The Cost of Ignoring Mental Health

Businesses are destigmatizing behavioral care and adopting strategies to add billions in productivity

By Clary Estes

Editor’s note: This is the first in a three-article series examining behavioral health issues impacting business.

More and more Kentucky businesses are realizing that investing in their employees’ mental health is good for the bottom line. There are myriad ways a company can begin addressing the mental health needs of their employees, but ultimately positive change starts in the office.

While the 40-hour workweek is the American standard for full-time employment, a 2014 Gallup Poll found many of us are spending considerably longer periods of time at the office. According to the poll, 42 percent of Americans spend the allotted 40-hours a week at the office, while another 50 percent are spending considerably more time at work, with 18 percent of employees spending 60-plus hours weekly on the job.

For many, work is not only a source of identity, it is also a primary source of socializing as well as stress. Thus, to combat mental illness in Kentucky workers, the office is a natural place to start.

In Kentucky, the number of mentally unhealthy days ranges from three to seven days per month, according to Foundation for a Healthy Kentucky’s kentuckyhealthfacts.org; that is 36 to 84 days per year, with the most mentally unhealthy areas concentrated in Western Kentucky’s coalfields region and the Eastern Kentucky mountain region.

“Kentucky is not much different from a lot of states in the United States” regarding mental health, said Courtney Keim, an industrial organizational psychologist and volunteer with the Kentucky Psychological Foundation.


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Kentucky ranks 22nd for good overall mental health but only 32nd for good mental health in adults, meaning the prevalence of mental illness increases as residents age.

Kentucky ranks exactly in the middle – 25th –  in access to primary care, with an average 1-to-67 clinician-to-patient ratio. This worsens to a 1-to-177 ratio for mental health services, though. For many new patients, there is a three-month wait to see a therapist for the first time, leaving the mental health issues they are trying to address to simmer.

The burden of poor mental health in the workforce is costing both companies and their employees. According to the National Alliance on Mental Illness (NAMI), serious mental illness costs America $193.2 billion in lost earnings per year.

An estimated 30 percent of employees experience mental health problems each year, with the nation losing 80 million cumulative workdays per year due to anxiety and depression. Mental illness and subsequent substance abuse costs American businesses an estimated $225.8 billion each year, according to a study performed by Dr. Walter F. Stewart in 2002.

Investing in employees’ mental health is a sound long-term investment. But how can companies identify and combat these issues?

Industrial organizational psychology research has identified four main toxic situations in the workplace that lead to increased mental health disorders among employees:

• a combination of job strain and low control over decision-making.

• an imbalance of effort versus reward.

• lack of support from colleagues and/or employers.

• feelings of job insecurity.

A combination of job strain and low control over decision making comes about when an employee is overburdened with tasks, but lacks the autonomy to make decisions over how and at what pace they complete those tasks, or even how many tasks they take on. This can lead to rapid burnout and a disconnection from the value of one’s work.

The combination of job strain to low control frequently goes hand in hand with the second issue of imbalance of effort versus reward, meaning that despite an employee putting in a huge amount of work and effort, they receive little to no acknowledgment for their efforts or time.

These issues usually lead employees to feel easily replaceable or as though they are disposable cogs in a machine rather than valued and indispensable parts of a company moving forward together to achieve and thrive. When employees lose their personal stake in a company, there inevitably comes a higher turnover rate, resulting in less stability and lost profits due to the company having to invest in new hires and increased training hours. Furthermore, if the issue itself is never addressed, the rotating door of new hires never stops and instability will continue.

Lack of support from colleagues and/or employers can manifest in a variety of ways, leading to feelings of isolation, which can in turn lead to severe depression within the workplace.

Another manifestation of this problem comes about when an employer or supervisor takes on a “my way or the highway” approach about work. When employees cannot contribute ideas for work or development, they quickly lose their stake, or even interest, in the well-being of the company and its long-term development.

If companies deter the constant and cooperative exchange of ideas, they are at a higher risk of intellectual stagnation. The key to innovation, and a cornerstone of American business, is the development and exchange of ideas. If companies invest in the ideas of their employees, they are more likely to thrive.

Lastly, the issue of job security may come about independently or as a result of the three other toxic workplace characteristics. Poor job security can actually come about as a result of a combination of job strain and low control over decision-making, an imbalance of effort versus reward and a lack of support from colleagues and/or employers – and may exacerbate mental health issues among employees.

Bad workplace costs: indirect but high

Since all of these toxic characteristics contribute to the degradation of workers and the instability of company structures and hierarchies, it would follow that the natural progression of these issues would lead to a company’s lower performance in the market and decreased job security for employees.

Together these four toxic characteristics are the legs that hold up the table of increased risk of mental illness for employees as a result of the workplace. And if the core issues of mental illness are not addressed within the workplace culture, the company will not be able to sustain itself in the long run.

There is further cause for prioritizing the development of workplace cultures to address mental illness.

“Your brain is an organ in your body and is not separate from it,” said Keim, the industrial psychologist.

For generations, the stigma of mental illness came about due to its relative imperceptibility. Yet, while the physical signs of mental illness can be and often are missed in the short term, they eventually show themselves in the long term.

“We also see the hidden costs (of not providing proper mental health care and healthy work environments),” Keim said. “We know, again from research, what stress does to the body and we know that long-term chronic stress on the body leads to things like heart disease, and it can lead to an increase in mental illness diagnoses.

“For example, if you went camping and all of a sudden a bear (appears), your body is going to activate that fight-or-flight response, and all the adrenaline and cortisol is going to start pumping to get you ready to fight the bear or run away from it. The problem is that your body doesn’t really differentiate between a bear in the woods and your boss yelling at you or being worried about getting fired. The same fight-or-flight response gets activated. It’s not as acute, but if it’s daily, chronic and long-term, the cortisol hormone getting released in your body over time builds up in your arteries, which can lead to heart disease and can take a toll on your autoimmune system. Eventually the organization is going to have to pay for that, and its health-care costs are going to increase because its employees are going to be sicker and have to go to the doctor more.”

‘Presenteeism,’ burnout, illness

But the issues do not stop there; the productivity of businesses is also affected on a fundamental level by mental illness. If left untreated, mental illness among employees can result in absenteeism or employees missing days from work as a result of illness. There’s also the often-overlooked counterpart of absenteeism, presenteeism, which occurs when employees work while sick, resulting in little work being done, increased poor health and exhaustion.

In many ways, presenteeism is a more insidious problem for businesses. It is less apparent, but can exacerbate already developed mental illness and promote more rapid burnout.

However, there is light at the end of the tunnel. There are a number of ways companies can create healthier workplaces, and they all come back to one idea: The workplace is as much a community as one’s home, family or neighborhood and to have happy and productive workers, you must have a healthy and supportive work community.

“Because of the stigma of mental illness, it really gets back to the culture of the organization. What is the culture? What is the climate in the organization? Is it one in which people feel safe and trusting of each other to be able to reach out for help? It’s a top-down (model of leadership.) I’ve seen some organizations that do very difficult work, but their employees feel they are supported,” Keim said.

“They feel like they can reach out and ask for help, and that’s because they see their managers, the executives, even the CEO of the organization doing that as well. Not just talking the talk, but walking the walk. They are themselves taking vacation and totally detaching from the job. (Employers) are leaving at 5 or even at 3 to go pick up their kid or to be a participant in some nonprofit, volunteer organization. So they’re taking advantage and utilizing all of those resources that may be available – not just offering them but using them. You need to have a CEO who’s open and honest about issues with their own mental health, who advocates for other people in the organization to go and get mental health treatment, and you’re going to see the employees doing that as well. So it really is looking at if the culture or the climate is or isn’t supportive of health and wellness.”

One cornerstone for promoting good mental health in companies is employee appreciation that is conveyed in a genuine way. While many companies may have employee appreciation measures put in place, if those measures are not genuine they threaten to promote ire in workers, rather than a sense of ownership.

Speaking publicly about why an employee is important to a company goes many steps further than simply stating, for example, that an employee has done well without going into much detail, or giving standardized symbols of merit to each employee without variation.

Another method for improving mental health in the workplace is by reducing ambiguity in employee and employer roles. When an employee is unclear about their responsibilities, scope of work, amount of autonomy or level of power within the company hierarchy, productivity plummets.

Teamwork and collaboration are also great ways to combat burnout and isolation in employees. When employees and employers feel that they are a team moving forward together, camaraderie develops. Companies do well to promote a ‘we did it’ mentality over an‘I did it’ mentality. It is equally important to develop a sense of teamwork and community in companies as it is to promote an employee’s sense of their own worth within that team and company structure.

Another key need for employees and employers is good work-life balance. By encouraging a good balance between work and home, companies may be able to reduce the number of mental-illness triggers outside the workplace such as family strain, fatigue, lack of hobbies or interests, etc.

In promoting workplace wellness, employers must lead by example when it comes to employees taking full advantage of company benefits. If an employer is not taking their full vacation time, an employee is less likely to as well. If an employer is staying until 10 p.m. at night in the office, employees are less inclined to leave by the standard 5 p.m. Employees are mirrors of their employers. An employer who prioritizes good mental health practices in themselves fosters that same care in their employees.

There are a number of Kentucky businesses that go above and beyond to promote a positive workplace culture and sense of community in their businesses.

For example, Passport Health Plan, a nonprofit, community-based HMO that administers Kentucky Medicaid benefits throughout the state, has been nationally recognized for its healthy workplace practices. The cornerstone of these practices is the company’s Passport Cares program, a company-funded emergency assistance program that employees can apply for if they are experiencing financial hardship due to a natural disaster, illness or other catastrophic circumstances beyond their control.

According to the American Psychological Association’s description of Passport in its news release for the awards ceremony, “The culture at Passport has a direct bearing on how its customers – members, providers, government officials, advocates and the community – perceive it. Among its offerings are a comprehensive wellness program, behavioral health services, healthy food deliveries and a peer-to-peer recognition program. Since embarking on its ‘cultural change’ program, the organization has enjoyed higher staff job satisfaction and increased productivity. Looking to promote from within, Passport has had 76 internal promotions within the last two years.”

“One thing that we continuously monitor and track is employee engagement,” said Liz McKune, Passport’s vice president of health integration. “We tried really hard to focus on communication so that everybody feels informed in the organization and can always be challenged. And so we have worked to try to foster stronger communication.”

When the company went through a significant change as a result of an alliance they built with Evolent health two years ago, there was a risk of role ambiguity and feelings of job instability for employees. By keeping the communication lines open, monitoring employee engagement and continually removing role ambiguity for employees, Passport Health was able to address mental health triggers before they had an opportunity to take root in the company.

As a result of such efforts, Passport Health has become a satisfying and fulfilling place for its employees to work.

As Kentucky businesses move ahead in the 21st century, developing a positive workplace culture can give the state’s entire economy an edge. More workers will want to move to and invest in Kentucky. Kentucky businesses will promote more innovation and creative development, giving the commonwealth an edge nationally and even internationally. And with a healthier workforce, health-care costs will go down, opening up new revenue sources across the state.

The stigma of mental health is still an acute issue in the United States, as well as Kentucky, but more and more commonwealth businesses are realizing that to get ahead in the market, investing in employees is the best way to move forward.


Clary Estes is a correspondent for The Lane Report. She can be reached at [email protected]

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