Mental Health Disclosure & the Workplace

memorial
A memorial of candles, flowers, and other items created in Düsseldorf, Germany, the destination airport of the Germanwings flight that crashed, killing all 150 passengers and crew on board.

On March 24, 2015, the world learned about a Germanwings flight that ended tragically. The plane crashed into the French Alps, killing all 144 passengers and 6 crew members (Calamur, 2015). In the search for answers, indicators point to how the plane’s co-pilot may have intentionally crashed the plane, which has caused many to wonder about his mental health status and history (Kulish & Ewing, 2015). Although Lufthansa (Germanwings’ parent airline company) was aware of the pilots history with severe depression, Lufthansa reported that the pilot passed its “state of the art” screening process, which includes testing of their technical ability and their psychological fitness (Kulish & Ewing, 2015). Further investigation into the pilot uncovered discarded doctor’s notes in the pilot’s apartment that had indicated he was too sick to work on the day of the crash (Kulish & Ewing, 2015).

The horrific incident with Germanwings and its pilot has raised debates regarding what measures employers can take to identify the mental health history of its employees. The current aviation system depends largely on pilots to disclose any medical or psychological issues they have or are currently experiencing (Goode & Mouawad, 2015). Many worry any new restrictions may deter those who need help from actually seeking help due to increased stigma around mental health (Goode & Mouawad, 2015).

Speaking to the Bloomberg Report, policy director of the National Alliance of Mental Illness (NAMI), Ron Honberg, says:

“We could be trying to create an environment that’s more knowledgeable and accepting of mental health conditions and doesn’t cause people to be ostracized if they admit to it.” (Tozzi, 2015)

Aviation is just one of many professions where one’s mental health may seriously risk theADA_2 life of not just the employee but also the lives of many others. Doctors, school bus drivers, law enforcement, utility workers, and many other professions involve high stakes. Yet, the Americans with Disabilities Act (ADA), which was established in 1990, prohibits employers from asking job applicants information regarding their medical status, including mental health (Tozzi, 2015). In the wake of the Germanwings tragedy, a looming question still remains: Why, when, what, and how should information regarding a person’s mental health be disclosed to others?

Mental Health & the Workplace 

The World Health Organization (2001) identifies mental illness as one of the leading causes of disability around the world. According to the National Institute of Mental Health (NIMH, 2012), major depression carries the “heaviest burden of disability among mental and behavioral disorders.” The NIMH (2012) estimates that 43.7 million adults suffer from mental, behavioral, or emotional disorders, and of those, 16 million, nearly 7% of all adults in the U.S., had at least one major depressive episode in the past year. Experiences of depression is estimated to cost the U.S. $23 billion in lost productivity annually (Harding, 2010). Michael Blanding, Assistant Professor at the Harvard Business School, estimates that workplace stress accounts for 8% of national health care spending, even contributing to 120, deaths each year (Blanding, 2015).

t1larg.health.depression.workplace
The National Institute of Mental Health estimates 16 million adults in the U.S. experience at least one episode of depression in 2012.

Recognizing the need for integrated mental health care, many employers offer Employee Assistance Programs (EAPs), a voluntary resource that allows employees free and confidential assessments, short-term counseling, follow-up services, and referrals for addressing a wide range of issues, including substance use, bereavement, and psychological disorders (OPM, 2015). Johnson & Johnson employees are invited to use the corporate gym to relieve stress and stay healthy, and General Mills provides mindfulness training and on-site guided meditation in its efforts to promote mental and physical wellbeing (Blanding, 2015).

Dr. Michelle Riba, professor of psychiatry at the University of Michigan
Dr. Michelle Riba, professor of psychiatry at the University of Michigan

However, the majority of workplaces do not carve time out for meditation, and mental health is often an afterthought rather than a component of its preventative health care strategies. Dr. Michelle Riba, M.D. serves as a professor of psychiatry and the associate director for the University of Michigan’s depression center. Dr. Riba believes careful thought and preparation are crucial for employees who are considering disclosing their health information to their employers.

“…for the individual who’s working in an office or another situation, one really needs to think about why any medical condition would be discussed. Not that there’s anything wrong with disclosing, but one has to be really clear about what one hopes to gain” – Dr. Michelle Riba, (Harding 2010).

In addition to barring employment discrimination on the basis of an individual’s disabilities, the ADA also requires employers to provide appropriate accommodations for employees with disabilities. It is, however, up to employees to disclose their disability and to identify what accommodates are necessary (Harding, 2010). For this reason, Dr. Riba and other advocates recommend employees carefully consider what is to be accomplished by self-disclosure. If an individual’s illness or medication may benefit from flexibility in terms of work hours or uses of sick days, this may be accomplished through self-disclosure.

Psychologist and assistant professor of psychology at Duquesne University, Susan G. Goldberg, offers 5 factors to consider before disclosure:

  1. How supportive is the person you are disclosing to likely to be?
  2. What type of culture does the company have?
  3. Do you have a proven track record?
  4. What is happening in the society as a whole? (i.e. current events)
  5. Do you need to disclose everything about the condition, or would it be better to be selective? (Tugend, 2014). 

Although, each place of employment has its own “culture” in terms of its receptiveness to discussions and accommodations around mental health, employees are protected by the ADA and other laws, including the Mental Health Parity and Addiction Equity Act (MHPAEA). The MHPAEA of 2008 prohibits companies (with 50+ employees) from charging higher deductibles or co-pays for mental health and substance abuse services as compared to other medical services (U. S. Dept. of Labor, 2015). The recently implemented Affordable Care Act (ACA) includes provisions for the treatment of mental health and substance use disorders to be considered an “essential health benefit” and prohibits insurance companies from denying individuals coverage based on a history of depression or any other preexisting mental health condition (Harding, 2010).

Mental health stigma continues to prohibit individuals from disclosing their disabilities.
Mental health stigma continues to prohibit individuals from disclosing their disabilities.

New federal regulations specifically require employers, specifically federal contractors and subcontractors (20% of U.S. work force) to regularly encourage employees to voluntarily disclose their disabilities (Tugend, 2014). The Partnership for Workplace Mental Health, an initiative of the American Psychiatric Association, is dedicated to raising the awareness of employers on how to support employees after disclosure, including strategies for reducing stigma in the workplace.

While Lufthansa considers what differences in its corporate structure could have prevented such a tragedy from occurring, employers around the world are also wondering how to protect their stakeholders, including their own employees from harming themselves and others. An integrated approach to mental health care and screening offers opportunities for intervening and providing services to employees, as well as address the issue of stigma and work place stress, which for many, continue to be an obstacle on the path to wellness.

References:

Blanding, M. (2015 April 6). Will the Germanwings crash affect how employers approach mental health? Forbes.com. Retrieved from: http://www.forbes.com/sites/hbsworkingknowledge/2015/04/06/will-the-germanwings-crash-affect-how-employers-approach-mental-health/

Calamar, K. (2015 March 24). As night falls, officials call off search operation for German plan. NPR.org. Retrieved from: http://www.npr.org/blogs/thetwo-way/2015/03/24/395011737/germanwings-a320-crashes-in-french-alps

Goode, E. & Mouawad, J. (2015 March 28). Germanwings crash raises questions about shifting ideas of pilot fitness. NYTimes.com. Retrieved from: http://www.nytimes.com/2015/03/29/world/europe/germanwings-crash-andreas-lubitz-mental-illness.html

Harding, A. (2010 September 20). Depression in the workplace: Don’t ask, don’t tell? Health.com. Retrieved from: http://www.cnn.com/2010/HEALTH/09/20/health.depression.workplace/

Kulish, N. & Ewing, J. (2015 March 31) Lufthansa says Germanwings pilot reported deep depression. NYTimes.com. Retrieved from: http://www.nytimes.com/2015/04/01/world/europe/lufthansa-germanwings-andreas-lubitz.html?_r=1

National Institute of Mental Health. (2012). Major depression among adults. NIH.gov. Retrieved from: http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

U. S. Office of Personnel Management (2015). What is an employee assistance program (EAP)? OPM.gov. Retrieved from: https://www.opm.gov/faqs/QA.aspx?fid=4313c618-a96e-4c8e-b078-1f76912a10d9&pid=2c2b1e5b-6ff1-4940-b478-34039a1e1174

Tozzi, J. (2015 March 27). Does your boss have a right to know if you’re mentally ill? Bloomberg.com. Retrieved from: http://www.bloomberg.com/news/articles/2015-03-27/does-your-boss-have-a-right-to-know-if-you-re-mentally-ill-

Tugend, A. (2014 November 14). Deciding whether to disclose mental disorders to the boss. NYTimes.com. Retrieved from: http://www.nytimes.com/2014/11/15/your-money/disclosing-mental-disorders-at-work.html

U.S. Department of Labor. (2015). Mental health parity. DOL.gov. Retrieved from: http://www.dol.gov/ebsa/mentalhealthparity/

World Health Organization. (2001). Mental health: A call for action by world health ministers. 54th World Health Assembly. Retrieved from: http://www.who.int/mental_health/advocacy/en/Call_for_Action_MoH_Intro.pdf

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