Mental Health at Work

Although the stigma of mental illness persists, more employers are recognizing the need to help their teams stay well in the workplace.

From left, Clive assistant fire chief Clayton Garcia, a military vet, and fire chief Rick Row work with psychologist Paul Ascheman to boost the mental well-being of the department’s staff.

Writer: Barbara Dietrich Boose
Photographer: Duane Tinkey

Within six months in 2019, three of Clayton Garcia’s former military colleagues, including a commanding officer, took their own lives. He still felt close to the men since his two deployments as a Navy medic in Iraq more than 10 years earlier. Shaken, he contacted another friend he’d served with.

“I asked him, ‘Would you call me if you were considering suicide?’ He said, ‘No way, I would just do it,’” recalls Garcia, assistant chief of the Clive Fire Department. “Being in a fire service, I’ve run a lot of suicide calls. What bothers me the most is how happy people can seem to be, but inside they’re a wreck. All they needed was an opportunity to talk with someone about their problem.”

According to the National Alliance for Mental Illness (NAMI), in 2020 1 in 4 American adults—up from 1 in 5 in 2019—struggled with a mental health issue, but only about half received treatment. In the workplace, people may be especially reluctant to disclose they have mental health issues or ask for help because of the persistent negative stigma that accompanies mental illness and its potential harmful consequences, such as perceptions they can’t do the work, aren’t worthy of advancement, or are strange, weak or even dangerous.

“The worst phrase ever invented is ‘It’s all in your head,’ because that implies mental illness is not real, but made up—a dramatized version of reality. It’s the result of weakness or personality defect or lack of faith,” says Peggy Huppert, executive director of NAMI Iowa. “Unfortunately, many Americans believe those things, but none of them are true. Mental illness is a very real illness, just like any other.”

Garcia wanted to help his fellow Clive firefighters get past that self-stigma. He worked with Clive Fire Chief Rick Roe and Paul Ascheman, a Des Moines licensed psychologist at Psychology Associates, to create a peer support team in early 2020 that department members can turn to after they experience trauma. In addition, to “take having to ask for help out of the equation,” Garcia championed a program, which began in early 2021, to require the 45 members of the department to have a onehour, one-on-one meeting with Ascheman once a year. They also can talk to him anytime they feel the need.

“Initially, there were a ton of questions—‘Is my job in jeopardy?’ That’s why we call it a proactive annual check-in, which is a huge difference from having a mental evaluation,” Garcia says. “It has absolutely no bearing on employment and is strictly confidential. In no way can the annual check-in get back to the department. On a Thursday and Friday, we have the appointments with Dr. Paul posted on the board. That made the program incredibly visible and normal. We took the hurdle out.”

Ascheman, a psychologist for the Iowa Department of Public Safety and other Central Iowa fire and police departments, says public safety professions “tend to focus on physical strength and performance, which can create a self-stigma that expressing emotions is a sign of weakness.

“Emotional composure and compartmentalization are critical traits in first-responder roles. They try to maintain that stoicism on scene, but it can become maladaptive when trying to cope with traumatic experiences,” he adds. “Proactive annual check-ins create a catalyst for change that says we’ve got to take care of these people and their mental health. Plus, they are not cheap to train. If we can keep them on through retirement, that’s a benefit for everyone in the long run.”

Mental illness has a harmful impact on employers as well as individuals. NAMI estimates that untreated neuropsychiatric disorders, including mental health conditions, cost the economy $200 billion in lost earnings each year through decreased work performance and productivity. The challenges and tragedies of the pandemic, acts of racial injustice and violence, and divisive politics gave mental health illness even greater urgency. In its 2021 “State of Workplace Empathy” report, BusinessSolver, a business management consultant firm in West Des Moines, reported that 88% of employees believe organizations should be doing more to promote mental health.

Stigma Persists

Despite the increasing willingness of companies to make that investment, the stigma of mental illness persists. The 2021 BusinessSolver report found that 66% of employees, 75% of human resources professionals, and 82% of chief executive officers believe that employers will view someone with mental health issues as a “burden.” Most employees want mental health support in the workplace, but only 29% say they’re aware of their organization having an employee assistance program (EAP), even though, according to the International Employee Assistance Professional Association, 75% to 97% of organizations have such programs.

“We’re not trained in our culture to be comfortable with our own difficult emotions, much less those of others,” says Sarah Noll Wilson, a Des Moines-based executive coach and leadership development consultant. “Our culture is high hustle, high pressure and high perfectionism.”

The stigma also affects interpersonal interactions at work. In a video promoting the Iowa Healthiest State’s “Make It OK in Iowa,” a campaign that aims to raise awareness of mental health and end the stigma, a man asks a colleague how her weekend was. Her admission that she struggled with depression initially paralyzes him in an awkward silence. The Make It OK campaign, which was created in Minnesota in 2012 and launched as a statewide initiative in Iowa in May 2019, provides tools and techniques for having conversations about mental health.

“If people learned I was diagnosed with breast cancer, think about how they would respond,” says Jami Haberl, executive director of Iowa Healthiest State Initiative. “Those same responses should occur if I said I was bipolar. We should be asking the same supportive questions—‘Tell me more,’ ‘How can I best support you?’ ”

That doesn’t mean an employee is obligated to be a colleague’s mental health counselor, Haberl emphasizes. “An employer or employee is not responsible for everyone’s problems. A person with cancer has a support network around them. What can you do as part of a colleague’s support network? It really comes down to building trust and being kind and empathetic,” she says.

Knowing the mental health resources one’s employer offers is one way to support a colleague. “If you feel someone is struggling with a mental health issue, share the phone number of your EAP and encourage them to use it,” says Tammy Hoyman, chief executive officer of Des Moines-based Employee Family Resources. Its EAP serves approximately 700 companies nationwide with a large network of affiliate counselors. “If I’m listening to a colleague describing symptoms of strep throat, I don’t say, ‘Let me prescribe medications for you.’ I say, ‘It sounds like you should see a doctor.’ Offering help and support is never the wrong thing to do.”

Starting at the Top

Whether and how its leaders support and talk about mental health are key to an organization’s culture and employees’ well-being. That’s been especially important during the pandemic, which fueled anxiety, isolation and stress about changing demands of family, work and daily life.

“We had a client who was told by a boss, ‘We’re going to work harder than ever!’ That was the wrong message to send during the pandemic,” Hoyman says. “If your people are burned out, they’re not going to stick around, and they aren’t going to be productive.”

She has worked to be more open and supportive with her own executive team, such as with a colleague who initially said “I’m fine” in answer to a how-are-you-doing question but, upon further encouragement, admitted to feeling unproductive and then “really depressed.”

“If we had not had those conversations, that employee would have stopped at ‘I’m fine,’ ” Hoyman says. “Businesses that are more open about these issues are going to fare better.”

Since the pandemic began, leaders at Delta Dental of Iowa have increased virtual and electronic communications to employees, many of whom were working from home, including promoting its EAP, telehealth care options, and resources of the Make It OK campaign and the National Alliance on Mental Illness. Supervisors had more one-on-one meetings with their staff members. The company also brought in clinical psychologist Warren Phillips, clinical director at Central Iowa Psychological Services, for virtual discussions on “being well during COVID.”

“By opening up those communications, people shared what they were experiencing and felt they weren’t alone. We informed employees about available resources so they wouldn’t have to take on a mental health counselor role,” says Beth Russett, Delta Dental’s human resources director. “Our strong culture and enhanced flexibility helped us get through this trying time. We let people know it’s OK to say, ‘I’m having a hard day, and I’m struggling.’ ”

Construction Industry

Leaders at Downing Construction, a commercial contractor based in Indianola, have long been mindful of the need for mental health supports for staff and became even more so since the pandemic started. According to a CDC analysis of data from 32 states, including Iowa, that participated in the 2016 National Violent Death Reporting System, working-age men and women in construction and extraction jobs had the highest suicide rates in a comparison of six major occupational groups.

“Our clients are trusting us to deliver what is typically the biggest and most financially impactful decision of their life. We are ultimately accountable for delivering their project on time, on budget and to the level of finish that is expected,” says Downing Construction CEO Joe Butler. “Once the stress of one project is complete, we turn around and immediately start another one, so there is very little down time in our industry.”

Because their job is “to be in full control of our projects at all times,” he adds, people in the industry can be reluctant to ask for help.

“It gives the perception of not being in full control,” Butler says. “We find that if someone does not ask for help, it is often too late to properly help them or fix the situation. If we can create an environment that allows people to ask for help when needed in the moment, we can stay ahead of whatever issue there may be and not let it get so burdensome to the individual.”

Last year, Kandace Edwards, Downing’s human resources manager, invited Jami Haberl of Iowa Healthiest State Initiative to give a presentation at the company “to open the door for the team to understand we all struggle and it’s OK to seek out resources,” she says. “It was very well received by everyone.”

The company also partners with a health and life broker who directly connects individual employees with health providers and services, including for mental health.

“This is important, because dealing with the illness itself is exhausting and leaves very little capacity for an individual to find the help they need,” Edwards says. “We are humans first and a construction company second. We’re blessed to have a supportive team. The work is really hard, but we all have a passion for each other and for the work.”

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