Mental Health in the Workplace – A Three-Way Viewdmec.org/wp-content/uploads/AC17_D2_HO.pdf ·...

Concurrent Session – Tuesday, 3:00-4:00 pm

Mental Health in the Workplace – A Three-Way View

DMEC Annual Conference Anaheim, California

July 31‐August 3, 2017

Presented by • Nancy Spangler, PhD, OTR/L – Workplace Mental Health Consultant• Marti Cardi, Esq. – ADA Compliance Counsel• Lisa Dau, MA, CEAP, LP – Medtronic EAP Director

Agenda• Changing the Conversation about Mental Health in Your

WorkplaceNancy Spangler, PhD, OTR/L, Consultant to American Psychiatric Association Foundation, Workplace Mental Health

• Mental Health Issues under the ADA

Marti Cardi, Esq., VP – Product Compliance, Matrix Absence Management, Inc.

• Workplace Mental Health: A Global Employee Assistance Program’s Perspective & Role

Lisa Dau, MA, CEAP, LPDirector, Medtronic Employee Assistance Program

Changing the Conversation about Mental Health

in Your Workplace

Nancy Spangler, PhD, OTR/LConsultant to American Psychiatric Association Foundation,

Workplace Mental Health


WHYSHOULD EMPLOYERS CARE ABOUT MENTAL ILLNESS??

THE PREVALENCE –

1 in 5 people experiences mental illness each year

(SAMHSA, 2015)

1 in 10 has a substance use disorder each year

(SAMHSA, 2015)


7

U.S. DEATH RATES FOR HEART DISEASE AND CANCER ‐‐‐1999‐‐2009

Source: CDC, 2011, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6021a6.htm?s_cid=mm6021a6_e&source=govdelivery

© 2015 American Psychiatric Association Foundation. All rights reserved.

APRIL 30, 2015PRESENTATION TITLE GOES HERE | 8

Percentages of Adults with Mental Disorders and/or Medical Conditions

(National Comorbidity Survey Replication, 2001-2003; used with permission)


Chronic medical conditions

Chronic medical + MH/SUD conditions

IMPACT ON BOTTOM LINE:

2 ‐ 3 x higher medical costs

(Milliman, 2014)

MedicalMental health/substance use disorders

Pharmacy

Disability Presenteeism and lost productivity

Absenteeism Unrealized output

Stress on team membersOvertime to cover sick‐day absences

Overstaffing Temporary workers

Recruitment Hiring costs Retraining

Look beneath the surface:

Impairment & Disability:

(WHO, 2008; Merikangas et al, 2007; Pratt & Brody, 2008)

• Depression is the leading cause of disability for people 15-44 in the US.

• Approximately 80% of persons with depression reported some level of functional impairment because of their depression.

• 27% reported serious difficulties in work and home life.


What depression feels like How it looks to co‐workers

Deep feelings of sadness Withdrawal from team, isolates oneself

Loss of interest in work or social activities Indifference

Difficulty concentrating, slowed thoughts Putting things off, missed deadlines, accidents on the job

Forgetfulness and trouble remembering Seems "scattered" or absentminded

Trouble making decisions Procrastination, indecisiveness, slowed productivity

Trouble sleeping or sleeping too much Late to work, afternoon fatigue, accidents on the job

Feelings of worthlessness or inappropriate guilt Unsure of abilities, lack of confidence

Energy loss or increased fatigue Low motivation, detached

Irritability, anger or tearfulness Inappropriate reactions, strained relationships with co‐workers

Weight or appetite changes Change in appearance

Depression in the Workplace:

What anxiety feels like How it looks to co‐workers

Heart racing, palms sweating, trembling A loose cannon

Having a heart attack Worrisome

Jittery, poor eye contact, restless Anti‐social, undependable

Dry mouth, lump in throat, can’t speak Aloof, uninformed, overly shy

Exaggerated startle, jittery, restless Discomforting, annoying

Trouble sleeping, disturbing dreams Late to work, afternoon fatigue, accidents on the job

Excessive worry, fear, preoccupation Unsure of abilities, lack of confidence

Embarrassment, self‐doubt Incompetence

Anger, muttering, yelling Bizarre, fear producing

Need to escape Excessive drinking or smoking

Anxiety, Trauma, & Stress-Related Disorders:

• Psychotherapy• Pharmacotherapy• Exercise • Sleep• Nutrition• Stress & resilience interventions

• Intensive outpatient for substance use

• Work focused intervention • Mindfulness (meditation and mindfulness‐based cognitive

therapy)

TREATMENT HELPS:Effective Treatments . . .


TALKING HELPS:Workplace communication campaigns

During Kansas City’s Community Initiative on Depression, Cerner implemented . . .

• Two month communication campaign• Electronic and face-to-face communications with

managers and employees about depression symptoms and EAP (employee assistance program) resources

Results:• 78% increase in EAP website log-ins• 32% increase in new counseling appointments

Moving from disparate program silos. . .. . . to integrated work

performance, total health management, well-being,

and thriving

COLLABORATING HELPS:

HR BenefitsWellness

OccupationalMedicine

DisabilityManagement

EAPCommunication Operations

Work Comp

www.workplacementalhealth.org

Network of 10,000 companies

Make the business case

Calculators, literature reviews

Practical employer guides

Working Well Toolkit]]

Mental Health Parity and Addiction Equity Act

Share best practices

Employer features in Mental Health Works

Searchable case studies of 70 employers representing nearly 3M employees

Partnership for Workplace Mental Health:Free employer resources


Worksite Education Resources:

ICU INITIATIVE

• Developed by DuPont, donated to Partnership to make it available to others

• Video‐based program teaches employees to identify warning signs of emotional distress, respond and refer

RIGHT DIRECTION DEPRESSION INITIATIVE

• Website and turnkey materials raise awareness and increase help‐seeking behaviors

• Ready to use posters, articles, PPT decks

v

Tools for resilience skill-building, early condition detection, and technology-based intervention:

Evidence‐based approaches based on cognitive‐behavioral therapy, mindfulness, chronic pain intervention, and leadership development

Personalization for employee, and customization for organization builds high participation

Works well with other wellbeing and human capital strategies (thus normalizing mental health intervention)

Challenge #1 to Employers

How will you change the conversation in your workplace?


Mental Health Disabilities and the ADA

Marti Cardi, Esq.VP, Product Compliance

Matrix Absence Management, Inc.

LET’S TALK ABOUT . . .

• When is a Mental Health Condition Protected by the ADA?

• Mental Health ADA Accommodations• Obtaining Medical Information under

the ADA

• Additional ADA Mental Health Workplace Challenges

• Resources

2015 2014 2013 2012

7.60%(2,130)

0.40%(112)

6.90%(1,926)

2.80%(775)

1.50%(433)

4.20%(1,177)

0.40%(99)2016

Anxiety

Autism

Depression

Manic Depressive

Other

PTSD

Schizophrenia

Mental Health Charges = 23.8% of Total ADA Charges Filed

https://www.eeoc.gov/eeoc/statistics/enforcement/ada‐receipts.cfm


When is a Mental Health Condition Protected by

the ADA?

What is a Mental Disability under the ADA?

A mental impairment that substantially limits one or more major life activities –

• As compared to most people in the general population

• Need not prevent, or significantly or severely restrict, a major life activity

• Evaluated in terms of severity and length of time

o Can be a “sliding scale” – e.g., more severe, shorter duration or less severe, longer duration


Mental impairment: "[a]ny mental or psychological disorder, such as . . . emotional or mental illness.“• Examples:

o Major depression

o Bipolar disorder

o Anxiety disorders (including panic, obsessive compulsive, and post-traumatic stress disorders)

o Schizophrenia

o Personality disorders



• Traits and behaviors are not mental impairments:• Examples:

o Stress

o Irritability

o Chronic lateness

o Poor judgment

• But traits or behaviors may be related to or a manifestation of a mental impairment

Mental Health ADA Accommodations

Mental Health Accommodations–Environmental Changes

• Provide space enclosures, sound absorption panels, or a private office

• Move employee to different location that reduces distractions or phobias

• Allow the employee to listen to soothing music or white noise

• Provide a noise canceling headset• Purchase organizers to reduce clutter• Increase natural lighting or provide full spectrum lighting


Mental Health Accommodations –Job Restructuring / Modified Duties

• Redistribute or eliminate marginal job functions o permanently or during times of stress

• Alter when and/or how a job function is performed (essential and/or marginal)

• Employer is not required to eliminate an essential function but can choose to do so or choose to reassign an essential function

Mental Health Accommodations –Light Duty

• Light duty” – temporary or permanent position mentally less demanding than employee’s normal job duties

• Light duty may be required under ADA if employer reserves certain jobs for light duty and if:• Employee cannot perform current position with or without RA;

and• Employee can perform the light duty position with or without

RA; and• Reassignment to vacant light duty position would not cause an

undue hardship

Mental Health Accommodations –Reassignment to Alternative Position

• Required only if: o No effective accommodation that will enable the employee to

perform the essential functions of his/her current position OR

o All other reasonable accommodations would impose an undue hardship

• Order of reassignment: o Vacant position with equivalent pay, benefits, status, etc.

o Vacant lower position (with pay/benefits for that position)

o No vacant position = no duty to reassign


Mental Health Accommodations –Reassignment to Alternative Position

• Employer must search for position – open now or in near future

• Courts are split on whether employee has to compete or be best qualified for open position – EEOC says no!

Obtaining Medical Information under the ADA

Mental Health Impairments: When can an employer get medical information?

• Employer can require medical info if employee’s

• disability,

• its effects, or

• the need for an accommodation

• are not obvious

• Employer can require employee to go to provider of employer’s choice, at employer’s cost


Mental Health Impairments: Why do we care about getting medical information?

• Ensure that employee in fact has a mental impairment

• Understand the employee’s actions, limitations, capabilities

• Identify which essential or marginal functions the employee cannot perform

• Identify possible reasonable accommodations

• Differentiate between impairment-related conduct and non-related conduct for discipline, coaching

ADA Limitations on Medical Inquiries

• A “disability-related inquiry” must be job-related and consistent with business necessity

• ADA definition of a “disability-related inquiry”: “a question (or series of questions) that is likely to elicit information about a disability.”

Examples “disability-related inquiries”

• Inquiring about the nature or severity of an employee’s disability

• Asking an employee to provide medical documentation regarding his/her disability

• Asking an employee about current or past use of prescription medications

• Asking a broad question: “What impairments do you have?”


Permitted questions under the ADA –Examples

• Asking an employee whether he/she can perform the functions of the position

• Asking an employee whether he/she has been drinking or is currently using illegal drugs

• Asking an employee conversationally, “How are you today?”

Inquiry must be job-related and consistent with business necessity:

• Employer has a reasonable belief, based on objective evidence, that:

o an employee’s ability to perform essential job functions will be impaired by a medical condition; OR

o an employee will pose a direct threat due to a medical condition; OR

o the exam follows up on a request for reasonable accommodation, where the disability or need for accommodation is not known or obvious

Contact with employee’s provider

• No set procedures like under FMLA

• Still need authorization from employee

• Use of form for provider a good start, but beware of one-size-fits-all – See EEOC Informal Discussion Letter 02/25/2014

• Ensure provider has list of employee’s essential functions


Use the Medical Provider in the Interactive Process

• Direct discussions with provider can be very productive

• Include employee so that it is part of the interactive process

• Obtain provider’s medical opinion on requested accommodations based on employee’s condition

• Get ideas for alternatives to the accommodation(s) requested by the employee

Additional ADA Mental Health Workplace Challenges

Supervisors and Supervisory Methods

• Common mental health workplace issue

• Employer is not required to change supervisors

• Changing supervisory methods and providing additional assistance can be a reasonable accommodation:o Day-to-day guidance & feedback

o Written job instructions & deadlines

o Clear performance expectations and consequences

o Frequent meetings to check on progress, provide next steps

o Encourage questions

o Develop strategies to deal with conflict


Mental Health –Conduct & Performance Issues

• Employer’s options and requirements under ADA may depend on whether the employee’s conduct or performance at issue is a violation of a “conduct standard”:

• “Conduct Standard”: A conduct rule that is job-related for the position in question and consistent with business necessity


• Examples of a conduct standard for any position: o Rules against theft, violence, threats

• Examples for a specific position:

o Absence and tardiness rules for a receptionist

o Rules requiring professionalism and courtesy for a customer service position

• Example not a conduct standard:

o Dress code and workplace courtesy rules for a warehouse employee with no customer contact and little interaction with coworkers


• Employer does not have to:

o Tolerate misconduct or poor performance caused by a disability if it doesn't know about the disability

o Excuse past misconduct once disability is disclosed

o Rescind discipline – even termination – when employee later discloses the issues were caused by a disability

o Excuse misconduct caused by employee’s failure to take mental health medication



• Employer may have to:

o Provide accommodation to enable mentally impaired employee to comply with conduct and performance requirements

o As an accommodation, excuse noncompliance with rules that are not a conduct standard

Direct Threat

• Direct threat: a significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation.o Significant risk: a high (not just slightly increased) risk of harm

• Assessment is based ono Individualized assessment of employee’s condition

o Most current general medical information

o Most current specific medical information about employee and medications

• Not based on o Assumptions of employee’s abilities

o Assumptions about employee’s type of mental impairment

Direct Threat – Examples from EEOC

• No direct threat: An employee with a mental impairment has a job operating

an electric saw. She discloses she takes medication that may decrease

concentration and coordination. Employer’s doctor learns that the employee

takes a relatively low dose with minimal side effects, and past work history

reveals no safety issues.

• Direct threat: An applicant was recently terminated by prior employer for

escalating incidents of workplace confrontations and threats. The applicant

took time off from his prior job to receive medical treatment but returned with

the same issues and was terminated. Since then he admits he has not

received any further treatment.



How will you convince your company’s leaders to invest in training your supervisors NOW to understand employees' ADA rights

and workplace mental health issues?

ADA Resources

Resources

• Job Accommodation Network: http://askjan.org/

• Accommodation Ideas for Mental Health Impairments

• http://askjan.org/media/Psychiatric.html

• State vocational rehabilitation agency: find your state agency at http://askjan.org/cgi-win/TypeQuery.exe?902

• Other state agency assistance: http://www.servicelocator.org/

• Federal Office of Disability Employment Policy (ODEP): http://www.dol.gov/odep/

• Return-to-work Toolkit: http://www.dol.gov/odep/return-to-work/


Resources

• EEOC Enforcement Guidance on the Americans with Disabilities Act and Psychiatric Disabilities (1997) https://www.eeoc.gov/policy/docs/psych.html

• EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act (2002) http://www.eeoc.gov/policy/docs/accommodation.html

• EEOC Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the Americans with Disabilities Act (ADA) (2000) http://www.eeoc.gov/policy/docs/guidance-inquiries.html

Resources

• EEOC Informal Discussion Letter 02/25/2014: Usage of ADA forms http://www.eeoc.gov/eeoc/foia/letters/2014/ada_reasonable_accommodation_02_25.html

• EEOC Fact Sheet: Work At Home/Telework as a Reasonable Accommodation (2005) http://www.eeoc.gov/facts/telework.html

• www.Matrix-Radar.com

Workplace Mental Health: A Global Employee Assistance Program’s

Perspective & Role

Lisa Dau, MA, CEAP, LPDirector, Medtronic Employee Assistance Program


• Medtronic – the company

• Medtronic’s support of mental health

• Medtronic’s Employee Assistance Program (MEAP)• Philosophy• Program model • MEAP’s interface points

• World's largest medical technology company

• Founded in 1949 as medical equipment repair shop

• Started with wearable, battery-powered cardiac pacemaker

• Developed implantable mechanical devices, drug and biologic delivery devices, and powered and advanced energy surgical instruments. Have technologies that are used to treat nearly 40 medical conditions.

o 85,000 employees worldwideo 160 countrieso 480 locations

Medtronic

• Living Medtronic’s mission

• Support taking leaves & use of benefits

• Encourage flex time, tele-commuting

• Encourage employees to take steps to take care of themselves (resilience)

• Employee Resource Groups (ERG’s)

• Partnerships & consultations

Medtronic’s Support of Mental Healthy Workplaces


• Robust wellness program and resources

• Issues/concerns taken seriously

• Encourages ongoing learning

• Code of conduct/voice your concern

• Employee development supported and encouraged

• Robust Employee Assistance Program

Medtronic’s Support of Mental Healthy Workplaces (cont.)

• Consistent with Mission:

“…to recognize the personal worth of our employees” and

“…be a good community citizen”.

• MEAP positioned as a Center of Expertise:Purpose is to build and enhance individual and organizational interpersonal competency and individual resilience through the application of psychology in the workplace. Holistic, global support designed to enhance employee productivity, effective teamwork, and a psychologically healthy workplace.

Medtronic Employee Assistance Program (MEAP)

Utilization drives: • Reduced medical and operational costs• Reduced risk to organization and supports a safe

work environment• Improved productivity and resiliency

Resource for:• Business & locations• Employees & their household members



Internal Center of Expertise• Program strategy, design and management• COE consultation• Workplace Safety and Security• Vendor standards, selection and management• Coordination and facilitation of vendor service delivery• Direct delivery of service by internal team



External Vendors• Direct delivery of services to employees & household

members • Global work life services• Skill based training• Robust websites with assessments, videos, online access to

answers

Delivery of high quality, culturally relevant, easily accessible programs that are well utilized, support employee engagement and address individual needs.

• 24/7 phone support

• Face-to-face or telephonic sessions

• Legal and financial consultation (where culturally available)

• Parenting and family consultation

• Resource and referrals for child care and elder care (where culturally available)



Delivery of high quality, culturally relevant, easily accessible programs that are well utilized, support employee engagement and address individual needs.

• Web based resources

• Employee training to enhance mental wellbeing and resilience

• Quarterly utilization reports and program review

• Program communication and awareness

• Managing all positive substance abuse testing results and fitness for duty situations in the US


MEAP’s interface with leaves, accommodation requests, etc.• Consultation and partnership with:

o Managerso ER/HRo Internal leave administratorso Employeeo Familyo Vendors



What is one step you can take to increase promotion or utilization of your company’s

EAP services?


Thank you!

Marti Cardi, Esq.VP, Product ComplianceMatrix Absence Management, [email protected] 800-866-2301 x 17477

Nancy Spangler, PhD, OTR/LConsultant to American Psychiatric Association Foundation, Workplace Mental Healthwww.workplacementalhealth.orgnspangler@spanglerhealth.comwww.spanglerhealth.com816-820-1870

Lisa Dau, MA, CEAP, LP – DirectorMedtronic Employee Assistance [email protected]

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