Expert Interview Transcript: Depression in the Workplace

May 29, 2018 from the CDC Workplace Health Resource Center.

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ANNOUNCER: This expert interview is a product of the Workplace Health Resource Center at the Centers for Disease Control and Prevention.

CASEY: Well hello folks. It can be quite a challenge to talk about depression, let alone in a public setting like a workplace. But according to the World Health Organization, depression is the leading cause of ill health and disability worldwide.

So it is absolutely deserving of an important conversation. And you know depression isn’t really only a topic for our personal lives, it can not only impact the ability of individuals to work but certainly impact their families and their loved ones and there’s also growing evidence that work associated stresses can actually contribute to an increased risk of mental health concerns including depression.

So this is a very important conversation for us to be having. In fact we now know that depression impacts the bottom line of companies from every sector, every industry, and ultimately can cost employees, employers, and the overall productivity of a nation billions of dollars each year in the U.S. alone.

So what should employers know about depression, this highly important topic and perhaps more importantly what can employers do to intervene? Well, my name is Dr. L. Casey Chosewood, I’m the director of the Office for Total Worker Health in the National Institute for Occupational Safety and Health. We’re based at the Centers for Disease Control and Prevention or CDC.

And the topic of this expert interview is depression in the workplace. Today I’m pleased to be talking to two wonderful experts on this topic, let me welcome Darcy Gruttadaro and Marcas Miles. Darcy is the director of the Center for Workplace Mental Health at the American Psychiatric Association Foundation.

In that role, Darcy builds strategic relationships with employers, business groups, and other key stakeholders to address mental health in the workplace. Before joining the center, Darcy served in senior positions at the National Alliance on Mental Illness. She’s also an attorney whose previous legal practice focused on healthcare and mental health issues.

Marcas Miles who’s also joining us today is the senior director of marketing, communications, and employer engagement at Employers Health, which is a national coalition of employers based in Ohio. Marcas is a recognized thought leader in addressing depression in the workplace and improving worker productivity. He’s also the co-creator of Right Direction, a free turnkey workplace initiative that aims to raise awareness about depression, reduce stigma, and encourage people to seek help.

Darcy and Marcas, welcome today, we’re so happy that you could join us.

Marcas: I’m happy to be able to join you as well.

DARCY: It’s a pleasure.

CASEY: Great, well let’s get started. Marcas, I’d like for you to weigh in first if you don’t mind and sort of share with us, what are the critical issues that employers should know about depression? In particular, really what are some of the things employers need to understand about its impact on their workers and their business? And why really we should be focusing on this important topic.

Marcas: Sure, there, you know Dr. Chosewood there are a number of issues and things that employers should be considering and we’ve already covered a lot of ground I feel in the opening and introduction. But it wasn’t until more recently that employers had even really given much attention to this topic and many employers still aren’t giving a lot of attention to it.

But I will say that you know I have seen a lot of improvement over the last few years and employers making the topic of depression and other mental issues part of strategic plans. And you know there are a number of reasons and there’s a lot of good information to support some of those reasons or all of those reasons but the first thing that I want employers to know is that they are in a very powerful position to address something like this. And they haven’t because of the sensitive nature of it and also not really knowing what to do or how to do it so it’s been one that has been overlooked.

However, all the while that’s it’s been overlooked employees are missing a lot of time out of the office so on average taking 10 days a year off because of depression related issues and what we also see is that employees are showing up to work but not showing up in a full mental capacity which in the employer space would be referred to as presenteeism so actually being present at the workplace but not really being present.

So you know presenteeism and absenteeism and are two pretty significant issues that really direct, directly impact the bottom line and that would be because of productivity. So from an employer perspective that’s where we really want to look is that, you know at that productivity piece. How does depression untreated impact productivity, how does it impact culture, how does it impact teamwork, so the total cost which is a pretty big number, $210 billion is what the estimated costs of depression each year is, which is about 50% of that as a result of workplace absence, disability, and presenteeism. And then the other 50% due to direct costs as far as health benefits and medical care.

So those are just a couple of the other issues and you know there are others that you know we can get into as well.

CASEY: Great, thanks a lot for that Marcas. Darcy, is there anything that you’d like to add to that question?

DARCY: No, I think Marcas did a great job really laying it out there, it’s a cost that employers really recognize must be addressed now because it’s hitting the bottom line and there’s a growing concern about the health and wellbeing of the workforce.

Marcas: Yeah, even though one thing that I, one thing that I didn’t really mention and we’ll probably be able to talk about it as we go along you know there’s a lot of stigma about help seeking for individuals who are struggling with depression however, there’s a lot of stigma for those that are responsible for health benefits and wellness and wellbeing at companies to also address it. So you know stigma is one that I’m sure again we’ll be talking about as we go on but certainly one that has been a barrier and a challenge why you know employers should be really looking at this to try to eliminate that.

CASEY: Great. Well let’s go into some specifics, so what are some of the signs of depression that employers might actually see you know among members of their workforce? What kinds of things should they have their eyes open to if they’re going to really be able to best intervene?

Marcas: The best way that I have tried to get folks to recognize or to illustrate to them are things that we probably already are seeing, so things like missing deadlines and work days, but that we’re labeling or we have been conditioned to label as a lazy worker or a tired worker or not a team player. So we have to really start looking at things with a different lens or through a different lens, so you know folks who are missing deadlines or missing workdays more frequently or more even sporadically.

So they’re not taking vacation days or consecutive days or planning time off. Looking for individuals who are having trouble making decisions or trouble concentrating. We can recognize in folks that we’re with every day you know if they’re just not acting like themselves or if their relationships with coworkers are poor. So there are a number of things, again, if we start looking at it a little differently we will be able to identify in our coworkers and even in ourselves.

And I’ll talk a little bit more about Right Direction, you mentioned that in the introduction but there’s a great resource that is a chart, that one column is indicated as what depression feels like, and then the other column is how it looks to coworkers. So again, many of the things on there are showing up late to work because of sleep issues, again the concentration, indecisiveness, those kinds of things. So things that might be presented as performance related issues rather than someone’s you know own personal behaviors that are probably or could be impacted by their depression.

CASEY: Great, thank you for that. And I understand there are quite a few folks that may not have a lot of outward signs or symptoms that might even be noticed by an employer, is that, has that been consistent with your experience as well?

Marcas: Again, I think it goes back to looking at it differently, and you know a key to really making progress and changing culture at a workplace is to engage managers and supervisors. And one of the first questions is that “well I don’t want to, you know, do I have to diagnose someone?” Well absolutely the opposite of that. We don’t want people in the workplace diagnosing their colleagues. However if you are in a manager or supervisor position it is your responsibility to identify performance related issues.

So again, you know moving from you know thinking of someone as a less than or a lazy worker rather, to “what’s going on with them that they’re like that?” And a lot of times, I’ll say to employers, typically HR and benefits folks because that’s the primary audience that I work with on a regular basis is that. You know the majority of people that are hired at your company you played a role in, and there was something that you saw in that individual, or that they presented well, that you know made you hire them, chose to hire them.

So you know rather than get to a point where we write them off or we get too frustrated by them let’s really take a different look at you know, what can we do to encourage them, introduce them to resources, and really look at it as an opportunity to assist, rather than kind of brush away or just kind of look at them as not an ultimate worker.

CASEY: Really helpful, thank you for that perspective Marcas.

Marcas: Sure.

CASEY: Darcy, along those lines, let’s continue down that road a bit and let’s talk a little bit about what is the employers role as it relates to addressing you know depression in the workplace? Are there certain regulations or legal issues that employers need to keep in mind when they’re talking about you know, what many think is a quite sensitive subject?

DARCY: Yes, I mean employers can play an absolutely key role and increasingly they are, certainly larger employers recognize this and that is in raising awareness about depression and providing managers and coworkers with information on what to do if they’re concerned about a coworker.

Sadly mental health still remains a taboo topic for many so it’s always helpful for employers to raise the issue out into the open and make the workplace a safe place to be having these kinds of conversations. And I’ll provide a couple of examples of employers that we’ve worked with on case studies. It’s always helpful if the conversation is started at the highest level of the organization.

And one of the organizations we’ve worked with is Tier One Performance Solutions who’s CEO came out and shared a personal story about how mental health had impacted him in a friend, a family member, and someone they were quite familiar with. It’s a small company in Covington, Kentucky. But once that conversation started, once the CEO began to talk about mental health openly in the workplace, it really opened the door to employees feeling comfortable coming forward to share their stories.

And given that mental health impacts one in five adults in our nation, you can imagine when you open the door to a welcoming conversation how many people walk through that door and really join in on the conversation. Also we’ve worked with American Express, and they’ve brought in speakers, again this goes to raising awareness and educating the workforce, they’ve brought in speakers to speak on a global level but also in their world headquarters in New York including Glenn Close to talk about her personal connection to mental health conditions and how conditions like depression impact individuals in the workplace but also the home life and community life and beyond the workplace.

Which is important too because let’s face it, we bring to work our full selves, including ways in which we’re impacted when we’re outside of the workplace so it’s important for us to be looking holistically at people. And then we’re going to talk in a bit about other formal programs like Right Direction that are turnkey and easy, that employers are increasingly bringing in to raise awareness and educate the workforce.

In terms of laws and regulations there are several that apply to employees experiencing depression. The first is the Americans with Disabilities Act or what is commonly referred to as the ADA. That is a federal law that protects employees with depression from discrimination and harassment at work and the law actually applies to private employers with more than 50 employees, and state and local government employers.

Employees, in order to receive the benefits of the federal law, must qualify with a disability which depression does fit that need, and they also have to be able to perform the essential functions of the job with or without reasonable accommodations, and I’m going to talk about reasonable accommodations in a moment.

There’s also the Rehabilitation Act of 1973 which is another federal law that also protects employees from disability discrimination and depression falls under that law as well. And that applies to agencies and groups that receive federal funding, so this would be public school systems, universities, and private schools that receive federal funding.

There are also state laws that protect employees that live with depression in the workplace from discrimination. But just to provide a few examples of typical, reasonable accommodations that an individual experiencing or an employee experiencing depression may request. There are things like flexible work or break schedules. An employee may ask for a private or quiet workplace space to work in.

They may ask for an accommodation to work from home and telework, they may ask for some guidance in terms of more written direction and task lists to really help them stay on task. Now employers are not required to provide all of the accommodations that employees may request because of course they may not be accommodations that would place an undue burden on an employer. So it would be difficult to telework for example if you worked in a manufacturing facility and you really needed to be on the job site. So they have to be reasonable accommodations.

The other law that I’ll mention that applies, could potentially apply to individuals experiencing depression is the Family Medical Leave Act. That also, FMLA as its commonly known now, it is also a federal law and it actually allows employees to take up to 12 weeks of unpaid leave in the event if they experience a serious illness themselves or to help care for a family member who may be ill.

In order to qualify you have to have been in the workplace for 12 months so you don’t get the opportunity to take advantage of FMLA right off the bat. But once you’ve been in a workplace for 12 months you can take advantage. And that federal law applies to employers with 50 or more employees so it doesn’t apply to very, very small businesses.

And I will say for those participating that are interested in learning more, the federal government has done a great job of providing excellent guidance on all of these laws frankly. The ADA and the Rehab Act of 1973 are well covered with the U.S. Equal Employment Opportunity Commission, or EEOC. They have excellent resources, very user friendly to review. And the FMLA, the Department of Labor, if you were to do a search on the Department of Labor and the Family Medical Leave Act, you would see excellent resources there as well. So for employers that want to learn more, highly recommend both of those federal agencies for information.

And then just quickly I’ll mention that with health plan coverage there is also a federal law that requires health plans to cover mental health and substance abuse services comparably to medical and surgical care, under the Mental Health Parity and Addiction Equity Act. So it’s commonly referred to as parity. Parity really requires, what we like to say is, mental health and substance use care on par with care provided in health plans for medical/surgical care.

It does apply to private sector employer plans with 51 or more employees so again, very small employers it doesn’t apply to. And I will say it’s very important that employers understand the federal parity law and there are also state parity laws. But the federal parity law, Congress has instructed the Department of Labor to get much more active on enforcement of the parity law, the federal parity law.

And employers are on the hook for compliance, not health plans, even though they deliver care under the health plan. Employers ultimately are responsible to ensure parity compliance. So it is very important that employers understand how the law works and how compliance works because there will be more enforcement of this from the federal government.

CASEY: Great, thanks Darcy. Really especially appreciate the refresher on quite a few applicable laws and regulations. That’s very useful for employers in this space. I also really enjoyed your examples, the case examples that you gave, and really driving home the importance of an open and accepting culture, and the telling of personal stories, it seems like a very powerful way to really raise awareness and normalize the conversation, decreasing some of the stigma.

DARCY: Absolutely. I just want to mention also that last summer a CEO responded to an employee who requested a mental health day through email and made an example of saying how much he appreciated that she was up front and forward about the fact that she needed a mental health day to, for self-care, and that received a lot of media attention. So I think this leadership piece is really key. When a CEO comes out and says I appreciate that someone is taking a mental health care to bring their best self back to work, that makes a tremendous difference in the workplace.

CASEY: Wonderful, I love to hear that, that’s great. Well, Marcas let’s shift gears and talk about some specific strategies that employers can put in place. So what are some 7
of the best practices that you’d like to see more of in workplaces across the country?

Marcas: Well, I will tell you that this is kind of a sweet spot for me and I have had the opportunity to work closely with I’ll say just a couple hundred employers over the last five to six years on this topic, on this subject, and I have a lot to say about but I’ll try to boil it down. But kind of set it up by saying that, we need to recognize that employers are in very different scenarios, openness to talking about or doing something about this topic, so that’s the first place.

But every company has to start somewhere and there are some that have done a lot of great things so it really is kind of a spectrum of what companies are doing or have doing. And I have learned, and I don’t know if Darcy would agree, she works closely with employers, but my own personal sense or what I feel is that there are really three kind of different categories or reasons why an employer would choose to kind of go down this path and one is, and I’ll start with it, because it’s the right thing to do.

And I’ve worked with, the online shoe retailer, for many years and they were a trail blazer, one of the first to utilize Right Direction which is the initiative that I helped to create. And you know they’re really known for their culture and being positive. So they’re really open to doing pretty much you know anything that seems like it’ll have a positive impact on their culture, on their employees, so they view it as just something that it really is the right thing to do for them.

Then you have companies that are very much driven by data, as most are, I would say the majority are more driven by the data and so Kent State University is an example of one who was seeing a lot of disability claims being tied to depression. FMLA leave, they saw in their annual HRA a lot of data pointing to a high incidence of depression in their population. They were spending a lot of money on drugs, medications for anti-anxiety and on anti-depressants, and they were seeing a significant portion of their overall medical spend on depression-related costs.

So they made this part of their five-year strategic plan for wellness and wellbeing with the hallmark being personal wellbeing, work life balance, and mental wellbeing. So they were doing it you know to help combat what they were seeing. And then you have companies like a large grocery store chain with about 76,000 employees that is very much in crisis mode. They, from having two leaders take their lives by suicide within a six month period in 2016, to a gas station attendant, they also have gas stations, being robbed and then shot and killed on Thanksgiving eve.

And so that’s a company and there are others like them that are always finding themselves in these crisis scenarios where they are having a hard time getting ahead of the issue but they’re really trying. And so those, in my opinion, are kind of the three reasons why and the three buckets of employers and you can find yourself if you’re an employer in any one of those and it’s okay wherever you are.

And again it’s about starting where you are, and one of the first things is to ensure that you’ve got the right vendors in place. And everything that I talk about goes back to utilizing the vendors and the resources that are already being provided to employees. An employee assistance program is the most obvious, or EAP as it’s referred, and making sure you’ve got a good partner.

I said at the very beginning that employers are in a very powerful position, with vendors as well. So over employees, with vendors, really over a lot of policy, and so you know talk to those vendors. Through Right Direction which is a free, totally free, online, no catch, resource to direct employees and employers. We provide things like a talk track, questions to ask your EAP. The last thing that you would want to do is really go whole heartedly into a depression awareness campaign to find out you’ve got a poor vendor in place so that’s really a good starting point.

In addition, you want to get your leadership in alignment and quite frankly there are still a lot of individuals in leadership positions that don’t see this as a priority, so some companies will have those challenges as well. Others like Tier One that Darcy mentioned, champion it. So again this is not a one size fits all kind of topic or issue to be addressed.

And then so once you’re educating company leadership, starting to form a culture that’s open and more transparent so that employees feel like the company does care about them, what we have found is that only 15%, 15% trained managers and supervisors to even recognize or talk about or promote like an employee assistance program or any other help seeking behavior. So we see them as key too, and we provide lots of resources to help educate managers in resources.

And then you know tapping into free resource So Right Direction was created because there was a significant lack in the way that an employer could even start talking about this. I’ve said a couple times how sensitive it is. So if you are in human resources and benefits and you expected to go and be able to source vendors and help keep costs down and because you like people and you like personnel, those individuals are now finding themselves having to manage, and kind of deal with, everyone’s health issues from smoking problems, obesity problems, and mental health issues.

So Right Direction became a way that kind of took it off of them with kind of a creative and clever campaign with lots of campaign resources and posters and content, all found at RightDirectionForMe, kind of big, .com, so RightDirection F-O-R-M-E .com and both employees and employers would find everything that they need on that website, so there’s lots of information to tap into there. Darcy’s organization at the APA Foundation, the Center for Workplace Mental Health, has some really great tools and resources that I’m sure she can expand on.

And then finally, I would say to leverage local and regional resources. There are many organizations that are federally funded, levy funded, that exist to be able to provide support not only to citizens in the community, but many of them have now created or institute workplace or business programs. So even having them come in and provide a speaker perhaps for some sort of employee gathering, provide local resources. There are grass roots organizations. A great example of this would be, I was at Zappos one time and they were having a mental health awareness fair which for some companies would probably be you know something that they wouldn’t even want to touch, let alone have a lunch and learn about it, but they did, they had a mental health awareness fair.

And in addition to their vendors, like their employee assistance program, their medical vendor, they brought in the local library for things to do outside of work so they really are about creating work/life balance. They brought in the United Way, they had volunteer opportunities. They brought in a local pet rescue center with adoptable dogs, a yoga studio.

You know they’re tapping into local resources to provide outlets for personal care and self-care and trying to look again that work/life balance and provide outlets and resources for employees, so that you know they have other things to do outside of work rather than focusing on their depression, or maybe it’s substance use disorder issues so I would say tap into those local resources.

So there are a lot of things that folks can do, and I’ll tell you, a number of employers that are actually moving towards that and taking steps is really great to see.

CASEY: Wow, excellent input there Marcas, thanks so much. I especially love your discussion around improving the culture to increase the awareness, improving the skills of supervisors in this area, really, really helpful. You know some of our own research at the National Institute for Occupational Safety and Health has looked at the connection between working conditions and workplace stressors that may lead to certain mental health outcomes so this improving culture, improving the skillset of supervisors is very much aligned what the research that we are seeing that shows that improving working conditions, increasing flexibility that both of you have referred to so far.

Talking about sort of improving the culture of respect, recognition, appropriate rewards, those interventions really go a long way in improving health outcomes of all types for workers.

Marcas: They do, and you know I, it’s just something that’s come onto my radar more recently and it’s probably always been there, but this idea of policy and culture. And you know, companies will say oh we’ve got a policy where you know we’ve got a really robust EAP program and folks are welcome to take time off to go get the care that they need or take a mental health day, but at the same time you have manager and other employees that are not being so kind about the individual that might do that, when they’re not there.

So it’s one thing to say that you have a policy to address it, but how is your culture aligning with that, so we really, if you’re being serious about this, ask yourself “in my company, where does policy meet culture?” And that’s where, when we look at that, if that’s kind of a disconnect then that’s a good starting point because if there’s already a culture of, you know. I’ll tell you one example and that would be even at my own company we recently went and had one week of paternity leave for male employees and recently increased that to three weeks.

And you know with the expectation that you know, please, take the time off. But you know as we were doing that and researching other companies we found that they say that, but then at the same there are you know people asking them to come to the office and do other things. So we’ve been very adamant that, one gentleman just in the last three weeks was the first one, and we’ve been very adamant that he actually take it and set an example so that it really is something that is a benefit that is legitimate.

And that’s just one example and it could be the same for mental health benefits and other issues that like so I would really strongly suggest someone look at if they’re you know going to be the champion for this, look at your policy and how does your culture align with that.

CASEY: Excellent input Marcas thank you so much for that.

DARCY: I also think, can I add a quick comment?

CASEY: Oh certainly, please do Darcy.

DARCY: Okay, thank you, to add on to the key strategies, a couple things that came to mind as Marcas was speaking. One is, on a national level we see that employee 11
assistance program use is fairly low. So it generally is 3-5% on a national average and many employers are concerned about those low utilization rates and it offers an opportunity to really create a communication strategy around your EAP to use that as a way to open up the conversation about mental health.

Because in promoting an EAP to let employees know it’s not enough to let them know once. There should be reminders because new people come on board and we’re all sort of inundated with so much information in this technology, information world we live in that it is important to remind employees about the EAP and that’s a great time to say “the EAP covers mental health, mental health conditions are common, depression is a common occurrence in the workplace and the EAP addresses depression as well as other issues.”

So it’s a backdoor way in for companies that aren’t really sure how to get started with the idea of talking about depression and other mental health conditions in the workplace. But it’s a great backdoor way in. And the other thing I wanted to comment on is Marcas made a great point of saying, giving those three examples of what really gets organizations started in the workplace mental health space.

And I think data is so key because often what a CFO or you know a chief financial officer, or the money person wants to really know is okay what is, you know, show me the numbers, show me the figures. So we’ve been working with some very large employers who have champions internally who are really interested in getting more information about depression out to the workplace. And what they’ve done is they’ve developed some sophisticated data collection systems that allow them to collect the data to show the workplace mental health activity they’re doing is leading to good result in reduced absenteeism, reduced disability rates and that allows them to go to a CFO or your chief financial person and say okay look at our numbers, this is really working, now we want to expand our workplace mental health program.

So it’s kind of a vehicle for those champions to say let’s grow the program into something bigger because we can do even better.

CASEY: Love that strategy, thanks for adding that along for the conversation Darcy. Let’s continue that thought Darcy, and talk a little bit more about having that conversation. So are there trainings that supervisors can actually take advantage of so they’re going to be more comfortable approaching this issue, and talk us through how starting a conversation with an employee you know who may be struggling with depression, what would that look like?

DARCY: So there are turnkey training programs and Marcas mentioned one which is Right Direction, which has lots of guidance in all of the resources that are available through Right Direction. We also have a program, a turnkey program on the center’s website called ICU, that is, it includes a five minute video and a lot of instructional information for managers, for employees, so that managers and organizations understand how to use the program. And actually DuPont used this worldwide, globally with their workplace and their employees and they gave the program to us because they really wanted more employers to be able to take advantage of it.

So both of these programs have a whole lot of information, for managers, for employees, so that you can certainly talk with someone who may report to you about any concerns you may have around depression or other mental health conditions, so that you better understand how to talk to peer to peer with a coworker who you may be worried about.

Those programs certainly exist and there are others out there, Mental Health First Aid is another one that some organizations are bringing in. There’s a program NAMI developed called a Stigma Free Company. There is also the NBA recently developed a program under their NBA Cares programs that is focused on mental health that has a great, two great webpages that talk about how to start a conversation with someone you’re worried about, whether it’s in the workplace setting or it may be a friend but, the NBA is recognizing that, and they’re an employer certainly, and they’re recognizing that athletes increasingly, professional athletes are coming forward and talking about depression and anxiety and how it impacts them in their professional athletic careers.

So there are those programs out there that exist. And so whether an employer uses a structured training program or designs their own, here are some of the key components that should really be included. One is certainly identifying signs of an employee who may be experiencing depression. And Marcas shared some of those and again the Right Direction materials, what’s really wonderful about them is it does as Marcas said have what depression may look like and what the person may be feeling. So it really has that key information that’s going to help an employer better understand the experience of depression.

And then of course, starting the conversation. And that is important that people have a sense of compassion, they understand these are health conditions like any other. It’s not the person’s fault, it’s not a character flaw, that depression is a condition that when people get treatment they get better just like they do for diabetes, hypertension, and other conditions.

So really understanding and approaching the conversation in an empathetic and compassionate way. As a manager, as Marcas said, it’s important that you speak to performance related issues but also show concern that you are wondering if there may be something wrong, that this is not the way that an employee has behaved or acted or performed in the past. So you know really tying it to I’ve seen your work performance and the way you’ve reacted to a team before and something is different. So really tying it to performance and having that conversation.
And then being willing to help in connecting either someone who reports to you or a coworker to EAP services, offering to be supportive if they’re interested in finding out more about what mental health benefits may exist through the employer. But expressions of concern really contribute to a supportive workplace culture that we talked about earlier.

And it’s not easy to start but it can be as simple as I’ve noticed that you’re not yourself, is everything okay? And is there anything that I can do to help? People who are experiencing depression often feel isolated and alone and unsupported and mental health still for many exists in the shadows and it’s really just helping to bring it into the light and all of that makes a conversation all the more important.

So really tapping into the resources, Right Direction, ICU, NBA Cares, there are resources out there. Reading a bit about it, the employer can help bring that information into the workplace, will help go a long way toward helping everyone feel more comfortable and normalizing depression and other mental conditions in the workplace.

CASEY: Exceptional Darcy, thank you very much. Guys we’re down to just a few minutes of time left, and I’d like to ask two more questions but I’ll ask you to be brief in your responses so we can get through both of them. Marcas, I’m certain there are going to be some challenges that companies can expect or even anticipate when addressing this, do you want to address a few of them?

Marcas: Sure, and I can probably just relate back to, refer back to things we’ve talked about like issues related to stigma and culture. So you know those I think can be pretty obvious once we start thinking about them and ways that we might be able to tackle those. Lack of resources available to employees and I think sometimes it’s just a matter of not promoting the resources that you have frequently enough.

94% of employers pay for an employee assistance program benefit per employee per month whether employees use it or not. And Darcy mentioned those statistics about the average being around 4, you know 4.25% I think is the average utilization rate which is actually improved over the last couple of years. However, typically employers only promote it one time a year during open enrollment and don’t talk about it again. And quite honestly, a lot of people don’t even know A: what EAP stands for and, B: who or where they would even go. And I think that’s a travesty that employees say that they don’t know where to seek help when they’re struggling.

Support from leadership is another one that I touched on, it’s very important and also you know trying to get them to understand and one of the resources in the Right Direction materials library is a Power Point specifically for leadership to show them the business case but also show them the other reasons why and what they can do to tackle this and there’s also a Power Point for managers and supervisors to help set the stage.

And then finally like all of us it’s a competing priorities issue, and it really is a matter of looking at the big picture and I’ve had employers say to me okay out of all the things that are on my radar and on my plate why is this the one that I should tackle? Well it goes hand in hand with a lot of other cost driving health conditions, and so if you tackle this one which in many ways can be easy, it by default will then help remedy some of the other issues.

And one last thing I’ll add that there was a survey of human resources folks and we asked them what they believe, or they were asked what they believe, drives or has the most effect on indirect cost to employees and by far they said mental health. And the one they said had the least was things like heart disease and high blood pressure. But when we also asked them about their benefit plan designs and which screening procedures they actively recommend, blood pressure checks were at the very top and mental illness screening was at the very bottom.


Marcas: So that illustrates yes the issue kind of at hand.

CASEY: Thanks very much for that Marcas. Darcy, in the few moments we have left, can you share with us what resources are available on the Center for Workplace Mental Health’s website that relate to depression?

DARCY: Yes, so we do have mental health topics and we recently posted an updated topic article on depression with detailed information on what employers can do to address it in the workplace. We also recently posted an article on collaborative care which is an evidence-based model that provides specialty mental health care and a care manager in the primary care setting and it has been studied for depression as well, so that’s a very important care delivery model.

We also have case studies with more than 70 case studies from large and small, both public and private sector employers, really identifying the innovative ways they are addressing depression and other mental health conditions in the workplace.

And finally we just launched a depression calculator which provides employers with the opportunity to calculate the cost of depression based on their industry, demographics, and more so lots there and hopefully employers can find what they’re looking for.

CASEY: Thanks very much for that Darcy, and my sincerest thanks to both of you. Your input today was exceptional and the practical advice that you gave, the resources, the wonderful guidance is just, it’s just really been exceptional. Folks we’ve been joined today by Darcy Gruttadaro and Marcas Miles. Folks I want to thank you both for sharing your insights. You’ve really illuminated how employers can help identify and treat depression and also some, hopefully avoid some of its costly impacts.

I really appreciate your joining me today for this interview, thank you both very, very much.

Marcas: I appreciate the platform, thank you.

DARCY: Sure, it’s been a pleasure.

CASEY: Super. Well that concludes today’s interview, thank you for listening. I encourage you to use the information shared by Darcy and Marcas to take steps to address depression in your workplace. On behalf of CDC’s Workplace Health Resource Center, I’m Dr. Casey Chosewood, thank you for joining us and thank you for making wellness your business.


ANNOUNCER: To find free, credible resources for creating healthy work environments, visit CDC’s Workplace Health Resource Center at It’s a one stop shop with hundreds of resources, including case studies, evidenced based summaries, issue briefs, tools for small businesses, webinars, videos, and more.

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The opinions expressed in this recorded interview are those of the guest speakers and do not necessarily represent the official position of the Centers for Disease Control and Prevention.