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The issue of mental health in the workplace is getting

more and more attention, and rightly so. One in

five Canadians will experience a mental illness in

their lifetime. In any year, 12 per cent of Canadians age 15

to 64 suffer from a mental disorder or substance depend-

ence, at least four per cent suffer from major depression

and three times that many have minor depression. Mental

illness accounts for more than 15 per cent of the burden of

disease in Canada, but gets only about 5.5 per cent of pub-

lic health dollars. And stigma, although on the decline, is

still a big issue.

In the workplace, mental illness is the second leading

cause of disability. Each day 500,000 Canadians are absent

from work for mental health issues and accounts for nearly

30 per cent of disability claims and 70 per cent of total

costs and claims attributable to mental illness have overtak-

en claims associated with cardiovascular disease as the

fastest growing category of disability costs in Canada. Most

mental health problems in the workplace occur in people

who are in their prime working years.

Mental health issues affecting the workplace fall gener-

ally into two categories:

1. Stress and related conditions from the workplace itself.

2. Employees dealing with issues originating outside the

workplace.

In either case, productivity suffers and employees may

either take additional time off or come to work at dimin-

ished capacity.

A study of days per year absent from work, for those

who did and did not report a mental health issue, in

Canada, 2003 showed:

Male Female

Age Range No Mental Mental No Mental MentalIllness Illness* Illness Illness*

20-34 19.63 54.56 28.68 79.01

35-49 27.13 73.65 20.76 72.62

52-64 20.10 57.58 30.60 77.70

*Mental illness refers to a diagnosed condition.

D A V I D M I C H A E L S

Key issues in workplace mental health

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Getting HelpRelatively few Canadians who need mental health serv-

ices get help. One study indicated that only 32 per cent of

those with a mental disorder or substance dependency saw

or talked to a health professional during the 12 months

prior to the survey. The professional most often contacted

is a family physician, followed by psychiatrists and

psychologists.

In Canada, there are about 12 psychiatrists for every

100,000 people, compared with 35 psychologists. Other

professionals providing mental health services include psy-

chiatric nurses and social workers. A lot of mental health

services are provided in the private health sector. If a per-

son sees a psychologist outside of a hospital, they have to

pay, either out-of-pocket and/or through private (often

employer sponsored) insurance. One study showed that in

2003, for people over age 20, almost 500,000 persons con-

sulted a psychologist; over 70 per cent had at least some

portion of the cost paid by private insurance; the rest paid

entirely out-of-pocket.

But there is good news. The chart below shows the

results of patient perceived outcomes for users of mental

health services, Ontario, 2004:

Per cent that Felt Better

Always/ Sometimes/ No/Item Usually Somewhat Never

Feel better prepared to deal with daily problems 49.4 40.1 10.1

Feel more ready to participate in usual activities 40.1 39.2 20.7

Feel helped by mental health services 70.0 25.4 4.6

Workplace ResponseIn general, the response from business and industry to

workplace mental health problems has not been adequate.

Much has fallen to Employee Assistance Programs (EAP).

While an EAP may be appropriate for certain items, when

it comes to mental health care for employees, EAP’s do not

go far enough. EAP’s may best work as a short-term way

for employees to enter the mental health service arena, but

they are not set up to effectively deal with many issues.

Depression is one of the most prevalent mental health

conditions, in and out of the workplace, and while medica-

tion is often a big help, psychotherapy is also very benefi-

cial, often in combination with medication. One of the

most widely accepted interventions showing excellent

results is Cognitive Behaviour Therapy (CBT), often done

over a course of 12 to 16 sessions. However, most EAPs

allow for only a few visits in any one year (often four to six)

or a few visits for any one condition.

Another shortcoming of EAP’s is they often only use cli-

nicians who are not trained or able to offer treatments such

as CBT. But EAP’s can refer depressed employees to other

facilities and/or service providers; the issue then comes

back to availability of professionals and cost. Still, EAP’s

should be aware of local resources and at least be able to

screen those who present with depression and/or other

mental health problems.

Health benefits offered by the workplace are also large-

ly inadequate for dealing with mental health. Many plans

do not cover psychological services or don’t give enough

coverage to allow for a proper course of therapy. Another

issue with health benefits plans is that coverage for “other

professionals,” usually referred to in those plans as “para-

medical” providers, often lump these disciplines with a cap

on services each year. Services from a psychologist may be

covered under the same umbrella as services from

optometrists, physiotherapists, chiropractors, etc., with a

limit of perhaps $500 per year.

Going ForwardThe current situation with workplace mental health

mirrors mental health in Canada generally. Those with

mental health issues face difficulty accessing services as not

a lot is covered by the public health system. Also, there is

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the issue of stigma; many people fear what others will

think. A lot of people are not aware of the fact that current

approaches to dealing with mental health conditions show

excellent results.

In the workplace, two of the most common ways of

addressing the issue, EAP’s and health benefits programs,

have significant limitations. And of course, offering more

under benefits plans, even though there may be a longer-

term payback, has short-term cost implications which busi-

nesses are not likely to assume, especially in the current

economic climate.

Employers can take some proactive approaches to deal

with mental health in the workplace, including education.

Workplaces can link with resources in the community,

whether directly or through their EAP.

Being aware of issues, ensuring a workplace that doesn’t

stigmatize, educating, and promoting optimal mental

health, are good places to start. .

David Michaels is the CEO at The Clinic For Emotional

Wellness Inc. in Vaughan, Ontario. David holds a Master’s

degree in health administration from the University of Toronto

and experience in government, public and private health care,

including over 16 years as the Administrator of one of Canada’s

largest children’s mental health centres.

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