Part 4: Mental Health at Work

Performant Mental Health, The Series

Editor’s note: We’re in the final stretch of this series. Be sure to check out the other articles: a beginner’s guide to mental health, addressing your own mental health, supporting others, and guest articles coming up next.

Barclays gets it. EY understands. Facebook is making headway. What these companies and others understand is that mental health is vital to the overall corporate health and sustainability of an organizations and its employees. They realize investments in mental health are good for business, too.1

We’re confident these companies also grok the sobering statistics:

  • In the US nearly one quarter of the workforce experiences a mental health or substance use problem each year.2
  • In Canada mental health issues account for 30 to 40 percent of disability claims, “with the prevalence of claims for mental health diagnoses climbing by 0.5 to 1 percent every year.”3
  • In the UK an estimated 12.7% of all sick days can be attributed to mental health conditions.4
  • In one survey “many people reported they would rather tell employers they committed a petty crime and served time in jail, than admit to having been in a psychiatric hospital.”5
  • Depression and anxiety impact the global economy at an estimated cost of USD $1 trillion per year in lost productivity.6

And in the current lockdown conditions brought about by a global response to COVID-19, companies are realizing now more than ever that ‘workplace’ is far more comprehensive than it was before. It’s no longer just the posh office chairs, cheeky meeting rooms, or inspirational posters that matter—all the factors contributing to an employee’s complete well-being need to be thoughtfully considered.

The Mental Health-Illness Continuum

To assess the complete spectrum of factors that contribute to one’s well-being, it’s helpful to understand how the factors that impact one’s mental health ebb and flow during the course of their life and therefore their employment at any given company. Some employees with strong mental health may develop issues months into their employment, while others hired with mental health issues may improve over time.

This ebb and flow of mental health is best represented by the Mental Health-Illness Continuum:

Mental Health-Illness Continuum showing maximum mental illness at left and maximum mental health at right

This continuum emphasizes two important points:

  • Each of us is somewhere different on this continuum at any point in time.
  • Each of us will move to different points along the continuum over the course of our lifetime.

As a leader or manager it’s not your role to assess where an employee is at along this continuum—that’s the role of medical professionals. However, you can construct an inclusive work environment and provide resources and healthy processes that help move every employee along a positive path on the continuum.7

We also appreciate how describes four quadrants of mental health that further demonstrate how mental health and illness co-exist in our lives:

Understanding this continuum is the first step in improving mental health at work.

Principles of mental health inclusivity

The next step in improving mental health at work is fostering inclusivity within the physical and virtual bounds of what constitutes your company’s work environment, one that genuinely helps people move positively along the continuum.

There are some outstanding resources on the web to help you do this. Deloitte’s blueprint for workplace mental health, APA’s COVID-19 remote work resource and database of case studies, Stark County’s stigma-free workplace link list, and NAMI’s guide for supervisors to name just a few.

Most importantly, positive movement along the continuum is most effective when it emanates from executive leadership. But leaders, be warned: this goes well beyond just encouraging staff to “open up.”

The problem with most corporate campaigns focused on getting employees to simply “open up” about mental health issues is that the value exchange is null. If you (the company) ask employees to open up, what are you offering in exchange? If the value exchange is simply “you’ll feel better” or “you’ll be more productive” chances are few employees will take your well-meaning but poorly constructed bait.

On the other hand, if the value exchange is “we know things could be better and we need your input to make changes” or “we can connect you with professional help at no charge to you” can you imagine the net positive exchange for your employees?

For workplace mental health initiatives to be most effective, they must move beyond the veneer of corporate altruism and into the realm of truly beneficial support systems. Inclusivity meets each employee where they are, not where you or the company are, and provides resources to help them move along their continuum.

Below are just a handful of ways to help you construct a more inclusive work environment.

Cultivate a stigma-free environment

We support the National Alliance on Mental Illness (NAMI) guidelines for stigma-free, inclusive workplaces:

  • Use respectful language to talk about mental health conditions.
  • Challenge misconceptions when you see or hear them.
  • See the person, not the condition.
  • Offer support if you think someone is having trouble.

Kaiser Permanente has visualized this nicely in their guide to workplace mental health:

Stigma-free mental health should be a natural extension of the other principles of inclusivity already in place in your organization such as ethnic inclusivity, gender inclusivity, and so on. “Overcoming mental health stigma is only one part of a larger effort to foster an organizational culture of psychological safety,” writes Naz Beheshti, executive wellness coach and consultant, “where employees feel free to voice their opinions, to share ideas, to take chances, to be their authentic selves.”8

Re-evaluate your performance evaluation methodology

We could write volumes about the mental harm inflicted by rigorous performance evaluations, but we shall be brief.

Personal experience and research have proven this simple fact: productivity is good for every aspect of health be it physical, mental, or emotional. Performance evaluation methodologies are designed to maximize productivity not only for the company’s well-being but that of employees, as well.

However, personal experience and research have also proven work environments that link performance to pay (bonuses, commissions, profit sharing, etc.) can be harmful to one’s mental and emotional health.9

Here are some red flags to consider as you evaluate your evaluations:

  • Overly prescriptive career ‘tracks’, ‘levels’, and ‘calibrations’ – While these can provide a helpful framework for managers and team members to evaluate current and future progress and determine bonus compensation, they can also shoehorn employees into templated expectations of performance (often unrealistic) that marginalize the unique characteristics, talent, and value each person brings to the table.
  • Gap-finding feedback more than strengths-based reinforcement – We encourage you to read this article carefully. You may disagree with some of its points and that’s perfectly OK. But we can attest from years of leadership experience that in our strengths—not our weaknesses—lie our greatest growth potential.
  • Rewarding misguided performance – As an organization your performance evaluation methodology will be both your triumph and your downfall. Downfall in that you may find missteps in your organization came as a result of how you incentivized and rewarded performance. Triumph in that the inverse is also true: the greatest way to influence the outcomes you want to see in the future (hopefully this includes improvements in mental health) will be to adjust how you incentivize and reward performance.

We could go on, but we promised to be brief.

Re-evaluate your PTO policies, too

It goes without saying paid time off (PTO) is often one of the most influential contributors to workplace mental and emotional health.

Do new hires begin with a zero balance? You might consider how this may negatively impact employees who have relocated or stepped into a high pressure role and may need additional time off as they settle in.

How does your maternity leave policy promote mental health for both moms and dads? Does it include adoptive parents for which government laws are not as favorble for mandated time off?

Is your PTO package a one-size-fits-all approach, which may be insensitive to the fact that the demands on each employee’s time outside of work vary widely? (Cameron is still holding out for more companies to adopt a “minimum vacation” policy to address this issue.)

Empower employees to support each other

This is all about education. And while consulting companies to implement mental health education is beyond the scope of this series, we mention this to remind us all that “in the trenches” employees are often the most valuable support asset within an organization.

Once again, have a look at NAMI’s guidelines as a starting point for educating peer-to-peer support within your organization.

Establish an Employee Assistance Program

While Employee Assistance Programs (EAP) are beyond the scope of this series, we mention this to flag the fact that “while most health insurance plans cover at least some mental health care, therapy can be expensive—even with insurance—and it can be hard to find providers who both accept your insurance and are taking on new patients.” An EAP can help offset the cost burden for employees and demystify the process of finding help, among other benefits.

EAPs can also send a clear signal throughout the organization that it’s not only acceptable but encouraged that employees seek help for mental health issues. As we’ve already mentioned in this article and previous articles in the series, the existing stigmas surrounding mental health prevent many people from acknowledging they need help.

We have observed that a growing number of psychiatric prescribers and counselors are finding work in the private-pay niche. The reason? It isn’t because insurance billing is a hassle, but rather many employees fear if they use company insurance their employer will find out and their job will be in jeopardy. Fear of losing one’s job can be a serious deterrent for seeking help.

Preventative mental health

In no particular order here are a few ‘scattershot’ suggestions for preventative mental health, whether employee, manager, or executive.

Leverage focus blocks

Consider blocking your time to increase focus and flow.10 We mean like really blocking your time, as in actual, recurring blocks in your calendar that allow you to do the work only you can do. These can be done at the individual or team level. The most effective use, however, occurs at the department, portfolio, or pillar level when cross-functional peers are aligned on shared blocks of time.

In a former leadership capacity, Cameron Moll (editor of this series) successfully implemented focus blocks across his team’s entire portfolio. Over the course of three bi-annual employee surveys (18 months) the team experienced a double-digit positive lift in work/life sentiment, in large part thanks to focus blocks.

Screenshot showing calendar focus blocks on Tuesdays and Fridays 9am-1pm and Wednesdays all day
Focus block times shared across cross-functional peers

Contact us if you’d like to schedule time with Cameron to learn more about implementing cross-functional focus blocks.

Take a mental health sick day

Yes, you can take mental health sick days the same as you would physical health sick days. You don’t need anyone’s permission to do so. And you don’t need to provide reasons for your absence.

Treat your absence from work with care, return as soon as you can, and resume performing to the best of your ability. End of story.

Reframe your expectations

For seasoned employees, it may be helpful to reframe your expectations of work performance in the latter stages of your career. In the bluntly titled “Your Professional Decline Is Coming (Much) Sooner Than You Think” by Arthur C. Brooks, well, the title pretty much speaks for itself. You’re not the young whippersnapper you once were. You probably don’t have the remarkable ability you once had. You’re closer to retirement now than distant. And “abundant evidence suggests that the waning of ability in people of high accomplishment is especially brutal psychologically.”

This isn’t a matter of lowering the bar for yourself, rather candidly reframing the value you now provide to organizations given your tenure and experience—and the reality of advanced age. “The biggest mistake professionally successful people make is attempting to sustain peak accomplishment indefinitely,” Brooks contends. Honestly, his article is well-worth your time.

Empathetic leadership and management

In light of COVID-19, are you managing the response or leading beyond the crisis? How’s your team holding up? (Here’s a helpful poll from Qualtrics to get a pulse on how team members are doing.)

Of course, empathetic leadership goes well beyond poll-taking and well beyond dealing with crises as they arise. You don’t need us to tell you this but we’ll say it anyway: It is your privilege and responsibility to intimately understand the on-going mental health of each team member and provide the support and resources they need to move themselves positively along their continuum.

We want to acknowledge the long-standing misconception that employees suffering from mental health issues perform inferior to those without any issues. While true in limited cases increasingly we’re learning many employees have imperfect mental/emotional health, yet are capable of solid performance.

If our current circumstances aren’t shining a bright spotlight on this misconception and the reality that many have imperfect mental health, we can’t imagine what possibly could. Managers and leaders cultivating work environments conducive to good mental health will become a defining characteristic of not only the economy’s recovery but also successful workplaces post-COVID19.

Below are a few suggestions for leaders and managers to create healthier, more inclusive work environments.

Validate, validate, validate

Validation is the healing balm of mental and emotional illness. It engenders empathy in the supporter (you) and conveys acceptance to the sufferer (your team member). It is the hinge upon which the doors of understanding swing.

Please read Part 3 for more about validation and your role as champion of recovery.

Give a voice to mental health

As we said in Part 3, take time in a meeting (or two or three) to mention that mental health is important to you, the leader, just the same as you would for other topics of holistic team health. If you’ve experienced mental health issues yourself, you might consider sharing this with your team if you feel comfortable doing so.11 You don’t need to give details. What’s important is they see you’re human, that this is a topic they can discuss with you if they ever need to, and they won’t be misjudged if they do.

“An environment where vulnerability is an asset is one where emotional intelligence is high and valued as a leadership trait,” Beheshti continues in her article. “An executive comfortable with their own anxiety will be more compassionate with a struggling employee.”12

Be conscious of the unintentional signals you may be sending

Some time ago a senior member of executive leadership posted a memo to their entire organization. The memo encouraged taking full advantage of the company’s paid time off (PTO) policy and ensuring adequate time to disconnect from work.

The memo was well-structured, the message was inspiring. However, the timing may have inadvertently communicated a subtle counter-message: it was posted on a Sunday afternoon when the offices were closed and most employees would (or should) have been disconnected from work.

We might debate the mechanics of corporate communication (done that!) and the merits of weekend work (been there!), but that’s missing the point. We share this experience to illustrate how the signals you send to peers and team members, both intentional and unintentional, can impact workplace mental health positively or negatively.

Consider these examples. If my head is buried in a laptop during a product review meeting, what signal might this send to the team presenting about how I value their time? If I encourage team members to bring their authentic selves but deliver critical feedback about their style of working, what mixed signals might this suggest? If I ‘helicopter’ in to chat threads and email chains while on PTO, what expectations might this set for team members when they’re on PTO?

Familiarize yourself with the adverse symptoms of mental health, but recognize people hide mental illness well

We covered many of the symptoms of depression and anxiety in Part 2, and here we add that “individuals with deteriorating mental health may exhibit changes in their mood, interactions, or performance at work. These include difficulties in making decisions, repeatedly missing deadlines, missing and/or being late to work, reduced quality of work, distractibility, and a general lack of interest and focus.”[^13]

Obvious signals like these aside, your team members will often hide mental health issues exceptionally well, at least until they escalate to a level that encourages them to quit or requires them to take medical leave of absence.14 “Most people who suffer from chronic anxiety or depression are excellent at faking wellness,” observes Morra Aarons-Mele, founder of Women Online and The Mission List. “We put on our makeup, get dressed, and show up on time. But we never know when an attack might be around the corner. This is why a work environment that is open and understanding is so important.” In Morra’s case, “I just quit, over and over again.”15

An inclusive work environment not only moves employees positively along the mental health continuum—it keeps them around, too.

Knowing your rights as an employee

Lastly, we close with a brief mention of the laws and protection provided to you, the employee, in regards to your mental health at work. With an international audience for this series we couldn’t possibly cover the laws of all nations pertaining to mental health regulation.

Rather, we’ll point you to this Wikipedia entry on mental health acts inclusive of the following countries: Canada, India, Ireland, Republic of Ireland, New Zealand, Singapore, United Kingdom, and United States. Please contact us to add your country’s laws for mental health to this list.

For the United States specifically, we draw your attention to the fact that common mental health conditions such as anxiety and depression are covered in the Americans With Disabilities Act (ADA) and that the Affordable Care Act provides free depression screenings.

← Part 3 | Part 5 →

We also offer virtual training for your team on understanding mental health and improving mental performance at work. Please contact us to schedule.

About the Authors

Cameron Moll
Cameron Moll (Editor) is a leadership consultant, author, speaker, and ecclesiastical advisor. For more than a decade he has worked closely with individuals and families to advise them through grief, mental illness, and other hardships in communities throughout California, Florida, and Utah. He has been building for the web since the late 1990’s and most recently served as the Head of Design for the Events platform on Facebook. Cameron’s work has been featured by NPR, The Atlantic, Forrester Research, Communication Arts, and many other prominent media organizations.
Suzanne Moll
Suzanne Moll is the mother of five children, all of them sons: two adults, two teens, and a toddler. Suzanne has spent countless hours advising women and children impacted by emotional stress, trauma, and other life-altering circumstances. She has a certificate in Plant-Based Nutrition (2015) from the T. Colin Campbell Center for Nutritional Studies at Cornell University and has an insatiable passion for whole foods. Suzanne is a native Floridian and finds her personal respite at the beach.
Eddie Brouse
Eddie Brouse (APRN, PMHNP) is a Psychiatric Mental Health Nurse Practitioner with nearly 20 years behavioral and mental health experience, counseling adults and juveniles impacted by depression, anxiety, personality disorders, and more. He has four tremendous daughters, one amazing son, and is a licensed pilot.


1. For more about these companies and their efforts with workplace mental health, see Barclay’s “This is me”, EY’s “R U OK?”, and Facebook’s #OpenUp campaigns. See also Deloitte’s article on the ROI of workplace mental health programs. 2. Mental Health Disorders Sourcebook, Sixth Edition, p. 71 (2016). 3. Sarah Champan et al., “The ROI in workplace mental health programs: Good for people, good for business”, Deloitte Insights (2019). 4. “Mental health statistics: mental health at work”, Mental Health Foundation (2016). 5. Mental Health Disorders Sourcebook, Sixth Edition, p. 78 (2016). 6. “Mental health in the workplace”, World Health Organization (2019). 7. Parents and teachers, this continuum also applies to little human beings. Here’s a helpful resource for you. 8. Naz Beheshti, “Stigma About Mental Health Issues In The Workplace Exists: Here’s What Companies Can Do About It”, ForbesWomen (2019). 9. “In the first big-data study combining objective medical and compensation records with demographics, researchers at Washington University in St. Louis and Aarhus University in Denmark discovered once a company switches to a pay-for-performance process, the number of employees using anxiety and depression medication increased by 5.7 percent…. And the actual number of affected employees is almost certainly much higher….” Lamar Pierce, “Performance-based pay linked to employee mental-health problems, study shows”, Washington University in St. Louis (2019). 10. Flow, or a flow state, is when you’re completely immersed in an activity and even lose track of time or temporary needs such as food. This article is one among many describing what flow is and its inherent benefits. 11. You’ll be in good company if you choose to be open about your own mental health. “Alyssa Mastromonaco is no stranger to tough conversations: she served as White House deputy chief of staff for operations under President Obama, was an executive at Vice and A&E, and is Senior Advisor and spokesperson at NARAL Pro-Choice America. So when Mastromonaco switched to a new antidepressant, she decided to tell her boss. ‘I told the CEO that I was on Zoloft and was transitioning to Wellbutrin,’ Mastromonaco said. ‘I can react strongly to meds, so I was worried switching would shift my mood and wanted her to know why. I talked about it like it was the most normal thing in the world —it is!’ Her boss was supportive. ‘You got it,’ she said.” Morra Aarons-Mele, “We Need to Talk More About Mental Health at Work”, Harvard Business Review (2018). 12. Naz Beheshti, “Stigma About Mental Health Issues In The Workplace Exists: Here’s What Companies Can Do About It”, ForbesWomen (2019). 13. Mental Health Disorders Sourcebook, Sixth Edition, p. 72 (2016). 14. There’s even a condition called ‘smiling’ depression. “Most people haven’t even heard of the term. The definition of smiling depression is: appearing happy to others, literally smiling, while internally suffering with depressive symptoms. Smiling depression often goes undetected. Those suffering from it often discount their own feelings and brush them aside. They might not even be aware of their depression or want to acknowledge their symptoms due to a fear of being considered ‘weak.’” Rita Labeaune, Psy.D, “The Secret Pain of ‘Smiling’ Depression”, Psychology Today (2014). 15. Christina G. Hibbert, 8 Keys to Mental Health Through Exercise, p. 151 (2016).