For all the talking we’re doing, for all the well-meaning campaigns, I still believe we are woefully under-trained (or untrained for that matter) in how to effectively and comfortably talk to someone about their mental health, particularly in the workplace.

This was the focus of a workshop I facilitated at the recent, successful Working Stronger conference hosted by the Canadian Mental Health Association – Alberta provincial branch.

The heart of this annual event is to bring together leaders and staff from various sectors and companies to acquire skills and engage in dialogue to increase the psychological health of their workplaces.

I performed my “Funny, You Don’t Look Crazy” about my lived experience with mental illness and my eventual return to work. Then I led an enthusiastic group of individuals in an interactive breakout entitled: “Ready, Set, Recognize: Detecting Mental Illness and How to Help”.

To be quite frank, I was nervous. I had several years employed in the not-for-profit health sector. But my corporate experience has consisted of a two-year stint in a small company (really small – 6 people including me!). 20 years ago.

I was hired as a marketing-assistant-slash-receptionist. Heavy emphasis on the receptionist part. Well, actually, heavy emphasis on the slash part. It was my first job since getting my “sea legs” back after being in the psych ward several times over the previous 5 years. Handling conversations, let alone their phone system, was going to take courage.

I held jobs both when I was struggling and in denial of my mental illnesses and also after when I was learning to manage them. It wasn’t easy for me. I know it wasn’t easy for my bosses or co-workers either.

4 simple steps to make the conversation easy and effective.

Working with well-meaning but misguided managers, and exceptionally talented ones, I’ve learned some strategies about what works and what doesn’t when it comes to addressing mental illness in the workplace.

The result is the framework I created called: O.A.R.S. (Observe, Ask + Actively Listen, Refer and Support). A simple protocol to support an employee or co-worker who may be facing a mental health issue.

The steps of O.A.R.S. are simple, but not necessarily easy. We aren’t used to having these conversations. The only way we’ll get confident is by practice.

One solution for companies is to offer safe learning opportunities and ‘rehearsal’ time for these dialogues in low-stake/no-stake situations.  We can be as awkward and unsure as we need to be and gain experiences of success that we can take into real-world scenarios.

I call the framework the Wizard of O.A.R.S. because, well, who doesn’t like a nice play on words? (Actually, I do know several people who don’t. But that’s beside the point.) And because oars bring balance, stability and direction to a boat. Just like oars, people can give support and guidance to those around them who may be facing mental health issues.

This is not a quick fix. The steps don’t work instantaneously. They can in rare cases. But they will gradually, over time, make a difference.

Observe – Changes in behaviour, length present + document

Ask + Actively Listen – Discuss concerns in terms of behaviour, its impact + needs

 Ask open-ended questions

 Mirror + validate

 Be patient + wait

 Be curious

 Discuss impact of behavior

 Focus on collaborative problem solving + actions

Refer – To resources in the workplace and/or community

Visit my resource page to download a Mental Health Resource Guide for additional tools.

Support – Continue to communicate and encourage; find agreement + set healthy objectives

Click here to download the detailed step by step O.A.R.S. e-guide with links to a fun video of Everyone Loves Raymond using active listening!

Observe, Ask & Actively Listen, Refer and Support: the Do’s & Don’ts

Before you have a conversation with someone at work about their mental health, here are some do’s and don’ts to keep in mind.

DO…

  • Set the conversation up for success
  • Check in with yourself: is it a good day for YOU to speak to them?
  • Check in: is it a good day for THEM?
  • Play it out: where, why now, how, what will you say, what might they say, how will you respond?
  • Have the facts: make sure the facts you have are correct
  • Determine your objective
  • Focus on building trust, rapport, safety + open dialogue so they feel free to talk
  • Speak to them as early as possible
  • Document behavior changes + note impact
  • Be clear about what you need from them
  • Prepare for own internal emotional reactivity
  • Plan + prepare for resistance
  • Listen without judgement
  • Use an icebreaker

DON’T…

  • Avoid talking about impact of behavior
  • Make assumptions about the behavior or jump to conclusions
  • Interrupt
  • Minimize or dismiss feelings
  • Try to fix or offer advice
  • Enable

Please note: The O.A.R.S. framework is for non-urgent situations. If you feel the individual is at risk of harming themselves or others, immediate care should be sought at the nearest emergency ward. If the individual refuses help and is actively suicidal or at risk for harming others, the police should be called to assist. Please consult your company policies and guidelines.

Do you want to make a positive impact? Have that conversation NOW.

Effectively talking to someone who you think may be struggling with a mental health condition at work can be fiddly and unclear. As a result, managers and supervisors postpone or avoid these conversations, especially if we think the person is going to respond with resistance. Maybe we hope the issue will resolve itself. It almost invariably doesn’t though.

Sometimes individuals dealing with mental health issues aren’t ready to admit it to others or themselves. I certainly wasn’t. It’s not an easy thing to accept. The stigma of mental illness, especially in the workplace, has decreased but it still exists. This can lead people to refuse assistance or refuse to acknowledge the problems directly.

Unfortunately, if left unaddressed, behavior resulting from mental illness may cause difficulties at work and result in discipline, termination or other negative workplace consequences.

As a manager, co-worker or ally you can be proactive and discuss the behavior with the person before it escalates into discipline or termination. The earlier you speak with someone, however uneasy this may be, the higher the chance for optimal outcomes. Early conversations also offer the best opportunity to prevent a condition (if present) from escalating or becoming chronic.

Letting a person who you’re concerned about know you’re willing to listen without judgement, support them and problem solve can open the door for discussion.

This is what Liz, my boss at the marketing company did when I went to her for help. Even before that, she prepped the ground for positive interactions. From the start of my time there, she focused on building a personal rapport with me. One based on trust, respect and active listening. She was frank, firm, fair, kind and honest. When I had difficulties, I knew she was the person I could go to and receive wise counsel and fair treatment.

My experience with Liz gave me confidence that has influenced me to this day. THAT is the kind of impact you can make.

 

 

© Victoria Maxwell

Could your workplace benefit from learning how to comfortably address mental health issues? Contact Victoria to discuss the Workplace Mental Health Awareness package: a performance of ‘Funny, You Don’t Look Crazy’ followed by the ‘Ready, Set, Recognize’ workshop. You’ll learn the simple O.A.R.S. protocol to make those awkward conversations easy and effective. Contact me.

While I sipped coffee and munched on a croissant, a supervisor approached me. I had just finished performing ‘Funny You Don’t Look Crazy’ (my story of mental illness and return to work) for a quiet but wonderfully engaged group of managers at a breakfast training event.

He confessed one of the biggest barriers he, the managers and staff face is being comfortable talking about mental health at the company. “We know how to discuss physical illnesses, but mental health issues? Not really.” It’s one of the most common remarks I hear. We don’t have an accepted vernacular and we’re not practiced at it.

Silence kills

This discomfort can lead people to say nothing, ranging from not intervening when they see someone in distress or not speaking up when they need help for themselves. Enter the deadly (literally) silence.

Results from a University of Oxford study found leaving serious mental illness untreated can shorten an individual’s life by as many as 10 to 20 years, similar to the mortality risk of tobacco smokers. 1

I started performing my one person shows about my experience with bipolar disorder and recovery back in 2001. At that time, other than Margot Kidder and Kay Redfield Jamison, there were few people divulging the personal secret of psychiatric disorder.  

Over the last 15 years though, we’ve made good strides in addressing mental health and making it more common place to discuss. We have the “Bell Let’s Talk” campaign, Mental Illness Awareness Week in October and Mental Health Week in May, to name just three.

However, even with these awareness initiatives, the discomfort of discussing mental illness in the office remains, and silence ensues. Silence breeds fear, drives myths and lets stereotypes remain unchallenged. These then reinforce reasons (though unfounded) for individuals who are struggling to refrain from getting help.

Using data collected from close to 500 university staff and students, a 2014 Australian study found the “silence surrounding mental health problems permeates … environment(s) and impacts on help seeking behaviours… (and the) recovery and well-being of affected individuals.” 2

According to another study out of Toronto, silence has negative implications for relationships and productivity in the workplace as well. 3

Programs that raise awareness and aim to reduce stigma are important. But if people’s discomfort of discussing mental illness is never addressed, these campaigns will be of little long term benefit.

4 steps to create comfortable conversations about mental health

Whatever role you hold in your company, the following are 4 strategies to increase your comfort and effectiveness when discussing mental health.

1. Find Company Mental Health Champions. Share Stories. Get Real.

Safe, inclusive and supportive environments will stop the silence on mental health.

Elio Luongo, Chief Executive Officer and senior partner, KPMG in Canada in a Special to The Globe and Mail agrees. How they went about that was a first in corporate Canada.

In 2017, they created the role of Chief Mental Health Officer (CMHO). They enlisted, Denis Trottier, an audit partner who has “lived through clinical depression while maintaining a successful career”. 4

Having an individual willing to disclose their own experience with mental illness and recovery can open up dialogue, change perceptions and create comfort faster than any other kind of educational program. Patrick Corrigan, one of the foremost experts in stigma research, found in study after study, the most effective method to change attitudes about mental health is what’s called contact-based behavioural health anti-stigma interventions. That is, “people with lived experience of mental illness or substance use disorders interact with the public describing their challenges and stories of success.” In fact, this kind of approach is twice as effective as an educational program alone. 5, 6

At Coast Capital Savings, then CEO Lloyd Craig, shared his devastating story of losing his son to suicide. Craig was a pioneer in workplace wellness initiatives and the Credit Union became a model for workplace mental wellness. In a short time, measures they took, which included Craig sharing his story, produced noticeable results. 7

Discomfort around mental health will only dissolve when people see it’s safe to share stories and ask for help. As Luongo puts it, it’s essential “we walk the talk, right from the C-suite level so that our people can be comfortable sharing their stories and talking openly about mental health at the firm.”

2. Be prepared for and accept the uncomfortable feelings.

Like difficult conversations that are…well…difficult. Uncomfortable topics are… well…uncomfortable. Paradoxically, knowing and accepting that something will be uncomfortable can make the experience easier to bear. Two studies out of Denver found accepting (versus avoiding) negative emotions was shown to be associated with reduced levels of anxiety and stress.8 Prior to talking about mental health, assume unpleasant emotions and sensations will rise within you. Your job is only to tolerate them, be mindful of those awkward feelings and continue the discussion. Preparing for them will make the conversation easier.

3. Practice talking about mental health.

Practice brings experience. Experience brings mastery and mastery brings confidence. 9, 10  Be intentional. Start with low risk situations. Take strategic opportunities to discuss mental health in casual conversation in positive terms. The more you do, the easier it will become. For example: decide that for each day over the next week, you will learn something about mental health and share it with others at work or on social media. Or choose to disclose something personal about how you stay mentally healthy. Let people know what you are doing and encourage them to join. Ask people what do they do to stay mentally well.

4. Make it fun and be curious.

This sounds counter intuitive, even improbable, maybe even insensitive. Make mental health fun? Yes. Even though mental illness can be a heavy subject that doesn’t mean learning about it, or creating a supportive environment, has to be. I consider myself to be an mental health icebreaker of sorts. I use a lot of humour as I share my personal experience with anxiety, depression and psychosis. Yes, I’ve managed to find something pretty funny about running down the street naked while in a psychosis – I think flirting with the ambulance guys has something to do with it.

Self-deprecating humour goes a long way to help people feel like they don’t have to walk on eggshells. A lighthearted and respectful approach opens dialogue up as well as people’s hearts and minds. The more serious we are about a subject, the more cautious we are asking questions and the more difficult it is to discuss.

Start simply. Hold short lunch n’ learns that explore well-being, host interactive workshops that offer strategies for mental wellness and self-care. Focusing on mental wellness first, can prime the pump for mental illness topics.

Silence is not golden. Speak up.

Michael Landsberg, former sports host of TSN’s Off the Record , lives with generalized anxiety disorder and depression and is a staunch mental health activist. He says: “When we talk openly, frankly and honestly about mental health, we’re one step closer to healing.” 11

The silence around mental health will only be broken if we take the risk to speak up. Every time we make a decision to talk about it, and not remain quiet, the more healing is possible. This means healthier companies, stronger communities and more vibrant families.  

How do you speak up about mental health at your work? Comment below and let me know.

For more Mental Health resources, tips & tools, sign up for my newsletter.

© Victoria Maxwell

References

1. University of Oxford. “Many mental illnesses reduce life expectancy more than heavy smoking.” ScienceDaily. ScienceDaily, 23 May 2014.

2. Curtin University. “The silence of mental health issues within university environments: a quantitative study.”: Archives of pychiatric nursing, Vol: 28, Issue: 5, Page: 339-44 Publication Year: 2014

3. University of Toronto. “Mental Health Issues and Work: Institutional Practices of Silence in a Mental Healthcare Organization” by Sandra Moll; Doctoral Thesis, 2010 

4. “Corporate Canada needs to help break the silence on mental health”  by Elio Luongo; Special to The Globe and Mail; January 31, 2018

5. Corrigan, P.W. (2012). Where is the evidence supporting public service announcements to eliminate mental illness stigma? Psychiatric Services, 63(1), 79-82.

6. National Academies of Sciences, Engineering, and Medicine. 2016. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington, DC: The National Academies Press. 

7. “Employers Who Are Walking the Walk” by Donna Panitow; Reprinted from “Workplaces” issue of Visions Journal, 2009, 5 (3), p. 29-30

8. Let it be: Accepting negative emotional experiences predicts decreased negative affect and depressive symptoms. Shallcross AJ, Troy AS, Boland M, Mauss IB. Behav Res Ther. 2010 Sep;48(9):921-9. doi: 10.1016/j.brat.2010.05.025. Epub 2010 Jun 1.

9.  Conger KJ, Williams ST, Little WM, Masyn KE, Family Research Group B. Development of Mastery during Adolescence: The Role of Family Problem Solving. Journal of health and social behavior. 2009;50(1):99-114.

10. Why a Sense of Mastery is the Key to a Better Confidence?  by Evelyn Marinoff

11.  Michael Landsberg, quote: https://www.thelavinagency.com/speakers/michael-landsberg

When mental illness hits, it can hit hard. It hits the person who has it hard and it hits the family equally hard – though in very different ways.

One of the most common questions I get after my workshops and keynotes is, ‘How can I help my loved one when they don’t think they need help to begin with?’ So common in fact I’ve written two previous posts, one on my Psychology Today Blog: How to Help Your Adult Child if They Have a Mental Illness and another on my own: Families Falling Apart. There are many reasons for not wanting help. Denial, shame, anosognosia (the inability to be aware of one’s illness – a frequent symptom of psychosis itself ). 

Regardless of the reason, as a family member or friend, it can feel powerless. I’ve been on both sides of the path. I was that ‘someone’ with bipolar disorder, anxiety and psychosis who wouldn’t accept the diagnoses for years. I am also the daughter of a mom with bipolar disorder and severe anxiety, who has accepted the diagnosis, but does little more than take medication, which unfortunately succeeds in alleviating only a few of her symptoms. Good treatment involves more than just medicine.

But there are steps you, as a loved one, can take. Here are a few to help you help your family member or friend move forward on the journey to recovery and wellness. Take what you like and leave the rest.

1. Remember the journey to accept that there IS a problem, is theirs alone. You can help prep the ground, by having discussions and listening with an open heart, by setting clear boundaries, by offering information when appropriate. You can help create an environment that increases the chances of the person reaching out for help, but you can’t do it for them.

Anyone who’s been in this position knows, it takes more than one conversation. It takes many. It’s about opening the door of possibility. It’s about voicing your concerns with compassion and clarity and without judgement. Difficult, I know – especially when the struggle has been going on, in some instances, for years. But the rewards of avoiding power struggles, directives and arguments are great. A list of resources follows at the end of this post.

At the same time, it’s about setting boundaries for your own well-being and recognizing you are not responsible for their health and happiness. If you’re a parent of an adult child, this is one that is most heart breaking to learn and understand. Letting go is tough even when the adult child is well and thriving.

2. Rebuild trust and rapport. When family members ask me how to help their loved one, the issue has frequently been going on for quite some time. During that period, entrenched power struggles usually have developed and mistrust on both sides has been established. Your adult son or daughter, brother or parent, may continue to get angry when you suggest anything. The trick is for you to NOT get angry back. Easier said than done. Tools from Dr. Xavier Amador’s LEAP (Listen Empathize Agree Partner) method (below) may guide you how to listen without creating power struggles and rebuild trust essential for healing. Dr. Lloyd Sederer’s TEDx talk offers excellent tips and encouragement.

It was important that my treatment was a shared decision-making process; that those around me, both parents and professionals, didn’t try to convince me to do something. I needed to have people empathize, understand and reflect back my experience. The more I felt respected and heard, the more open to suggestions I became because I felt like I was being empowered not attacked.

3. Evaluate whether you really are the best person to talk to your loved one right now. Be honest. If conversations almost always end with tempers flying, another person who has his/her best interests at heart and can communicate more easily is a better option – at least for now.

4. Invite your loved one to go to the doctor together to address a legitimate physical issue. The problem could be poor sleep, or frequent headaches. You might feel that they stem from a mental health issue, but tending to a physical complaint is often easier to address first.

If mistrust and tension in your relationship is high, this may not be a good option. But, it’s surprising what sometimes works. The goal is to have them be willing to see someone for a general check-up. In that appointment have a mental health check-up too.

Resources:

  • Crisis Lines:  If you need help immediately, please search this list of crisis lines and centers and contact one of them right away.
  • Download this free Mental Health Resources and Tips e-guide I created from my website. It has many of the resources listed here and others for loved ones, individuals living with mental illness and employers and staff.
  • Dr. Lloyd Sederer’s TEDx talk ‘When Mental Illness Enters the Family offers excellent tips for parents, loved ones and others when supporting someone who is struggling with mental health issues but isn’t able to see they need help. In addition to his talk, he has a widely praised book “The Family Guide to Mental Health Care: Advice on Helping Your Loved Ones
  • Dr. Mark Komrad’s video has some good points. I wouldn’t watch the first part but from 49:30 minutes he describes when, how to talk to someone, some do’s and don’ts. Some of his approach is paternalistic, but some of the tips are useful. His book “You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling may be a helpful read. I can’t vouch for the info as I haven’t read it yet, but it comes recommended.
  • Dr. Xavier Amador’s book “I don’t need Help, I’m Not Sick describes his well-known LEAP (listen, empathize, agree, partner) approach. This post gives a concise summary of his LEAP programThis video illustrates a role play contrasting a traditional communication method and his LEAP method: Dr. Amador focuses heavily on anosognosia (when someone lacks the ability to be aware that they are ill). He makes a point to differentiate this from denial. You can find individuals who have been trained in his method on his referrals page.
  • Practical tips for family and friends on the “Living with Mental Illness: A Guide for Family and Friends” website.

I hope these resources help. Let me know if they do. If you have ones not listed here that are especially effective, please mention them in the comment box.

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© Victoria Maxwell