Mental Health in the Workplace
Mental Health Disorders and Stress Affect Working-Age Americans
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Mental health disorders are among the most burdensome health concerns in the United States. Nearly 1 in 5 US adults aged 18 or older (18.3% or 44.7 million people) reported any mental illness in 2016.2 In addition, 71% of adults reported at least one symptom of stress, such as a headache or feeling overwhelmed or anxious.4
Many people with mental health disorders also need care for other physical health conditions, including heart disease, diabetes, respiratory illness, and disorders that affect muscles, bones, and joints.5–8 The costs for treating people with both mental health disorders and other physical conditions are 2 to 3 times higher than for those without co-occurring illnesses.9 By combining medical and behavioral health care services, the United States could save $37.6 billion to $67.8 billion a year.9
About 63% of Americans are part of the US labor force.10 The workplace can be a key location for activities designed to improve well-being among adults. Workplace wellness programs can identify those at risk and connect them to treatment and put in place supports to help people reduce and manage stress. By addressing mental health issues in the workplace, employers can reduce health care costs for their businesses and employees.
Mental Health Issues Affect Businesses and Their Employees
Poor mental health and stress can negatively affect employee:
- Job performance and productivity.
- Engagement with one’s work.
- Communication with coworkers.
- Physical capability and daily functioning.
Mental illnesses such as depression are associated with higher rates of disability and unemployment.
- Depression interferes with a person’s ability to complete physical job tasks about 20% of the time and reduces cognitive performance about 35% of the time.11
- Only 57% of employees who report moderate depression and 40% of those who report severe depression receive treatment to control depression symptoms.12
Even after taking other health risks—like smoking and obesity—into account, employees at high risk of depression had the highest health care costs during the 3 years after an initial health risk assessment.13,14
Employers Can PROMOTE Awareness About the Importance of Mental Health and Stress Management
Workplace health promotion programs have proven to be successful, especially when they combine mental and physical health interventions.
The workplace is an optimal setting to create a culture of health because:
- Communication structures are already in place.
- Programs and policies come from one central team.
- Social support networks are available.
- Employers can offer incentives to reinforce healthy behaviors.
- Employers can use data to track progress and measure the effects.
Action steps employers can take include:
- Make mental health self-assessment tools available to all employees.
- Offer free or subsidized clinical screenings for depression from a qualified mental health professional, followed by directed feedback and clinical referral when appropriate.
- Offer health insurance with no or low out-of-pocket costs for depression medications and mental health counseling.
- Provide free or subsidized lifestyle coaching, counseling, or self-management programs.
- Distribute materials, such as brochures, fliers, and videos, to all employees about the signs and symptoms of poor mental health and opportunities for treatment.
- Host seminars or workshops that address depression and stress management techniques, like mindfulness, breathing exercises, and meditation, to help employees reduce anxiety and stress and improve focus and motivation.
- Create and maintain dedicated, quiet spaces for relaxation activities.
- Provide managers with training to help them recognize the signs and symptoms of stress and depression in team members and encourage them to seek help from qualified mental health professionals.
- Give employees opportunities to participate in decisions about issues that affect job stress.
Many Businesses PROVIDE Employees With Resources to Improve Mental Health and Stress Management
- Monitors the effect of supervisors on worker well-being, especially when supervisors change.
- Conducts ongoing, anonymous surveys to learn about attitudes toward managers, senior executives, and the company as a whole.
- Normalizes discussion of mental health by having senior leadership share personal stories in video messages.
TiER1 Performance Solutions16
- Focuses on six key health issues: depression, anxiety, obsessive-compulsive disorder, schizophrenia, bipolar disorder, and addictions as part of its Start the Conversation about Mental Illness awareness campaign.
- Provides resources to assess risk, find information, and get help or support using multiple formats to increase visibility and engagement. For example, information is provided as infographics, e-mails, weekly table tents with reflections and challenges, and videos (educational and storytelling).
- Maintains the “InZone,” a dedicated quiet room that is not connected to a wireless internet signal, which gives employees a place to recharge.
- Combines professional and personal growth opportunities through goal-setting, one-on-one coaching, development sessions, and biannual retreats.
Tripler Army Medical Center18
- Requires resiliency training to reduce burnout and increase skills in empathy and compassion for staff members who are in caregiver roles. Training sessions mix classroom-style lectures, role-playing, yoga, and improvisational comedy to touch on multiple learning styles.
Certified Angus Beef19
- Provides free wellness consultations by an on-site clinical psychologist. Employees do not have to take leave to access these services.
- Holds lunchtime learning sessions to reduce stigma about mental health and the services available to employees.
- Offers quarterly guided imagery relaxation sessions to teach stress management strategies.
- Provides comprehensive and integrated physical, mental, and behavioral health insurance coverage, including round-the-clock access to employee assistance program (EAP) services.
- Extends EAP access to anyone living in an employee’s home, with dedicated programming for those who are caring for children or elderly parents.
What Can Be Done?
Strategies for Managing Mental Health and Stress in the Workplace
Health care providers can:
- Ask patients about any depression or anxiety and recommend screenings, treatment, and services as appropriate.
- Include clinical psychologists, social workers, physical and occupational therapists, and other allied health professionals as part of core treatment teams to provide comprehensive, holistic care.
Public health researchers can:
- Develop a “how-to” guide to help in the design, implementation, and evaluation of workplace health programs that address mental health and stress issues.
- Create a mental health scorecard that employers can use to assess their workplace environment and identify areas for intervention.
- Develop a recognition program that rewards employers who demonstrate evidence-based improvements in metrics of mental health and well-being and measurable business results.
- Establish training programs in partnership with business schools to teach leaders how to build and sustain a mentally healthy workforce.
Community leaders and businesses can:
- Promote mental health and stress management educational programs to working adults through public health departments, parks and recreational agencies, and community centers.
- Support community programs that indirectly reduce risks, for example, by increasing access to affordable housing, opportunities for physical activity (like sidewalks and trails), tools to promote financial well-being, and safe and tobacco-free neighborhoods.
- Create a system that employees, employers, and health care providers can use to find community-based programs (for example, at churches and community centers) that address mental health and stress management.
Federal and state governments can:
- Provide tool kits and materials for organizations and employers delivering mental health and stress management education.
- Provide courses, guidance, and decision-making tools to help people manage their mental health and well-being.
- Collect data on workers’ well-being and conduct prevention and biomedical research to guide ongoing public health innovations.
- Promote strategies designed to reach people in underserved communities, such as the use of community health workers to help patients access mental health and substance abuse prevention services from local community groups (for example, churches and community centers).
- Encourage employers to offer mental health and stress management education and programs that meet their needs and interests, if they are not already in place.
- Participate in employer-sponsored programs and activities to learn skills and get the support they need to improve their mental health.
- Serve as dedicated wellness champions and participate in trainings on topics such as financial planning and how to manage unacceptable behaviors and attitudes in the workplace as a way to help others, when appropriate.
- Share personal experiences with others to help reduce stigma, when appropriate.
- Be open-minded about the experiences and feelings of colleagues. Respond with empathy, offer peer support, and encourage others to seek help.
- Adopt behaviors that promote stress management and mental health.
- Eat healthy, well-balanced meals, exercise regularly, and get 7 to 8 hours of sleep a night.
- Take part in activities that promote stress management and relaxation, such as yoga, meditation, mindfulness, or tai chi.
- Build and nurture real-life, face-to-face social connections.
- Take the time to reflect on positive experiences and express happiness and gratitude.
- Set and work toward personal, wellness, and work-related goals and ask for help when it is needed.
Any mental illness is defined as having any mental, behavioral, or emotional disorder in the past year that met Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria (excluding developmental disorders and substance use disorders). Mental illness can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment.
Mindfulness is a psychological state of moment-to-moment awareness of your current state without feeling inward judgement about your situation. Mindfulness can be achieved through practices foster control and develop skills such as calmness and concentration.
Self-management is a collaborative, interactive, and ongoing process that involves educators and people with health problems. The educator provides program participants with the information, problem-solving skills, and tools they need to successfully manage their health problems, avoid complications, make informed decisions, and engage in healthy behaviors. These programs can be provided in person, over the phone, or online.
- Substance Abuse and Mental Health Services Administration. Behavioral Health Spending & Use Accounts, 1986-2014. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. HHS publication SMA-16-4975.
- National Institute of Mental Health. Mental illness website. https://www.nimh.nih.gov/health/statistics/mental-illness.shtmlexternal icon. Accessed March 29, 2018.
- Centers for Disease Control and Prevention. Data table for Figure 16. Health care visits in the past 12 months among children aged 2-17 and adults aged 18 and over, by age and provider type: United States, 1997, 2006, and 2015. https://www.cdc.gov/nchs/data/hus/2016/fig16.pdf pdf icon[PDF – 898 KB]. Accessed July 3, 2018.
- American Psychological Association. Stress in America: Coping with Change, Part 1. Washington, DC: American Psychological Association; 2017.
- Merikangas KR, Ames M, Cui L, Ustun TB, Von Korff M, Kessler RC. The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Arch Gen Psychiatry. 2007;64(10):1180–1188.
- Scott KM, Lim C, Al-Hamzawi A, et al. Association of mental disorders with subsequent chronic physical conditions: work mental health surveys from 17 countries. JAMA Psychiatry. 2016;73(2):150–158.
- Glassman AH. Depression and cardiovascular comorbidity. Dialogues Clin Neurosci. 2007;9(1):9–17.
- Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–229.
- Melek SP, Norris DT, Paulus J, Matthews K, Weaver A, Davenport S. Potential Economic Impact of Integrated Medical-Behavioral Healthcare: Updated Projections for 2017. Milliman Research Report. Seattle, WA: Milliman, Inc.; 2018.
- US Department of Labor, Bureau of Labor Statistics. Databases, Tables & Calculators by Subject website. Labor force statistics from the Current Population Survey. https://data.bls.gov/timeseries/LNS11300000external icon. Accessed July 3, 2018.
- Lerner D, Henke RM. What does research tell us about depression, job performance, and work productivity? J Occup Environ Med. 2008;50(4):401–410.
- Dewa CS, Thompson AH, Jacobs P. The association of treatment of depressive episodes and work productivity. Can J Psychiatry. 2011;56(12):743–750.
- Goetzel RZ, Anderson DR, Whitmer RW, et al; Health Enhancement Research Organization (HERO) Research Committee. The relationship between modifiable health risks and health care expenditures: an analysis of the multi-employer HERO health risk and cost database. J Occup Environ Med. 1998;40(10):843–854.
- Goetzel RZ, Pei X, Tabrizi MJ, et al. Ten modifiable health risk factors are linked to more than one-fifth of employer-employee health care spending. Health Aff. 2012;31(11):2474–2484.
- American Psychological Association, Center for Organizational Excellence. The Awards website. Prudential Financial. http://www.apaexcellence.org/awards/organizational-excellence/oea2017external icon. Accessed July 3, 2018.
- American Psychiatric Association, Center for Workplace Mental Health. The Awards website. TiER1 Performance Solutions. http://workplacementalhealth.org/Case-Studies/Tier1PerformanceSolutionsexternal icon. Accessed July 3, 2018.
- American Psychological Association, Center for Organizational Excellence. The Awards website. Beehive PR. http://www.apaexcellence.org/awards/national/winner/54external icon. Accessed July 3, 2018.
- American Psychological Association, Center for Organizational Excellence. The Awards website. Resiliency Training. http://www.apaexcellence.org/awards/bphonors/winner/99external icon. Accessed July 3, 2018.
- American Psychological Association, Center for Organizational Excellence. The Awards website. Setting the Bar for Emotional Wellness. http://www.apaexcellence.org/awards/bphonors/winner/86external icon. Accessed July 3, 2018.
- American Psychiatric Association, Center for Workplace Mental Health. Case Study website. Houston Texans. http://workplacementalhealth.org/Case-Studies/Houston-Texansexternal icon. Accessed July 3, 2018.