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Businesses Materials for a Mental Health Friendly Workplace: Executives Booklet

A Mental Health-Friendly Workplace: It’s in Every Company’s Best Interest

An introduction for business executives

This booklet introduces a new program developed through a partnership between your State’s mental health department and the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

The program offers a free-of-charge startup package—Workplaces That Thrive: A Resource for Creating Mental Health-Friendly Work Environments—that your human resources personnel or managers can use to become familiar with practices that promote good mental health and with ways to institute them in your workplace. The resource also provides ready-to-use materials for supervisor training and for communicating with employees about their role in creating a Mental Health-Friendly Workplace.

The resource is provided to businesses in California, Florida, Pennsylvania, Texas, and Wisconsin, all of whom are participating in a pilot program to promote mental health and reduce stigma and discrimination associated with mental illnesses. To obtain a free-of-charge resource for your business, of-charge resource for your business, contact the individual or organization in your State that provided you with this booklet, go to www.allmentalhealth.samhsa.gov, or call 1-800-789-2647 (English/Spanish) or 1-866-889-2647 (TDD) to learn who to contact within your own State.

An Invitation

This booklet is an invitation to you—one of America's business leaders—to take a serious look at the role of your employees' mental health in relation to their well-being and productivity, and your bottom line. As you undoubtedly know, costs related to health issues and employee productivity are highly salient in today's increasingly competitive marketplace.

Mental Health in the Workplace

The phrase "mental health" brings to mind:

• on-the-job stress and/or "burnout;"
• the need for conflict resolution between employees;
• the emotional "fallout" from a traumatic event; or
• dealing with employee anxiety when there are major changes.

Often proactive "mental health-friendly" practices can prevent or help resolve problematic work situations such as those above.

Mental health and mental illness can be pictured as two points on a continuum with a range of conditions in between. Mental health issues that employers face range from stress to serious mental illnesses such as depression, anxiety disorders, or adult attention deficit/hyperactivity disorder. Mental illnesses are surprisingly common. They affect almost every family and workplace in America.¹

It has been said that many employers simply do not know how to work productively with employees who have mental illnesses.² In fact, many people don't realize that effective treatments are available for mental illnesses and that people recover from mental illnesses and continue to live productive lives.

Unfortunately, many people with serious mental illnesses do not seek or receive treatment. Common reasons people do not seek treatment include: cost, fear, not knowing where to go for services, and concern about confidentiality and the opinions of coworkers and others in the community. This fear of what people may think—the stigma that surrounds mental illness—is a serious barrier to treatment and recovery. The Mental Health-Friendly Workplace can help overcome these barriers by providing access to appropriate mental health services for employees.

No community is unaffected by mental illnesses; no school or workplace is untouched.

Most of the estimated $79 billion in annual costs associated with mental illnesses is due to lost productivity—approximately $63 billion.³

—President's New Freedom Commission on Mental Health

Benefits to Business

A Mental Health-Friendly Workplace makes good business sense. It benefits owners, managers, and employees in ways that affect the bottom line. Consider the following outcomes:

• Higher productivity and motivation. Employees feel valued and secure and work more effectively when employers demonstrate a commitment to their well-being.
• Reduced absenteeism. Workplace stress is a major cause of absenteeism. Helping employees manage their stress and overall mental health can boost productivity.
• Health insurance cost containment. Instituting health and wellness programs can help hold down health insurance rate hikes.
• Preparedness for disasters. Assisting employees in times of sudden unexpected trauma with counseling, peer support groups, and links to needed community services can help businesses become productive again sooner.
• Loyalty and retention. Businesses with mental health-friendly practices have documented remarkably low turnover rates, along with cost savings in recruitment, new employee orientation, and training.
• Hiring and promoting the most qualified people. By openly supporting mental health-friendly policies, employers can increase the pool of qualified applicants.
• More efficient workplace practices and policies. The process of thinking about mental health can generate helpful internal policy and benefit reviews, and more effective workplace systems and procedures for employees as a whole.
• Better workplace relations. Awareness of and openness to mental health issues help create a positive climate for understanding, conflict resolution, and support.
• Diversity, acceptance, and respect in the workplace. Embracing diversity includes people who live with mental illnesses. In becoming more inclusive, businesses can both thrive and set a standard for others.

What does a Mental Health-Friendly Workplace Look Like?

Businesses that value the health of their employees, including their mental health and well-being, have specific practices and policies in place. Such companies can be small, medium, or large. Outstanding examples abound among large corporations in the United States; however, businesses with only a few employees also have found meaningful and innovative ways to be mental health-friendly.

Below are specific practices and policies that characterize a Mental Health-Friendly Workplace, many of which are found in organizations large and small.

The Mental Health-Friendly Workplace:

• Welcomes all qualified job applicants; diversity is valued.
• Includes health care that treats mental illnesses with the same urgency as physical illnesses.
• Has programs and practices that promote and support employee health-wellness and/or work-life balance.
• Provides training for managers and front-line supervisors in mental health workplace issues, including identification of performance problems that may indicate worker distress and possible need for referral and evaluation.
• Safeguards confidentiality of employee health information.
• Provides an Employee Assistance Program or other appropriate referral resources to assist managers and employees.
• Supports employees who seek treatment or who require hospitalization and disability leave, including planning for return to work.
• Ensures "exit with dignity" as a corporate priority, should it become essential for an employee to leave employment.
• Provides all-employee communication regarding equal opportunity employment, the reasonable accommodations policy of the Americans with Disabilities Act, health and wellness programs, and similar topics that promote an accepting, anti-stigmatizing, anti-discriminating climate in the workplace.

Three Portraits of Mental Health-Friendly Workplaces

Small Business: Coffee By Design, Portland, Maine

Shortly after opening her first Coffee By Design shop a decade ago (which has now grown into three shops plus a coffee roasting business), Mary Ann Lindemann was inspired by a television report that described a European village that took responsibility for the mental health needs of its residents. At the same time, she read about Maine's transition to a community-based mental health system. These two converging experiences led her to a simple, yet profound epiphany: "One person at a time, we can make a difference."

With this realization, Lindemann renewed her company's commitment to the mental health of her employees, who number about 30, and patrons. She has helped staff learn about working with customers who may have mental health problems, and she has put in place a number of mental health-friendly practices for her employees. These include:

• Employee trainings about mental health and mental illnesses;
• Flexible shifts for employees recovering from mental health problems;
• Support for an employee returning to work after a mental illness;
• A revised job application form that stresses the company's commitment to "honesty and diversity;"
• Dissemination of brochures and other materials on mental health during May, which is Mental Health Month; and
• A benefits package that includes mental health coverage. Recently, short-term disability was added.

Lindemann's mental health-friendly policies and practices have produced positive results: In 2002, Coffee By Design won an award from the Disability Rights Center for work on behalf of people with mental illnesses, based on a word-of-mouth nomination. In 2003, Aetna Inc. named Coffee By Design its Northeast Region winner of the Small Business of the Year award. Strong customer loyalty has helped them achieve 40 percent annual earnings growth, in spite of competition from Starbucks and Dunkin' Donuts. Lindemann says, "A mental health-friendly workplace is inseparable from our bottom line."

Large Corporation: Quad/Graphics, Pewaukee, Wisconsin

It happens every day, but most people never give it a thought until it affects them—tragedy in the workplace. Quad/Graphics, America's largest privately held printing company, experienced a catastrophic fire in which a 10-story storage facility collapsed and caused the company's first onsite employee death. Shortly after, Quad/Graphics lost its president, Harry V. Quadracci, in a drowning accident. To handle these major events, Quad/Graphics, QuadMed employee assistance program (EAP) proactively addressed bereavement needs for all employees. Information packages were provided and QuadMed team members visited all of the plants and spoke to employees individually, letting them know they were available to help if needed.

" It might not seem like a lot," said Dan Bird, employee assistance counselor, "but this really went a long way toward keeping our company on track in this very difficult time."

Beyond its employee assistance program, Quad offers trainings and accommodations to its 12,000 employees to help them care for their mental health. These include:

• Mental health screening and stress management classes throughout the year;
• Workplace wellness training for managers that includes guidance on identifying issues and referring employees to the EAP;
• Special efforts when work pressure is highest to make employees aware of the EAP services and benefits;
• Making the EAP and its services more visible to employees during times of crisis, such as an employee's death on the job; and
• Special supportive arrangements for employees returning to work after a mental health-related absence.

Quad's leadership in returning disabled employees to work earned them the CNA Insurance Companies' first-ever CNA Disability Accommodation Award in 1995. "While nurturing the mental health of staff is good for the bottom line, more importantly, it's the right thing to do," Bird said.

Medium-sized Company: Highsmith Inc., Fort Atkinson, Wisconsin

When Highsmith Inc., a distributor of library furniture and supplies in rural Wisconsin, experienced a staggering 53 percent increase in health insurance premiums, the company examined its culture and instituted programs that they credit with holding premium costs at a steady level, increasing productivity, and maintaining very low turnover. Mental health-friendly practices are both implicit and explicit in the corporate culture. Highsmith's 300 employees enjoy the following programs designed to help them care for their mental health:

• A comprehensive menu of health promotion and disease prevention activities and programs such as mental and emotional health programming and screenings, domestic abuse outreach and education, and stress reduction and time management programs;
• Learning and development through classes that span job and career development, personal well-being, self-care, physical well-being, and work/life enrichment;
• An employee assistance program (EAP) that pays special attention to mental health issues. The company partners with its EAP to provide employees with tools to balance work/life;
• An orientation session for new employees that includes "First Aid Kit for the Mind," a session about signs of mental illnesses, stress, and substance abuse, and tips for maintaining mental fitness;
• An annual health screening that includes a meeting with an EAP counselor to talk about personal well-being and learn more about the tools and resources to balance work and life; and
• An intranet section that links employees to quality health information on a variety of topics including depression and anxiety, relationships, and domestic abuse. Another section, Leader's Edge, features resources for line managers including "Your Role and the EAP."

Making the choice to integrate mental health into a comprehensive approach to encourage healthy lifestyle choices has paid off for Highsmith. At a time when health insurance premiums are increasing at double-digit rates, Highsmith's premiums have held steady. The rate increase for 2002 was 2.9 percent, and 3.1 percent for 2003.

Employee loyalty was tested in April 2002 when there was a workforce reduction affecting 31 employees. A month later, the EAP conducted a resiliency survey finding that faith and trust in the management remained solid. The average length of service is 13 years with minimal turnover. From 1999 to 2002, turnover in the Madison/Milwaukee corridor was averaging 22 percent, but Highsmith's turnover was around 8 percent.

High Performers May Need Support Too

When a Highsmith employee's 20-year marriage ended in divorce, she was left alone to raise her teenage son. Keeping problems at home became difficult. She did not know where to turn for help, but she found support at Highsmith.

Highsmith assisted her with educational opportunities in personal well-being and referred her to a counselor from their employee assistance program. With the consent of the employee, the counselor came up with an approach to provide her team with information on depression and discussed ways they could support her during this difficult time. In addition, the employee's line manager provided her with time off from work to attend therapy sessions.

The result: This employee remains one of the company's top performers. The employee discovered the positive impact of physical activity on her emotional well-being and overall health. As a result, she started to use the one-mile path that surrounds the building to walk during her breaks, joined in the onsite exercise classes, and saw dramatic changes in her overall health. She said, "If it wasn't for the people at Highsmith, I would not be here today."

Next Steps: Using the Mental Health-Friendly Workplace Resource

First, assess where your company is now and where you want to go:

• Have you noticed excessive absenteeism, low morale, low productivity?
• Could these issues have been dealt with more effectively?
• What elements of a mental health-friendly environment are already in place?
• What additional elements could help you with future issues?
• How will the worth or value to your business of this undertaking be assessed (i.e., how will you know that you are achieving the benefits?)?

Second, order the free Mental Health-Friendly Resource from the individual or group in your State that provided this booklet (or follow the instructions below).

The Resource contains:

• Descriptions of Mental Health-Friendly Workplace practices;
• Downloadable materials to help in creating Mental Health-Friendly Workplaces;
• Training modules for supervisors, including reproducible materials and PowerPoint slides; and
• Ready-to-use materials for communicating with employees, including a poster, print PSAs, and drop-in articles for in-house communications.

The resource is designed for human resource personnel, or in the absence of HR personnel, for the staff who administer corporate benefits and other personnel policies; communicate health, wellness, and work-life balance information; and coordinate training of supervisory staff.

You can obtain Workplaces That Thrive: A Resource for Creating Mental Health-Friendly Work Enviroments from the individual or organization in your State that provided you with this booklet or by calling the National Mental Health Information Center at 1-800-789-2647 (English/Spanish) or 1-866-889-2647 (TDD). Or visit www.allmentalhealth.samhsa.gov. Ask for the free Mental Health-Friendly Workplace Resource.

Myths Surrounding Mental Illnesses

Myth: People with mental illnesses can't hold jobs.

Fact: On the contrary, many are productive employees, business owners, and contributing members of their communities.

Myth: Employees with mental illnesses, even those who have received effective treatment and have recovered, tend to be second-rate workers.

Fact: Employers who have hired these individuals report they are higher than average in attendance and punctuality, and they are as good or better than other employees in motivation, quality of work, and job tenure. Studies reported by the National Institute of Mental Health (NIMH) and the National Alliance for the Mentally Ill (NAMI) conclude that there are no differences in productivity when compared to other employees.

Myth: There's no hope for people with mental illnesses.

Fact: There are more treatments, strategies, and community supports than ever before, and even more are on the horizon. People with mental illnesses lead active, productive lives.

Myth:People with mental illnesses are violent and unpredictable.

Fact: Chances are you know someone with a mental illness and don't even realize it. In reality, the vast majority of people who have mental illnesses are no more violent than anyone else.

Resources Used in Developing This Publication

New Freedom Commission on Mental Health. (2003). Achieving the Promise: Transforming Mental Health Care in America, final report. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. DHHS Pub. No. SMA-03-3832.

Center for Mental Health Services. (2001). Hand in Hand: It's Worth the Investment, A National Summit on Best Practices for Mental Health in the Workplace, summary report. Washington, DC: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

Gabriel, Phyllis. (2000). Mental Health in the Workplace: Situation Analysis, United States. Geneva: International Labour Office.

Harnois, Gaston and Phyllis Gabriel. (2000). Mental Health and Work: Impact, Issues and Good Practices. Geneva: World Health Organization and the International Labour Organization.

Kramer, Laurie Maloff. (2001). Mental Illness in the Workplace: A Resource Guide for Minnesota Employers, revised edition. Minneapolis, MN: Mental Health Association of Minnesota.

Mindout for Mental Health Campaign. Line Manager's Resource: A Practical Guide to Managing and Supporting Mental Health in the Workplace and Working Minds Toolkit: A Practical Resource to Promote Good Workplace Practice on Mental Health. London: Department of Health.

OpenMindsOpenDoors. (2003). Mental Health in the Workplace: An Investment in Human Capital. Harrisburg, PA: OpenMindsOpenDoors, c/o Mental Health Association in Pennsylvania.

1 New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America: Final Report. Rockville, MD, DHHS Pub. No. SMA-03-3832.

2 Statement by Rita R. Handrich, Ph.D., University of Texas-Austin EAP, at "Can Health Services Research Influence Policy Private Actions?" Conference jointly sponsored by the Association for Health Services Research and the National Alliance for the Mentally Ill, December 8-9, 1999.

3 Rice, D.P. and Miller, L.S. (1996). The Economic Burden of Schizophrenia: Conceptual and Methodological Issues and Cost Estimates. In M. Moscarelli, A. Rupp, & N. Sartorius (Eds.), Schizophrenia (pp. 321-334). Chichester, UK: Wiley.

For additional copies of this booklet, or to obtain a copy of Workplaces That Thrive: A Resource for Creating Mental Health-Friendly Work Environments, please call the National Mental Health Information Center at 1-800-789-2647 (English/Spanish)or 1-866-889-2647 (TDD). Or visit www.allmentalhealth.samhsa.gov.

My Story

• READ REAL STORIES about people’s experiences with mental illnesses.