Improving ROI With Attention To Mental Health

MENTAL HEALTH AND THE WORKPLACE New Approaches To Wellness That Help ROI by owen aShton, Cpa, CpSS

Jolting feelings struck my chest as I was driving home from work years ago. “Is this a heart attack?” I asked myself. I immediately changed direction to a hospital emergency room. Tests showed my heart to be quite healthy. “You have a very small chance of having heart problems over the next 10 years,” the doctor said. That was a relief, but what about those strange chest sensations? With the help of my wife, Becky, I determined it had been some kind of stress attack. I had a history with anxiety problems. Becky suggested they were likely related to work. I often felt like my job was in jeopardy. My boss at headquarters (on the other side of the country) liked to keep me on edge — a strange management style, I thought. On another afternoon, I became silently so upset at how he treated me during a telephone call that I left our offices and drove around for a few hours to calm down. I knew I should not let outside circumstances control how I felt. I sought counseling to help me develop healthier thinking habits. Perhaps you have experienced job stress like this.

I’m sure I precipitated lots of stress in those working under my direction. Many years ago, there was a young man who fell asleep during meetings on multiple occasions. Also, his follow-up on assignments was quite poor. Rather than meet with him one-on-one to address these issues, I gave him a bad time, and he left the organization. Perhaps he had a sleeping disorder and I could have provided support to resolve the issue. Perhaps good follow-up skills were something he just hadn’t been exposed to but could have been taught.

Another woman I hired had a difficult time understanding the mathematical concepts behind the economic value added model that I had developed for the company. Rather than spending time with her to walk through the mathematical underpinnings, I treated her with contempt and probably made her feel stupid. She wasn’t, but she left.

When workers feel mistreated, misunderstood, or otherwise abused, this can cause trauma and can lead to adverse effects on individual functioning. Further, individuals who are predisposed to depression, anxiety, and other mental health conditions (and aren’t we all at least sometimes in our lives?) can be triggered so that these conditions are exacerbated, which also leads to poorer functioning. Unsupportive or hostile work environments not only put a burden on individual workers — or perhaps is traumatizing for the individual — they also burden productivity and organizational success. More and more research shows that these mental health matters significantly impact the organizational financial performance. This is because an organization’s workplace culture — and how that translates to how it feels to work there — is an amalgamation of the words and actions of all work associates, particularly of senior leaders as they set the example and the tone. They also make decisions that impact how easily workers can get professional treatment to help recover from mental health conditions. Treatment works! Untreated mental health conditions place an unneeded burden on everyone.

I would not want to give the impression that individuals with mental health conditions are prone to be burdens on organizations. To the contrary, many are distinguished contributors. Nassir Ghaemi, a respected professor at Tufts University in Boston, writes that history

demonstrates that dealing with mental health challenges helps build realism, resilience, empathy, and creativity in leaders. Think Lincoln, Gandhi, and Churchill. So, workers may need help in dealing with mental health challenges, but they also may be among an organization’s strongest contributors.

Studies show the notion that leaders must balance between the human element and the bottom line is a false choice. Rather, investing in workplace mental health shouldn't be viewed as too ethereal and touchy-feely for hard-nosed, bottom line-oriented CPAs and corporate finance leaders. It is a matter that needs serious attention. It should be more than a temporary focus during this especially stressful time of a pandemic.

Deloitte Study Long before COVID-19 hit, some organizations were investing significantly in workplace mental health. In 2019, Deloitte Canada published a whitepaper entitled, “The ROI in workplace mental health programs: Good for people, good for business.” The paper reported that Bell Canada, with 52,000 employees, launched a mental health initiative in 2010 which had resulted in a $4.10 return for every dollar invested. And yes, that’s Canadian dollars.

The Deloitte paper reported that a study of the stock performance of S&P 500 Index companies showed that over a six-year period, companies with high health and wellness scores appreciated by 235% compared to the overall index appreciation of 159%.

ROI improves via better employee performance. Companies with a focus on mental health show less absenteeism, turnover, and presenteeism. Further, costs for healthcare benefits and disability claims decline. In a survey by Mind Share Partners, 60% of employee respondents said that their productivity at work was affected by their mental health. They reported difficulty concentrating, avoiding social activities, difficulty thinking, reasoning and deciding, taking longer to do tasks, and less responsiveness to email and other communications. The survey stated that depression costs U.S. companies on the average $5,500 per year per person in productivity losses. mental health I can relate to this. As I’ve aged, I find it more difficult to push through workdays when I am mentally not feeling well. I recall arriving at work feeling awful. I didn’t want to miss too many days, so I gutted things through. I had two goals: 1) Survive the day until I could go home to bed, and 2) Not let on to anyone how awful I felt and how unproductive I was. Back in those days, I was the poster child for presenteeism.

The Deloitte report states that millennials tend to be more anxious and less optimistic than their elders, in a large part due to the pervasiveness of bad news via technology. Accordingly, the need for leaders to pay attention to the mental health of their workers is becoming more acute.

Some prefer the term “mental fitness” over “mental health.” They see “mental fitness” as broader — meaning a state of well-being and having a positive sense of how one feels, thinks, and acts. The term “mental health” to some is scary and “only applied to other people.”

So what does a focus on mental health, or mental fitness, look like? Efforts often include:

Leadership Buy-in and Training

Any meaningful change must come down from the top. Leadership that promotes mental health must be modeled by senior leaders. Organizations that have shown the best return typically have mental health as a top priority for leadership training. Topics include emotional intelligence, fairness, integrity, how to support psychological health and safety, communication, collaboration, problem solving, and conflict management. The leadership embraces a trauma-informed approach, as described below.

Mental Health Treatment Coverage in Company-Provided Health Plans and Employee Assistance Programs

Organizations ensure that their benefits plans include mental health treatment resources with low out-ofpocket costs that encourage employees to get help. They also provide high quality employee assistance programs that are easily accessible and responsive to employee needs.

Employee Awareness About Mental Health and Anti-Stigma Campaigns

In the 1990s and early 2000s, a 15-year period over which I received counseling for depression and anxiety, I never once submitted a claim for reimbursement to my employer’s medical benefits plan. I was afraid that if my supervisors knew about my mental health conditions, it could be career limiting. I once sat in an informal meeting with the COO of a smaller organization when he disparagingly referred to issues of the CEO’s children that he knew about through his review of medical claims. Can you imagine the fear that triggered in me?

Right now may be a great time for organizations to consider increasing their focus on mental fitness. Multiple resources to help have emerged recently.

Salt Lake Chamber of Commerce and Utah Community Builders In October 2020, the Salt Lake Chamber's nonprofit foundation, Utah Community Builders, launched its "Workforce Resilience Through Mental Fitness" initiative. Clark Ivory, CEO of Ivory Homes, and Lisa Eccles, President and CEO of the George S. and Dolores Dore Eccles Foundation, hosted the launch event. This campaign will provide Utah business leaders with information, tools, and resources to improve the mental fitness of their employees, thus elevating the mental and emotional resilience of Utah’s workforce, and by extension all Utahns.

In that launch event, Johnny Hanna, CEO of Homie, related his personal story of seeking therapy for mental health challenges. He shared his experiences openly and said that this has improved the well-being of many in his organization. “As a society, we have neglected our minds. We have normalized personal hygiene and keeping physically fit, but we have ignored our mind and being mentally fit," he said. “I know as leaders we have an obligation to lead on issues like this. ... I hope you can join us in helping to eliminate the stigma by being a vulnerable leader and by introducing mental fitness principles to your coworkers.” About 10 years ago, I decided to write and publish a book about my journey to recovery from chronic depression and anxiety. For many years, I was unaware of my situation. My dear wife saw things in me that I didn’t and encouraged me to begin counseling. As noted above, I continued psychotherapy on and off over several years. It helped me get to a much better place, and this was exhilarating! I felt for other individuals who were still stuck — perhaps unknowingly as I was — and I wanted to help them.

I contemplated how going public about my journey would impact my career. I feared that I would no longer be hirable for positions in corporate finance management. I decided it was worth it. Since then, I haven’t tested the waters in corporate finance; mental health advocacy has been my career. But can you imagine the thrill I feel to see the Salt Lake Chamber take up this initiative and for the CEO of a respected Utah company to openly tell his story? Room Here In 2019, multiple tragic suicides rocked Utah's high tech business community. There was a feeling that a better conversation around mental health was needed. This was addressed last summer by Trent Mano and Rachel Merrill as they launched Room Here, a 501(c)(3). Their website encourages organizations to make a pledge to promote mental fitness by taking these steps: 1) Measure the company’s mental health culture, 2) Make a clear plan to improve, and 3) Share what is learned with the community. About 100 organizations have signed the pledge! Visit Roomhere.org for business and community resources. Trauma-Informed Utah A major study undertaken in the U.S. by Kaiser Permanente and the Center for Disease Control in the 1990s found a strong correlation between traumatic events during childhood called adverse childhood experiences (ACEs) and lifelong negative outcomes. ACEs include various kinds of abuse as well as parental substance use, divorce, incarceration, mental illness, and domestic violence. The survey asked participants to identify which of 10 specific ACEs they had experienced before the age of 18. The researcher then compared

those to negative outcomes later on in life for the study participants. They found a strong correlation between higher scores of ACEs and physical and mental health problems, suicide, career struggles, unstable family relationships, poverty, and homelessness.

A similar study was undertaken in Utah a few years ago. It found that individuals who scored zero ACEs had an occurrence of chronic depression of 15% while individuals with four or more had an occurrence of 45%. Further, of those individuals with a zero ACEs score, 7% experienced chronic obstructive pulmonary disease (COPD) compared to 17% of those who scored four or more. The correlation on family economics was also significant. While only 10% of Utah’s general population has ACE scores of five or higher, 46% of the individuals receiving financial assistance from Utah’s Department of Workforce Services scored five or higher.

Incidentally, I scored 4/10 on the ACE test, which, I believe, is a major factor in my experiencing chronic depression and anxiety. Fortunately, many positive mitigating factors shielded me from being more impacted.

With these findings in mind, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) concluded that addressing trauma was key to reducing and treating mental health conditions. Accordingly, it developed an approach that is called Trauma-Informed Care (TIC) or the Trauma-Informed Approach (TIA). Here are the six key principles SAMHSA outlined:

Safety — Every individual feels physically and psychologically safe

Trustworthiness and transparency — Operations and decisions are conducted with transparency to build trust among all stakeholders

Peer support — Individuals with lived experiences with trauma are available to provide mutual support

Collaboration and mutuality — Partnering and the leveling of power differences between staff members help establish more meaningful relationships from top to bottom. mental health Empowerment, voice, and choice — Individual strengths are recognized and built upon

Cultural, historical, and gender issues — The organization recognizes and actively addresses past stereotypes and biases

Many believe that TIA should not be limited to the area of preventing and treating mental health conditions. On the contrary, it’s believed that these principles should be adopted throughout healthcare, in education, in parenting, and in business.

To this end, in 2017, Gov. Herbert and the legislature designated Utah as a trauma-informed state and encouraged all citizens to be trauma-informed. I was recently asked to serve on a steering committee to develop a center to promote and support traumainformed approaches throughout Utah. This is so exciting.

Beginning a couple of years ago, I have worked part time for the state of Utah Division of Substance Abuse and Mental Health (DSAMH) as a career and education counselor for individuals in recovery from mental health conditions and substance use disorders. I’ve found this quite rewarding during the sunset of my career. But the best part of the job is working with a number of enlightened people. As you might imagine, many in the group are mental health and substance use disorder professionals. They tend to give a lot of attention to how their co-workers are doing — especially mentally. As you might expect, everyone tends to be fairly transparent about how they really are feeling.

I feel comfortable telling my supervisor, Sharon Cook, when I’m having a bad day. She encourages me to keep up on my self-care and to take vacation or sick time when I need it. This feels so amazing! Late last summer when our team hadn’t met together in the flesh for months, she held a team meeting in a park. Camp chairs were placed in a circle — physically distanced, of course. She launched into a creative campfire program (without a real campfire) that warmed our hearts. I still have a cardboard cutout campfire that she hand-crafted hanging in my home office. She brought individually packaged treats, and even remembered my special ketogenic diet. Her preparation demonstrated that she cared about each of us personally.

Pam Bennett, my supervisor’s supervisor, is a highlyeducated, brilliant professional who accomplishes amazing things. But the first time I attended a group work meeting with her, she spoke of what she saw as her personal weaknesses in completing her responsibilities. I recall that her genuine modesty and openness was downright shocking! I don’t know if my jaw dropped. I was used to bravado and self-promotion in dogeat-dog environments where no one ever admitted to any chinks in their armor. Since that first meeting with Pam, I’ve found that she’s always this way — and it endears everyone to her. Her approach creates a healthy, productive environment of cooperation and teamwork where everyone helps and supports each other. Achieving team goals is much more important than who individually gets the credit.

I don’t have a lot of one-on-one contact with the director of DSAMH, Doug Thomas, but when I do, the interaction is always positive. One day when he happened to be passing by, he paused for a moment and said, “Owen, how may I help you today?” I knew he meant it. His emails to our whole staff are not always task-focused. He shares tips for self-care. Last March at the beginning of telework, he started an email chain sharing photos of our favorite pets. (My share was a stretch. It was the moose along the mountain hiking trails east of my home — the nearest thing Becky and I have for a pet.) He always has an open-door policy even now during telework. He’s very approachable, admits it when he feels he’s made a mistake, and acts like he believes he’s just one of us.

As I’ve thought back over my 30 years working at large CPA firms and in finance management positions, I’ve worked under some great leaders. Intuitively, they seemed to follow TIA principles before it was even a thing. But that hasn’t been the norm. You’ve probably witnessed, as I have, these clichés in action (and I’m sorry if they are too graphic and don’t follow TIA recommendations to avoid trauma-provoking words): “Being thrown under the bus”; “Throwing other bodies out in front of you so the lions eat them first”; “Blood running under the door” as leaders discuss compensation and direction; “Stepping on others to climb the corporate ladder.”

I haven’t witnessed anything like these things during my time at DSAMH. From top to bottom, leaders make themselves vulnerable and accessible. I’d march up any hill right behind any one of them!

Now some may say that the kind of leadership I’ve found at DSAMH just isn’t practicable in the rough-and-tumble world of for-profit enterprises. Maybe they are right. But I’m idealistic enough to think that we all could do better — and our organizations would be better for it. I believe that over the years I’ve changed for the better in how I interact with others, so I think everyone else can too. And I believe that the new mental fitness in the workplace initiatives coming to Utah can help us.

I’ve witnessed how more enlightened leadership has impacted my state of mind as I work. Right now, I’m more motivated than ever to try to perform well and really give my best to help achieve organizational goals. Not surprisingly, I’m happy to report that I haven't made any trips recently to the ER, and I’m no longer the poster child for presenteeism. n

Owen Ashton, CPA, CPSS, is a career and education counselor in the peer support program with the state of Utah Division of Substance Abuse and Mental Health and a Certified Peer Support Specialist at Silverado Counseling Services. He is serving as the president of the National Alliance on Mental Illness (NAMI) Utah. He authored the book, "Rising Above Fog: A Riveting True Story of Personal Triumph." He previously worked in auditing for KPMG and Deloitte. He and his wife of 45 years, Becky, have seven children and 29 grandchildren.