How do supervisors perceive and manage employee mental health issues in their workplaces?

1 Introduction

Stigma has been recognized as a significant barrier to the full participation of people with mental illness in the workforce [1]. In recent years the traditional method of combatting stigma through anti-stigma campaigns that target the general population has been replaced with an approach that targets specific social contexts, particularly those in which stigma has been clearly observed and examined [2]. The workplace is one such context. There is much evidence to suggest that stigma is operating with particular vehemence within employment settings. Research in this area points to the many forms and consequences of workplace stigma, including: high unemployment rates among people with mental illness [1]; workplace policies, such as those related to absenteeism, that disadvantage people with mental illnesses or mental health problems [3]; difficulties with the enactment of duty to accommodate and related workplace legislation protecting the rights of workers with mental illness [4]; discriminatory hiring beliefs and practices [1, 5]; social distance demonstrated by coworkers [6]; and high levels of stress experienced by workers with mental illness who have come to expect rejection and devaluation on the job [7, 8]. Even help-seeking behaviors appear to be restricted by stigma in the workplace with evidence that people will not fully use employee health benefits when they fear that it will lead to disclosure and subsequently impact their employment [9].

Workplace supervisors are well positioned to influence the employment pathways and success of workers with mental illness, by virtue of their involvement in establishing workplace culture and communications, allocating job duties, team development and other workplace functions. Yet, to date there has been little research directed to their role in reducing stigma, enabling productivity and creating workplaces that are inclusive and supportive of people with mental illness. This paper begins to address this gap by presenting findings from a qualitative study that examined the experiences of supervisors in managing mental illness in their workplaces.

This research was conducted under the mandate of The Mental Health Commission of Canada (MHCC). The MHCC was formed in 2007 as a federal government initiative (see http://www.mentalhealthcommission.ca) to explore the many aspects of the ways in which people with mental illnesses are viewed in society and to enhance Canada’s treatment of people who live with mental illness. The Commission’s Opening Minds (OM) initiative aims to reduce stigma and discrimination associated with mental illness by changing attitudes and behaviours. Using a staged and targeted approach, Opening Minds has engaged over 80 organizations in focused anti-stigma efforts and has conducted evaluations to determine the success of these programs in reducing stigma. It is the largest systematic anti-stigma effort undertaken in Canadian history.

2 Background

Research on ways of combatting stigma towards mental illness has moved the field from the broad campaigns that attempt to appeal to the population at large, to more focused approaches that incorporate evidence-based components. Studies examining the former have shown mixed results. Most campaigns have low public awareness rates [10] and while they may lead to the development of positive and counter-stereotypic portrayals of mental illness, the learnings are generally tied to the context in which they were learned [11]. Although the effectiveness of such anti-stigma campaigns is questionable, there are a number of components that appear to be associated with positive outcomes. Direct contact strategies (i.e., positive contact with a person with lived experience of a mental illness) to reduce stigma have yielded promising findings [12], likely because empathy is increased and anxiety is decreased, thereby decreasing prejudice [13]. It appears that contact-based education is particularly powerful when participants’ negative assumptions about those with mental illness are challenged, such as by hearing stories of recovery, interacting with those who are successfully managing their mental illness [14–16], and finding personal relevance in the stories being told [17].

Recently, there has been increased attention to understanding the way stigma is expressed within specific social contexts, as well as attempts to dismantle the forces perpetuating stigma within these contexts. Smith [18] points out that, at its core, stigma is a “dynamic, relational process” (p.S49), supporting the need to consider what events and situations are reflective of stigma within relationships and how it is experienced by all parties involved. The MHCC’s Opening Minds initiative adopted a strategy that combined context-specific anti-stigma programming with incorporation of best practices as it developed and evaluated anti-stigma efforts for four population targets – health care workers, the media, youth in school settings and workplaces [2]. It is the latter context – the workplace – that is the focus of this paper.

Given the importance of employment to social inclusion, well-being and health, the workplace is an important social domain for anti-stigma efforts. Within the Opening Minds initiative, workplace antistigma programs incorporate contact-based education, in light of research that suggests it is a promising practice to reduce stigma [12]. Audiences hear personal stories from and interact with individuals who have recovered or are successfully managing their mental illness. Some OM antistigma programs target supervisors in particular, and one such program, delivered to a public service organization in a metropolitan area, was used as the basis for this research. The program involved three short webinars and accompanying discussion questions around the topics of awareness, sensitive conversations/communications, and solutions. The objectives of the program were to: raise awareness amongst all supervisory staff to decrease stigma and better understand the continuum of mental health/mental illness; identify problems related to mental health earlier and prevent them from escalating; improve supervisor self-confidence and efficacy to handle current problem situations related to mental health; and improve the ability to create a healthy workplace environment.

A previous study by two of the authors that advanced a theoretical understanding of stigma in the workplace, informed this research. It highlighted that that the salience of mental illness in the workplace varies across workplace situations and persons, that is, the experience of mental illness in the workplace means different things to different people (e.g. co-workers, supervisors, the worker with mental illness, etc.) [19]. This finding was foundational to the current inquiry that set out to understand the meaning of mental health problems to supervisors, a highly influential group.

Supervisors or front-line managers may be particularly well positioned to positively impact levels of stigma in the workplace. With the responsibility of overseeing workers to meet the organization’s production/service goals, supervisors are key people in supporting the capacity of all workers, and influencing the social climate of the workplace. In addition, the front-line supervisor can be the organization’s point person in implementing reasonable accommodations in the context of disability, including those associated with mental illnesses, and encouraging worker help-seeking and personal health behaviors [20]. In many ways, supervisors “set the stage” for how mental illness, and workers with mental illness, will be understood, treated and negotiated in the workplace. This study aims to advance understanding of how supervisors experience and perceive mental illness and stigma in their workplaces.

3 Methods

The research presented here is based on the qualitative evaluation component of a workplace antistigma program targeting supervisors. A total of 11 supervisors participated in this phase of the study. The participants were purposefully selected from a subset of 37 supervisors who indicated an interest in participating; selection was oriented towards obtaining a varied sample in terms of gender, department, age range, level of stigma related to mental illness (as measured by a standardized stigma survey), and their ratings of the anti-stigma program they attended. Participants ranged in age from 31–60 years (average age = 49), with at least one participant from each of five major departments, and were quite evenly split by gender (6 male, 5 female). Each of the supervisors participated in a single interview.

The interview focused on the supervisors’ participation in the anti-stigma program as a springboard for discussions about their experience of mental illness and stigma in the workplace. Interview questions included: What do you think about the company’s decision to run the program?; How did you feel about the program?; What else do you feel is needed to effectively recognize and address mental health concerns at work?; If you have had experiences in dealing with mental health concerns in the workplace, can you tell us about them?; Reflecting back on these situations, what would help prepare you for such circumstances in the future?

Interviews lasted 45 minutes on average and were tape-recorded and transcribed, and then managed using NVivo v. 10 software for qualitative analysis [21]. Ethical approval for the study was obtained from the research ethics boards of the universities in which this research was conducted and all participants provided informed consent.

The data were analyzed for major themes using established procedures for conventional content analysis as described by Hsieh and Shannon [22]. Following a reading of the interviews as a whole, analysis entailed line-by-line coding, consideration of key concepts and the organization of codes into related categories. The researchers met regularly to discuss codes and to reach consensus on the description and boundaries of the emerging categories. These focused categories were then used to develop a description of how the category informed an understanding of mental health in the workplace as it related to the supervisory role. The dimensions of these categories were then further developed, leading to final analytic themes.

4 Findings

Analysis of the qualitative data led to two emergent topic areas and three themes. The first topic area – perceptions of the supervisory role relative to managing mental health problems at the workplace – contains the theme “A relevant part of the job.” This theme reveals the relevance of managing mental health problems to the supervisory role and the perceived importance of training in workplace mental health. The second topic area – experiences of supervisors in dealing with mental health problems – contains the themes “Expressions of mental health-related problems” and “Managing mental health issues in the workplace.” These themes describe the varied manifestations of mental health problems in the workplace and the range of responses from supervisors.

5 A relevant part of the job

Supervisors viewed the management of mental health problems and related stigma at the workplace as relevant to their supervisory role. Their role includes conveying expectations of accountability related to performance, supporting individual employees and neutralizing a toxic work environment. The mental health anti-stigma training was considered evidence of the organization’s investment in the issue of workplace mental health as an integral consideration in the way business is to be conducted, giving credibility to its relevance for supervisors. Overall the organization was perceived to be supportive of the supervisors’ roles in navigating mental health issues at work, by providing training experiences, clarifying expectations and “gray areas” and providing access to personnel that could assist with problem-solving around difficult situations. As highlighted in this quote, these resources and supports for supervisors provided a foundation for them to then offer support to employees:

Similarly, the organization was perceived as offering workplace structures and processes that enabled supervisors’ active focus on supporting workplace mental health and well-being and associated positive work relations. These included for example, learning and development programs, flex worktime periods, open discussions of work-life balance and annual staff surveys.

With regard to supervisors’ specific experiences with mental health issues on the job, two overarching themes emerged. The first theme relates to how supervisors perceived mental health-related issues and the second relates to their experiences of managing mental health-related issues. Each of these themes is developed in the following section.

6 Expressions of mental health-related problems

Supervisors described four ways that mental health related problems requiring their attention were expressed in the workplace:

Behavioural pattern changes were interpreted by supervisors as possible evidence of mental health related issues. These included changes in the ability to do the tasks of the job because of being late, unfocused, or forgetful, and difficulties with social relations including becoming defensive, quick to anger, irritable, withdrawn, and cursing in meetings.

7 Managing mental health issues in the workplace

Supervisory management of workplace mental health issues involved responses at four levels (see Table 1):

1. Supporting the person on the job. In working with individual employees the supervisory role was perceived to include both the implementation of accommodations (as directed by staff with relevant authority), and careful consideration of how particular job activities would be completed while attending to the well-being of the worker:

Supervisors reflected that managing boundaries with individuals experiencing mental health problems was sometimes difficult, because offers of support needed to be carefully balanced with respecting privacy and legal rights to non-disclosure:

Oftentimes, workplace issues related to mental health come to light through concerns of other employees, the supervisor’s observation of difficulties, or directly from the person themselves. Supervisors perceived their role as responding with compassion, providing workers with information and direction related to relevant policies and available resources and designing approaches to support both performance and well-being:

Supervisors can find themselves in the challenging situation of engaging workers in authentic conversations about the personal and workplace impacts of mental health issues. For example, workers can have a strong intention to sustain their involvement in work activity as a means of protecting their own mental health, but underperform on the job in a way that impacts the workplace. Supervisors can also receive defensive responses from workers when efforts are made to reach out to them with the intention of supporting their well-being:

2. Managing the workplace social climate. Supervisors felt that managing the workplace climate was complicated where mental health issues were involved. It demanded proactive responses to the concerns of co-workers about the performance and presentation of workers perceived as having mental health difficulties, and at the same time strategies to manage worker reactions that impact the social dynamics of the workplace. These reactions varied from curiosity, to questions or concerns about the accommodations that were apparently being received, and, in some cases, resentment. Development of communication strategies that kept co-workers informed in matters relevant to the work while respecting the privacy and dignity of the individual was described as an important response:

Complicating the management of the social dynamics of the workplace for supervisors was what described as a “ripple effect”, referring to the social impact of what was perceived as either undiscerning disclosure of mental health difficulties by individual employees (…   they’re sharing maybe too many personal experiences with the team members. It causes anxiety and it causes pain to the rest of the staff regardless of whether or not they have mental health issues themselves. Because they worry.”) or engendering conflict within teams by sharing information differentially (“So some of us had insights, the others didn’t and those of us who did know, we were inclined to defend and that caused even more stress”).

3. Supporting return to work. The management of the return to work of employees who have been off work in the context of mental health problems was experienced as involving a unique set of management issues. Specific concerns raised were how to engage the work team in welcoming the person back, how to best message the situation to the team while respecting the privacy of the returning worker, how to manage situations where workers return and leave the work scenario multiple times, and modifying work activities to be consistent with return to work plans. Supervisors also revealed that oftentimes they experienced challenges related to negotiating organizational policies and procedures in the return to work process. Even though the organization was oriented to developing a supportive and inclusive workplace, supervisors could experience occasions where particular policies acted against, what one supervisor referred to as, “thinking progressively” to support the reintegration of an employee with mental health issues. This situation is less of a fault in policies, but more of the need to balance higher level organizational policies with problem solving approaches at the local level in a manner that is nuanced to individual and context needs.

4. Personal care and development. Finally, managing mental health and related stigma in the workplace comes with associated stressors that can compromise the well-being of managers themselves. A genuine desire to support their workers comes with an emotional price for managers who are tending to these needs in the context of workplaces that fall short on backfilling human resource needs, and subsequently increase the workload of managers and create stress:

Supervisors recognized their own need for support and assistance in the process of supporting their employees, and to this end, would seek out workplace resources for learning and development, advice and assistance. Having workplace resources and experts available (for example, a mental health nurse, consultations with human resources, EAP program awareness) was repeatedly cited as a factor that facilitated their ability to respond to mental health related situations.

This study examined the experiences of front-line supervisors in a large public service organization with respect to mental health and stigma in the workplace. Despite their perception of their own organization as highly supportive and actively committed to mentally healthy workers and workplaces, supervisors experience challenges to this goal in their everyday jobs. A number of tensions in the role of the supervisor who is managing employees with mental health concerns are revealed by the findings. First, while supervisors perceived that they were responsible for such management by virtue of their roles, they often lacked certainty on the degree and manner in which to tackle mental health issues to convey concern and support in appropriate measure. A lack of clarity about what constitutes a breach in privacy stood in the way of supervisors responding in ways that they felt would convey genuine interest and concern. Supervisors faced difficulties in discerning the boundaries that they needed to respect while reaching out, and tempered their responses for fear of overstepping those boundaries. The tension between respect for privacy as both a fundamental right and a factor that can stand in the way of providing workplace supports for people with mental illness has been documented in other studies as well. For example in an institutional ethnography of mental health in the workplace conducted by Malachowski and colleagues [23], it was found that workplace absenteeism policies prioritized the privacy and confidentiality of the employee but created a significant barrier in providing workplace supports and accommodations for the employee living with self-reported depression. Their research highlighted how workplace policies designed to protect employees may have the unintended consequence of preventing support for employees with mental health issues. Interestingly, the current study also found that policies designed to create a supportive and inclusive workplace prevented “thinking progressively” as they are unable to account for the nuances of individual people and contexts.

Another important tension revealed by this study relates to discussing mental health issues as a way of combatting stigma on the one hand, and the social impacts of undiscerning or differential disclosure on the other. While disclosure did serve to foster understanding and problem solving, it also caused supervisors to question whether the content, process and individuals to whom disclosure was directed affected the climate and productivity of the environment. Disclosure and stigma have long been associated with one another and it has been widely documented that fear of stigma may lead employees to choose not to disclose [1, 24]. Decisions about disclosure are complex and are often based on a number of factors [25, 26], and the provision of guidance about whether and how to disclose may fall into the laps of supervisors. Supervisors can play an important role in helping employees figure out the disclosure process that will best reduce stigma and at the same time enable healthy and productive working relationships, and need to be equipped to do so. Further, they can play an important role in setting the tone for social relations in the workplace in response to disclosure, and other mental health related workplace situations. The scant research that exists on managers dealing with employee mental health issues suggests that they have a responsibility to do more to prevent unhealthy corporate cultures that create and sustain the idea that people with mental health problems are disabled [27]. This study showed that supervisors can indeed be active in neutralizing the negative assumptions and stereotypes that have been associated with absenteeism or workplace accommodations, such as assumptions questioning the legitimacy of mental health related issues on the job [19]. This role is in keeping with the National Standard of Canada’s Psychological Health and Safety in the Workplace [28] which identifies that immediate supervisors have a responsibility to care about the emotional well-being of all of their employees, and workplaces should be free from stigma, harassment, bullying and other psychologically unsafe environments.

Finally, the delicate balance between supporting others who may be experiencing mental health issues at work, and caring for oneself was highlighted by supervisors. This insightful reflection calls for additional research on the potential outcomes that may result from the push for managers to be tuned in and involved in others’ mental health. Burnout is common among mental health service providers and administrators and its consequences can be severe and far-reaching, from impaired emotional and physical health, a diminished sense of well-being, job dissatisfaction, and damage to the morale of other employees [29]. It is possible that such impacts can be also experienced by supervisors in workplaces. Methods of preventing negative impacts on supervisors who increasingly see their roles as encompassing the management of stigma and mental health in their organizations, particularly while dealing with pressures to meet the productivity bottom-line, may therefore be called for.

There are a number of limitations of this study. Firstly, the research was conducted in a single organization. As all organizations have their own cultures, the findings of this study are undoubtedly grounded in the values and unstated norms of the organization, and may not be reflective of supervisors in other organizations with contrasting cultures. Nevertheless, the insights gleaned from this single organization are highly valuable as they may resonate with other supervisors carrying out their work under common privacy legislation and other policies. Indeed, the focus on single case studies is commonplace and highly useful in organizational effectiveness literature [30]. Secondly, the sample size of 11 participants is small but it should be noted that it does reflect the experiences of almost one-third of the supervisory staff of this organization, and that participants were purposefully selected. Again, this precludes generalization of findings, but in keeping with the purpose of qualitative research, the perceptions of these participants allow an in-depth understanding of how some supervisors perceive, make meaning and manage mental health problems that they confront in the workplace a central aim of this study.

9 Conclusion

This study highlighted supervisors’ commitment to issues of stigma and mental health in the workplace. It emphasizes the salience of these issues for the supervisor’s role and illustrates the ways in which stigma and mental health issues intersect with the work of supervisors. The research offers a view of the tensions supervisors experience as they carry out responsibilities that are meant to benefit both the individual and workplace, and protect their own well-being as well. It points to the need for future research and training, in areas such as balancing privacy and supports, tailoring disclosure processes to suit individuals and workplaces, and managing self-care in the workplace. The growing attention and commitment of managers to their employees’ mental health opens the door to a new research agenda that can shed light on supervisors’ needs, and lead to best practices not only in managing stigma and the mental health of their employees, but also in promoting their own well-being and leadership capabilities.

Conflict of interest

None to report.