Why Work Matters: Rethinking The Role Of Work In Mental Health Treatment

Ken Dolan-Del Vecchio, LMFT, LCSW, DVS, CEAP, SPHR
Vice President, Health and Wellness, Prudential Financial, Inc.

Because most of us spend the majority of our waking hours at work, what happens there greatly affects many dimensions of our lives, including our mental health. For some, work can be a source of stress. But for many, work also provides stability, structure, and a sense of purpose. In addition, work creates important social connections and friendships. Most people become emotionally invested in their workplace and feel a sense of community with their co-workers. In fact, research shows that unemployment negatively affects mental health. Presumably, this results not only from economic stress, but also from the assault to self-esteem and social relationships that disconnection from the workplace brings.

Many years ago, an esteemed colleague declared during a lecture that when we face unplanned disability—whether it’s due to a mental health condition, physical ailment, or to provide care for someone else—the life disruption can be so momentous that it amounts to a psychiatric emergency. Such is the significance of our work.

Yet work—with all its implications for mental health—is often not fully considered nor adequately addressed by many health care professionals, including mental health clinicians and, as a result, few spend much time addressing their clients’ relationships with the world of work.

We all—mental health professionals, employers, and employees living with mental illness—can benefit from adjusting our view of work to recognize the major, often positive, influence it can have on mental health. In fact, preserving the ability to work (sometimes through workplace accommodations or a flexible schedule) can enhance treatment plans and promote recovery by allowing individuals to maintain their employment status, workplace productivity and income, daily structure, and an important aspect of their identity.

How we ignore work
Typically, mental health clinicians focus a great deal on their client’s social network, family, and relationship history. Whenever a therapist assesses a new client, it makes sense to also include questions and prompts such as

• Tell me about your work.
• How long have you been at it?
• How long have you been with your present employer? (Or, if self-employed, it’s important to learn about the client’s business, exploring how it’s doing financially, who else is involved, how important work relationships are faring, what number of hours the client puts in, how their schedule affects others with whom they live, etc.)
• How are things between you and your supervisor? How about between you and your co-workers?
• Tell me about your work environment: What’s good about it? How is your work helping you to do as well as you’re doing right now? Have you noticed any changes in your work performance and productivity?  What kinds of changes might make things at work better for you?”

Unfortunately, these questions are not always asked, so important discussions don’t happen. Without such exploration, the therapist gains little understanding of how work may contribute to the current challenges facing their client and how it may also play a role in their healing.

How work can be integrated into treatment
Even in cases where the workplace is a primary source of anxiety, there still may be benefits that argue for a continuation of work at some level. A complete separation from the work environment may not be the best solution. We know that the longer people stay away from the workplace, the more they feel disconnected from it. The value of a daily routine and the emotional satisfaction derived from working should be considered in every treatment plan.

At Prudential, we have a Return to Work/Accommodations program for employees experiencing health challenges and we encourage those who are on disability to talk with their treating clinicians about the relevance of workplace accommodations. A workplace accommodation changes some aspects of the way an employee performs his or her job in order to help them continue to perform the essential functions. The accommodation allows them to continue their treatment and recovery without losing their identity as an employed person.

For example, if work can be performed remotely, we ask the manager of that employee if their business can function with the person working remotely for a period of time. If an employee suffers from an anxiety disorder and has been overstimulated by their current work setting, we might move their cubicle, desk, or office to a quieter location. Sometimes people struggling with a mood disorder find that they are better able to work at particular times of day. A flexible schedule, shifting work hours toward a later start time, for example, may prove helpful.

Our Return to Work/ Accommodations program acts as a confidential bridge between the employee working with her or his mental health service provider and the employee’s supervisor. The accommodations team takes information from the former and shares only functional requests with the employee’s supervisor. After all, a supervisor has no need to know their employee’s diagnosis. They only need to know the specific ways in which the employee’s work situation can be changed to help that employee return to or remain at work.

What employees can do
Admittedly, not everyone works for Prudential, and accommodations of this kind may seem unattainable in your own work setting. However, many organizations do offer flexible work arrangements and there is no reason an employee can’t seek one when faced with a medical and/or mental health crisis. For example, an employee who has cancer may work with their supervisor to flex their work schedule around chemotherapy appointments. A similar flexible-work arrangement can be sought by someone managing a mental health condition.

While these may seem like difficult conversations to have and you might think your own work culture just isn’t this progressive, I counter that every culture is dynamic rather than static. We each have some ability to influence our organizational culture. So if you think your workplace isn’t where it ought to be in regard to mental health, perhaps you can seize the opportunity to influence your culture. Seek out an ally or HR contact who can work with you on the challenges you’re currently having completing your job. Then, working with your provider, you can strategize accommodations that would allow you to continue performing the essential functions of your job.

Remember, employers want employees to be healthy and productive, so anything that will help an employee be successful at his or her job is in everyone’s best interest.

Your Turn

• What kinds of workplace accommodations have been helpful for you or someone you know dealing with a mental health condition?
• In what ways do your mental health clinicians foster conversation about work and it’s role in your mental health?
• What things can companies do to help employees living with a mood disorder be successful at their job?