or your business falls under HIPAA rules.
- “Reasonable cause” HIPAA violation: $100 – $50,000
- “Willful neglect” HIPAA violation: $10,000 to – $50,000 plus potential criminal charges
- Fraud violations: $100,000 fine, up to 5 years in prison
- Intent to sell, transfer, or use PHI: up to $250,000 fine, up to 10 years in prison
- Maximum penalty for willful violations not corrected in a timely period: Maximum $1.5 million per year
For more information on how to protect private health information specifically related to mental health, see this HHS bulletin.
· Get Sound Legal Advice to Comply with Employment Regulations
Just as the manager in our scenario is not a doctor, we are not employment lawyers and our advice should not be construed as legal advice. Seek the advice of a professional who will become familiar with your case and the laws in your state.
For example, legal advisors can help you keep on the good side of relevant EEOC and ADA requirements that require you to make “reasonable accommodations” for employees with disabilities, and that can include those with mental health issues, such as depression.
After consultation with an employment attorney, you may determine that HIPAA rules do not directly apply to your business.
This can be the case if your business has a “hands-off” approach to managing health benefits, e.g. it outsources all the management of your benefits programs (including worker compensation claims) to a third-party provider.
On the other hand, if your company directly manages medical benefits – including self-funded plans like health flexible spending accounts
(health FSAs) and health reimbursement arrangements (HRAs) – you will be subject to HIPAA privacy rules. Even inviting an on-site health clinic to the workplace can trigger the applicability of HIPAA rules, so be sure to consult with your counsel on how to structure these arrangements.
The bottom line: HIPAA rules may or may not apply to your business.
Nonetheless, it’s still good practice to avoid receiving, storing, or transmitting PHI. Leave that to the healthcare providers, the insurance company, and your HR department, if applicable.
How to Help Employees without Breaking HIPAA, EEOC, and ADA Rules
Let’s come back to our scenario for how a manager can engage with an employee whose job performance has deteriorated and they suspect may have depression or another mental health issue.
The key point is to keep the discussion centered around objective observations and the impact that it is having on the business.
For example, you can address a specific behavior in an objective manner:
“I saw that you were not able to complete your individual projects by the deadline you committed to earlier.”
Then you can point out how this behavior is causing a problem.
“I bring this up because it makes it hard for our team to complete our big project on schedule.”
Next, connect this to the business case.
“We could lose our number one client if we deliver this project late.”
Allow the employee to address their behavior with an open-ended question.
“Is there a reason that you couldn’t complete your work by the deadline?”
If the employee responds by bringing up problems outside of work, you can respond:
“I’m sorry about that; we want to support you while also maintaining your privacy. If you need help, stop by Ellen in the HR department to learn about resources available to you.”
As you can see, this approach avoids discussion of PMI and keeps the conversation focused on performance objectives, which is your role as a manager, and leaves the tricky part of handling sensitive private healthcare information to the HR professionals and healthcare providers.
Plan Ahead: Create an Action Plan Before You Need to Intervene
As you can imagine, conversations such as these are not easy.
Furthermore, the successful treatment of a mental health condition may involve many parties, including your HR department, the insurance company, the healthcare provider, etc.
We recommend creating an action plan to assist and train managers on how to handle these situations, rather than having to address them on an ad hoc basis as they come up.
This might also be a good opportunity for role play, with a manager tasked with portraying the role of an employee, including reviewing (and possibly recommending changes to) the employee handbook and other employee resources outlining your available mental health benefits.
HIPAA’s ‘Duty to Warn’ Exception allows you to Protect Yourself and Your Employees in an Emergency Situation
You don’t have to look far to see that behavioral and mental health problems are on the rise in American society today.
Alcohol and substance abuse is up. Violent crime is also up, with many areas experiencing double or triple-digit increases in car break-ins and thefts (including catalytic converters), and now ‘bank jugging’ where criminals follow bank customers home to rob them of cash. Retail stores are on the lookout for flash mob looting sprees, and in 2021 the FBI booked a record number of airline passengers for causing in-flight fights. Worse yet, the increased threat of violence and murder continues to haunt our schools, churches, and other public places, as well as the workplace.
We don’t want to equate cases of depression with violence. (Remember we are not doctors either.)
But cases of violence in the workplace are on the rise, which leads to a concern that HIPAA privacy rules might prevent timely communication (such as from a psychologist or other healthcare provider) that a patient they are treating might pose a risk to themselves or to others.
You should know that HIPAA has clear guidelines on this.
Section 5 CFR 164.512(j) outlines the “Duty to Warn” exemption to HIPAA privacy rules covering emergency situations, which allows healthcare providers or anyone with knowledge or suspicion of imminent harm to alert authorities or other people who need to know, such as employers.
Tragically, there have been many instances where warning signs were not heeded in time. We recommend taking the opportunity to add this to your planning processes, to practice “closing the loop” with healthcare providers, and have a well-practiced action plan in place should an employee or other individual pose a risk to your workplace.
We Wish You a Safe and Prosperous 2022
2021 has been a difficult year for many of us, but we’re hopeful that the coming year will be better.
We’ll be here for you, manufacturing custom furniture solutions for your office, laboratory, manufacturing facility, material handling operations, school environments, and more.
If you can imagine it, we can build it, here at our Formaspace factory headquarters in Austin, Texas.