Behavioral Health: Creating the Optimal Work Environment

By Phyllis Hanlon

In any given year, approximately 18.8 million American adults suffer from a depressive disorder and nearly 80 percent of those with depression report some level of job-related functional compromise, according to the Centers for Disease Control and Prevention (CDC). Moreover, individuals with depression miss, on average in a three- month period, 4.8 work days and realize 11.5 days of reduced productivity. Depression also comes with a hefty price tag, according to the Journal of the American Medical Association, costing employers between $17 and $44 billion a year, depending on the industry.

In today’s competitive world, work stressors abound, from high job demands and low job control to lack of social support in the workplace and job dissatisfaction. Finding ways to overcome the physical, financial, and social impact of depression, stress and other psychological disorders on employers and employees can be challenging but not impossible.

Stress in the workplace


The American Psychological Association (APA) recently released the results of its annual Stress in America survey ( and the findings reflect what many companies already know —stress on the job affects a significant number of workers. “This year, 65 percent of respondents reported workplace stress,” said David W. Ballard, Ph., assistant executive director for Organizational Excellence and member of the Stress in America team, noting a slight dip from last year’s figure of 70 percent.

Dr. Ballard, who has a doctorate in clinical psychology and an M.B.A. in health and medical services administration, pointed out that both the employee and the organization feel the effects of stress in the workplace. On the employee side, stress can lead to decreased job satisfaction, reduced motivation, lack of commitment, and low morale. “Stress has a negative effect on the work experience and decreases connection and productivity,” he added.

Depending on the individual, stress may manifest in different ways, from gastrointestinal difficulties and musculoskeletal issues to depression and anxiety. “The key as an individual is to understand your stress and how to deal with it.

On the flip side, the American Institute of Stress estimates that workplace stress costs companies an aggregate of $300 billion every year in absenteeism, turnover, legal, medical, and insurance fees. Additionally, decreased performance and productivity tend to lead to poor work quality and reduced customer service and satisfaction. In combination, these factors can affect a company’s reputation. “A company is not seen as a good place to work,” said Dr. Ballard.

“Dealing with workplace stress is a shared responsibility between employer and employee,” Dr. Ballard continued. “The employee has to develop skills to manage the stress. And the employer has to create an organizational culture that allows the employee to perform at his or her maximum.

Although many occupational health programs have already implemented stress management programs for their clients that might include workshops, seminars, lunchtime learning sessions, fitness classes, meditation, and access to employee assistance programs (EAP), Dr. Ballard said these programs are just the tip of the iceberg. “This does not consider the larger organizational factors.”

System-wide factors can impact employees negatively, so advise client companies to make sure the hiring process identifies employees who are a good fit, Dr. Ballard advised. “Provide adequate training. Have the resources to meet the demands of the job, and assess the physical and environmental risks, such as ergonomics. Consider a company’s social environment. Make sure workspaces are conducive to teamwork,” he added. In some cases, suggests that management consider redesigning jobs to minimize role conflict. “With layoffs, the remaining employees have to pick up the slack. Some of those responsibilities are in conflict with current job duties.”

Work-life in balance

While some of these suggestions rely on common sense, companies may still struggle to find the keys to an optimally healthy work environment. One of the most common challenges involves organizations that look for off-the-shelf/one-size-fits-all programs for health promotion and wellness. “There needs to be a system approach. You have to understand the real needs of the company,” said Dr. Ballard. “Start with a good assessment of how to build employee resources. A lot of success for work-life balance has to do with how well you customize policies and programs.”

The APA’s Workforce Retention Survey, assets/general/2012-retention-survey-final.pdf, measured employee retention and the reasons behind it. Dr. Ballard said many consulting firms examine why individuals leave a job but do not look at why they stay. “In this survey, we found that benefits and pay are important, but what topped the list is enjoying what [employees] do, if the job fits with the rest of their life. In other words, if there is a good work-life balance.” More than two-thirds of respondents (65 percent) said they remained with a company because the job matched well with other aspects of their lives. The same percentage said enjoyment of their work was the reason they stayed with the company. Companies with employee recognition programs earn kudos as they build self-esteem, but they also yield a financial bonus. In fact, a January 2013 Gallup poll (see link to APA Workplace Retention Survey, 2012) found that companies who recognize their employees enjoy 27 percent higher profits, 50 percent higher sales, and 50 percent more customer loyalty.

Jeffrey P. Kahn, M.D., author of Angst: Origins of Anxiety and Depression (Oxford University Press, 2013) and CEO of WorkPsych


Associates agree that company culture in combination with an individualized approach is the best strategy for creating behavioral health programs. He asserts that generalized psychological tools, such as the Hamilton and Beck Surveys, do not delve deeply enough into the precise issues that employees might be facing. “You have to find out the specific diagnosis, and should also look at the circumstances and personal lives of the employee,” he said.

 As for corporate leadership, Dr. Kahn said that management who genuinely care about their staff versus the bottom line will fare better. Also, clearly defining the company’s hierarchy enables the employees to understand how they fit into the organization. “People like to feel they are in the right spot,” he added.

Six basic social instincts significantly affect efforts to create a healthy work environment, Dr. Kahn explained: inclusion, a naturally derived hierarchy, a comfortable workplace, an atmosphere of respect, a sense of purpose, and appropriate use of intellect.

Clare Miller, director at the Partnership for Workplace Mental Health, a program of the American Psychiatric Foundation and a subsidiary of the American Psychiatric Association, added that easy access to mental health benefits is critical. Employers who become aware of changes in behavior, such as missed deadlines, lack of concentration, tardiness, decline in decision-making skills, as well as physical symptoms that could indicate an underlying mental health issue, were within their rights to initiate a conversation with that individual. “But keep focused on the work impact of the behavior,” advised Ms. Miller. “This will yield two benefits. It will protect the company and be respectful of the employee.” Once the employer has addressed the work problem, she said, it would be appropriate to refer them to the company’s EAP.

ComPsych, a provider of EAP solutions, suggests on its website that effective plans will offer 24/7 access to a live person who can assess and triage employees when they need additional help. A successful program should also include a broad network of licensed, credentialed, local providers who can offer relationship and family counseling as well as treatment for substance abuse, stress, depression, and other behavioral matters. In times of crisis, a good EAP must be able to provide critical incident stress management on-site, and it should also contain a training component for managers responsible for detecting and making referrals for services.

While companies can overcome barriers to access, stigma still prevents many individuals from seeking help, so employers need to make concerted efforts to change this way of thinking. “Mention mental health every time you are talking about physical health in your wellness communications from the company,” Ms. Miller suggested. “Make a connection between diabetes and mental health, heart disease and mental health, etc.”

Successful leadership

In 2006, the APA began honoring companies with its Psychologically Healthy Workplace Award (PHWA). Since that time, 40 companies have received the award, which acknowledges organizations that foster employee involvement, growth, and development, promote health and safety, and recognize their accomplishments.

In 2012, the Kaiser Permanente Center for Health Research received a PHWA for its internally run and financed Leadership Development Program (LDG). “The LDG program has benefited our organization by motivating employees to succeed,” said Mary Durham, Ph.D., director of the Kaiser Permanente Center for Health Research and an investigator with its Work, Family & Health Network.

The LDG program facilitates communication at all levels of the organization and encourages employee involvement. “Only top performers are selected to participate in the LDG. Though some intangible benefits are difficult to measure, I believe that providing leadership training has helped boost employee morale, in- increase productivity, and reduce rates of absenteeism,” said Dr. Durham. “We are also benefiting from having a strong bench of well-trained leaders ready to step into positions of authority. One of our first LDG participants has been chosen from a very competitive field of candidates to be our new director of Research Data and Analysis.

Now, instead of having to wait for an outsider to get up to speed, we have a proven leader with deep knowledge and experience of our organization ready to hit the ground running.”

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