Mental Health in the Workplace

Krista Benes of Mental Health Commission of Canada (MHCC) discusses the labour market as it relates to mental health. With the right supports, employers can discover an untapped labour pool, while making their workplace more inclusive.

Video Transcript:

(Krista Benes) So over the next little bit, what I’d like to speak to you about obviously is mental health and employment. You know, it’s interesting, the intersection between mental health employment and how it really resonates with all of us.

Just in the cab ride over here this morning, the cab driver who had pulled up to take me from my hotel here was saying, “Oh you know.” He said, “Oh, what are you here to do?” and I said “Oh, I’m gonna give a talk on mental health and employment.” And he said, “Oh.” He said “There’s been so many deaths by suicide among taxi drivers in the last number of years, given the changes in regulations and the increase with Uber driving, et cetera.” 

And he said, “You know, employment can create a lot of stress and by not having employment can create a lot of stress.” And it was just interesting in how quickly he responded and had something to say about the intersection of mental health and employment. So, it’s an important area and one that I’m happy to be working in.

Today I’d like to talk to you about addressing mental health at work. We’ll have a look at the employment cycle, some promising practices as well as take a closer look at some case studies of the work that we’ve done at the Commission. So the Mental Health Commission of Canada is a not-for-profit organization. We’re funded by Health Canada and our original 10-year mandate that we conducted looked at developing Canada’s first ever mental health strategy. It addressed stigma and discrimination, and we built knowledge exchange across Canada.

As well through that mandate, it was expanded to include the housing and homelessness project the At Home/Chez Soi Project. Our current funding has been renewed for an additional two years and the work that we’re doing now focuses on suicide prevention; addictions and mental health; population based mental health; and engagement with Canadians, provinces, territories, and federal partners.

It’s very individualized, what impacts our mental health, but there are so many variables. And we know that employment is one of those big variables. In fact, 50% of your health is determined by factors such as your income, your disability status, and your employment and working conditions.

We know that the economic and social conditions in which people live in are now being recognized as important factors and determinants in individual health, with income emerging as the most critical factor. The rate of people leaving long-term disability income programs in Canada is less than 1%, yet we know that most people want to work.

Most people see work as an essential part of their recovery. Most people feel really good about being productive and it’s a basic human need. It’s a typical adult role in most societies. It can be a way out of poverty. And working may prevent entry into the disability system in the first place.

So, over the course of our time together this afternoon, we’re going to look at some of the ways, some of the barriers to employment. Mental health is fluid. It’s on a continuum and it can vary over the course of even one day. It can move from good to poor along a gradient. Mental health is the capacity of each of all of us to think, feel, and act in ways that enhance our ability to enjoy life and deal with the challenges we face.

It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice interconnections and personal dignity. It differs though from a mental disorder. A mental disorder causes major changes in person’s thinking, emotional state and behavior and disrupts the person’s ability to work and carry out their usual personal relationships. 

So there’s a difference between the two. However, the presence of mental illness does not mean a lack of mental health. So as you can see from this gradient, a person can have optimal well-being. However, they could still have the presence of a mental illness and be actively feeling symptoms related to those, that illness.

Whereas in the bottom half of the gradient, a person languishing with minimal well-being while living with a mental illness. So for example, if you have a diagnosed mental illness but you’re doing things to also support your mental health, we talked about a couple of those things that impact our mental health already, you heard examples.

But if I’m exercising and I’m getting enough sleep and I’m, you know, nourishing my body with really great food, I can move along the continuum to improve my mental well-being, even though I’m still diagnosed with a mental illness. 

So I just wanted to give you a picture, that the two can operate together and can be impacted along sort of a gradient line and can change. So to place the 1 in 5 people living in Canada with a mental illness today in the context of how many people are living with other major illnesses in a given year, there’s about 1 in 25 people in Canada living with heart disease, and 1 in 15 people with type 2 diabetes. So the number is quite high, 1 in 5.

We all know, either we’re experiencing mental health issues ourselves or we know a family member or a colleague. We’re all touched by it. Mental health problems and illnesses are the number one cause of disability in Canada and account for nearly 30% of disability claims and 70%  of the total costs. 10% and 25% of mental disability costs currently borne by employers, they could be avoided.

We’re gonna talk about some strategies of how we can avoid some of those costs. We also know that the longer a person is away from work due to illness, the less chance there is a successful return to the workplace. So if somebody’s been off work for six months, they have about a 50% likelihood of returning to work. However, that decreases to 10% if they’ve been away from the workplace for nine months or longer. So the sooner that we can intervene and the sooner that we can work towards supporting people getting back to work, the better.

And we know that if unaddressed, the impact of mental health problems on lost productivity, including absenteeism, presenteeism and turnover will cost Canadian businesses $198 billion over the next thirty years. So we have to do something about it. These are some of the costs associated with an unhealthy workplace.

Presenteeism, I’m not sure, does anyone know, do you all know what presenteeism is? Where if you show up to work and you could be surfing the internet all day. You look like you’re there, you’re dressed in the part, you know, you’ve got what you’re supposed to wear but you’re not doing anything. You’re not accomplishing anything because you’re so focused on your own mental health or your mind is somewhere else.

Workplace conflict can be a big source of an unhealthy workplace. Organizational change. Turnover and related costs. And this is one of the main reasons that people leave a workplace, is because they’re unhappy with the workplace culture or the unhealthy workplace that they’re in.

So there’s an employment gap. Up to 90% of Canadians living with a severe mental illness are unemployed. We know that unemployment is associated with a twofold to threefold relative risk of death by suicide compared with being employed. So why? Why is mental health in the workplace such a major issue that we’re dealing with still, even though people want to work and want to be employed?

There’s stigma. There’s still a lot of stigma around talking about mental health and mental illness. There’s lack of employer awareness and training, although not for this group because you’re all here learning about things you can do. The episodic nature of the illness. We know that we can be really, really well for a long period of time. 

However, then we’re not. And there’s not often things in the system in place to account for that. You know, whether it’s even financially supporting individuals when they’re off. There’s a lot of stress that comes with the disincentives that are built into the system, that we can’t always account for.

The hours of work, full-time versus part-time. And you know not all jobs come with the opportunity to be able to work part-time. And so developing flexible work hours and work schedule can be a really important component for people living with a mental illness. However, it’s not always easy to find that balance.

So we have an untapped talent pool, though, waiting for us. And we know that we need to tap into them. The Canadian Chamber of Commerce has identified skill shortages as one of the top 10 barriers to competitiveness in Canada, costing the Canadian economy billions in lost GDP. One source estimates that we’re going to be about 2 million workers short by 2031. And roughly 60% of Canadian CEOs report the labor shortages already affecting business growth.

So we’re gonna have to get creative about thinking about where we go to meet these shortages in finding the workers that we need. The good news is that Aspiring Workers, the group that I’m here to talk about today, they have the skills that we need. They’re qualified. According to Statistics Canada over 50% of Canadians with disabilities aged 25 to 62 have a post-secondary education. They’re on time. Research shows that 86% of persons with disabilities rate on average or better in attendance. They’re high-performing. 90% of persons with disabilities rate on average or better on job performance, compared with their colleagues without disabilities. And their loyal. Job turnover among people with a disability is estimated to be 20% of the rate of other employees.

And Statistics Canada research indicates that in organisations with accessible employment practices, employee retention was 72% higher among people with disabilities. Want to reduce the stigma for them, change attitudes and processes towards hiring and retaining those living with a mental illness. We know that employment plays an important role in the recovery from mental illness.

The concept of recovery refers to living a satisfying, hopeful and contributing life, even if there may be ongoing limitations from mental health and illnesses. It refers to a process or journey of healing in which to the greatest extent possible, people are empowered to make informed choices about the services, treatments and supports that best meet their needs.

And as I say, at the heart of recovery is the idea that people have goals and the opportunities to move forward and the hope to meet those goals. And employment has always been, when I worked in frontline mental health with the Canadian Mental Health Association, when a person was further along in their recovery, employment was one of the goals that was always set continuously as a plan for moving forward.

So, one of the things that we look at is when we think about employment for people living with mental illness, is that we have to think of the big picture. Anywhere from what we’re doing around recruitment, all the way through to prevention and promotion. And I think it’s important that we take a holistic perspective when we think about these elements.

So when we talk about recruitment, you know, what can we do to embrace this talent pool? How can we…  I think that some of the more conventional channels of looking for…  to fill vacant positions are not always going to land on the candidates from the Aspiring Workforce. Embracing diversity looking for different ways to try and target your talent pool.

I think we need to be flexible about the onboarding process. There’s a number of organizations out there, like I was mentioning around supported employment, that can really make a difference in helping you to get the person you need to get the job done. But it’s important to have that conversation right from the get go with employees. What can we do to support you at work? How can you be the best? How can we support you to be the best worker that you can be and be successful in your job? I think having those conversations upfront and early can prevent or circumvent any issues that may come on down the line.

Just conscious of my time, sorry.

We know that currently mental illness is rated by employers as one of the top 3 drivers and 80% of short and long-term disability claims. But when employers offer an integrated disability management program, the duration of health leaves in absence are cut in half. And in turn employees are likely to remain employed and find success in a supportive environment.

So with regards to prevention and promotion we talked about wellness activities that you can implement in your workplace to ensure your workplace is a good one that’s supportive and creates a culture that’s mentally healthy for employees. There’s training and education. One of the programs that we offer at the Mental Health Commission of Canada is the Mental Health First Aid program, similar to like, a first aid. Is that what it’s called? First aid program.

The Mental Health First Aid program is one where it trains people to look for the signs and symptoms of a colleague who may be in distress. And how do you respond? How can you be there to be that first support on the scene to help? That creates awareness and reduces stigma in the workplace.

Stay at work. We can talk about accommodations. We know that accommodations don’t cost that much money. In fact, most accommodations cost less than $500. Reduced hours, flexible start times and finish times. Increase the number of breaks. Have a space where a person can work quietly. Working from home options. You know, having a wellness room. These kinds of things make a huge difference.

When somebody is off on medical leave, it’s important to have continuous communication with them when they’re away from work. You know, develop a plan to maintain contact. And then when they return to work, talk about a graduated scheduling, a recovery focused plan, one that they’re a part of so that they can know what they can expect. They best know their needs.

And so working with them to support them to get back to work and getting work in an environment that they’re comfortable with is the best way to approach that. This is just a bit of a recap. Raising awareness. We all have a role to play, you know, culturally at work. It’s not just, it’s got to be frontline employees, management.

I’ll just play a quick clip if there’s a chance.

(Howie Mandel from clip) In the United States, I was on the Howard Stern Show. And I have OCD. And part of it is I have these rituals that I can’t touch things. And he thought it was funny to, the door was kind of dirty and nobody would open it for me. And I started to panic and go through anxiety. And I didn’t know we were still broadcasting.

I said, “No, I see a psychiatrist. I have OCD, I’m medicated. This is not funny, this is not a joke.” And they ended up opening the door for me. And then I realized that this got broadcast. And I went down onto the street. This was Manhattan in New York. And I walked out into the street and I thought, you know, how can I deal with this, you know? And how can I even look at anybody?

And right when I walked into the…  I was facing the traffic. Somebody came up to me and said, “Are you Howie Mandel?” And I wouldn’t even make eye contact, I was so embarrassed. And I went, “yeah” and they said, “I just heard you on Howard Stern.” And I went, “Oh my God.” Like, what do I do now? Do I just run into traffic and just end it here? And the next two words were the words that made my life different. And the guy just said into my ear, “Me too.” 

If we take care of our mental health like our dental health, we’ll be okay. We all talk about our dental health. Talk about my mental health? No, no, no. In corporate North American Canada, you can say in the middle of day, “I got to leave at 3:00. I got to go see my dentist.” But you look at the looks in the office when you say, “You know what? I got to go to a psychiatrist.” You’ll get looks and that’s what’s wrong. And that’s why we got to talk about it. There’s no stigma. I’m crazy, I’m mental. I’m talking about it.


(Krista Benes) So Howie’s a great advocate for raising awareness around mental health and for Bell Let’s Talk. Okay, so very quickly, these are the workplace mental health factors. When I talked about creating a positive psychological health and safety environment at work, these were identified in the National Standard for Psychological Health and Safety. 

There are 13 factors that really impact employees’ mental health at work. There’s a great set of videos that we have, and I can give you the link to that, that you could use at a lunch and learn or in any way that you could to raise awareness around what’s impacting our mental health at work. Things like civility and respect, engagement, organizational culture, work-life balance, these are all important factors.

We know that millennials will change jobs an average of 4 times in just the first 10 years of their lives. So these are the things that they’re citing as important and the reasons why they’re leaving workplaces. So I think it’s important that we all address these items if we want to keep employees in our workplace.

As I said, here’s some of the resources around increasing awareness and education. These factor videos are available on our website. I talked about the National Standard for Psychological Health and Safety. As I said, this is a resource that’s freely available on our website and it talks about how do we implement the standard into our workplace? And so there’s a number of pieces that come with that to support organizations in doing this, the Assembling the Pieces guide.

And there was a case study research project that was done, and it followed 40-plus organizations across Canada of various shapes and sizes to implement the standard in their workplace. And what this project did was followed those organizations, identified some of the promising practices that they found throughout the research project, the things that worked for them, the things that didn’t work for them.

It’s a great way to be able to reach out to an organization that may be similar to yours in size or even in type of business, and  work with them to try and figure out how to implement a psychologically healthy and safe workplace. Of the organizations who implemented the standard. So the first was the Michael Garron Hospital. This is the Toronto East General Hospital. 

It’s a community teaching hospital which includes inpatient beds comprised of acute care, rehabilitation, complex continuing care and mental health. The hospital has over 2,500 unionized and non-unionized employees and health care providers, 413 physicians and midwives and over 500 adult and student volunteers. And they implemented the standard as a strategic priority in order to support their staff. Their goal is to increase staff engagement, which they believe will lead to improved inpatient care. And ultimately, they believe it’s the right thing to do.

So some of the outcomes. The organization has experienced a 7% decrease in overall health care costs over the last 4 years and a decrease in days absent from 10.66 in 2008 to 6.55 in 2014. The overall staff engagement scores have significantly increased, placing them as a leading community hospital in 9 of 11 engagement categories. And they believe their staff engagement score improvements have been a significant driver in improving their patient satisfaction and overall quality metrics.

The last point I wanted to make was that we recently got the results back from a business case project that we worked with a number of researchers from McMaster University and the Institute for Work and Health on. And what they set out to do was to explore how organisations support and accommodate workers with mental illness, and consider the costs and benefits of supporting and accommodating workers with mental illness.

So what they did was… they did a study that looked at both the qualitative and quantitative costs with making accommodations for people living with mental illness. And then they did an economic analysis of those costs to see what the return was, whether it was a negative or positive one, for both the employers and the workers.

And what they found was really quite amazing. They looked at 5 different workplaces that were varied in size, geography, sector and structure from a small cafe to a large governmental organization. And they interviewed people in the workplace. They interviewed the individual who had been diagnosed with the mental illness, or who self-identified as living with a mental illness. They interviewed colleagues. They interviewed management. 

And then they looked at a number of factors. So when they considered the economic analysis these were some of the costs that they considered as they looked at the 5 different organizations, the 5 individuals working across the organization. So how much did it take to plan for the person’s time? What was the time that it took to meet with the person to make those accommodations? They looked at things like productivity at work, the individual’s intent to stay. 

And then there were a number of intangible benefits that couldn’t be included in the economic analysis but were of equal value, things like job satisfaction, quality of life, work relationships. But what they found was that for the small cafe, for example, the worker benefits projected over a 5 year period. So both the cost-benefit analysis for both the worker and the organization were projected over a 5 period.

And as you can see there is as little as 1.9 times the benefit and as great over 12 times the benefit for the worker. And some of these accommodations that are listed here were very, you know, were quite small. The manager writes down tasks, runs through the tasks the day before, sends text message reminders, gives regular check-ins.

They found that most people relied on universal supports that were available, and that there weren’t really very many additional accommodations that were made. So most people would rely on sick days or flexible work from home options to get the accommodations that they needed. And the positions varied anywhere from a person in a management position to a solutions analyst or an inspector.

We’re very proud of the results and the work that the researchers did on this project.

So I just wanted to say thank you very much for having me today.

Thank you very much.