Mental Health at Work (Part1): Should we open Pandora's box?
by Toya Lorch (July 2019)
“In companies where people experience real wellness, it has always been part of the corporate DNA and not just a fad.” i
Manfred Kets de Vries
Mary, 43, was made a partner in her law firm four years ago, something that had been her ambition for a long time.
But after a while, her close colleagues began to notice that she was behaving differently at work. She showed little enthusiasm for new projects, missed important deadlines, had difficulty processing information and became easily irritated. Mary’s fellow partners hesitated to approach her, but her subordinates were more proactive. One of them invited Mary to lunch in the hope that she would open up about what was happening. To his surprise, Mary denied that her performance had deteriorated and avoided any subject that might lead to a more personal conversation. After this, another colleague, representing the entire team, shared with the HR director that “Mary was not being the Mary they had always known”. With the CEO’s approval, the HR director approached the other partners. They were
aware of Mary’s difficulties but their reactions ranged from deep concern to no concern at all. After this round of interviews, the CEO asked to see Mary and shared with her the feedback the HR director had received. He expressed his concern and willingness to support her in whatever way she needed, proposing more support staff or flexible working hours. But Mary turned his offer down. She insisted that everything was OK and that she didn’t want to be treated differently from the others. She didn’t want to be perceived as needing special conditions to fulfill her role.
What is going on with Mary? Is she going through a career crisis? Is she finding it hard to establish work-life balance? Is she just too tired to perform as well as she used to? Or is she struggling with something far more personally depleting? Is she afraid for her mental health?
The statistics about the incidence of mental health issues in the workplace are worrying. Depression and anxiety have a significant impact on individuals, teams and the bottom line. In fact, the estimated cost to the global economy of these mental health-related issues is US$1 trillion per year in lost productivity. ii
Yet poor mental health is not swiftly recognised or acknowledged, by sufferers and colleagues alike. Its impact on the workplace, and the negative effects working conditions can have on mental health, are usually played down. There are many reasons for this, ranging from fear of social stigma and unsympathetic corporate culture to general lack of awareness of symptoms or potential causes.
Mary’s behaviour raises some obvious questions.
— Is her worsening mental health contributing to the deterioration in her performance?
— If so, how can she be encouraged to acknowledge and confront this?
— What elements of Mary’s job could be contributing to her mental health problems?
— How should her colleagues, the HR director and CEO act now?
— What might be at stake, for Mary and the firm?
Unfortunately, obvious questions don’t necessarily come with obvious answers. In an organisational context, it’s almost inevitable that the initial response will be to look for quick fixes. But a complex topic like mental health at work requires a systemic, multi-level approach: national, organisational and individual.
— Public investment to promote mental wellbeing, prevent and treat poor mental health varies enormously from country to country. Government expenditure on mental health is less than US$1 per capita in low- and some middle-income countries compared to high-income countries (US$80-plus). The majority of spending goes to mental hospitals, which serve a small proportion of those needing care. Every US dollar invested in scaling-up treatment for common mental illnesses such as depression and anxiety leads to a return of US$4 in better health and ability to work. iii
— Most organisations are starting to assess the impact of poor mental health and mental illness on productivity and retention. Nevertheless, organisations that recognise employees’ mental wellbeing as a strategic business priority are still reluctant to act when a co-worker seems mentally unwell.
— Personal characteristics (background, culture, family values) and degree of awareness about mental health will influence how individuals approach their own and others’ mental health. Research has shown that awareness is the most powerful strategy for promoting mental health and reducing the stigma associated with poor mental health and mental illness.
To return to Mary: as time passed, it became even more difficult for her colleagues to understand what was going on with her. After her meeting with the CEO, there were periods when she performed well and gave her colleagues a glimpse of hope that she would soon be herself again. But this would only last for 2–3 days. When her performance review was due, a senior partner approached her informally to prepare her to hear that the remuneration committee had decided that she wouldn’t be eligible for a bonus. The committee would cite her lack of initiative in prospecting new clients as well as the negative feedback her subordinates had shared with the HR director.
Do Mary’s difficulties seem familiar to you? Or have you been in the same situation as Mary’s co-workers? Missed deadlines, cognitive impairment and outbursts of bad temper lead to frustration, disempowerment and a downward spiral of underperformance. Not knowing what is happening to someone you care about or depend upon increases anxiety and triggers a range of distinctive reactions – turning a blind eye, overreacting or, conversely, feeling unable to act.
When we are faced with a sensitive or complex problem like Mary’s, it can be helpful to find a precedent or story with which to compare it. This exercise can supply some unexpected insights and suggest ways forward. I like to draw an analogy between the Greek myth of Pandora’s box and the process and challenges that organisations have to confront if they really want to create a culture that promotes mental health and supports individuals with a temporary or chronic poor mental health condition.
Pandora was the first mortal woman the gods created, and the myth tells how the very mixed blessings she was endowed with, the things that made her human, set her up to fail. Zeus himself gave her the two gifts that prompted her ultimate downfall: curiosity and a strongbox that she should never open because its contents were not for mortal eyes. Inevitably, Pandora was unable to control her curiosity and she opened the forbidden box, letting out all the evils of the world before she could slam the lid shut. But through her despair, Pandora heard a small sound from the box. Opening the lid once more, she released the last trapped thing – hope to counter the evils she had released.
On the organisational and personal level, we need curiosity to open the Pandora’s box of mental health in the workplace, allowing fears, fantasies and dilemmas to emerge, and then the curiosity to inform ourselves about how to face them. Then we need to be courageous enough to address complex dilemmas and explore effective and sustainable actions. Last but not least, we should be able to translate hope into commitment and accountability in order to implement actions. Looking at these in turn, we might be able to generate some hypotheses and explore possible actions that could be applied to Mary’s case.
The stigma around mental health prevents individuals who are suffering and those around them from making proactive responses. How many times have you been approached by a colleague worried about his or her mental health? Have you ever reported upwards your concern about a colleague’s mental health? Have you ever shared concern about your own mental health with a manager or colleagues? I’m pretty sure the answers to these questions will be “Never” for most of us. It takes courage to broach a taboo issue and confront stigma. We need to be forearmed – and the best way to arm ourselves is to inform ourselves.
Mental health, like physical health, is much more than simply the absence of illness: it’s also a state of wellbeing. Mental wellbeing is the ability to cope with the day-to-day pressures of life, to work productively, interact positively and realise our potential. Poor mental health is a state of low mental wellbeing where we are unable to fulfill our potential, cope with day-to-day pressures and relate to others as we would like to. When poor mental health is recognised as circumstantial and treated properly, the symptoms are reduced and remission occurs in 80% of cases. Mental ill-health is a different matter. The condition is characterised by unusual thoughts and feelings that lead to
unpleasant experiences for a considerable time. Depending on the severity and effectiveness of treatment, mental illness might or might not cause impairments. Some mental ill-health conditions are chronic; when individuals are exposed to certain triggers, they become susceptible to sequential crises that can cause long-term impairment. iv
This is where curiosity comes in. We can tackle stigma by sharing information and citing real cases of workers who are engaged and productive, despite challenging mental health conditions. Sharing our own mental health stories can be instrumental in changing organisational attitudes towards mental health. v
— Think about where you stand in relation to the issue of mental health. Are you indifferent, sceptical, pessimistic, lost, enthusiastic, relieved?
— Update your knowledge and assumptions about mental health by understanding different perspectives, for example, neuroscientific, psychiatric, sociological, psychological.
— By informing ourselves, we can map the risk factors that could harm our mental health, protect our mental wellbeing and recognise early signs of deteriorating mental health in others.
— Information will help individuals and organisations to invest in the prevention of mental health issues and to know where to find psychological and medical help when needed.
— Key stakeholders (employers, employees, NGOs, professional associations) can spread information about best practices in mental health protection at both organisational and individual levels.
We should be able to extend to mental health challenges the systemic approach that is taken to physical health challenges at all three levels, national, organisational and individual. An excellent example of this is screening for breast cancer, a national programme in many countries, which begins at grassroots level by encouraging all women to self-examine regularly and showing them how to do so.
Mary’s colleagues didn’t approach her directly because of the stigma associated with mental health issues. Most people still see depressive symptoms as signs of weakness or laziness. And most people feel uncomfortable approaching someone they think is unwell; after the relief of hearing the expected “Don’t worry, I’m fine,” they are usually more than happy to give up checking. vi Mary’s colleagues could have supported her better if they had known how to. Mary was clearly resistant to opening up, either because she was afraid of the negative repercussions of being mentally unwell or because her depression affected her capacity to assess her own emotional state.
I will return to Mary’s case in part 2 of this blog, when I explore the ethical and operational dilemmas associated with opening the Pandora’s box of mental health in the workplace. Part 2 will address the importance of reframing dilemmas as strategic priorities and business cases. I will also share some practical ideas on how to translate hope into actions, highlighting the impact that leaders and managers can have on such a complex and relevant topic.
i Kets de Vries, M. F. R., 2019. Trust: The Corporate Wellness initiative of the Future. Available at
ii World Health Organization. 2019. Mental health: massive scale-up of resources needed if global targets are to be met. Available at: https://www.who.int/mental_health/evidence/atlas/atlas_2017_web_note/en/ [Accessed 23 May 2019].
iii World Health Organization. 2019. Mental health: massive scale-up of resources needed if global targets are to be met. Available at: https://www.who.int/mental_health/evidence/atlas/atlas_2017_web_note/en/ [Accessed 23 May 2019].
iv Guide for Line Managers written by UK based charity Mind (www.mind.org.uk)
v Youtube. (2019). This is me campaign by Deloitte. [Online Video]. 18 April 2019. Available
from: https://www.youtube.com/watch?v=rI3mzVpTKFU [Accessed: 16 May 2019].
vi "Ask twice” campaign by UK charity Time to Change. (https://www.time-to-change.org.uk)