Nearly 80 percent of employers offer programs to promote the physical well-being of their employees.
They may want to expand wellness programs to address depression and other mental health issues, based on a disturbing trend documented in a recent study by the American Journal of Preventive Medicine.
“Every 20 minutes, someone commits suicide in the United States,” says Bert Alicea, licensed psychologist and vice president of EAP and work/life services for Health Advocate Inc. in Plymouth Meeting, Pennsylvania. “Given that rate, there is a possibility of a suicide at your workplace.”
The study found that slightly more than 1,700 employees committed suicide in the workplace between 2003 and 2010, for an overall rate of 1.5 per one million workers. Suicides declined between 2003 and 2007 but then spiked during the remaining years of the study. Non-workplace suicides totaled 270,500 during this period, for a rate of 144 per one million people.
Among the significant findings about workplace suicides:
Rates were higher for men (2.7 per one million).
Workers aged 65 to 74 (2.4 per one million) were more likely to end their lives.
The profession with the highest suicide rate is protective services such as police and firefighters, followed by farming, fishing and forestry.
The human toll is devastating, but there also is a high economic cost. A 2010 analysis estimated the price of depression at $210.5 billion, with 45 percent to 47 percent attributable to direct costs; 5 percent to suicide-related costs; and 48 percent to 50 percent to workplace costs.
There often are more questions than answers on this sensitive topic. Why would a person kill him or herself, and why in the workplace? The journal article suggests:
Occupation can largely define a person's identity and psychological risk factors for suicide, such as depression and stress, can be affected by the workplace. Also, as the lines between home and work continue to blur, personal issues creep into the workplace, and work problems often find their way into employees’ personal lives.
Clare Miller agrees with this assessment. She is director of the Partnership for Workplace Mental Health, which is part of the American Psychiatric Foundation in Alexandria, Virginia.
“The line between work and home more and more is nonexistent,” she says. “More of us work at home part time or bring work home to do in the evenings, so there is no line of demarcation.”
In other words, home is no longer a safe haven from work-related stress, and personal issues also enter the workplace. “Employees may be dealing with other things in their lives, such as divorce or separation; financial hardship; or the death of a family member,” Alicea says.
The increase coincides with the recent recession, and workplace bullying also can play a role.
“We did a study not long ago that found that asking people to do more with less can increase stress,” Miller says. “We also have found more incidences of bullying, which can be an outgrowth of poor organizational practices.”
Education is essential
Regardless of the cause, employers have an opportunity to educate and encourage employees, and intervene if necessary. As the Journal article states:
Suicide is a multifactorial outcome and therefore, multiple opportunities to intervene in an individual's life—including the workplace—should be considered. A method that may reduce the burden of suicide suggested by the National Action Alliance for Suicide Prevention Research Prioritization Task Force was increasing the number of people trained for suicide assessment and risk management. Implementing effective and evidence-based programs for the training of these individuals is pivotal. The workplace should be considered a potential site to implement such programs and train managers in the detection of suicidal behavior….
A successful strategy has two key components—education and observation. Although society has come a long way, many people still attach a stigma to mental health issues. “The objective is to create awareness and change mental health from a taboo subject to something that can be openly discussed,” Alicea says.
Health Advocate Inc. offers a number of printed resources to its clients. Partnership for Workplace Mental Health offers a number of free resources to all employers.
“We have program called the Right Direction Iniative for employers to use to raise awareness of depression, which tends to be a leading cause of suicide,” Miller says. “Not every person who has depression is suicidal, but it can be a key indicator. We have a portal through which employers can get communications materials, posters and information for company newsletters. We encourage them to use it as a tool to get employees started talking about mental health.”
Programs like this will succeed only if employees are educated, know where to turn for help and are encouraged to not be afraid to seek assistance. That information often is lacking. For example, many employees are not even aware that their company has an EAP, she says. Although top-down commitment is important, the best prevention tool may be peer-to-peer accountability.
“Colleagues really need to reach out to each other, because they often can see tangible signs of depression,” Miller says. One practical tool is a Workplace Mental Health website called ICU, which is free to access at www.workplacementalhealth.org/Spotlights/ICU.aspx
The worst outcome is to play “Monday morning quarterback” and connect the dots only after a tragedy has happened, Alicea says.
“Don't be afraid to ask questions,” he says. “Employees may have a change in appearance, or say things such as ‘life is not worth living’ or talk about hurting themselves. One sign by itself may not be an indicator, so look for different factors. Have a responsible plan to provide education before a situation occurs.”
An EAP, if properly implemented, can be a valuable resource.
“Your EAP can help you see those red flags and assess risk factors,” Alicea says. “But don't implement an EAP simply for the sake of saying you have one. Show that you care about your employees, and make it visible. Present it not as a medical model but as an educational model. If you do it right, it will have a big return on investment.”
One of the best things an EAP can provide is a nonthreatening atmosphere to talk things over. “Confidentiality is really important,” he says. “Employees need to know they can call us anonymously or even do a depression assessment on our website.”
Perhaps the most important thing an employer can do is to counter the stigma surrounding mental health. “Don't ignore it,” Alicea says. “It's OK to talk about mental health. If employees are not comfortable, make sure they know it is confidential.”
Human resource professionals can play a critical role in helping prevent workplace suicide, Miller says.
“HR professionals are in a position to really make a difference,” she says. “I would point to two things. The first is in their role as a purchaser of health care. You need to really ask questions of your health vendor partners. Ask about mental health, because that issue often is not raised.
“Second, take action to promote awareness of services to employees. Don't wait for the perfect mental health awareness plan, because it will never happen.”
An ounce of prevention can go a long way
Businesses can take a number of steps to reduce the risk of workplace suicide. The organization Workplace Strategies for Mental Health recommends the following:
Be aware of individual risk factors. These can include previous suicide attempts; suicide by an acquaintance; addiction or substance abuse; mental illness; access to lethal drugs or weapons; or stigma that discourages employees from seeking help.
Implement a comprehensive psychological health and safety management system to help improve overall workplace culture and resolve issues more effectively.
Reduce stigma related to mental health issues so all employees feel safe asking for help.
Ensure your EAP provides appropriate support and counseling services to those who may have thoughts of suicide.
Ensure that employees are aware of confidential EAP or community services that are available to help them.
Be prepared and aware by providing suicide intervention training.
Increase interpersonal and social competency through training in stress management and coping skills to help individuals deal with problems.
Raise awareness of organizational and community supports, including expertise through human resource, mental health agencies or EAP to help managers and union representatives make appropriate referrals.
Resolve workplace issues quickly and effectively to reduce feelings of hopelessness.
Offer evidence-based suicide prevention education to employees. Provide education to help recognize mental health problems, including warning signs of suicide.
Promote awareness that many suicides are preventable; make facts available about suicide, risk factors and prevention approaches.
Ensure employees understand that they are not required to intervene or put themselves at risk if they are ever in the position of responding to a situation of a potential suicide.
Expand awareness of mental illness and addiction.
Help reduce stigma associated with mental illness, substance abuse and suicide.
Encourage help-seeking behaviors for such problems.
Create a caring work environment in which co-workers support each other. Promote listening and interpersonal skills to help individuals improve their relationships.