Setting expectations with managers that employee health and wellness (physical and mental) are part of their responsibilities and training them to identify and address issues early will become increasingly important, says Dr. Kristin Tugman, vice president of health and productivity and holistic wellness for Prudential. She offers guidance and suggestions for how employers can equalize mental and physical health in the workplace in this podcast episode.

Get additional context and context from Dr. Tugman in this Q&A: Time for Change: Employers Can Help Turn the Tide with Mental Health Awareness and Treatment

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So during your presentation, titled Mental Health at Work Employee Rights and Employer Responsibilities, you posed the question: What does depression look like in the workplace and how does it show up in the context of separating issues of performance from mental illness? You then added, and I'm quoting you here, “maybe it is a performance issue, but we've got to ask the question first and give permission to ask for help.” I'm hoping you will talk about how managers and supervisors should approach the issue of mental health in the workplace and how they can safely engage in what you described as productive conversations with employees and when they hand off to human resources or absence management professionals.

Dr. Kristin Tugman: Yeah, sure. I think one of the things we have to recognize in most workplaces is that managers don't necessarily come to work every day understanding how to have conversations about mental health, and they don't even necessarily think that that's part of their role. But where we are getting to in the workforce in general is that employees are expecting a commitment to mental health and mental well-being. And I think that was starting even pre pandemic. But as we watch employees sort of shift their priorities and think about sort of reemerging from the pandemic and ultimately, it's natural. We all reprioritize after a crisis, and we think about what's important. And they want to know that in their work, where they spend so much time, that they are cared for and that their employer cares about their mental health and well-being. We're going to see that even more as new generations step into the workplace. Generation Z talks openly about mental health, and that's going to be a big piece of how they make their decisions relative to the employee errors of choice as they enter the workforce. So it's becoming more and more important. So I say all that to say that one of the most important ways that we can equip managers with the ability to think about mental health in the workplace is to train them. So I absolutely recommend employee sensitivity or employee sensitivity trainings, meaning managers understanding what depression looks like in the workplace and what depression and anxiety, what things to say and not to say. Because as much as we think it can sometimes be intuitive, it's not. We know all too often in corporate America, we are doing more with less, and we're trying to hit our productivity goals, and we're moving at the speed of sound. And if folks aren't productive, we do want to jump to the conclusion that it's a performance issue. So managers have to know that part of their role is climate and creating a culture of mental health and well-being. And so they're not going to just come to the table knowing that we have to train them and we have to help them understand why mental health is important and how it impacts productivity and again, what it looks like. And so generally, what depression and anxiety can look like in the workplace is a performance issue. And so if you think about depression, right, so when folks are depressed, they're not getting joy out of things that they used to get joy out of. They are typically pretty fatigued. And that's either because they're not sleeping at night or they're feeling like they want to sleep too much. Maybe that's an escape. They feel confused and have a hard time keeping their concentration intact. And so what does that show up like at work? It shows up as poor quality. It shows up as I didn't make my deadline. It shows up as maybe I'm offline at times when you didn't expect me to be offline. If they're coming into the office, they might show up late, they might be cranky, right? And they might not be the most fun folks to be around. So you might see their relationships with coworkers deteriorating. But so the challenge is not to jump to the conclusion that's a performance issue. And the key is to recognize a shift in how someone is behaving and then be able to take a step back and have a conversation about it. So I've noticed that you have missed the last two report deadlines, and that's not like you. Is there something I can do to help? And just offering that dialogue is going to help an employee not be put on the defensive. It's going to help an employee recognize that their manager cares, and it's going to help the employee recognize that it's okay for them to talk about what's happening for them. And that's really important if we're going to maintain the productivity of our workforce. And again, it doesn't come naturally. So we've got to set that expectation that mental health is important in the workplace. I mean, we all have mental health every single day, and I think we forget about that. We know we have physical health. We know we might wake up with a sinus infection or we've got allergies in the spring and I'm just not myself today. But it's the same with mental health. We all have mental health. We might have a stressor happening and it's making us feel like we're not ourselves today. And that's okay. We've really got to focus on equalizing mental and physical health in the workplace.

Heather Grimshaw: I think mentioning the allergy piece is a really good example because we feel very comfortable talking about allergies. Or maybe you have a cold. And I think you've already answered my follow-up question that I had in terms of how managers give permission to ask for help. Is it maybe as simple, and maybe simple isn't the right word there, for a manager to say, “How can I help?”

Dr. Kristin Tugman: I think so. But I think it starts before that. It starts before the one on one when you have to say, hey, you've been missing deadlines. Is there something going on? And what do you need? And how can I help? It starts with creating a culture of mental well-being and really opening sort of the ability for employees to have a dialogue about mental health. Just as we were just talking about how it's normal to say, hey, I'm a little stuffed up today, so forgive me if I don't sound like myself or feel like myself. We've got to be able to do that with mental health. And that comes from being sort of diligent about conversations around mental health. Again, it doesn't just happen. We need to do things like expect that managers will, maybe in a team huddle or a staff meeting, will say, “hey, really, how is everybody doing?”

We want to make sure that you are taking care of your self-care. What's one thing that you have done this week to take care of yourself and have folks talk about their self-care? Hey, typically maybe I'll take a break and I'll go for a two-minute walk outside just to get some fresh air. By doing that consistently then at the time at which somebody actually is experiencing an emerging mental health condition, they're much more comfortable talking about it and sharing it and asking for the help that they need at the time that they need it. So it's definitely not just in this pocket. We're going to ask the question. It has to be a consistent theme across the workforce. I like to think about it in sort of a pyramid as we think about building a culture of mental well-being. Because we know today, basically what we do is we wait in the world of mental health and in the workplace and in our communities, we wait for somebody to need something, and then we hope that they know where to go to get the EAP number. Not even thinking about the fact that they might not be motivated to do that legwork because they are depressed and feeling anxious and they don't know where to turn and they're not thinking clearly. But we also hope they can get an appointment. 12% of therapists are accepting new patients. So in my view, in our workplaces, in our communities, in our worlds, it's really a moral imperative to think about mental health and well-being differently and to communicate about it differently. And so if we keep doing what we're doing, this mental health crisis will never be mitigated. It will only continue to increase because we don't have access to care. And so we've got to think about, again, how do we equalize mental and physical health? How do we have and the workplace is such an amazing opportunity because we all come to work, we all know each other, we talk a lot of times about our work family and our coworkers really impact our emotional well-being. They just do. And so if we can again create this culture that allows us to talk about mental health and so a lot of times that's having like a steady drumbeat of maybe events and it's not one and done. I don't recommend just having one event during May for Mental Health Awareness Month, but have events throughout the course of the year. And they don't have to be dramatic. They can be using employee resource groups or they can be just kind of taking a minute in a town hall to have an executive share their own mental health story. And if we can do that, then we start to normalize the conversation around mental well-being. And the next piece that I think is really effective is folks need to know that they can vent and they have a safe space to do that. And sometimes that's all we need. And so we recommend doing things like peer support. Maybe you have folks go through mental health first aid. There's always in a workplace people who are passionate about mental health and well-being, who've had their own experiences, who want to give back and want to help others. And it's really effective to know that there are coworkers peers who you can talk to and not that they're anywhere near acting as a therapist, but they're listening and then providing resources to an individual to make sure they're getting the help that they need at the time that they need it. And then we're always going to need access to therapists and we're always going to need crisis intervention. But I hope that if we build that culture, then less folks sort of move up a level on that pyramid that I sort of visualize as I talk about this. So again, kind of a long-winded way to get back to how do you create the environment in which employees are comfortable talking about their mental health? It has to be a collective, comprehensive effort in my view, where we all take responsibility for mental well-being and it's going to take time. Absolutely. It's a huge culture shift, but that's when employees are going to feel comfortable raising their hand and saying that they need something.

Heather Grimshaw: It absolutely is a huge culture shift. And that leads me to my next question for you, which is really that need for employers, as you mentioned, to change their attitudes about mental health issues. And I liked what you said about the fact that talking about these issues is not intuitive and there is a lot of fear and that we assume that people are manipulating the system, especially when there's a disability that we can't see. So in terms of the steps that employers can take to address this issue or shift that attitude about mental health, do you have some recommendations?

Dr. Kristin Tugman: So it's definitely hand in hand with culture because if we're living in a culture that doesn't necessarily recognize mental and physical health equally, we're going to have a much harder time giving folks grace and space to heal when it's a situation or a health condition that we can't see. And so it's so interesting, I think, when I think about just the psychology of it, our brains are trained to think negatively. We actually have to really work to get our brains to immediately think positively or think positive intent. And so if you couple that sort of propensity with the notion that most of us at work are doing more of less right, and we're just doing the best we can to meet our performance goals and moving really quickly and trying to be as productive as possible when somebody suddenly can't do it. And we don't have that culture that really accepts mental health and we're still living in a world of stigma, we're going to immediately sort of jump to the conclusion, why can't Joe keep up his end of the bargain? Like, everybody else is stressed, everybody else is coming in every day, everybody else is getting their work done. What's that person's problem? Are they just trying to get out of it? And because in the end, there's a lot of employers that don't necessarily have policies and practices around having conversations and trying to adjust job tasks and keep people at work, then suddenly that person's out of work and we're picking up extra work because they're not able to do it. And so it does create a level of frustration. So again, that's why we've got to have this culture of mental well-being.

Because generally what happens, when somebody is experiencing a mental health challenge or condition… We've talked about what that looks like at work. Ultimately, it's not like that person is oblivious to the fact that their job performance might be suffering. And a lot of times there's shame and guilt with that. And then the individual goes out of work and is concerned that my coworkers are going to be upset with me because I know they're having to pick up my slack. And so ultimately that exacerbates the anxiety that the person is experiencing. There's anxiety about coming back to work, and in the end, it likely prolongs their disability event and they're out longer than we would anticipate. So it gets back to culture. And if we're normalizing mental health and somebody actually needs to go out, we have an environment that accepts that, that supports that, and stays in touch with the individual, helps them feel comfortable about their need for recovery, and then sets them up for success when they return and really talks to them about what it's going to be like, it's okay. Are there things that we need to modify for a little bit in order to make sure that you're successful? That's the ultimate environment, setting folks up for success versus where we might tend to live, which is in a world of stigma and cynicism that ultimately prolongs somebody's disability event.

Heather Grimshaw: I think that's such an important component about that shame and guilt for someone who is struggling with a mental health issue and is out of work and then worries about their colleagues, that's something that may not occur to people who are dealing with this. So that's helpful. And I think earlier in our conversation you mentioned the fact that only 12% of therapists are accepting new patients. That was something that you also mentioned during your presentation. Along with the need for employers to be more innovative with care options. Will you share some ideas for how employers can be more innovative in this area?

Dr. Kristin Tugman: I think one of the most important things is for employers to be honest about it, just in terms of their evaluation of what's really happening within their benefits. Take a look at your [employer assistance program] EAP utilization and take a look at the ability to actually get in to see a therapist. How long is it taking for the individual to get a call back? How long is it taking for the individual to actually get an appointment? How satisfied are those employees with the care provider that they were originally given? Think about that with your health plan. How long does it take to get in to see a provider? Talk to your employees about the gaps and be honest about it. Don't shy away from it. Sometimes we don't want to hear bad news, but it's really important to understand the reality of what employees are dealing with when they seek care. So we can start with that baseline. So what are the gaps and then how do we fill the gaps? There's a new digital solution that coming out from a mental health perspective almost every day and I think they are good alternatives. We just want to make sure that they're meeting the needs of employees. So there's a lot of great ones that do pretty simple things around resilience training and meditation and naturally reducing anxiety. But those are typically pre mental health conditions. So just be aware of that. I like the ones that really emphasize a clinical connection but also meet you where you are on your mental well-being journey. And so wouldn't it be great if we have access to a tool that can start us off before we have a mental health challenge, really thinking about resilience techniques and mindfulness techniques. Because we all could do stress reduction every day. Like I said, we have mental health every single day. So it's important to use the tools around self-awareness and self-preservation as much as we can to avoid mental health challenge or mental health condition. And so to have those tools that allow us to have that self-awareness, maybe take mental health assessments, depression screenings, anxiety screenings, periodically again, just like we would have a physical checkup. I don't understand why we talk about preventive medicine, why that doesn't equate to preventive medicine for mental health. We should think about it differently in my view. And so if we have those tools again, maybe we don't get to a point of needing therapy. But I like the clinical ability to have a clinical interaction so that if somebody does have an exacerbation of symptoms and it looks like they need therapy to have somebody be able to actually reach out to them and talk to them and make a referral to a provider is really important because, like we said, we wait for somebody to need something, and then we hope that they have the wherewithal and the ability to proactively reach out on their own. Typically that's not realistic. And so that clinical interaction, I think is really important to get people access to the care that they need. And there are additional community resources that a lot of folks don't know about. We do work with a group called NeuroFlow that follows sort of that same pattern that I recommended and talked about. There certainly are others that employers can consider. But I would just say again, be creative, meet people where they are in their mental well-being journey. Don't wait for them to need something, provide them the tools through these solutions, but be mindful of it having a clinical interaction so we can get to people when they need care and get them an actual appointment. It doesn't solve at all. We are in a mental health provider shortage, but it doesn't mean it's not worth the effort to try to figure out how we can get more people access to the care that they need it at the time that they need it.

Heather Grimshaw: One of the comments that you've made in the past is we need to go upriver and figure out why people are falling in instead of throwing people life vests. And I think it's such a great visual. What are the things that you can do to identify early on that there is an issue brewing?

Dr. Kristin Tugman: I think one of the mistakes that employers make is they don't make it a part of performance objectives. All too often we have managers who really are technical experts and not necessarily they don't necessarily consider themselves to have the soft people skills. While we call them soft, they're just as important as having technical skills. Being a manager is a dual role. You have to make sure that you're working with employees and giving them job satisfaction and developing them and building relationships and making them feel comfortable at work while maintaining the integrity of the work that you do and meeting your technical performance objectives. And so I think it's important to really demonstrate to future employees and current employees if you're going to maintain or retain the employees that you want to retain, to show them that this comes from the top down. This is part of our performance objectives. We expect that managers think about climate just as much as they think about their actual productivity objectives.

Heather Grimshaw: That's great. And it kind of brings us full circle. One of the first things you said is making sure that managers realize that mental health, mental well-being is part of their role. And I would think that that is not common for most employers. I think that would go a long way in terms of changing some of that culture, making sure that mental health and well-being is as top of mind for employers as that physical well-being. So thank you so much for your time today and your willingness to talk with us.

Dr. Kristin Tugman: That's great. Thank you so much for having me.