Sep 10, 2020
By Joe Grasso, PhD
Mental health struggles are universal. In a typical year, an estimated one in five adults in the United States will develop a diagnosable behavioral health condition. But in a year that’s been anything but typical, a growing number of American adults reported symptoms of a mental health or substance use disorder in June. The number of people experiencing suicidal thoughts has more than doubled compared to 2018, with 11 percent of American workers and 11 percent of U.S. adults overall reporting thoughts of self-harm or suicide, according to Lyra Health and Centers for Disease Control and Prevention (CDC) surveys conducted this summer.
Despite the prevalence and growing awareness of suicide, it’s still a taboo topic, and stigma around seeking mental health treatment–which can make a big difference for those who are at risk–remains. Employers, while only one part of the equation, can play an important role in breaking this taboo by normalizing mental health in your workplace. And since the best prevention strategy is early intervention, people leaders within companies can help prevent suicide by recognizing when an employee is in distress and connecting them to care.
As a manager, it’s normal to feel some anxiety around approaching an employee who may be showing signs of emotional distress. You may wonder, “How should I approach this?” and, “Am I saying the right thing?” As daunting as it may feel, know that you have what it takes to handle this situation by following the right steps and showing empathy. Read on for skills you can use to help employees who are in distress and potentially at risk of suicide.
The following are some broad categories of indicators that an employee is in distress or potentially at greater risk of self-harm or suicide. Keep in mind that these signs may not always be obvious, and if you’re working in a separate location from your employees, they can be tougher to detect. However, it’s important to check in and pay attention as best as you can in order to connect employees to help when needed.
You may notice that the employee’s typical way of acting has shifted in a concerning way. The person may be quicker to anger, or express sadness at work (such as crying at their desk). These changes may be dramatic and sudden or more subtle and gradual.
When you notice behaviors changing in a worrisome way, such as reckless conduct, mentions of increased substance use, or sudden withdrawal, this can signal that someone is experiencing mental health issues.
If an employee reports trouble remembering things, paying attention, staying on task, or retaining new information, these are also potential signs of distress.
Pay attention to troubling comments about the employee feeling trapped or hopeless, about their ability to cope, and more serious statements like wanting to hurt or kill themselves.
If you suspect that an employee is struggling or just want to rule it out, here are appropriate actions you can take in three different scenarios.
The employee not only discloses thoughts about harming themselves or others but also a plan to carry it out and the intent to do so. That’s an emergency, and merits an immediate call to 911, your security team, or both, depending on your company’s protocol.
In this case, the best response is to call your employee assistance program (EAP) and immediately connect the person by phone. (If you and the employee are in separate locations, it may be best to encourage them to call the EAP directly). An EAP representative can conduct a risk assessment to determine whether the person is in immediate danger.
In this case, it’s best to connect with the employee to understand their situation and inform them of relevant benefits such as the EAP. What follows are some best practices for approaching this conversation.
Having the conversation
Invite the employee to check in with you in a private room or via video chat, and make sure to set aside at least 30 minutes to talk. Go into the conversation with clear objectives in mind and anticipate potentially helpful resources you can share. This usually includes your EAP or how to access short-term disability or workplace accommodations.
It’s important to open the dialogue in a direct, concise, and non-judgmental way. You could open with something like, “I’m noticing you haven’t seemed like yourself lately,” or, “I’m concerned about you.” Justify that concern by describing the observed behaviors that led you to worry. Be specific, concrete, and as objective as possible.
This could sound like, “I noticed you haven’t been showing up for meetings,” or, “I noticed you haven’t been responding to emails and you seem distracted.” Give specifics whenever possible. This lets the person know you’re concerned and why, and sets the stage for inviting them to share what might be going on.
You can start the next part of the discussion with questions like, “What’s been going on for you?” or “Can you tell me more?” That way, you’re keeping it open-ended so they can share as much or as little as they want.
Oftentimes, people will share at least some of what’s happening with them, but it’s still possible the employee will respond by shutting down the conversation. If that happens, don’t pry further: Your job isn’t to be a detective, but to let them know you’re there to listen and learn about the broader context.
When an employee does share what’s going on, it’s best to respond by validating their emotions. Let them know they’re not alone and it’s not unusual to feel this way. You might offer something like, “I can understand why you’d feel overwhelmed given the situation you’re in,” or, “I think many people might feel that way given the scenario.” You can also express your gratitude that they opened up to you with something like, “I can imagine how hard that is to share, and I appreciate you sharing it with me.”
The most important step in this conversation? Referring the employee to relevant resources. After validating their feelings, shift the conversation toward those resources. You can say something like, “Have you considered looking at your benefits intranet page to see if there’s a resource that might help out in this situation?”
If it seems appropriate given what they’ve disclosed, you can get more specific and say something like, “One of our benefits, the EAP, offers coaching and therapy, and it could be helpful for you to consider.”
When someone has just shared that they’re going through something difficult, the urge to offer advice is understandable. But keep in mind that what the employee disclosed to you is just a small piece of a larger picture, so your advice could be unhelpful since you lack context.
People may judge in a way they think is helpful with thoughts like, “If only this person knew this isn’t such a big deal,” or, “I should let them know this isn’t as bad as it seems.” That kind of message can feel invalidating, and what’s distressing to one person may not be to another.
Labeling someone can be stigmatizing and cause shame. And chances are, it’s not going to be an accurate diagnosis anyway. Leave that clinical work to psychologists and therapists.
You don’t want someone to feel compelled to seek care because their employer requires it. A better approach is to provide the relevant information without mandating or even using the word “should.”
Indicators of suicide risk include statements that make clear that the person is considering self-harm or suicide such as, “I just want to end it all.” Slightly subtler signs could include comments like, “I don’t think I can go on living anymore” or statements indicating that the person feels they have no reason to live, and nothing left to lose.
While people may make exaggerated or flippant comments or engage in morose humor, it’s always better to take these statements seriously and be wrong versus the potentially tragic alternative of dismissing them and being wrong. To get clarity, it’s best to ask directly if an employee has thought about hurting themselves. A direct approach would be something like, “Sometimes when people are really upset they think about hurting themselves – are you having thoughts like that?”
If the answer is vague like, “Not really,” or “Maybe,” err on the side of caution until you can get a clear “yes” or “no.” You might say something like, “When you say ‘maybe,’ it makes me concerned and want to know more about what you mean by that.” This way, you’re signaling that you won’t just let their response go and will follow up.
If the response is “yes,” the first thing to do is to take a deep breath. Then, talk to the employee about getting help. The best practice in this situation is to call the EAP while you’re in the room and have the employee speak to an EAP representative in the moment. (If you’re in different locations, encourage the person to call the EAP themselves).
Remember – if the employee says they’re not only considering suicide but has a plan to carry it out, treat that like the emergency it is and call either your security team or 911. The immediate concern in that situation is ensuring the person’s safety and getting them evaluated.
When an employee is struggling with their mental health, knowing how to respond can be tough. Remember that there are no perfect words here – the important thing is to express your concern and connect the person to the help they need. Getting someone who’s struggling into care is the single most impactful thing you can do to help them feel better and prevent suicide.
If you want help connecting with a therapist, Lyra can assist you. You can get started today if Lyra is offered by your employer. Sign up now.
DISCLAIMER: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
ABOUT THE AUTHOR
Joe Grasso, PhD is the Clinical Director of Partnerships at Lyra Health and a licensed clinical psychologist. He specializes in mixed-methods research and evaluation, health care quality improvement and implementation science, and program development. Dr. Grasso also provides evidence-based psychotherapy for adults in San Francisco.