MENTAL HEALTH IN THE WORKPLACE:

A CALL TO ACTION
M. Daniele Fallin, PhD
Chair, Dept of Mental Health

Ron Goetzel, Rich Mattingly

 Sources of Psychological Distress
During the Pandemic
Associate with the virus:
► Fear of infection, illness, and/or death
► Fear of same for family and friends
► Feelings of powerlessness
► Grief (loss of friends, loved ones)
► Anxiety associated with accessing health care
► Anxiety about own covid-like symptoms

Associated with Closures/stay-at-home:

► Loss of income
► Social Isolation
► Grief (loss of experiences like raduation, etc)
► Uncertainty (not knowing if infected, when isolation will end,

etc)
► Discrimination
► Violence
► Caregiving / Parenting
► Others!

2
 Context: Pre-Pandemic, Mental Health Already
Major Public Health Problem
Public health is best known for addressing communicable diseases, but in every nation
and income bracket, many people endure debilitating mental disorders and dependency
on drugs and alcohol that destroy quality of life—and sometimes life itself.

• Depression and anxiety are already high

• Suicide is a leading cause of death in US;
>4% of adults reported having serious
thoughts of suicide in 2018
• 1 in 3 adults report feeling worried,
nervous, or anxious on a daily, weekly, or
monthly basis
• Deaths due to overdose have increased
more than 3X in the past 2 decades

3
Most Mental Illnesses Result in Lifelong Challenges

Image: Johnson & Johnson Global Public Health, Asia Pacific Roadmap for Partnership in Mental Health

• Reduced life expectancy for severely ill (10-25 years early)

• Co-occurring psychiatric conditions and substance use
• Co-occurring physical medical conditions
• Other functional disabilities
• Discrimination
• Social isolation
• Reduced educational and employment opportunities
• Stigmatization
4
Interconnection of Physical and Mental Health

Risk of Chronic Medical Conditions Associated

with Depression over the Life Course: Baltimore
Epidemiologic Catchment Area (ECA) study
follow-up, 1981–1996

Condition Relative Risk

Type 2 diabetes 2.2
Hypertension 2.2
Heart attack 4.5
Stroke 2.7
Any cancer 1.0
Lung cancer 0.8
Breast cancer 3.4
Colon cancer 4.3
Prostate cancer 1.1
Arthritis 1.3

Public Mental Health, Ed 2, Wiley.

5
Societal Financial Costs are High

6
 Mental Illness and Symptoms are
Treatable and Preventable!

Suicide is Preventable
• Restricting means
• Firearms, poison, rope materials,
heights
• Focus on risk:
• Mental disorders and substance use
• War and violence
• Disasters
• Discrimination
• Abuse
• Financial loss
• Pain
• Multisector approach: Fight stigma,
provide social, psychological, medical
support

7
 Most People Affected Never Get Care

► Despite evidence for recovery with

treatment, and for prevention
effectiveness, most people affected
never get care

► In US, only 40% received care

► Unmet need is much worse in low- and

middle-income countries

Public Mental Health, Ed 2, Wiley

8
 Stigma

► US President’s 2003 New Freedom

Commission on Mental Health found that,
“Stigma leads others to avoid living,
socializing, or working with, renting to, or
employing people with mental disorders—
especially severe disorders, such as
schizophrenia. It leads to low self-esteem,
isolation, and hopelessness… Responding to
stigma, people with mental health problems
internalize public attitudes and become so
embarrassed or ashamed that they often
conceal symptoms and fail to seek
treatment.”

► Stigma is a major barrier to care seeking,

policy change, increased funding and
decreased discrimination

9
 Context of Mental Health:

► Mental health is already a major public health problem

► Affects lifelong abilities and experiences

► Treatable, and often preventable

► High unmet needs, limited access to care

► Deep and enduring stigma

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 How to Make Societal Impact?

► Work with employers!

11
 How to Make Societal Impact?

Partner with employers and empower employees!

Decrease prevalence of mental illness
Decrease absenteeism
Increase employee wellness
Decrease employer costs
Increase awareness and utilization of prevention or treatment
services
Decrease stigma and consequences of disclosing mental illness

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 Presenteeism / Absenteeism

 Few employers are aware of the

extent and details of
absenteeism/presenteeism and
medical costs.
 This is often due to underreporting,
stigma, and complex or unclear
data

13
 Business Case: Cost Burden of
Mental Illness to Employers

• Mental health disorders are costly for business, totaling $186

billion in 20141

• Often comorbid with physical health conditions2,3,4,5

• Projected savings of $38-68 billion/year by integrating medical

and behavioral health services6

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 Business Case: The Health and Productivity
Burden of Mental Illness

• Poor mental health, stress at work associated with7,8

 Reduced job performance
 Reduced engagement in work
 Disrupted communication with co-workers
 Impaired day-to-day functioning
 Higher rates of disability, unemployment

• Major depression associated with ~11% decrease in productivity9

15
Depression Among Employees

16
Depression Among Employees:
Physical Health Also Affected

17
Business Case: Treatment and Prevention are
Possible and Save Money

18
Johns Hopkins/Luv u Center for Mental Health
in the Workplace

19
 Recommendations for
Strategies at these level:
• Individual
• Organizational
• Policy / Societal
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©2018,
©2015, Johns
©Johns
2014,
© 2014, Hopkins
Hopkins
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Johns University.
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 Sources of Psychological Distress
During the Pandemic
Associate with the virus:
► Fear of infection, illness, and/or death
► Fear of same for family and friends
► Feelings of powerlessness
► Grief (loss of friends, loved ones)
► Anxiety associated with accessing health care
► Anxiety about own COVID-like symptoms

Associated with Closures/stay-at-home:

► Loss of income
► Social Isolation
► Grief (loss of experiences like raduation, etc.)
► Uncertainty (not knowing if infected, when isolation will end, etc.)
► Discrimination
► Violence
► Caregiving / Parenting
► Others!

21
 CDC Data from June 2020

https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm#T1_down 22
TABLE 2. Comparison of symptoms of adverse mental health outcomes among all respondents who completed surveys (N = 5,470), by
respondent characteristic* — United States, June 24–30, 2020
Prevalence ratio¶ (95% CI¶)
Symptoms of anxiety Symptoms of trauma or Started or increased Serious consideration of
Characteristic or depression stress disorder substance use suicide in past 30 days
Gender
Employment status
Employed vs. unemployed 0.96 (0.87–1.07) 1.28 (1.12–1.46) 2.30 (1.78–2.98) 3.21 (2.31–4.47)
Employed vs. retired 3.01 (2.58–3.51) 2.84 (2.42–3.34) 4.30 (3.28–5.63) 5.97 (4.20–8.47)
Essential vs. nonessential worker 1.42 (1.30–1.56) 1.52 (1.38–1.69) 2.36 (2.00–2.77) 2.76 (2.29–3.33)
Receiving tx for anxiety vs. not 2.43 (2.26–2.63) 2.21 (2.01–2.43) 2.27 (1.94–2.66) 2.54 (2.13–3.03)
Receiving tx for depression vs. not 2.20 (2.03–2.39) 1.88 (1.70–2.09) 2.13 (1.81–2.51) 2.35 (1.96–2.82)
Receiving tx for PTSD vs. not 2.75 (2.55–2.97) 2.87 (2.61–3.16) 3.78 (3.23–4.42) 4.95 (4.21–5.83)

 Increased trauma or stress, substance use and suicide consideration among workers
 Increased anxiety, depression, trauma or stress, substance use and suicide
consideration among essential workers
 Increased anxiety, depression, trauma or stress, substance use and suicide
consideration among those with existing MH conditions

https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm#T1_down 23
https://www.jhsph.edu/departments/mental-health/mental-health-and-covid-19/ 24
How Will Workplace Mental Health Change Due To
The Pandemic?
► Important to measure and evaluate!

► Local, JHU experience

► Increased awareness and acceptance of mental health
challenges – decreasing stigma
► Increased promotion of wellness
► Multiple workshops and trainings
► Increased access to information and services
► RISE program for health care workers:
http://www.johnshopkinssolutions.com/solution/rise-peer-suppo
rt-for-caregivers-in-distress-2/

25
 Summary Takeaways

1. Mental health challenges are common and costly

2. There is a business and public health case for a
focus on workplace/employer mental health
3. COVID has made mental health worse
4. Employers are now more critical than ever in
addressing mental health
5. Johns Hopkins has a new center dedicated to this;
we and others have recommendations for action

THANK YOU JOURNALISTS !!

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References
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trends in Health. Hyattsville, MD. 2017. https://www.cdc.gov/nchs/data/hus/hus16.pdf. Accessed
March 6, 2018.
2. Merikangas KR, Ames M, Cui L, et al. The impact of comorbidity of mental and physical conditions
on role disability in the US adult household population. Arch. Gen. Psychiatry 2007;64(10):1180-
1188.
3. Scott KM, Lim C, Al-Hamzawi et al. Association of mental disorders with subsequent chronic
physical conditions: Work mental health surveys from 17 countries. JAMA Psychiatry. 2016;
73(2):150-158.
4. Glassman AH. Depression and cardiovascular comorbidity. Dialogues Clin. Neurosci. 2007;9(1):9.
5. Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review
and meta-analysis of longitudinal studies. Arch. Gen. Psychiatry 2010;67(3):220-229.
6. Melek SP, Norris DT, Paulus J, et al. Potential economic impact of integrated medical-behavioral
healthcare. Updated Projections for 2017. Milliman Research Report, January 2018.
http://www.milliman.com/uploadedFiles/insight/2018/Potential-Economic-Impact-Integrated-
Healthcare.pdf. Accessed March 1, 2018.
7. Wang J, Adair CE, Patten SB. Mental health and related disability among workers: a population-
based study. Am J Ind Med. 2006;49(7):514–522.
8. Greenberg PE, Kessler R, Birnbaum HG, et al. The economic burden of depression in the United
States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64(12):1465–1475.
9. Lerner D, Adler DA, Chang H, et al. The clinical and occupational correlates of work productivity
loss among employed patients with depression. J Occup Environ Med. 2004;46(6 Suppl):S46–
S55.

© 2014, Johns Hopkins University. All rights reserved.

©2016,
©2018,
©2015, Johns
©Johns
2014,
© 2014, Hopkins
Hopkins
Johns
Johns University.
University.
Hopkins
Hopkins All
University.
University. All rights
Allrights
rights
All reserved.
reserved.
rights reserved.
reserved. 27