Dalla Lana School of Public Health

She’d been working long hours and travelling a lot for a huge project that had just ended. Although she was young, she knew there was a family history of heart troubles. After doctors checked her out, however, their diagnosis was not what she expected. She had not had a heart attack. She’d had a panic attack.

She wasn’t convinced. Her family doctor ran more tests, but there was no evidence her heart was involved. The panic and anxiety did not subside, though, so her doctor advised her to go on short-term disability right away, which she did.

Oldham ended up being off work for three months. Even after she started to feel better, she worried about what it would be like to go back to work. She was a manager in a large corporation, and dreaded the curiosity of her co-workers. “One of my big worries was about the awkward questions, that people wouldn’t know what to say, that people would treat me differently,” she says. “None of that happened.” Instead, she says, things just picked up where they’d left off. People were just happy to see her back.

She returned feeling that she understood herself a bit better. She also understood mental illness a bit better – that it wasn’t a sign of weakness, or something you are always able to control, but just an illness like any other.

Despite those insights, however, a few years later, the panic attacks came back. This time, the triggers were more personal. Her mother had recently died. A relationship had ended. She found herself falling into a deep depression. Once again, she went on short-term disability.

Not long after the news reached the office, a colleague gave her a call at home. He wanted her to know that he understood what she was going through – that while his situation was different, he’d also experienced a period of stress — and shared this to let her know that she wasn’t unique. “You feel like you’re the only one,” she says. “It helped me to know that it’s very common.”

Mental illness is in fact the most common cause of short-term disability in the Canadian workplace, says David Goldbloom, a professor of psychiatry at U of T who champions mental-health initiatives for employees. Mental illness affects at least one in five workers, he says. According to data from the Centre for Addiction and Mental Health, 500,000 Canadians call in sick to work every week because of mental health and addiction conditions. The total cost of mental illness on the Canadian economy is estimated to be more than $50 billion a year.

A good chunk of that cost, says Goldbloom, is not from people recovering on leave, but from lost productivity in the workplace. It’s a phenomenon known as “presenteeism” – employees dutifully showing up for work but not functioning at full capacity because of an unmanaged mental illness. Oldham admits she spent a month like that before taking her second leave. She remembers being unable to listen, to concentrate, to think.

Despite the fact that it’s all around us, mental illness is not always easy to recognize in others. It is largely invisible and fluctuates from day to day, week to week. As a result, it often confuses supervisors, co-workers and even the people themselves, says Arif Jetha, a work and health researcher at the Dalla Lana School of Public Health and at the Institute for Work and Health. “People with these mental health conditions struggle to communicate their needs at work – and that inability to communicate one’s limitations can often be misconstrued as a performance issue.”

There are lots of examples of people put on probation or fired for a decline in productivity or quality of work, when this may be due to a treatable mental health problem, says Bonnie Kirsh, a professor in the department of occupational science and occupational therapy at the University of Toronto. She has spent much of her career studying methods and interventions aimed at inclusion in the workplace, as well as combating stigma. “When someone who is competent seems to be slipping, the question to ask is why,” she says. “Maybe something is going on.” If their mood changes, they become unusually irritable or they start to miss work – these can all be signs, she says.

Co-workers are often the first people in the workplace an ill person will turn to, says Goldbloom. They tell co-workers before managers, before HR. Throughout her month of distraction during her second episode, says Oldham, a co-worker was her primary support.

Goldbloom encourages bosses to have a frank discussion with any employee who appears to be suffering a mental health crisis. “Have a human and meaningful conversation,” he says, “not where you offer your diagnosis, but where you express your concern.” Managers should ensure there’s adequate privacy and time, he says. “This is not a hand-on-the-doorknob conversation.”

Says Goldbloom: “Don’t blame the person. Don’t ignore the person. Don’t do nothing.”

In 2013, the Mental Health Commission of Canada launched a national guideline for how to manage workplace mental health. Called the National Standard of Canada for Psychological Health and Safety in the Workplace, it aims to provide guidelines, tools and resources to help promote mental health and prevent psychological harms in the workplace. Although adopting the standard is voluntary, Kirsh says the guidelines have begun to change workplaces.

“Employers are hungry and eager to introduce training and education into the workplace,” she says. They recognize the huge economic costs of both absenteeism and presenteeism – not to mention the untold human costs. She and her colleagues have evaluated and modified more than 24 cases where workplaces have instituted programs to combat stigma and promote resilience. They have also studies how workers perceive such programs. Although there is still far to go, Kirsh says there has been much more openness about mental health in recent years. “You can raise the issue without having to pretend it’s lower back pain,” she says.

In addition to voluntary standards, there are also human rights laws. According to the Canadian Human Rights Commission, employers have a “duty to accommodate” workers who have disabilities, including mental health disabilities, in an effort to help people succeed.

But some employers lack clarity about that obligation. “There’s a misperception that accommodation can be expensive and will require a great deal of change,” says Jetha. In a recent study, he found that “soft accommodations” – such as scheduling flexibility, additional social support and better communication, plus health benefits – were most often needed, rather than significant adjustments to the workplace.

“What our research consistently shows is that it can be affordable.” One analysis by Jetha’s colleagues showed that, for every dollar spent on support, an organization got $7.40 back – in the form of fewer work absences, higher productivity, lower turnover and fewer compliance-related fines, among other things.

When Oldham returned after her second leave, for instance, she was offered the opportunity to ease back in. Her employer said she could work part days, or only a few days a week. The offer of flexible hours made it possible to imagine going back. But in the end she didn’t need to reduce her hours. Everything fell right back into place.

Illustration by Francesco Ciccolella