28 Nov Mental Health: a leader’s guide
Early thoughts on a new test of leadership
The pressure is on for leaders to understand and manage the mental health risk. This complex topic will test our leadership skills. Three forces of change are driving this pressure and they are accelerating:
- Mental health problems are becoming much more common
- Health and Safety legislation clearly articulates a duty of care for mental health
- The way we work today is disrupting our wellbeing – physical, emotional and mental
Disaster mitigation and physical safety presents a direct, tangible threat we can engage – identify, prevent and minimise. Objective, measurable and simple. We are making progress.
Mental health leadership is obscure, subjective and messy to engage – uncomfortable, complex and threatening. The prevalence of mental health issues is rising fast and we have barely started. Some leaders may question their own sanity.
In the past, we could say that “he or she has a screw loose” and dismiss the problem to a specialist. This is no longer acceptable nor viable. Leaders will have to get their heads around the topic and work out how to manage the consequences skilfully.
Increasing Rates of Mental Illness
With alarmist reports in popular press and solid science to support it, we have to accept an increasing number of challenging behaviours, diagnoses, treatments and management issues as a consequence of what is called mental illness. In particular, leaders must understand the range of presentations:
- Attention Deficit and Hyperactivity Disorders (or adult attention deficit)
- Social anxiety disorders including Autism Spectrum Diagnoses
- Anxiety disorders including “stress”
- Hostility disorders including impulsive outbursts of anger and destruction
- Depressive and mood disorders
- Alcohol and other substance abuse
- Schizophrenia, Borderline Personality Disorders, Bipolar (mania) Disorders and Narcissism
Basic Medical Overview
Incidence is the probability of a disease. Prevalence, more helpful, is a measure of the condition at a point in time. It is measured as the number of people with depression out of the population. At present, just over 300 million people suffer from both depression and anxiety (World Health Organisation, Depression and other Common Mental Health Disorders, 2017). This is a rate of 4.4% for depression and 3.6% for anxiety. Both are more common amongst females. Depression increases with age while anxiety reduces with age.
Remember that these numbers are based on strict criteria and diagnosis. When experts discuss anxiety, figures closer to 20% are quoted (Anxious, Joseph Le Doux, 2015) and depression figures are closer to 10%, with only half being treated. Chronic stress at work is closer to 80% (American Institute of Stress, 2017 https://www.stress.org/workplace-stress/), with significant regional and country differences.
A Framework to Understand Mental Suffering
Over the 20 years of our work we assess resilience through both the prevalence of healthy functioning and unhealthy functioning. We believe this is a very helpful way for leaders to understand how people cope under pressure.
We group resilience failure under four main headings:
1. Pressure Disorders
Pressure disorders are primarily cognitive. They start with overload and confusion which can result in cognitive failure – disengaged, attention disorders and distraction.
- Excessive workload or complexity
- Long hours, shiftwork and travel
- Poor sleep, nutrition, illness and pain
- Morally challenging leadership behaviour
- Excessive demand, performance anxiety through to bullying
2. Emotional Distress
Emotional reactions follow failure to achieve or to connect effectively with others. In withdrawal, we feel isolated and retreat. In vulnerable we lose the power of positive emotion to motivate and fall prey to negative emotions of sadness, anger and fear.
- Been seen to fail or feeling as if we have upset others
- Limited support and love at home
- Social anxiety through to Autism Spectrum Disorder
- Peer group pressure
3. Mental Distress
Mental distress starts with what we call distress (chronic stress). This is most often identified with physical symptoms such as tension, respiratory, cardiac, abdominal or skin disorders. People feel overwhelmed by pressure and experience anxiety and worry. This may progress into mild depressive symptoms dominated by sadness.
- Distress symptoms – body, sleep, weight
- Emotional outbursts – tears, panic, anger
- Hyperventilation – sighing, breath-holding, mouth breathing
- Health issues may be present
- People may present as “not coping”
Under pressure impulse control disorders, often associated with anger or hostility, are much more common.
4. Psychiatric Diagnoses
Depression, diagnosed as unremitting sadness, loss of confidence, confusion, appetite and sleep disturbance for two weeks is the most common. Suicide takes 800,000 lives per year and depression has a massive cost to productivity.
Leaders must consider:
- Sadness, low self-worth, guilt, hopelessness and tears
- Confusion, poor memory, decision-fatigue
- Sleep disturbance – early waking and oversleeping
- Appetite and digestive disorders
- Irritability, anhedonia (loss of joy), agitation
Alcohol and substance abuse is also common and can present in many ways. Schizophrenia affects roughly 1%, as does bipolar disorder. These can manifest as psychotic episodes. Borderline personality disorder, narcissism and antisocial disorders.
Leaders have a duty of care to notice when resilience fails amongst their reports. Noticing these signs and considering what one can do appropriately to stimulate bounce is very effective.
For example: at Confused simplify priorities and give people a clear goal. At Disengaged understand how to establish rhythms, breaks and rejuvenation disciplines. At Withdrawn, reach out to a person and be sincerely interested. However, a leader’s job is not to be a psychiatrist.
While a better understanding and skilful bounce reinforcement is effective, it is important to know where skilled help can be found. That may be through human resources, EAP, coaches, psychologists or medical specialists. Our experience is that many leaders do not follow up. When someone is referred to expert help it is important to know that the event actually happened, how it is followed up and preferably some measures on how things have improved.
When one of your team is struggling with a mental health issue it can be unsettling. Be brave and meet with confidence. You are an important aspect of recovery.
- Be clear about time, location and agenda – give people time to prepare
- Be really clear about the boundaries of your role, business needs, and the time lines for recovery
- Listen carefully and question skilfully
- Affirm emotional needs explicitly.
- Appreciation (thank you for meeting, your work is appreciated)
- Affiliation (you are a key part of our team, we want to work with you)
- Status (your job and contributions is highly valued and important)
- Role (we know you have worked hard and enjoyed your role)
- Autonomy (ultimately the decision is yours)
We are seeing increasing distress amongst leaders who, while dealing with demanding roles, are taking perhaps too much of a supportive role with team members who may be suffering. The world of work is tough. Leaders must remain strong and resilient themselves. If we become too involved in the suffering of others we may suffer what is now termed empathic distress. The leader takes on the suffering of the team member. This will render you ineffective as a leader and will compromise both effective empathy and skilful support.
As we deal with more distress in the workplace, leaders need to step up to and take much better care of their own physical, emotional and cognitive resilience. Implementing a daily routine to support and sustain resilience is essential.
- Master your day – how to create routine that works for you
- Grow leadership expertise – discipline, rhythm and innovation
- The professional’s pain – gain insight and take action
- The Resilience Diagnostic – assess workplace mental health