Posted by dj... on January 3, 2000, at 3:05:11
November 7, 1999
Pitfalls in Treating Workplace Depression--------------------------------------------------------------------------------
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--------------------------------------------------------------------------------By BARBARA WHITAKER
sk an experienced manager about the "reasonable accommodation" that employers must provide under the Americans With Disabilities Act, and you are likely to hear about wheelchair ramps, Braille signs in the elevator and other physical changes to assist workers with physical handicaps.
But what does "accommodation" mean for workers suffering from depression? The question nettles employers across the country.
Depression, of course, is not simply the blues. It is a clinically defined mental disorder that is estimated to affect roughly 1 in 10 Americans over the age of 18, sapping their energy, impairing their concentration and making them prone to mood swings and unexplained absences. Add up the work time lost to the illness and the medical bills for treating it, and by some estimates depression costs American employers $36.2 billion a year.
Yet in many a workplace, depression is regarded as a character flaw rather than a treatable illness, and some employers follow what amounts to a don't ask, don't tell policy, implicitly expecting workers to soldier on in silence or be stigmatized as "not up to the job," said Thomas W. Croghan, a research physician with Eli Lilly & Co. and an associate professor at Indiana University.
Such attitudes are part of the reason that the government gets more disability-act complaints from workers with emotional or psychiatric impairments than from workers with any other kind of disability. In preliminary figures for the federal fiscal year ended Sept. 30, 2,681 of the 17,014 complaints filed with the Labor Department concerned emotional or psychiatric impairments, and almost half of those -- 1,278 -- involved depression.
For managers, failure to grapple with the problems of depressed employees is economically shortsighted, experts say. Several academic and corporate studies have found that getting depressed workers into treatment is cost-effective because the workers' restored productivity, even if not 100 percent, still outweighs the cost of treatment. "It'll probably cost you more if you don't address it," said Thomas J. O'Connor, director of PRS Disability Management, a Falls Church, Va., consulting firm that provides return-to-work assistance for professionals with depression.
Dr. Daniel J. Conti, director of the employee assistance program at Bank One in Chicago, related an example at his company: An information systems manager whose job kept him on the road almost constantly went on disability leave because of depression. When he wanted to return to work, he was told by his doctor that he would not be able to travel.
At first glance, there seems to be no solution, Conti said. But a disability coordinator in the program had been monitoring the manager's treatment during his leave and had kept in touch with both his physician and his work supervisor. The case manager was able to win agreement from both on a reduced-travel schedule for the employee, with an eye toward a gradual increase back to the pre-leave level.
"We got the person back to work earlier in an accommodated fashion" than would otherwise have been possible, Conti said, "and my bet right now is that this person will be able to stay at work."
In a tight labor market, retaining workers, disabled or not, is a high priority. "People can't afford, given their investment, to throw someone away and get someone new," O'Connor said.
But when it comes to depression, he said, the disabilities act has led employers to focus too much on the risks they face.
"They are walking on eggshells, so they look toward the safest way to deal with it, risk management and compliance," he said. "We want employers to embrace employee management."
In Bank One's case, integration of the employee assistance program with the company's human resources and benefits departments makes it easier for the program staff to help managers cope with difficult situations.
In the name of privacy protection, though, some companies prefer to keep more distance between employee assistance programs and other departments.
Still, applying the law to depression remains a problem for employers and employees alike. Attempts by the Equal Employment Opportunity Commission to clarify how depression fits in under the law have failed to resolve some important issues.
"As it is now applied, the ADA only partially accommodates the needs of depressed workers," researchers concluded in a recent study published in the September-October issue of Health Affairs, a journal of health policy.
The study found that a growing number of employers believe that they should encourage a worker with depression to seek treatment, but that they often hesitate because of concerns about how to approach the employee. And they are not sure what the law requires, an uncertainty that employees share. Especially blurry is whether the act applies in cases where medication can keep symptoms of depression in check.
"The law is unclear as to where the need to accommodate ends," said Croghan, the Lilly research physician, who was an author of the Health Affairs article.
Experts point to a recent United States Supreme Court decision in which two airline workers whose impaired vision was correctable were found not to be protected under the law. The courts might apply the same reasoning, the experts say, to depressed workers.
"Depression is extremely treatable," said Peggy R. Mastroianni, associate legal counsel for the Equal Employment Opportunity Commission. "To the extent that these cases give them less protection, it is a concern."
But, Ms. Mastroianni said, depressed workers may find that they still have protection under the ADA if they have a record of disability or if their medication creates side effects that hamper their performance.
Chai Feldblum, a law professor at Georgetown University Law Center who helped write the disabilities act, said the Supreme Court ruling meant that "greater attention will be given to the absurd Catch-22 created by this law."
Ms. Mastroianni said the commission expected to issue more guidelines on depression soon. Whether or not they turn out to be helpful -- some consultants say the commission's past efforts have only muddied the waters -- they are further evidence of heightened awareness.
"I think many companies are still struggling with the how-to of dealing with depression in a proactive way," said Gregg O. Lehman, president of the National Business Coalition, which provides information to employers on how to buy health care coverage for workers. "But increasingly, companies are embracing the fact that we have to do something."
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