Long-term disability claims increase as employers learn more about depression
Long-term disability claims increase as employers learn more about depression
Nobody knew about Heidi Mortensen’s dark secret while she was teaching junior high-school students in Steinbach, a small farming town on the Manitoba prairie. She hid it well, behind the efficient image of a German, English and history teacher who was usually in control of the boisterous adolescents in her classroom. But between classes, Mortensen sometimes slipped into the school bathroom and burst into tears, overcome by the shame, guilt, self-hatred and anger that seethed inside her. She did not tell her doctor, and it never occurred to her, the eldest daughter of hardworking Manitoba hog and grain farmers, to confide in the principal. She might have lost her reputation, or worse, her job. “I had to put on a false front,” Mortensen says. “I went through hell inside, never realizing what was wrong.”
She was clinically depressed. And like many of the estimated 670,000 working Canadians who suffer from depression, Mortensen kept her illness to herself. That reticence does not surprise Neasa Martin, executive director of the Mood Disorders Association of Metropolitan Toronto. Even though the workplace has become the main social centre for many Canadians, it is still “very unsympathetic,” says Martin, who has watched her own father battle manic depression. The enduring stigma of depression makes it risky to disclose the illness to a boss. “People lose credibility,” says Martin. ‘They lose legitimacy when they’re identified as having
a mental illness, even a treatable mental illness.”
But even if most Canadian employers would still rather not face the problem, they will not be able to dismiss it for much longer. The human and financial cost of depression is climbing dramatically in the Canadian workplace, in part because of the heightened stress of jobs that demand more from fewer people. Psychological problems, principally depression, are the fastest growing cause of longterm disability leaves, expanding at least five to seven times faster than physical causes. The cost: $300 million for long-term depression claims in 1994, and climbing. One leading insurer, Mutual Fife of Canada, reports that the volume of its long-term “mental and nervous” claims has doubled in the past decade.
Another disturbing sign: only treatments for migraine and ulcers now account for larger payouts from workplace insurance plans than prescriptions for Prozac and other antidepressants. If employers continue to ignore the growing problem, experts warn, they could see an explosion in
long-term disability claims. ‘This is a time bomb just waiting to blow up into disability,” says Fred Holmes, senior consultant at Towers Perrin consultancy. Most of corporate Canada is in denial about depression, he says—employers are looking for magic solutions when they should be changing the workplace to reduce the stresses that can trigger depression.
For the sufferer, the cost of ignoring the illness can be devastating. In Mortensen, depression was first unrecognized, then untreated—and it nearly killed her. In 1990, after a decade of teaching, she quit to run a day care centre at home, partly to be closer to her two children, Jenny and Kent, then aged 1 and 3. But when her husband walked out two months later, she tumbled into a black pit of de pression. “It was like being in an altered state,” she says now. “Nothing could reach me. Nothing mattered. The pain was so great I couldn’t go on any more. I felt numb. I just knew I had to stop. I felt so worthless, so hopeless.”
One day, while the kids were with their father, Mortensen went to a lonely highway on the outskirts of Steinbach and stepped in front of a transport trailer. The driver swerved and missed her. She walked into a field, lay down and listened to the crickets. They pissed me off,” she recalls. “I was angry and sad that I wasn’t killed.” In the weeks that followed, Mortensen tapped into a source of strength and hope: her faith. Raised as a Roman Catholic, she renewed her commitment to religion, and drew strength from a native spiritual centre near Winnipeg. Mortensen joined several 12-step programs that referred to higher powers and offered peer support. It was the start of a long and sometimes faltering trip to recovery. “Faith,” she says, “is a tremendous gift that gave me strength, but it is not for everybody.”
Compared with the human pain of depression, the cost to employers may seem insignificant. And in fact, few em-
ployers even understand how expensive it is. A 1994 survey of 35 insurers by Mercantile and General Fife Reassurance Co. of Canada showed that 19 per cent of all long-term claims (at least four months off) were of a psychological nature. Within one single professional group— teachers—the number soared to 42 per cent. Women in their 30s were most vulnerable—31 per cent of their claims were psychological. Since then, files of five major insurers show psychological disability claims to have risen to roughly one-quarter of long-term claims.
That should start ringing the alarm bells, says Dr. Michael Ross, co-director of Toronto’s Centre for Occupational and Organizational Psychiatry at North York General Hospital, which helps employers cut the risk of mental health disability and gets sick people back to work as quickly as possible. “People do best when they maintain a routine, and the structure provided by work is very important,” he says. “It’s a place where we have relations, feel part of something, feel we’re productive, satisfied. It’s a big part of self-esteem.” But, in fact, family doctors often prescribe time off work without an effective plan to get depressed employees back to health and work as quickly as possible. Ross’s clients are major employers that are bearing the enormous costs of having 3.5 to 4 per cent of their workforce absent on psychiatric disability leave. For every dollar they spend on disability benefits, he says, companies have to spend another three dollars for retraining, lost productivity and related expenses.
Some employers are getting staff back on the job earlier by eliminating the most stressful tasks and shortening work hours. After trying to commit suicide on Halloween night three years ago, Agnes Vandergang cut her hours as a consultant at a Toronto mental health agency while she went through a recovery program at a hospital. She thinks working part-time helped her get back on her feet. “With so much of my identity and self-worth tied up in work,” she says, “the idea of being off was devastating.” But employers willing to alter job descriptions remain rare. “It’s usually all or nothing—return to work or total disability,” says the Mood Disorders Association’s Martin.
In a move to catch depression and other mental illnesses before they become costly disability claims, most large companies have signed up for employee assistance programs. They give employees a telephone number to call for confidential advice. They can also provide counsellors, psychologists and psychiatrists for further treatment. One-third of all large workplaces in Ontario had EAPs in 1993, double the number in 1989, according to a survey by the Toronto-based Addiction Research Foundation. But while they are helpful, it is not clear that EAPs have curbed absenteeism, the Foundation reports. Nor is it clear if they have put a dent in long-term disability leaves caused by depression.
Many EAP providers teach employees to cope with stress, one of the causes of the rising toll of depression. But some employers are trying to change the workplace to cut the risk of mental problems. On the leading edge are banks such as CIBC, which uses a focusing technique imported from California that aims to help employees learn to cope better with stress. The bank’s program also includes massage therapy, flexible hours, working from home, help with child care problems and training to make managers more supportive. “The flexibility of the workplace and the relations with the manager are fundamental to someone’s health, physical or mental,” says the bank’s medical director, Dr. David Brown.
It has long been known that supportive managers have fewer absentee employees. What is more, say Brown and others, when employees do get sick, their relationship with their boss is the key to getting them back to work quickly. “The single most important thing employers can do to affeet the bottom-line cost of disability,” says Marie Makinson, senior adviser, medical resources, at Manulife Financial Group Benefits, “is to pick up the phone and say, ‘How are you?’ ” But first, employers have to face the problem. ‘We’ve got a long way to go to eliminate the stigma of depression” in the workplace, says Ed Pennington, general director of the Canadian Mental
Health Association, which has just completed a three-year public education campaign to do just that. It is too early to judge the results, but in Manitoba, Mortensen sees positive signs of change, both in the workplace and in her own life. As she recovered, Mortensen continued working, first in her day care centre and later as a facilitator for a grassroots organization of mental health support groups. “It’s really important to have a purpose, to have practical things to focus on,” she says. “If I didn’t have that I would have gone deeper into the hole.” Mortensen is in good shape now, and is using her hard-won knowledge to help other people with mental health problems at a Winnipeg residence and recovery centre. □
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