Downtime:Clinical Depression in the

Workplace

Jean Crossman-MirandaEmployee Assistance Program

City & County of San Francisco

Clinical Depression

• Affects a person’s body, mood, thoughts

• Can be chronic condition, acute episode

• Costs $55 billion annually in worker absenteeism, diminished productivity, and health care costs

• Intangible costs include reduced work quality and ill will among fellow employees

• More than 11M suffer; only one-third seek treatment

At-Risk Populations

• Strikes nearly 12 million in U.S. annually

• All age, racial, socioeconomic groups

• Nationally recognized patterns – teens, elders, women

• Alcohol abuse only exacerbates Clinical Depression

Populations Most At Risk

• Nearly one in ten Americans in a lifetime

• Ages 25 – 44

• Females diagnosed most often

• People under great stress

• Family history

Causes of Clinical Depression

• Family History – 20% to 25% have relative with a mood disorder. Up to 50% for Bipolar

• Chemical Imbalance – influence energy level, emotions, sleeping/eating patterns

• Psychological Makeup – neg. orientation to life: low self-esteem, pessimism, stress

• Environmental Triggers – traumatic experiences, work conditions, safety issues

Key Differences

The key differences between someone who is sad or sorrowful and someone with Clinical Depression are:

• Duration of symptoms

• Severity of symptoms

Good times do not alleviate Depression!

People with Clinical Depression

• Commonly become isolated and hide their feelings from others

• Often blame themselves for their illness and feel guilty for being “weak”

• May try to “drown their sorrows” with alcohol and/or drugs

• May have a “dual diagnosis”

Clinical Depression Screening Test (1)

• Feelings of sadness and/or irritability that don’t go away

• Loss of interest or pleasure in activities previously enjoyed – hobbies, sex, others

• Sleeping disturbances such as falling asleep, waking up spontaneously, or oversleeping

• Difficulty with memory, problem-solving, decision making

Clinical Depression Screening Test (2)

• Feelings of guilt, lack of self worth, hopelessness or helplessness

• Decreased ability to concentrate

• Fatigue or loss of energy

• Changes in weight or appetite

• Restless or slowed activity noticed by others

• Thoughts of suicide or death

Bipolar – Manic Phase

• Increased energy and decreased need for sleep

• Inappropriate excitement or irritability

• Increased talking or moving

• Promiscuous sexual behavior

• Disconnected and racing thoughts

• Impulsive behavior and poor judgment

Dysthymia

• Less severe form of Clinical Depression

• Keeps people from “feeling good” or enjoying life

• People with dysthymia “go through the motions” of daily life, often with little pleasure or enthusiasm, for years

Seasonal Affective Disorder (Sad)

• Linked to changes in brightness and duration of daylight and thus to the seasons of the year

• May include anniversary component

• Treatment for winter SAD is daily exposure to bright, artificial light and sometimes medication

Signs of Clinical Depression in the Workplace (1)

• Poor team player

• Decreased productivity

• Irritability and hostility

• Withdrawal from others or, conversely, extreme dependence on others

• Feelings of hopelessness or despair

• Slowness of speech, chronic fatigue

Signs of Clinical Depression in the Workplace (2)

• Slumping posture, flat or blank facial expression

• Inability to concentrate, focus on details, remember; decline in dependability

• Unusual increase in errors in work

• Proneness to accidents

• Tardiness, absenteeism, “presenteeism”

• Lack of enthusiasm for work tasks

Myths and Facts

• Clinical Depression is a character flaw, a sign of personal weakness

• A person can relieve Depression through willpower

• Clinical Depression doesn’t really affect your everyday life; you just appear unhappy

• Clinical Depression is no excuse for missing work.

• So what. Nobody dies from feeling blue.

The Supervisor’s Role

• Recognize early warning signs – awareness is key

• Interact sensitively and appropriately

• Educate all employees about symptoms of Clinical Depression and action to take

• Encourage employee to seek diagnosis and treatment

• Support employees on the job

Unhelpful Messages

• Urging someone to “just get over it”

• Encouraging them to take a vacation or find a new hobby

• “Tough it out” rather than seek treatment

• Ignore, deny, or downplay the fact that an employee is suffering – “not my business”

Considerations for Management

• Supervisors should not diagnose

• Maintain good communication

• Discuss any observed performance problems

• Stay alert to possibility of illness

• Urge employee to consult EAP or MD

• Obtain direction and help from EAP

Four-Step Procedure

1. Observation and Documentation:

– Watch for changes in attendance, behavior, performance and productivity

– Document the specific, factual, behavioral to demonstrate to employee that s/he needs help

– Include dates, times, descriptions of events

– Use check list of on-the-job warning signs

Next Steps

2. Constructive Dialogue:

- Focus only on work performance problem

- Reassure employee s/he is valuable and the purpose is to help regain level of performance of which s/he is capable

- Ask about any problems that might be affecting job performance: sound her/him out as to what’s wrong, help him/her take steps to overcome it

Constructive Dialogue

It is important for the supervisor to:

• Hold employee accountable for her/his work performance, standards, criteria

• Stick to the facts, do FOSA “gap analysis”

• Schedule a follow-up meeting(s) to review performance

• Be prepared to take whatever action is necessary if there are no changes

Third Step

3. Referral:

– Present referral as positive step, a way of getting help, not as a punishment

– Mutual goal is to restore employee to good spirits and normal productivity

– Motivate employee to follow through with the referral

– Avoid words that lay blame or imply judgment

Last Step

4. Follow-up

- Session to review progress toward meeting performance standards

- Set and reinforce expectations & goals

- Monitor performance without “spying”

- Be flexible and accommodate, but hold employee accountable

- Make allowances but don’t coddle

- Respect the employee’s privacy

What to Expect

During a constructive dialogue, an employee may put a lot of effort into:

• Denying….

• Explaining….

• Minimizing….

….the supervisor’s feedback

and observations.

Employees’ Attitude Towards Depression

• Fear about the effect that treatment will have on their job

• Concern about confidentiality

• Unaware that they have Depression

• Fear that their insurance is inadequate to cover costs

• Certainty that nothing will change for the better (a symptom in itself)

Ineffective Responses

• Badgering and nagging add to distress

• Pressure or resentment can trigger volatile team dynamics

• Diagnosing, labeling the problem or counseling the employee creates liability

• Trying to “fix” the problem is unrealistic

• Laying blame or implying judgment should be avoided

Effective Supervisory Responses

• Don’t be critical, but encourage normal routine tasks to be performed

• Counter pessimism with sensitivity

• Bolster self-esteem and confidence through understanding, patience, support

• Encourage person to seek help

• Early identification of problem, discussion with employee, and referral to resources

Advice for Co-Workers

• As much as possible, maintain a normal relationship with employee

• Point out negative thinking without being critical or disapproving

• Acknowledge that person is suffering, in pain

• Hold accountable for appropriate behavior

• Take care of yourself. Clinically depressed people can create anger, resentment

What Else Co-workers Can Do

• Respectfully encourage person to seek professional help

• Encourage person to continue treatment and take medication as prescribed

• Offer encouragement and pay genuine compliments

• Show respect and make person aware of her/his value to co-workers/team, and encourage “connecting” with work team

The Bottom Line

Clinical Depression in the workplace must be addressed because it negatively affects an individual’s performance, fellow employees’ morale, and the organization’s bottom line

• Consult physician, psychiatrist, counselor

• Treatment is available and successful for the majority (80%) of people with Clinical Depression

Employee Assistance Program

• Employee and Organizational Health and Wellness benefit

• Solution-Focused Brief Therapy & Counseling

• Cost-free, confidential, voluntary

• Prevention, Intervention, and “Post-vention”

• Neutral and Non-Partisan: Accountable to both Labor and Management

• Staffed by licensed psychotherapists

• Available to Employees, their Family Members, Significant Others, Workteams, HR, Management

Using Your EAP

If you notice these behaviors in the Workplace:

• Inattention/preoccupation

• Complaints, errors or low productivity

• Anger, stubbornness, contentiousness

• Increased absences, tardiness

• Poor working relations

Call EAP for:• Clinical Assessment and

Brief Counseling and targeted referrals

• Crisis prevention/CISD

• Drug-Free Workplace

• Training, workshops, facilitated meetings

• Supervisor/manager consultation, coaching

• Mediation, Orientations

Psychotherapy

• Work to understand the illness

• Solve problems, handle tasks

• Manage stressful situations that could trigger another episode of the illness

• Foster hope, encourage options, create plan for when and how to get help if a relapse occurs

What A Therapist Will Do

• Listen

• Challenge unhealthy logic, explore solutions

• Assist with options and resources

• Recommend action

• Help design a balanced lifestyle

• Help develop problem solving and decision-making skills

• Encourage physical exercise, socializing, etc.

Resources

• Wellness Councils of America

• National Institute of Mental Health

– Depression/Awareness, Recognition and Treatment (D/ART)

• Depression & Related Affective Disorders Association (DRADA)

• National Alliance for the Mentally Ill (NAMI)

• National Mental Health Association

THANK YOU!