The Need to Be Open on Mental Illness

Hoarding. Depression. Two instances of attention deficit disorder. These are personality characteristics of different people whom I have reported to over the years. Executives with titles like CEO, president, director or founder. I’m here to tell you that people in the executive suite, just like the rest of society, live with mental illness. I know this because I’ve worked for them and, more importantly, because I am one of them. I have lived with chronic depression since I was eight years old. I also, by many measures, have had a rewarding and successful career in consulting and financial services. I want to share my thoughts on three vital issues: first, why senior executives should lead more conversations in the workplace about mental illness, including suicidal behaviors and suicide prevention; second, why I think it is important; and third, some ways we might be able to start more meaningful dialogue. In the past, we’ve often treated mental health as a personal issue that individuals must overcome on their own or with a healthcare provider. But addressing mental health conditions such as depression, substance-related disorders, personality disorders and suicidal behaviors is just as important as addressing any other public health issue. Mental health problems are just as critical as childhood obesity, cancer, hypertension, heart disease, stroke or HIV/AIDS. Over the past few decades, medical science has had great success bringing the death rates down in many diseases. There has been no significant reduction in suicide in more than 50 years. Just as we have  handled other public health issues, we must tackle mental health problems like suicide together in an organized fashion as a total community. Suicide and suicidal behaviors (or SSBs) are complex heterogeneous behaviors commonly manifested in the presence of mental illnesses. They are multifactorial and complex because not all SSBs have the same underlying etiologic factors. I want to approach mental health from the perspective of my personal story. It is a story about one strategy I believe we can all support to improve mental health in the workplace by reducing stigma and increasing awareness and support, thereby lowering the number of suicides. While a change of culture has happened with many illnesses that were previously taboo, there is still a silence around mental illness and suicide. This is even more noticeable in the workplace. So, how do we break the silence? I think there are a number of strategies, many of which we see today: public service campaigns, mental health parity in insurance coverage and workplace programs that provide employee assistance, just to name a few. These are all important components to raising awareness, providing support and changing attitudes. However, I think one of the most effective ways to break the silence is for business leaders who have experience with mental illness and suicide – either personally or through someone close to them – to start talking about it. I have worked in places where we talked about religion, politics and even gun control. We talked about our physical health. We talked about our families and what we did over the weekend. We talked about our dreams and aspirations. So why in the world wouldn’t we talk about our mental health in the workplace? We don’t because the stigma is so strong that the topic is buried. Yet when leaders remain silent about mental illness, there is a discernable and substantial cost to the rest of society. Such silence contributes to the misperception that successful people do not get depressed. It keeps people from seeing that treatment allows many individuals to continue in or return to successful professional lives. Silence also contributes to the myth that people who are brilliant or full of life cannot possibly have so much despair as to kill themselves. They do.  Every day. Just look at Robin Williams. Most people I know were shocked at the news of his recent death. Honestly, I was shocked that everyone was so surprised. I didn’t know Robin other than as a fan, but I did know he had a history of depression and substance abuse. As a celebrity, this was both the fodder of tabloids as well as the legitimate press. He was very open about his challenges. And, as someone who has lived with depression all his life, I know that frequently depressed people use humor to hide the pain they feel – to keep people from seeing the dark inside that no one wants to see. Like many of us who live with the condition, I believe Robin Williams wore a brighter self in public to distract from the darkness that settled over him behind closed doors. Most people don't see depression in others, and that's by design. We depressed people simply hide ourselves away when we've dimmed so as not to shade those who live in the sun. So the fact that Robin Williams died by suicide was not surprising to me at all. It certainly is a tragic loss of a great entertainer. But watching the mass reaction highlighted to me how little people know about depression and suicide. I even sensed a restraint at first to report his cause of death as suicide. Then, when it became known he had Parkinson’s, it was almost a sigh of relief, as though that, instead of depression, was the real cause. It almost allowed the suicide to be explained away and silenced. It is this silence that helps perpetuate the stigma of mental illness. The notion is that successful people don’t get depressed and that depressed people are not successful. We know neither of those statements is true. But the stigma perpetuates the myths. These myths pervade all facets of society, and business leaders are the community gatekeepers. It does not matter whether you are speaking about mega-corporations or small business. Leadership is likely to come into contact with those at risk for suicide or mental health problems. However, these business leaders ordinarily are not trained to be influential. From the public health perspective, the reduction of stigmatization of mental illness including suicide must be a first step at prevention efforts on a large scale. There is a difference between those exhibiting a diagnosable mental health issue and those who are able to have access to proper mental health care. This, too, is part of the challenge. Business leaders and those in the public arena have a unique opportunity to lessen this stigma, to mobilize research efforts, to raise money and to educate others who do not have the same financial and educational advantages. Where I work, we do talk about mental health, depression and suicide. We talk about it because I talk about it. People look to me to set the tone of the workplace. More than anyone, I am responsible for establishing what is okay and what is not okay to say and do in the office. Whether I like it or not. Whether I recognize it or not. As the senior person in the office, setting the tone and defining what is acceptable is one of the most important roles I play. There are forward-thinking companies out there providing programs and assistance to employees. Prudential offers an employee assistance program, training for managers to spot distress among employees and health clinics that screen for mood instability and more. Still, the company recommends employees stop short of telling managers about their diagnoses, according to Ken Dolan-Del Vecchio, vice president of health and wellness. The reason he gives is, "We don't want managers to be acting as surrogate counselors." No company would say the same thing about heart disease or cancer. Dupont trains managers to identify signs of distress in workers. However, Paul W. Heck, global manager of employee assistance and WorkLife services, says conversations with a boss about a diagnosis "would never be encouraged." Managers at Dupont who do identify distress are asked to remind employees of the assistance program, which offers free counseling. While these efforts are laudable and provide valuable services to employees, it’s obvious that corporate America still views mental health as something not to be discussed. It is not just a matter of confidentiality concerns for the firm. The message is to keep silent. But there is no way to break the stigma if we keep silent. And the reality is that the fear is unwarranted, and, if discussion starts at the top, it can easily change attitudes and behaviors. There is much that business leaders can do. While leaders are more likely to be committed and indeed supportive if they understand what’s in it for the company, the most effective way to gain leadership support is if they personally relate to it. Senior executives like to have a cause, whether it’s cancer, homelessness, youth or any number of issues; business leaders frequently are champions. They use their position and influence to engage the staff, corporate communications, HR and other resources, including the community, to work together to address social needs. Their ability to effect change is vast and untapped when it comes to mental health and suicide. We just need to get them talking about it. Two years ago, I had wrist problems and had to get physical therapy for several months. In the beginning, I went to a see a therapist twice a week. Everyone knew about my wrist problem. They knew where I went twice a week, and they were sympathetic to what I was experiencing. Today, I no longer need physical therapy, but I do go to a doctor every week. I go to see a different kind of therapist. The kind you talk to and get advice from. In the beginning, I told people I was going to see my psychiatrist. Now, I don’t feel the need to re-enforce the point every time I go to see my therapist, because everyone already knows. Seeing this therapist is just like seeing my physical therapist. I have declared it okay to leave the office to see your doctor, even if that doctor is focused on mental health. I’ve set an example that it’s okay to talk about this at work, and, more importantly that mental health should be treated no differently than any other health concern. This openness definitely has an impact.  A while back, we were in the office on a Monday morning talking about the weekend. One person had been at the family house on the lake with the extended family – grandparents, aunts, uncles. One of his aunts was going through another depressive episode. The employee admitted that in the past when his aunt was depressed he tended to leave her alone and felt she should “just get over it.” But this weekend, he spent time talking to her, listening to her and reassuring her. His exposure to someone living with depression in a different setting allowed him to be more sympathetic and understanding. I’m sure if friends or co-workers exhibited signs of depression, he would be able to be more supportive of them, too. Getting to know a co-worker living with a mental illness changed his attitude. While I would never have chosen to be born with depression, I have learned to appreciate what it has given me. True, it has presented some significant challenges and difficult times. But these challenges have also given me a tremendous amount of strength and resilience. I draw on this both in my personal and my professional life. Having been in financial services for much of my career, I have experienced significant work challenges. I led the effort to keep a major financial service provider funded and operating as it went through a downsizing from more than 14,000 to fewer than 4,000 employees. Back in 2007, during the early stages of the financial crisis, I was at a major financial services company when an industry analyst used the "bankruptcy" word speaking about the company. The press descended in droves, customers were concerned and a year later the company was acquired by another bank. In all these situations and many more, I have been counted on as a leader during substantial adversity. Yet these challenges cannot compare to the difficulties I have faced with depression. It is through the struggles with depression that I learned how to attack really difficult situations and how to get through the tough times at work. Depression has also given me an increased empathy toward others. While I think this manifests itself daily in the way I manage, it certainly helps in those situations when it is most needed. Once, as soon as I had started a new job, an employee whom I had not met did not show up for work for several days. No one knew what happened until we heard through one of his friends that he was in the hospital psychiatric ward after attempting suicide. He had served in Afghanistan and had post-traumatic stress disorder (PTSD). He had just bought a house that he and his fiancée were going to move into. But, before moving in, his fiancée broke up with him. When he got out of the hospital, he contacted another executive he knew. This person knew my background with mental illness and suggested the two of us meet. When we met, it was clear he wasn’t ready to come back to work, so I got him to agree to meet me for coffee twice a week. This was my way of making sure he got out of the house and allowed me to help him with referrals for things like therapists and support groups. I talked with him about being in therapy and how it had helped me. Because the people who hired me knew of my advocacy around mental health, I was brought into the conversation and was able to provide support as this young man started down the road to recovery. I’m happy to say he got the help he needed and now, years later, is thriving. In the alpha-male-dominated, type A, adrenalin-charged executive suites of corporate America, admitting to weakness of any sort is viewed as taboo and a job-killer. The prevailing view is that people at the top get paid a lot of money and should be able to handle whatever their job throws at them. It is incredibly difficult to find examples in the press of senior executives who have taken a leave or resigned for mental health reasons. And we know death by suicide is often attributed to other causes. However, we are seeing mental health in the press more and more. Last year, Barclay’s compliance chief resigned after taking a leave of absence for stress and exhaustion. In 2011, the new Lloyd's chief executive took a leave of absence after eight months on the job for stress-related problems. Last year, the CEO and the CFO of two different companies in Switzerland died by suicide, and their deaths were reported in the press. And I’m sure you are all aware of the recent string of Wall Street suicides. So, while the perception is that people at the top can and should handle anything, the reality is somewhat different. Clearly, there are people at the top who are experiencing mental health problems. People in the highest offices of corporate America do live with mental illness. Personally, I think depression is a much more common affliction with executives, entrepreneurs and leaders than society is willing to admit.  And, just going by the numbers, many, many more have a family member, relative or friend living with a mental illness. There have to be senior executives who have been affected by suicide. It seems to me depression is the family secret we all share. Frequently, a bereavement leads to depression, which, in turn leads to suicide of a family member, which can lead to another period of bereavement, depression and suicide. It can be an evil circle. So how do we create awareness and a sense of urgency around mental health in corporate America? How do we make sure suicide-prevention efforts are supported and sustained? There are many strategies. I’ve already mentioned things like anti-stigma campaigns, health care parity, wellness clinics and employee assistance programs. Together with mass media and extensive research into the causes and treatment of mental illness, we should see a change in corporate cultures. These are critical efforts, and we should continue supporting them. I’d like to propose one more strategy. That is a concerted campaign targeting senior executive leaders to become mental health and suicide prevention advocates. How do we accomplish that? Let’s reach out to senior executives in a number of ways. Above all, we have to make talking about, and then communicating about, mental health concerns acceptable in their rarified sphere of influence. Only then can we create support groups, arm them with thorough training about mental health and suicidal behaviors, create speakers bureaus of senior leaders who are open and sharing and teach them to become knowledgeable advocates. First, let’s provide support for the leaders themselves. Clearly, there are people at the top are who are experiencing mental health problems. Why not create a support network for these individuals? Let’s provide a safe environment for senior executives to talk with their peers about what they are going through – personally and professionally. Philip Burguieres was the youngest CEO of a Fortune 500 company. In 1996, this self-described workaholic had to leave his job because of depression. It was several years before he returned to work. Today, he is a vice chairman of the Houston Texans football team. He is actively sought by CEOs with similar stories. He has been rather public about his very private support of a secret network of CEOs with depression. We could extend Philip’s example to create a safe community for senior executives challenged by mental illness to talk, share, and find support. It could even be positioned as an extension of the increasingly popular executive coach strategy. Let me give you another example. Last year, the UK arm of Deloitte, the international business advisory firm, appointed a British senior partner, John Binns, as its mental health and personal resilience advisor. Deloitte is one of the most forward-thinking companies with respect to human resources of all the places I have worked. After taking a leave for depression, John created a group of nine mental health champions at Deloitte UK, partners in the firm who were trained to discuss and support mental health in the workplace. He provides one-on-one advice for individuals in the firm who want to speak about mental health issues affecting them or their family. He also provides mental health awareness and advisory services to other businesses across the UK. We know that most deaths by suicide are by individuals with a diagnosable mental health issue, but only a minority those individuals receive any mental health service. Confronting mental health in the workplace should be an effective method of reducing deaths by suicide. As the stigma is reduced and more people get the care they need to recover, efforts like zero suicides among people who are receiving care become more significant. Moreover, to the degree benefits like employee assistance programs, wellness programs and general awareness and prevention programs are used in the workplace, advocacy by senior management is the best way to make these efforts a sustainable and core part of the organizational culture. So why do I think this will work? Why should corporate leadership become a major force in mental health efforts including suicide prevention? Why will it make a difference for people with mental illness and suicide attempt survivors to be open in the workplace? For me, the answer is simple. I’ve been through this before. Coming out of the mental illness closet is not the first closet I’ve come out of. Twenty-three years ago, when I was accepted into business school, I made the decision to be open and honest about being gay. It may not have been a revolutionary act at the time, but it was a time when almost everyone in corporate America still was in the closet. I decided that I didn’t want the next generation to experience the same prejudice, ignorance and stigma that I experienced. I told myself that if I were someplace that didn’t want me because I’m gay, I could take my Stanford bachelor and Kellogg MBA degrees and go somewhere else. This spring marked my Kellogg 20^th anniversary. I ran into someone I knew quite well during school but had lost touch with over the years. While re-connecting at the reunion, he mentioned that he was against my being open while at business school. But now he sees what’s happening with gay marriage and thinks my being open must have made a difference. I look back at the past 25 years, and I know the important role every out and open gay person has played by simply being honest about who they are. And one important lesson we have learned is that to ask others to accept us means we have to accept ourselves. I think the people living with mental illness and suicide attempt survivors at the corporate level need to come out of the closet. We are the best positioned to shatter the silence. If we can combine this openness with change in the business world driven from the top down, I know we can make a significant impact on the stigma around mental illness and suicide. I talk about mental health in the workplace because it’s the best way I know to break down the stigma. I want to make a difference, and I can afford to take the risk in an effort to effect change. As the senior executive in charge, setting the tone and defining the organization’s core values is one of the most important roles I play. Living with depression has not always been easy. However, in many ways it has made me a better person, a better manager and a better business leader. Living with depression has been challenging, but it has not kept me from succeeding.