The revelation that Lufthansa Airlines knew about Germanwings pilot Andreas Lubas’ depression prior to his crashing his plane and tragically killing 150 people has sparked outrage that the company should have prevented Lubas from flying. This outrage will no doubt be compounded by recent reports of the pilot having practiced a “rapid descent” that possibly could have been identified by Lufthansa.
Previously, Piers Morgan’s suggestion that “depressed pilots on medication for mental illness should not be flying passenger planes” sparked a different kind of outrage – that preventing depressed people from working is a form of stigma and discrimination. This apparent paradox in the public debate reflects the complexity of employee mental health: How does a business help identify and treat depressed or suicidal employees without stigmatizing and violating their employees’ civil rights ?
On the one hand, businesses should be very concerned and aggressive about addressing depression. The World Health Organization estimates 350 million people worldwide suffer from some form of depression. Further, depression tends to be chronic, with depressed individuals vulnerable to relapse. More depressed individuals often experience no pleasure, have no energy, can’t concentrate, cannot sleep or eat, and predictably have poor performance at work. In fact, depression is now considered the second leading cause of disability worldwide, with many people experiencing severe dysfunction, particularly at work.
Perhaps one of the most tragic aspects of depression is that it carries a risk for suicide. Depression is one of the most common mental disorders among people who exhibit suicidal ideation and behavior, with some studies showing that over 50 percent of those who attempted suicide having a history of depression. Further, depressed individuals do appear to have an increased risk of violence than non-depressed people. Accordingly, businesses such as Lufthansa who do not properly screen depressed employees are at risk for claims of negligence.
As a result, any business leader who cares about his or her business and/or employees should want to screen for and treat depression, and possibly even remove depressed employees from harmful situations. But this is a dangerous trend with a slippery slope. Stereotypes of depression and mental illness are often misguided. Research suggests that less than 1 percent of depressed people actually commit suicide.
Further, while depressed people may be more likely to commit violent acts than non-depressed people, research suggests that only 4 percent of depressed men and 0.5 percent of depressed women commit violent acts. And there is certainly very little evidence linking depression to mass murder akin to what occurred with the Germanwings plane.
More, this misperception of depressed people as harmful or violent has consequences. Research suggests that many depressed people perceive that they will be discriminated against in a variety of circumstances such as work. Stigma and discrimination against people with mental health issues is prevalent and widespread. In fact, evidence suggests that health-care providers and even some mental-health professionals hold stereotypes of people with mental health problems.
This stigma has serious negative consequences. For many people, this stigma prevents them from seeking care. In 1999, the U.S. Surgeon General labeled stigma as perhaps the biggest barrier to mental health care. Research suggests that perception of stigma is significantly related to depressed people avoiding seeking care. Further, as people begin to experience depression, stigma may cause some people to try to avoid, separate from or suppress these feelings, all of which have been linked to the worsening of depression.
So what can be done?
One area in which businesses, employees and advocates should agree is that there needs to be access and support for treatment of depression. Recent legislation holds promise that people with mental health issues will receive care comparable to those with physical health issues. For example, The Affordable Care Act of 2013 expanded upon the Mental Health Parity and Addiction Equity Act of 2008, providing more possibility that mental health conditions will be covered on par with physical health conditions.
We have treatments that work for depression; there is evidence that medications and psychotherapy both have efficacy in reducing depressive symptoms. In the case of more severe forms of depression, combining medication and psychotherapy is particularly efficacious. When considering the effects of depression on health care costs and disability, these treatments are not only efficacious, but also cost-effective.
There is considerable room for businesses to show leadership in this area by not only directing those who struggle with depression to the best resources, but also developing and evaluating creative workplace programs to prevent and manage depression.
It is encouraging that 75 percent of businesses report having Employee Assistance Programs (EAP) that often represent the first and only line of defense against depression for many people. Further, there is evidence that workplace treatment programs, particularly those that implement cognitive-behavioral therapy, can be efficacious in treating depression.
But more can be done. Businesses, schools and the general population need to have a clear, systematic and serious way of managing depression. Perhaps as important as the procedures and structures is the executive “buy-in” — the sense that depression is an important issue for the company and will be dealt with seriously.
Further, clear and firm policies need to be in place to investigate depression. This includes directives on whom an employee should speak with if managing depression, as well as strict investigative and legal policies to protect employees. Human resources and employee assistance workers should be trained to detect and provide the proper referrals for care for victims of depression.
Depression is a serious but treatable mental disorder that can impact well-being and work productivity. The more that we treat depression as a serious issue, the more people will be able to get the help they need.
Workplaces are unique in that they not only represent opportunities to identify and treat depression and all mental health issues, they also set the tone for valuing mental health treatment and de-stigmatizing depression. It is time for us all to help address and prevent this serious public health issue.
By Dr. Michael Friedman
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