Transcript Downtime: Clinical Depression in the Workplace

Downtime:
Clinical Depression in the
Workplace
Jean Crossman-Miranda
Employee 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 NonPartisan: 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:
Call EAP for:
• Anger, stubbornness,
contentiousness
• Training, workshops,
facilitated meetings
• Increased absences,
tardiness
• Supervisor/manager
consultation, coaching
• Poor working relations
• Mediation, Orientations
• Clinical Assessment
and Brief Counseling
and targeted referrals
• Inattention/preoccupation
• Complaints, errors or low • Crisis prevention/CISD
productivity
• Drug-Free Workplace
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 decisionmaking 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!