A Publication of WTVP

Bringing light to the darkness of hidden—and costly—employee mental health struggles

Jayne sits in the manager’s office. “This could be my last day here and I can’t lose my job!” she worries. Like every other day for the past two months, this one began with Jayne forcing herself out of bed after a night of poor sleep. No breakfast, no appetite, tearful on the drive in… just so sad. Other drivers going slowly didn’t help and Jayne told them off—in her mind. In the manager’s office, she sighs: “If I do manage to fake my way through today, the end is inevitable.” Her problem is compounded by one simple fact: Jayne is the manager!

Each day in the U.S., some 10 million people struggle through the work day with what the Substance Abuse and Mental Health Services Administration (SAMHSA) calls “hidden disabilities.” There are not visible scars or marks on the bodies of the Jaynes and Jacobs who suffer from depression, anxiety, ADHD, bipolar disorder, PTSD or OCD, but the impact of these conditions on the workplace is palpable. Lost productivity, absenteeism, and mistakes on the job due to clouded decision-making result in losses upwards of $230 billion per year for American businesses. This is to say nothing of the incalculable loss in creativity and ingenuity—dashed hopes for those with mental health issues and the people who work beside them.

Hidden In More Ways Than One
The hiddenness of mental health difficulties is not limited to the invisible nature of these struggles. Consider depression and anxiety, which rank first and fifth respectively among the top 25 chronic physical/mental health problems affecting lowered productivity and absenteeism in a study of 14 major U.S. companies.

The majority of people who suffer from depression and anxiety don’t seek treatment, though both conditions are eminently treatable. The most common reasons cited are fear of jeopardizing one’s job in a tough economic environment and the perception of falling hopelessly behind at work if one does seek treatment. Also contributing to hiddenness is the fact that the symptoms of each disorder manifest differently at work than they do at home.

Consider the depressed employee. At home, he isolates himself. At work he tries to “soldier on,” even though interrupted sleep and depression lead to impaired judgment and irritability with colleagues. He gains the reputation of being difficult and lazy, trying to do as little as possible. Morale problems develop and productivity goes down, even as wages increase because both the depressed person and his colleagues require overtime to get their work done.

The anxious employee suffers along a different path. Her condition is not likely to be diagnosed for five to 10 years because it masquerades as a gastrointestinal or cardiac problem. In the meantime, a worker who could be very capable judges herself harshly, believing that her fatigue and excess worry are signs of personal weakness.

The impacts of both depression and anxiety show up in the workplace in the form of absenteeism and, even more impactfully, “presenteeism.” The latter occurs when an employee goes to work despite a condition that prevents him or her from fully functioning. Employees taking work home to finish or staying at work to catch up because they could not keep up is also considered presenteeism. The price tag in lost productivity and work quality for absenteeism was $84 billion in 2013. Presenteeism costs to U.S. businesses were even greater, totaling $150 billion in 2013.

Leveraging Light: Three Strategies
Employees with mental health concerns can continue to be valuable contributors if interlocking strategies, known as the “3-As,” are employed:

Strategy 1: Affirmative environment. Make good mental hygiene a key ingredient in employee health goals. In work settings where people can come to management with mental health concerns without fear of losing their jobs, the hiddenness of these “hidden disabilities” disappears. Given the high cost of mental health-related absenteeism and presenteeism, it makes sense to be proactive.

Strategy 2: Access to mental health care. Once people know their mental health needs are a priority, engagement and assistance to competent care by the employer becomes paramount. This can be done by keeping up-to-date referral lists of local providers and sharing this information with employees at their time of need. Better yet, provide direct access to competent local care by arrangement. One study of employer-provided mental healthcare and worker productivity found that mental health interventions cost the company between $100 and $400 per user, but returned 26 extra hours of work weekly from the group utilizing the program, worth about $1,800 per week to the company.

Strategy 3: Accommodation. The simplest accommodation is the provision of time off for psychotherapy and medical appointments. Examples at work include reducing distractions and interruptions. Providing a quieter workspace or permitting use of headphones can accomplish this. “Most accommodations in the workplace can be established with little or no cost. They just require… flexibility and creativity,” states Melanie Whetzel, a lead consultant for the U.S. Department of Labor’s Job Accommodation Network (JAN). The JAN is a comprehensive resource for employers and employees to understand rights and accommodations regarding behavioral health concerns. It is free and available at

In any group of 100 employees, at least 16 are estimated to be suffering mental health concerns at any point in time. The practice of bringing light to the darkness of hidden employee mental health struggles is not only the right thing to do, it’s cost-effective. It just makes good business sense as a return on investment. iBi

Rachel Banaszewski is a counselor intern at The Antioch Group, Inc. and a candidate for the MA in clinical mental health counseling at Bradley University. Ryne Bonn is a counselor intern at The Antioch Group, Inc. and will receive the MA in clinical mental health counseling from Bradley University. Steven A. Hamon, Ph.D, a licensed clinical psychologist, is co-founder and president of The Antioch Group, Inc.