Fear Not, I Bring You Good News
Thoughts About Mental Health In The Workplace
As an anxious child, I took comfort from the Christmas story at this time of the year:
Fear not, for behold, I bring you good news of great joy that will be for all the people. For unto you is born this day in the city of David a Savior, who is Christ the Lord.
Today, some people think of me as someone with an unfounded amount of self-confidence, but it is a carefully nurtured trait. As a child, I was spooked by life in general — by darkness (nyctophobia), by flying (aerophobia), by people (social phobia) and sharks in places where there were none, like in our swimming pool (galeophobia or selachophobia).
At this time of the year, my fear wasn’t helped by local traditions, such as the Krampus runs that take place in the two weeks before the Nikolaus day[i] (Dec 6th). Krampuses are thought to have pre-Christian origins, and they accompany St. Nikolaus on the evening of Dec 5th to scare and punish the children who have misbehaved. Nowadays it is an almost civilized and nostalgic affair. Back in the good old days young, masked (and often drunk) guys, clad in furs and with cow bells attached, roamed the streets in darkness and beat up everyone who crossed their path with birch rods and leather lashes[ii].
As you may expect at this point, anxiety was not a recognized condition for kids, and you were generally expected to pull yourself together or as my German-born mother would say: reiß Dich am Riemen.
And too bad if you were a grown-up who suffered from mental health issues, you would have been told to keep it a secret, for you might end up in a closed institution and bring shame to your family. There was a stigma about mental issues back then, and it persists today — globally.
What is the mental health problem in the workplace?
Being neither a psychologist nor a human resource expert, I am trying to get my head around this topic through reading about it[iii]. My knowledge is anecdotal or derived from literature. I am not a journalist who has interviewed 1,500 people about the topic, but thankfully others have done that for me[iv].
Mental health challenges are not always associated with clinical or chronic mental illness[v]. In 2021, 76% of American workers reported at least one mental health issue — from anxiety to problem gambling. To conclude that three quarters of all American workers are mentally ill would be a stretch, although there is a lot of craziness in this country, but that’s a different topic. Emotionally or mentally unhealthy would be a better description for most people, and I am going to use those terms somewhat interchangeably.
We use the phrase ‘mental health’ almost every day. Mental health is a state of emotional, cognitive, and behavioral equilibrium that allows the individual to function responsibly in their family, social, and work environment, as well as to enjoy well-being and quality of life. Many people, when they hear the term mental health, think of mental illness. But mental health is something more significant than the absence of mental illness.
On the other hand, emotional health refers to overall psychological well-being: how we feel about ourselves, the quality of our relationships, and the ability to manage our own emotions and deal with difficulties. Being emotionally healthy is greater than being free from depression, anxiety, or other psychological problems[vi].
The US government compiles statistics on this topic and while those never capture the full picture, they are very likely to contain grains of truth. It distinguishes between any mental illness and a subset of it, serious mental illness:
Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness as defined below).
Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.
21% of all US adults or 52.9mn people fall into the AMI category, and half of them received some kind of mental health service in the last year. NSDUH (National survey of drug use and health) defines mental health services as having received inpatient treatment/counseling or outpatient treatment/counseling, or having used prescription medication for problems with emotions, nerves, or mental health. Serious mental illness is much less common, only 5.6% or 14mn adults suffer from it.
Some more facts on this:
- Women have a significantly higher share in both categories, AMI and SMI, more than ten percentage points higher than men
- Younger people have a higher share in the AMI category, while older people have a much higher share in the SMI category — young people (18–25) are only 12% of the overall population
- In what may seem odd to Europeans, the US keeps detailed statistics on race (ugly word), and white people represent the biggest block in the AMI category, while dual race people are most affected by SMI. 78% of the US population are white, including a large Hispanic population.
These numbers probably underestimate the number of people who are affected by mental and emotional difficulties. They are just quantities, and many cases may be light and temporary while others may be more serious than we think. We do know that a lot of people are dealing with issues and the workforce (about 150mn people) is just a subset of 60% of the entire adult population.
We have no reason to assume that the workforce is healthier or sicker than the overall population, but we have an idea of what’s bugging them:
People may be unhealthy with work or from work, to paraphrase Covid. So many causes of mental health issues — genes, upbringing, physical issues, dysfunctional relationships, age or even work — make it hard to pinpoint cause and effect. We all walk on thin ice when it comes to our mental or emotional health. An unexpected event like an accident, the loss of a family member or a job can turn the tide and push us into a dark spot.
Without doubt, Covid has increased our sensitivity to mental health at work, and known issues have increased in the last two years. Outside Covid, I am not sure that we can call the last years an epidemic or a trend of historic magnitude. We don’t know how much of this is due to a decline in stigmatization, better diagnosis or increased awareness. Whatever the answer is to this question, we have to deal with it in serious ways.
Physical health and mental health are closely intertwined and often reinforce each other. Someone’s neck pain may be the consequence of stress at work, but their withdrawal from social life may be the consequence of sleep deprivation due to unbearable neck pain. Or maybe it was all the other way round — who can tell?
My sympathy also goes to the many people who work in physically taxing and underpaid jobs: the Amazon driver who works 10 hours to make not even minimum wage while under constant monitoring by apps; the workers from the Smithfield meat factory in Sioux Fall that I saw, buying dozens of instant noodle soup packs and looking like the unhealthiest people I ever met; the immigrant workers in the fields of California, picking strawberries in degrees of 100F and of course the many nurses who go to work through my area in Chicago, dressed in their scrubs in the early morning hours (if I was a German politician, I would be obliged to include the roofers here).
Now you may assume that the US is the epicenter of workplace related mental health issues. If suicides are any indication, the problem is a global one, although the US is leading here too (guns as a plausible explanation):
- 307 suicides at work in 2019[vii] (CEOs are more affected than police people)
- In France[viii] 3.8% of workers admitted to having had suicidal thoughts in 2019 and one third said it was due to their work and employment situation (France Telecom got infamous in the mid 2000s when 35 workers committed suicide during a phase of job cuts)
- By some estimates, 650 suicides per year in the UK could be work related
- We don’t have estimates from Germany (other than 11 cases per 100k in the general population, which is middle of the range), but we know that it affects the medical profession, the police force, workers in forestry, managers (bankers are most at risk) and the army[ix]
- Italy has the lowest number in Europe, no wonder — Italian people have a talent for happiness and great food. Finland is bad when it comes to suicide numbers, but it regularly ranks as the happiest nation on the planet
In the US, we should be truly worried about the next generation to enter the workplace. We are seeing an explosive growth of suicides among the 15- to 19-year-olds, for whom gun deaths are now the leading cause of deaths. Gun control anyone?
Managers will not become therapists, but we can do something
Looking at the factors that negatively impact mental health in the workplace, it should be easy to resolve the issue. Companies could just start multiple projects and address every factor in a systematic way. Jack Donaghy from 30 Rock showed us how to do this: The Six Sigma Wheel of Happiness Domination. If the world was that easy, we would all be ideal weight and run a marathon.
Managers are not therapists, and they are unlikely to heal people’s issues. But at least, they should attempt to not make matters worse. People are often just statistical figures when times get rough, as the focus always turns to headcount- and not payroll-reductions. Therefore, it is easier, cheaper and more effective to get rid of 10 people with a 50k salary in the customer service department than the one senior executive with a 500k salary. If the prime cause of suffering is emotionally draining work (37%), we need to stop treating people as a measurable, quantifiable and constantly monitored production factor (think keyboard-stroke-monitoring) and allow them to instill meaning in their work[x].
Studies like the Mindshare report show that mental health and job satisfaction are positively affected by diversity initiatives. Most companies, especially large ones in the US, have come a long way in this respect. Hiring, supporting and promoting diverse groups is a first step. Where we are lacking, is in overcoming the many borders that are separating us in our everyday lives. Our understanding of each other’s Lebenswirklichkeit (life’s reality) is seriously deficient.
Treating people not only as equals but also in diverse and individual ways will address many of the above-mentioned factors. This is a huge challenge for any company, also a legal and HR nightmare. One-size-fits-all may be the most efficient guideline when it comes to company rules, such as return to work, training, vacations, workplace standards, sick days etc., but it is not be the best and only one. On the other hand, a thousand accommodations for a thousand individuals are an unmanageable pandora’s box.
Finding the right middle-ground here is the challenge of our times when it comes to mental health at work. It will require something that our increasingly centralized corporate world is afraid of: delegating authority to lower levels and empowering team leaders and managers to develop their own communication and leadership style. If it’s true that an employee’s satisfaction depends up to 80% on their immediate boss, we need much more qualified and better leadership on all levels.
Delegation of authority will provide much needed relief for upper management, because people on the executive level are prime candidates for mental issues, from anxiety to depression and burnout. Physical health issues are the norm (heart illness as the leading cause of deaths in the US), and we have been getting a lot of news about premature executive deaths (health related or self-induced).
For comments, please contact me at max@zentyment.com. To receive my writings by email, you can subscribe via Medium.
Footnotes
[i] Named after St. Nicholas, the 4th century bishop of Myra, also called Santa Claus in the United States
[ii] In 2013, after several Krampus runs in East Tyrol, a total of eight injured people (mostly with broken bones) were admitted to the Lienz district hospital and over 60 other patients were treated on an outpatient basis
[iii] Kelly Greenwood and Julia Anas in Harvard Business Review, Oct 2021, https://hbr.org/2021/10/its-a-new-era-for-mental-health-at-work
[iv] Mindshare Partners 2021 Mental Health at Work Report
[v] https://www.nimh.nih.gov/health/statistics/mental-illness
[vi] https://kentuckymentalhealth.com/comparison-of-mental-health-with-emotional-health/
[vii] https://stats.bls.gov/opub/ted/2021/workplace-suicides-continued-to-rise-in-2019.htm and here in the Guardian: https://www.theguardian.com/us-news/2022/may/27/us-workplace-suicide-rates-pandemic
[viii] https://www.etui.org/sites/default/files/ez_import/beh5_2_19.pdf
[ix] https://www.naspro.de/dl/Suizidpraevention-Deutschland-2021.pdf
[x] Another Austrian, Viktor Frankl, wrote extensively about this topic: https://www.pursuit-of-happiness.org/history-of-happiness/viktor-frankl/
