![]()
Part I
GENERAL ISSUES
![]()
CHAPTER 1
Mental Health in the Workplace: Toward an Integration Organizational and Clinical Theory, Research, and Practice
JAY C. THOMAS
JEFFREY HITE
Until recently, there has been little need for a Handbook of Mental Health in the Workplace. Two factors accounted for this: lack of awareness of the extent of mental disorders by those who design and manage organizations, and the ease of eliminating the problem by eliminating the affected employee. In this chapter, we present sufficient data to show that mental illness1 is pervasive in American society as well as in economically advanced societies in general. We also argue that organizations will find it in their own interests, as well as the employeeâs, to attempt to accommodate the needs of an individual experiencing mental distress. Our third goal in this introduction is to outline briefly how mental health issues intersect with organizational practices. No attempt is made to be comprehensive in reviewing the literature to meet this third goal. The other chapters in this book, some of which we cite in this chapter, accomplish that. The intent is to present the issues sufficiently to demonstrate that mental health and organizational theory and practice are, indeed, bedfellows, and have been for a long time.
The stigma attached to mental illness was sufficient to cause most people to keep personal or family distress hidden whenever possible. One result of keeping mental health issues in the closet was the perception that such problems were rare, and hence of no concern to anyone except those who were afflicted and medical or psychological specialists. Mental health has come out of the closet, thanks in part to the well-publicized problems of several politicians, celebrities, and athletes. When the public learned of senators and Olympic champions coping with depression, of movie actors with personality disorders, and of innumerable well-known personages struggling with alcohol or drug addiction, not to mention the thousands of veterans with symptoms of posttraumatic stress disorder, the problems of a parent or child, or of oneâs self, became less shameful and were recognized as a common situation.
Mental disorders are, in fact, extremely common. Epidemiological studies cited in Milazzo-Sayre, Henderson, and Manderscheid (1997) indicate that within the United States, in a 1-year period, approximately 28% of the adult population has a mental or addictive disorder. These authors cite other evidence that indicates that nearly 3% of the adult U.S. population suffers from a âsevereâ mental disorder during a 1-year period. The National Institute of Mental Health (NIMH) provides data on its Web site that give an idea of the numbers of Americans with various types of mental disorders. Selected figures are presented in Table 1.1. Comorbidityâthe joint appearance of two or more disordersâcomplicates the picture somewhat, but the total still adds up to a great many people. These numbers represent only adults, who may have jobs. There are also millions of children with mental disorders whose parents may well be employees, probably distracted ones. Finally, the prevalence of mental disorders is sufficient to gain the attention of the Surgeon General of the United States, who commissioned a major report issued in 1999 (Satcher, 1999). This report concluded that all Americans are affected either directly or indirectly by mental illness, through family, coworkers, friends, or neighbors. With all of this information, it is impossible to escape the conclusion that mental health concerns can, and probably do, appear in almost any workplace in the country.
The second factor why a handbook on mental health in the workplace is needed can be traced to the needs and responsibilities of employers. It is now clear that mental health issues are in the workplace, but these issues affect the way organizations are managed and even the profitability of enterprises. Recently, the Wall Street Journal acknowledged this impact by devoting most of the cover page of its Marketplace section to this topic. The lead article begins as follows:
In a typical office of 20 people, chances are that four will suffer from a mental illness this year. Depression, one of the most common, primarily hits workers in their most productive years: the 20s through 40s. Its annual toll on U.S. businesses amounts to about $70 billion in medical expenditures, lost productivity and other costs. (Tanouye, 2001, p. B1)
Gabriel (2001) gives a somewhat more conservative estimate of the cost of depression to U.S. employers: between $30 billion and $44 billion. These totals consist of direct treatment costs, costs associated with absenteeism, lost productivity, and mortality costs due to suicide. Such costs will also occur for other mental disorders, although the weighting may change as a function of the type and severity of disorder.
Gabriel (2001) also cites interesting figures from First Chicago Corporation, which indicate that, out of 10 common medical afflictions, mental illness is second only to ischemic heart disease in total cost. Cancer is a near third. Outpatient treatment costs are comparable for all three, and both heart disease and cancer have roughly double the inpatient cost of mental illness. However, mental illness results in far higher short-term disability costs, which ultimately result in increased expenses and lower profits. Disability is a common consequence of mental illness. Internationally, mental illness, including suicide, is second only to âall cardiovascular conditionsâ in disease burden (measured in DALYsâDisability Adjusted Life Years, lost years of healthy life) in established market economies (NIMH, n.d.-a). Therefore, disabilities are expensive to employers, those who are disabled, and society at large.
| Table 1.1 | Estimated Numbers of American Adults With Various Mental Disorders |
| Disorder | Estimated Occurrence |
| Major depression | More than 19 million |
| Manic-depressive illness (bipolar disorder) | More than 2.3 million |
| Schizophrenia | More than 2 million |
| Anxiety disorders | |
| Overall | More than 16 million |
| Panic disorder | About 2.4 million per year |
| Obsessive-compulsive disorder | Approximately 3.3 million |
| Posttraumatic stress disorder | About 5.2 million |
| Social phobia | About 5.3 million |
SOURCE: National Institute of Mental Health (n.d.-b).
In the past, because mental illness was so costly, as long as sufferers were stigmatized, employers could deal with the problem easily by terminating the affected employee. Since enactment of the Americans with Disabilities Act (ADA) in 1990, it has been illegal to fire an employee solely because of a disability. âReasonable accommodationâ must be made to allow most people with disabilities to continue working, if at all possible. Many other countries have similar or more stringent laws (Gabriel & Liimatainen, 2001), so the need to work with mentally disabled employees does not end at the U.S. border.
Even if there were no legal impediments, termination has not been easy and is often costly (Miner & Brewer, 1976). Labor agreements, while allowing for termination in cases of egregious behavior, often afford an employee with protection, so that termination can be a drawn-out and expensive affair. Unless the employee has managed to alienate his or her coworkers, there are also problems of morale and perceived injustice. These may have significant, albeit hidden, costs that many employers would just as soon avoid. There is also the issue of fairness. We do not terminate an employee who has suffered a heart attack or cancer. A broken leg, not covered by ADA, may still be looked upon with some patience by an employer, although with some disappointment. Why, then, terminate an employee who is suffering a bout with depression or anxiety? Indeed, an employee with a broken leg from a skiing accident may be out of action longer than many with major depression. Finally, a employer may have a lot invested in an employee, an investment that is not easily abandoned. So, there are a number of sound business reasons to find an accommodation. Cronshaw and Kenyon (Chapter 25) and Tetrick and Toney (Chapter 26) offer insight into how such an accommodation may be found and implemented. However, the human resource professional or industrial and organizational (I/O) psychologist needs some basic knowledge about the most common disorders, including the nature of the disorder, precipitating stressors, and treatment.
ORGANIZATIONAL PRACTICE AND MENTAL HEALTH
Elton Mayo (cited in Gellerman, 1963), Chris Argyris (1957), Douglas McGregor (1960, 1966), and other mid-20th-century writers pointed out that organizational practices may affect mental health. Mayoâs work inspired an extensive, but curious, form of industrial counseling, similar in some respects to Rogerian nondirective counseling, but oriented toward work (Highhouse, 1999). Although there was some anecdotal evidence of the methodâs effectiveness, it eventually lost favor due to an inability to show a positive impact on employees or the bottom line. In the Argyris formulation, a workerâs adaptation to rigid hierarchy, autocratic management, and an unenriched job was itself an indication of retarded emotional development. The nature of the job could prevent the worker from attaining full mental health. McGregor, writing more or less contemporaneously with Argyris, believed that organizations were designed based on assumptions about the workers. His Theory X2 consisted of management assumptions that had three basic assumptions but included several inexplicit beliefs, such as the following:
- The average man is by nature indolentâhe works as little as possible.
- He lacks ambition, dislikes responsibility, prefers to be led.
- He is inherently self-centered, indifferent to organizational needs.
- He is by nature resistant to change.
- He is gullible, not very bright, the ready dupe of the charlatan and the demagogue. (McGregor, 1966, p. 6; items renumbered from original)
Theory Y, in contrast, was based on the opposite assumptions of human nature. Of note is the Theory Y assumption that âpeople are not by nature passive or resistant to organizational needs. They have become so as a result of experience in organizations [italics added]â (McGregor, 1966, p. 15). Thus, if Theory X paints a picture of a man or woman who lacks full mental health, Theory Y holds that it is the organization for whom he or she works that is responsible. Today, we would question this last premise, realizing that to some extent, employees bring their mental disorders with them to work or develop them coincident to employment. Meaningful work is regarded as therapeutic by some psychologists, as described in some later chapters, but it seems doubtful that work alone is generally an effective therapy.
We present these classic theories in some detail because they form the foundation for the primary organizational and motivational theories up to the present. On the intellectual side, virtually everyone hopes for a world in which Theory Y is true, but our behavior often reveals little faith in that occurring. To illustrate, one of the unspoken worries about the ADA was that it would encourage malingering, the ultimate Theory X behavior. Claims of disability are often met with skepticism by management and coworkers. No one disputes that disability claims should be investigated and substantiated, but we maintain that this book will help lead to informed skepticism rather than an automatic assumption that a claimant is most likely âfaking it.â
The universal rejection of Theory X by organizational theorists opened the door for current conceptualizations of flat hierarchies; self-managed, team-based organizations; and expectations that employees make decisions with the organizationâs interests at heart. All of these concepts require an assumption that employees either can or can be easily taught to communicate openly, face situations honestly, work together with others, recognize othersâ priorities and adapt to them, shift priorities or tasks quickly and easily, and make and carry out decisions that may be contrary to their own interests (Cannon-Bowers, Tannenbaum, Salas, & Volpe, 1995; Wellins, Byham, & Wilson, 1991). People who are depressed, anxious, or overly stressed may have difficulty carrying out required behaviors to meet these assumptions. Individuals with personality disorders or psychotic conditions may not be able to gain or use such skills, except in extraordinary circumstances. Thus, the ultimate success of current theories of organization may depend upon the prevalence of clinical or even subclinical mental disorders in the workforce. To our knowledge, few, if any, studies have examined the robustness of these management theories to violations of the assumptions of a mentally healthy workforce.
THE IMPACT OF THE WORKPLACE ON MENTAL HEALTH
The workplace itself may contribute to distress and,...
