While the responsibility of identifying and managing any medical condition ultimately falls to the employee, employers can provide support or find help for an employee. (Image: Shutterstock)

Americans spend much of their lives at work. At the same time, nearly 1 in 5 U.S. adults lives with a mental illness. Statistically, encountering behavioral health conditions in the workplace is inevitable — it's how employers choose to understand and address them that matters.

The good news is that employer attitudes toward mental health and substance abuse are changing. More employers than ever want to provide the support their employees need. However, attempting to provide support without understanding how these conditions progress can further exacerbate an employee's condition.

Related: Coming soon: Onsite behavioral health clinics

Knowing the different stages of behavioral health conditions is the first step to addressing them. This article will briefly highlight one example of the possible behavioral health condition progression, as well as its potential impact on employee health and work habits if employees fail to receive the right support at the right time.

Stage one: Emergence of a mental health or substance abuse condition

One of the challenges facing employers when addressing behavioral health conditions is that they often begin without notice. The emergence of a condition may be triggered by anything from job-related stress to the loss of a loved one. Whatever the cause, symptoms are often mild at their onset. Many employees assert that they can handle a situation and refuse help from co-workers or supervisors for fear of a stigmatizing response.

While the responsibility of identifying and managing any medical condition ultimately falls to the employee, employers can provide support or find help for an employee at this stage. Employee assistance programs (EAPs) are great resources for employees. Moreover, creating stigma-free work environments and building workplace cultures that support mental well-being are crucial to addressing or even preventing behavioral health conditions.

Stage two: Early clinical symptoms

During the second stage of most mental health and substance abuse conditions, symptoms will most likely increase. Work performance suffers more than in the first stage, which may lead to supervisors trying to manage performance. Referrals to EAPs are more common at this point.

Still, employees may continue to conceal their behavioral health issues at this stage, and symptoms may go unnoticed. If signs are apparent, absence management and stay-at-work disability management strategies are best implemented at this point. By implementing strategies, employers can help employees address issues proactively and help them stay at work or return to work quickly.

Stage three: Severe conditions

Employees often experience severe symptoms during the third stage of health condition progression. At this point, symptoms directly impact an employee's ability to work, and an affected employee may require a disability leave.

Ideally, employers will consider employee accommodations before stage three, but providing support when employees reach this stage is still important. Support is sometimes mishandled by supervisors who develop negative perceptions of employees facing severe health conditions. They may see the employee as constantly complaining, unreliable, difficult to work with or always unhappy.

To prevent mismanagement, it's important to provide employees with outside resources. Assisting them in obtaining services through an EAP, identifying reasonable accommodation strategies under the ADAAA, supporting the employee's FMLA application and helping them identify in-network health care providers are all effective ways to aid employees with significant behavioral health conditions.

By involving other resources, employers can reduce the likelihood of behavioral health condition mismanagement.

Stage four: Chronic impairment

If employees do not improve by stage four, they may experience severe or chronic symptoms and apply for long term disability (LTD) benefits. This could lead to job loss and loss of health insurance benefits. Employees may develop a “disability mindset,” focusing on their limitations and ignoring their capabilities, and this, in turn, may lead to a belief that they can't return to work.

Goal-directed case management and return-to-work strategies are often initiated or continued at this point, but their impact is less than during earlier stages. Generally, the earlier the intervention, the better the chances are that an employee will return to work.

Stage five: Recovery

The last stage is where employees see improvement in their condition — either through treatment or as part of the natural course of the condition. Recovery can occur at any stage in the behavioral health journey, but recovery before severe or chronic symptoms develop often depends on employees receiving timely and effective care and support.

During recovery, stay-at-work and return-to-work strategies can have a positive impact on limitations and restrictions. Training managers and supervisors on the importance of EAPs, wellness and HR support can be valuable to both employers and employees to prevent future instances of behavioral health conditions.

The impacts of providing support

Less than half the people who meet the diagnostic criteria for a mental health diagnosis will ever receive treatment. Despite this, mental health and substance abuse conditions are common in the United States. Without effective service and support, these conditions may remain hidden, and work can suffer as a result.

The first step to addressing behavioral health conditions is starting an informed conversation about them. By discussing how to tackle these issues, we can reduce their severity and decrease mental health stigmatization in the workplace.

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Dr. Dan Jolivet is the Workplace Possibilities practice consultant at The Standard, where he previously led the Behavioral Health Case Manager (BHCM) team and managed the psychiatrist and psychologist peer consultants.

Terri L. Rhodes is the chief executive officer for the Disability Management Employer Coalition (DMEC). Terri has extensive knowledge and expertise in all aspects of absence and disability program management.