Virtual Care Makes Mental Health More Accessible for Employees
It has been said, in nearly every way possible, that 2020 was a brutally tough year. While the year definitely presented many challenges, there were also many learning opportunities.
It has been said, in nearly every way possible, that 2020 was a brutally tough year. While the year definitely presented many challenges, there were also many learning opportunities.
One area that emerged was the increased acceptance and use of telemedicine. Prior to COVID-19, many employers offered telemedicine to employees as part of their benefits plan. However, in the wake of the pandemic, nearly half of all employers have started expanding their health-care benefits, especially in this area. In response, telemedicine has not only grown in volume, but it has also grown in scope — particularly in the area of mental health.
Over and above the convenience and safety that telemedicine helped provide worldwide during the last year, an unexpected increase for mental health support also arose. Mental health in the United States has always come with unique challenges and stigmas — many don’t know how to ask for help; others don’t want family members, friends and co-workers to view them as weak, unconsciously yielding to the misguided cultural idea that asking for help lacks strength. The good news is that telemedicine appears to be chipping away at these roadblocks by offering accessibility and connectivity while also slowly removing the stigma associated with reaching out for support.
In a 2016 study published by The Lancet Psychiatry, it was reported that “For the U.S., every $1 invested in expanded treatment for depression and anxiety leads to a return of $4 in better health and enhanced labor participation and productivity.” Further, improved mental health within society offers more than just economic rewards and improved personal well-being: a 2011 study conducted over the span of 19 countries produced data that revealed that mental illness increased the likelihood of divorce by up to 80%.
Since the pandemic, the number of people seeking assistance with depression has skyrocketed. Whether struggling to cope with the stress of the pandemic in general, dealing with illness within one’s familial and friend circle, adjusting to a new work-home balance, or pushing oneself to quickly learn new ways to accomplish one’s workload, across the board, individuals have indicated that they feel burnt out, especially when it comes to work. Indeed, the Center for Infectious Disease Research and Policy reported that COVID-19 has tripled the rate of depression in U.S. adults throughout all demographic groups. As unfortunate as that is, the spotlight and a more welcoming perspective on mental health care may prove to provide society with a better path in the future.
“From the ashes of a pandemic and economic crisis may rise a mental health movement that could draw the focus of businesses looking to improve productivity. They will realize a workforce with improved mental health can lead to increased productivity, a better company culture and progress at every level.”
According the FAIR Health’s recent white paper, “The Impact of COVID-19 on Pediatric Mental Health,” for the age group 13-18 in April 2020, “claim lines for generalized anxiety disorder increased 93.6 percent as a percentage of all medical claim lines over April 2019, while major depressive disorder claim lines increased 83.9 percent and adjustment disorder claim lines 89.7 percent.” Furthermore, as it regards overdoses for the 13-18 age group, the FAIR Health’s white paper finds that “there was an increase of 94.91 percent as a percentage of all medical claim lines in March 2020 and 119.31 percent in April 2020 over the same months the year before. Claim lines for substance use disorders also increased as a percentage of all medical claim lines in March (64.64 percent) and April (62.69 percent) 2020 as compared to their corresponding months in 2019.”
Teladoc’s October 2020 study release noted that mental health virtual care visits went up 79% for men and 75% for women since January of that year. This rise in virtual care usage goes far beyond convenience, safety and affordable access. This confidential and accessible service provides tools and support previously inaccessible and shunned. While virtual care will never replace the need for in-person care, it can act as a life preserver for those in need and a springboard to more in-depth services for those who might never have reached out if it were not for the instant and convenient access of telemedicine.
The ups and downs of 2020 certainly provided an environment in which the entire population collectively felt stuck, vulnerable, isolated and a level of stress in a way many of us have never experienced. And maybe it is that collective experience that has allowed us as a society to break through the barrier of accepting the positives of mental health support. It seems, at the very least, the notion of seeking help for mental health as a weakness is slowly and steadily fading.
If society continues to take a positive path of changing the mindset on mental health care, it could have wide sweeping effects. The future is bright for the telemedicine segment — and individuals, businesses and society as a whole will be better off for it. From the ashes of a pandemic and economic crisis may rise a mental health movement that could draw the focus of businesses looking to improve productivity. They will realize a workforce with improved mental health can lead to increased productivity, a better company culture and progress at every level.
In short, the Greek philosopher Thales’s view on health — “A sound mind in a sound body” — held true in 2020, which has shown businesses firsthand that a workforce of sound minds helps produce a business with a sound body. And, at the end of the day, no matter how you look at it, a more accepting outlook on mental health care is definitely a good thing.
For the last 10 years, Carlson’s company, Benefit Intelligence, has worked with GLJ Benefit Consultants to help provide ALA member firms with access to valuable benefits, including Teladoc’s no-copay telemedicine program and SupportLinc’s employee assistance program.
As leaders and managers in the business of law, we have an opportunity to speak out on mental health to establish an agenda of change. Creating a culture of openness will help us normalize conversations about mental health and well-being. The more we know and understand about the correlation between mental well-being, a supportive workplace culture and an engaged, satisfied workforce, the better we will be at creating environments in our organizations where employees feel valued, cared for and part of the shared vision.
CLM® Application Credit for Functional Specialists: in Human Resources Management toward the additional hours required of some Functional Specialists to fulfill the CLM application.
CLM® Recertification Credit: 1 credit hour in Human Resources Management
HRCI: 1 credit hour General Credit
SHRM: 1 credit hour for Leadership and Navigation
SHRM Learning Format: Self-Paced/E-learning
One of my favorite Rolling Stones songs is “You Can’t Always Get What You Want,” with its theme focused on the essence of optimism and eventual disillusion, followed by resigned pragmatism of “you get what you need.” This has been my personal experience the last several years. It’s also how this course came to be, along with a confession to an ALA colleague that my life was not going as I thought it would.
I mentioned that I was deeply sad, felt lost and alone, and that I’d recently started therapy. Her response surprised me. She said “good for you” and that admitting such things takes courage. It wasn’t the reaction I thought I would hear from her, yet it was exactly what I needed — encouragement that had me feeling understood and seen as the opposite of broken or ill. For the first time in a long time, I felt like myself and wanted to do something bold with that feeling. This course is a component of that boldness.
This course is about learning to help those we work with — as well as ourselves — in a compassionate, supportive and nonjudgmental way with the desired outcome of being able to be our best selves in our personal and professional lives. To achieve this, I’ve asked for assistance from a couple of people I know who have a passion for helping others be their best.
Let’s get started.
According to the 2017 Mental Health in the Workplace report by the World Federation for Mental Health, mental illness among employees costs companies in the United States an estimated $2.5 trillion per year.1 And the number is expected to rise to $6 trillion by 2030. Emotional difficulties affect employees’ ability to concentrate, make decisions, problem-solve and interact collaboratively with colleagues and clients. When employees are not well, performance suffers. The pandemic and the subsequent isolation it induced have only exacerbated these issues.
“The legal profession attracts intellectually competent, high-achieving individuals who generally prefer to think rather than feel their emotions,” says Bella Sterling, MS, MA, a Resident Counselor specializing in trauma, relationship issues and family counseling. “As a result, the distinction between being dedicated to the profession and being enslaved by it gets blurry.
As legal management professionals, we are very aware of the staggering statistics of depression and substance abuse in the legal field. In fact, the American Bar Association launched a Well-Being Campaign to address substance-use disorders and mental health challenges in our industry.
But those statistics largely focus on attorneys, overlooking the other legal staff who are in no way immune to the same issues. There is little research done on the “emotional labor” that paralegals and legal secretaries perform by staying calm, deferential and reassuring to clients while also facing unscheduled demands for research and preparation put on them by their superiors.2
It’s not surprising then that individuals in the legal industry suffer from higher incidences of anxiety, social alienation, isolation and depression than the general population. Research shows that the rates of depression in the legal community are higher than among doctors, dentists, teachers and clergy.3 The National Institute for Occupational Safety and Health found that male lawyers aged 20 to 64 are more than twice as likely to die from suicide as men the same age in a different occupation.3
“Add to the mix long hours, lack of autonomy, intense competition [and] job insecurity, and the environment becomes a breeding ground for psychological distress and mental illness,” says Sterling.
This rang very true for me. For the last two years, my distress had been accumulating. I moved from Austin, Texas, after accepting a position with a firm managing their office in Washington, D.C. My position also entailed overseeing a construction project for new office space. I found myself in a new city, with a new job and as ALA’s new President-Elect. Not long after, I was also managing another office in Philadelphia. Then the week before I became ALA President, I was overseeing an office move.
I’d had an active 12 months, and the excitement of my term as President was only just beginning. In reality, I was a wreck. I don’t think I realized just how much of one I was because I simply kept trying to keep up with all that was going on around me. Learning a new role at work and taking on the role of President of the Association’s Board of Directors meant lots of time spent figuring those things out. I felt burned out and uncertain if I was doing a good job at work or in my volunteer role. I was in a new city without any social or support network to turn to; it was a lonely time. There was also not much time left over for anything else; joy and happiness in any part of my life was hard to find.
I didn’t set out to have a crisis or to find myself in such a dark place, yet that’s exactly where I landed. So as our organizations went remote because of the pandemic, we began managing employees working from home and tried to monitor their well-being during this challenging time. But I found myself again neglecting my own well-being.
It finally occurred to me that in my present condition I was not in the best shape to lead or manage people. Rather than continue to do what I had always done before in difficult times — just keep on keeping on — I sent an email and asked for help.
I wonder now why it took me so long to do that or why things had to fall apart before I asked for assistance. I believe part of the explanation is in the stigma our society associates with mental health, which is especially rife in the perfectionist culture of the legal industry. Turns out, I’m not alone in that. Sterling says one of the particularly toxic myths that keeps many people from seeking help is believing that mental health issues are a sign of character weakness.
“From a standpoint of a therapist, the truth is often just the opposite,” she says. “People who struggle with mental illness must work extra hard to continue functioning in a society taking care of families, jobs and pets despite the misery they are facing on the inside.”
I’m certainly not the only person experiencing these heavy feelings. In fact, statistics on mental health in the United States reflect that as a society we are not well. In 2013, one in six adults was taking a psychiatric drug such as an antidepressant or a sedative. In 2016, the number of psychiatric prescriptions increased from 32.73 million to 45.64 million.4 According to a report released by the National Center for Health Statistics in March 2020, the rate of antidepressant use in this country among teens and adults has increased by 400% between 1988 and 2008.
“Initially, I was shocked to hear that almost half of all adults living in the United States will experience a mental health challenge at some point over the course of their lifetime and that many do not seek professional help. Then, I looked back over my lifetime and it did not strike me as shocking anymore. We all go through difficult times,” says Astrid Emond, MSOD, IP Administration, Trademark and Learning Manager at Cooley LLP.
Research confirms that emotional distress among employees leads to loss of productivity, staff turnover and presenteeism, defined as showing up for work but not performing due to anxiety, depression or addictions.5
CONTINUE THE CONVERSATION
There is more to this topic than we could fit into this article. So Bella Sterling, MS, MA, joined us on Legal Management Talk to dive into this issue more. We cover some of the myths that surround mental health and why it's so hard to ask for help. Plus, we discuss why the pandemic is helping us face these issues. Listen to our conversation.
Emond recently went through a mental health first-aid certification course organized by Mental Health First Aid USA and managed by the National Council for Behavioral Health. The course helps people understand and respond to other people with mental health challenges, disorders or crises, and helps raise awareness of mental health in general.
“The instructors in the course were very clear that mental health first aiders do not diagnose or treat mental health challenges; instead, they are to observe possible signs and symptoms of mental health challenges,” says Emond. Signs and symptoms might include an unusually sad mood, lack of energy and tiredness, difficulty concentrating or making decisions, becoming agitated and unable to settle, changes in appearance and personal hygiene, and continually arriving late to work. A certified mental health first aider trains to assess risk, listen without judgment, provide reassurance and information, and connect a person to professional help.
Sterling says signs of emotional distress can vary. However, on the level of a human nervous system, the first function that suffers under stress is one’s capacity for social engagement. When someone looks withdrawn, tense or lethargic or appears irritable and aggressive during a conversation, these are signs that their nervous system is in overdrive and has shifted from the social engagement function to either a “fight or flight” or “freeze” mode.6
“Managers will want to pay attention when an employee who is exhibiting difficulty with mood regulation is also not replying to emails or returning calls, for instance,” says Sterling. “When these warning signs are present, the best approach is to suggest a one-on-one conversation.”
The Mental Health First Aid course also highlighted the importance of self-care — something Emond has become a firm believer in after suffering a significant health scare years ago. “We’ve heard the instruction on airplanes to ‘put your oxygen mask on first before helping others’ or ‘you can’t pour from an empty cup.’ We need to ensure that we are taking care of ourselves if we want to help others. I appreciated getting a template to create a self-care plan considering various domains. Doing this will help when stress builds,” Emond says.
Even though it’s not easy, try to encourage colleagues that some days it’s OK that you’re not OK and to reach out for support.
“As we all know, this past year has brought many difficulties. I remember one rough day in particular. I could not focus, my heart was in pain, and I chose to reach out to my teammates (and boss) and share my struggles in a rather clumsy way,” Emond says. “The support I got was overwhelming — and many shared similar feelings. Letting go of what I thought I should be doing and saying in the workplace and deciding to be vulnerable and transparent allowed me to have deeper conversations and connections at work. And to my surprise, others opened up to me. As a result, I feel closer to my colleagues. Rather than feeling weak for being vulnerable, I felt my spirits lifted and stronger to face the day.”
Although it is usually job pressure and negative work culture that lead to mental distress, law firms are generally the last to step in to help, notes Sterling. “As more workplaces recognize that it is in their best interest to invest in the well-being of their employees, legal management professionals will need to adjust their perspective on mental health services, dispelling the stigma and mystery that still surrounds them.”
“When others let their guard down and are vulnerable with me, I try to do whatever I can to support them. Generally, it starts with asking what they need,” Emond says.
Responding to an individual’s distress with compassion is a good approach to take. The key to working with an employee in distress is not to sound punitive or judgmental. Sterling suggests a statement like “I noticed you’ve not been returning emails and missed a few deadlines. It seems out of character for you and got me concerned.”
“Managers will want to pay attention when an employee who is exhibiting difficulty with mood regulation is also not replying to emails or returning calls, for instance. When these warning signs are present, the best approach is to suggest a one-on-one conversation.”
The most useful skill for dealing with distressed employees is to be comfortable with raw emotion. Jumping in too quickly with helpful suggestions is not as beneficial as simply listening and staying receptive. “Listening to listen, not to respond” is a good rule to remember.7
“I also learned that people are more likely to seek help when someone close to them suggests it,” Emond says. “Just imagine the impact each of us can have by looking out for someone we know and suggesting help. I am happy to have tools that can help me address my concerns for someone.”
Whatever the conversation might be, Sterling says the intention should be placed on the well-being of the employee. “If the individual is encouraged to take time off, it is best to reach out by email or phone every few days and check in. The expression of concern is healing to all humans and will remind an individual that their workplace is a place of support,” she says.
And don’t shy away from asking whether the employee would consider talking to a mental health professional — with an assurance of full confidentiality.
It might also help to approach counseling in terms of coaching. “Rather than seeing counseling help as the last resort for an employee in crisis, managers are encouraged to view counseling on par with coaching,” Sterling says. “The coaching industry is booming in the United States, and coaches are often used by law firms to provide a performance edge to high-achieving employees. Similarly, counseling services can be viewed as a collaboration on how to successfully navigate stresses of a high-competition, high-pressure, high-stakes industry.”
As legal managers, we are well-versed in change management. It’s knowledge that can be used to help move mental health conversations forward in our legal organizations.
Emond points to organizational development expert Edgar Schein’s culture work, where he suggests the “tools” leaders have available to teach organizations how to perceive, think, feel and behave based on their own conscious and unconscious convictions. They include:8
In the context of mental health in the legal industry, Emond says to consider what we do to measure and support the mental health of employees. “It is important that our espoused value of mental health in the industry is supported by our culture. We need to consider if that is the message we want to send to our employees. Self-care and mental health need to become a higher priority.”
For example, firms might encourage people to take time off; however, the policies might reward those who take little to no time off. Or firms might encourage people to take care of their mental health, but when an employee needs a late start to work because of something that happened to them in the morning, flexibility isn’t allowed.
Yet promoting work-life balance is essential for keeping employees healthy. Managers must be proactive in reaching out, scheduling check-ins and face-to-face time, and encouraging employees to take time off, as many might be reluctant to use PTO when working from home. Giving employees a choice in organizing their work schedule and encouraging them to take time off to dedicate to family, sports and relaxation must be priorities.
“Counseling services can be viewed as a collaboration on how to successfully navigate stresses of a high-competition, high-pressure, high-stakes industry.”
Self-care is something Emond models at her firm. “One way to [do] that is to take PTO — even during a pandemic when I am unable to travel or visit family,” Emond says. “I take PTO so I can recharge my body and mind by getting outdoors. I am lucky to live close enough to a National Forest and National Park. I tell people about my hikes partially to normalize taking time out for oneself. Then, I encourage them to take time out for whatever brings them joy or just to rest.”
Emond says let each individual find what self-care means to them, then encourage them to practice it without guilt or worry about judgment. “Not to say we should never work late — we are legal administrators and sometimes there are fires — however, if the fires are a daily occurrence, we need to reevaluate what this does to us and whether it is the culture we want to promote for others.”
The pandemic exacerbated the issues of depression, fear and isolation that are already prevalent among the legal profession. In addition to the regular demands of work, there is a collective sense of dread that makes all people more vulnerable to psychological distress. There are also pressures of childcare and lack of social interactions that contribute to the feeling of doom and gloom, says Sterling.
Stigma surrounding mental health creates a challenge for those who struggle to find support among colleagues. The façade of perfectionism among peers may lead individuals to believe that they are the only ones struggling and, therefore, should toughen it up and keep going. But that’s not a sustainable practice, as I myself found out. It’s something I hope this article can start to change for our industry.
“I am trying to pay closer attention to others, listen deeper, be supportive and admit to being human and fallible. I want to promote self-care for mental well-being, raise awareness around mental health, and reduce the stigma associated with seeking help,” says Emond.
But the industry itself needs to do some self-examination, Sterling says. It is important to point out that there is a danger in interpreting employee’s distress in a workplace only in terms of individual troubles to be addressed by medication, resiliency trainings and well-being strategies.9 Such approach would make the individual bear what the profession as a collective should take responsibility for.9
“One client described to me how his law firm hosted a workshop designed to assist with emotional regulation. Even though over 300 people showed up for the workshop, my client felt vulnerable to exposing himself by participating in the workshop,” says Sterling. “‘If you are feeling weak, you can’t show it,’ he stated.” Despite skyrocketing rates of depression among lawyers, it is still rare to hear someone in the law profession openly admit to mental health problems.10
Multiple reports point to the necessity of changing the culture in which employees lack autonomy, work unreasonably long hours, have minimal control over workloads and where work demands outstrip an individual’s ability to cope with these demands. On top of introducing specialized programs that teach employees meditation, mindfulness and relaxation techniques, there also must be a movement to implement policies for how mental health issues will be treated in regulatory processes. “For instance, fighting bullying, discrimination and inappropriate behaviors in the workplace are all part of shifting the culture and addressing challenges in law community systemically,” says Sterling.
It is worth mentioning that most well-being initiatives in legal communities are directed toward lawyers, but that also needs to shift. Sterling says such a culture is bound to propagate mental distress equally among lawyers as well as their support staff.
And as legal managers, we can play a part in moving this conversation forward — given all that 2020 threw our way, such conversations are more vital than ever.
“My hope is to help remove barriers someone might experience seeking care — stigma being one of those barriers,” Emond says. We seek help when we experience physical challenges; seeking help for mental challenges should be just as common practice. Recovery and mental health are possible.
When life deals us unexpected twists and turns and we find ourselves off course and out of sorts, there is no shame in admitting that. Life is not easy; in fact it’s often difficult, and seeking assistance navigating these challenges and having open conversations about them is something we as legal management professionals can model in our organizations so those we work with do not have to feel alone in their distress or pursuit of contentment. The Rolling Stones understood that and are indeed the same band that once sang “(I Can’t Get No) Satisfaction” and later confessed you don’t always get what you want — but finding what you need may actually be best.
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