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How to talk to your boss about mental health

This article was written by Olivia Goldhill. Let's learn.

Any decent workplace wants to handle the mental health of its employees kindly and effectively, whether out of compassion or pure self-interest. One in four people suffer a mental disorder at some point in their life and, left unchecked, mental illness can be a huge drain on a productive workforce.

On some level, it’s obvious how to deal with mental health at work: Be supportive, take it seriously, provide accommodations. Those are good rules of thumb, but they’re banalities. Knowing how to best handle a specific situation will likely require more nuanced guidance.

Consider the conflicts for everyone involved: Employers have to balance looking after employees with respecting their privacy. Managers often have no way of determining the severity of mental illness or the level of support required. Employees, even the ones who confidently talk about mental health in the abstract, might feel more comfortable creating an excuse rather than saying they need a day off for managing their depression.

In the scenarios below, we show just how tricky dealing with mental health can be and offer guidance for handling things, whether you’re the person in need of assistance or a colleague in a position to help.

When time off is needed for a brief mental health flare up

There are many reasons someone accustomed to coping with and effectively treating a milder mental illness might suddenly find they can’t struggle through any more. Personal circumstances, such as a divorce or family emergency, can cause anxiety and depression; changes in mental-health medication can lead to debilitating side effects; and sometimes an underlying condition flares up for no apparent reason.

For employees: According to Denise Rousseau, professor of organizational behavior and public policy at Carnegie Mellon University, when dealing with a one-off mental health episode, employees need only tell their manager that they’re ill. “From an attitude of care, it doesn’t matter the reason why they need a day off,” she says. That said, there can be social pressure in many workplaces to briefly explain why you’re sick. If you want to give a reason, details beyond “I need a day off for mental health reasons” are unnecessary—a good manager should accept this without probing further or making assumptions about the employee’s experience. There’s no reason to interrogate the occasional sick day.

For managers: It may seem surprising when a typically enthusiastic colleague mentions mental-health difficulties, but a positive persona is no indication of mental health. Taking a day off for mental health reasons is not code for simply feeling a bit down or stressed, and managers should respect this sick day as they would for any other illness. They certainly shouldn’t ask employees to work from home or pressure them to come back to the office early. Mental health conditions only worsen if they’re left untreated; it’s far better for an employee to take time off, un-pressured, then suffer through a worsening condition.

When an ongoing, chronic condition needs managing

All manner of health conditions can be severe enough to affect someone long-term. Some people suffering from mental illness may need more sick leave than usual, perhaps a day every month or so, or else help managing stress. Those who don’t seek accommodations may try show up at work to avoid getting in trouble, but they probably won’t be particularly effective and their health is likely to deteriorate.

In the US, employers are required by the Americans with Disabilities Act (and there are many similar laws internationally) to provide “reasonable accommodations” to qualified employees with disabilities. So it’s well within employees’ rights to ask for flexible hours and for help managing acute stresses—such as talking through tactics for dealing with the most stressful parts of the job—as accommodations for a chronic condition.

For employees: In an ideal world, where the company is supportive and the manager trained in how to deal with such requests, employees would simply be honest about their needs. But there’s so much stress connected to these situations because many companies are far from perfect, and because even well-meaning managers often fall short. “I would use my discretion about whether a person is trustworthy to have information [about my mental health],” says Rousseau. In other words, if you have a good relationship with a manager and feel comfortable talking with them about your health, then trust those instincts. If you’re at a small company with a weak HR team, then Rousseau suggests framing the request as one focused on your value as an employee and the benefits of flexibility. In that situation, she says, “I’d want to keep my manager in the loop about what I’m doing” and emphasize that “this flexibility helps me manage my stress.”

For managers: There are plenty of basic accommodations that can help those with chronic mental health conditions work effectively. Even just being open to the conversation can be hugely beneficial. The UK government organization Acas has many specific examples (pdf) of reasonable adjustments that a manager or employer could propose, such as flexible schedules and part-time work options. Acas also suggests that managers should assign a mentor or buddy who can provide support to a colleague dealing with mental health challenges. Sometimes it’s easier for employees to be open with someone who’s not their manager. Even if two people aren’t formally appointed “buddies,” managers can help identify and encourage such relationships, simply by suggesting that colleagues go for coffee with each other, recognizing that such breaks aren’t an escape from work, but a way of coping or lending support.

When someone at work doesn’t ask for help, but seems to be unwell

It can be even more difficult dealing with mental health issues when someone in need of help doesn’t ask for it. If you see a colleague who seems to be distressed or behaving unusually, don’t automatically assume they’re suffering from a mental disorder; a stroke, for example, can also leave people disorientated, acting erratically, and unaware they need medical attention. Either way, it’s important to see how they’re doing.

If an employee seems unwell: In the past, some organizations demanded that managers immediately step aside and call in HR to assess the situation. Though this reflects a well-meaning concern to protect employees’ privacy and to handle a sensitive situation appropriately, it can seem bureaucratic and impersonal. Rousseau says good managers play a role in looking after employees’ wellbeing. “Managers are the frontline HR people,” she says. “It’s appropriate for the manager, who has the relationship with the employee, to talk with them.” A first step is to talk with the employee directly and see if they’re aware of any issues or concerns. “It’s always better if someone [tells you] they have a problem,” says Rousseau. If they do say they’re suffering from a health issue, then the workplace can arrange support and medical leave if necessary. If the employee doesn’t seem aware of the problem, then the manager should confidentially consult HR and, if necessary, HR should help the employee arrange to see a doctor.

If a manager seems unwell: Rather than addressing it immediately, Rousseau suggests confidentially asking whether another colleague has noticed the manager acting differently. “You want to be in a position where several people can validate that there’s an issue,” she says. If there does seem to be a problem, the employee should arrange to talk to the manager directly and see if they’re doing ok. “You don’t want to go around the person’s back without connecting with them first,” she says. “Adopt an attitude of care and concern. It’s not a subordinate-to-manager issue, it’s a person-to -person issue.” If the manager doesn’t raise any concerns, then their reports can talk to HR or, as a last resort, go to the boss’s boss, who can hopefully arrange care.

When an employee returns to work after a medical leave related to mental health

Some companies actively discourage managers from discussing medical leave with their direct reports, or vice versa, to protect against privacy concerns. But Rousseau says it’s perfectly appropriate to ask how someone is and if they need any accommodations when they return from a medical leave.

“People can come back well, ready, and resilient, or still not quite ready to work but feeling the need to work. You need to find out how the person is to provide the appropriate support,” she says. It can be good to simply tell an employee that it’s ok to ask for support if they need it, or arrange a weekly chat to help address any issues.

“Mental health needs ongoing management,” says Rousseau. And workplaces can play a significant role in that management. After all, recovery will be far slower if people simply get support at home and ignore all health issues at the office. We spend a huge amount of time at work. Just as office life can exacerbate mental health issues, it can also held lead to dramatic improvements.

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