Masking the pain: Substance use and mental illness in the workplace

Tom Regehr is a cheerful man, with a disarming smile and a big laugh. He's not shy about discussing his turbulent history - years spent unemployed and homeless, using alcohol and drugs to mask depression, and then years more spent recovering his mental and physical health. Like many others, Tom was nearly destroyed by the results of his addiction. But, unlike so many, he eventually came to realize that his addiction was not the cause - it was the effect. "I now identify myself as a trauma survivor," he says. "The addiction was what got all the attention, it's what everyone saw, but it was the trauma that was at the root of everything."

Mary Ann Baynton, director of Mental Health Works, an initiative of the Canadian Mental Health Association, Ontario, agrees. "It's often the addiction that first gets noticed, especially in the workplace. But what we tell employers is to respond to the person, not the addiction." Mary Ann works with business-owners and employers who recognize mental health and addiction have implications for the workplace. "They're both both bottom line and human resource issues."

The bottom line is significant; an estimated $30 billion cost to the Canadian economy due to mental illness and addiction. It's also estimated that 38% to 50% of all workers' compensation claims are related to substance abuse in the workplace. But the employees affected can't simply be pushed out of the workplace; alcoholism is recognized under employment law as a disability, so employers cannot terminate an employee suffering from alcoholism without first trying to help.

In Tom's case, he first started drinking heavily in university. After he graduated, he was able to maintain both a career in landscape construction and his addiction, for many years. Then, when he began working in his own business, the hours became more demanding. "I started to get into cocaine. Two years of that, added to the all the booze that never stopped flowing, led directly to me being homeless and unemployed."

After several years, Tom began a long journey to sobriety, finally managing to overcome his addiction. But in the process, he learned that his struggles were nowhere near over; although he was no longer drinking or using drugs, his mental illness was still a major factor in his life. "I was four years 'sober' but my life was totally unmanageable. I couldn't keep a job, a relationship - I couldn't keep a friend." he says. "I did get healthy enough that my trauma started to surface and I was diagnosed with clinical depression." Tom began working with a therapist and began putting his life back together. "I got sober and then five years later, I got well. In my healing, I was healing from the original trauma as a youth as well as feeling so disfranchised that I felt I didn't exist."

According to Mary Ann, Tom's experience is not unusual. "Substance abuse so often co-exists with mental health issues and the use of drugs or alcohol can be an individual's attempt at self-medicating. They are trying to dull their pain with the only strategy that has worked so far." It is, for trauma survivors, a survival technique.

As he entered therapy, Tom began working full time for the first time in many years, and initially found it very difficult. He would be so overcome with panic that he would have to run out of the building. His boss's reaction was just the kind of support Tom needed to hear; "He said, 'We need your skills, we need you here, so tell me what you need from us to do that.' The next time I wanted to run, I just walked around inside the building, and then I didn't need to run. I worked hard for that guy." For every employee, oyalty comes from a sense that you are valuable and valued.

In her experiences with Mental Health Works, Mary Ann hears similar stories constantly. "When employees with addiction or mental health issues are treated with respect, when they are given the support they need, they are frequently the hardest workers in their organization. They have a great deal of loyalty to their employers." The office of Ontario's Auditor General backs her up; their numbers show that there is a 565% return on investment for making addiction treatment easily accessible to employees.

Both Mary Ann and Tom want to share with employers is that they have an obligation to offer help to employees with addiction or mental health issues, but they need to do it in an appropriate way. "You are not therapists, you guys," Tom tells employers. "It's not your job to diagnose, it's your job to take care of your production quotas and your profit."

Mary Ann agrees. "Employers should focus on finding solutions at work. That way, they're meeting their obligations and leaving the medical or therapeutic interventions to objective and qualified outside professionals." Finding solutions at work means applying a four-step process that Mental Health Works teaches managers to implement.

Step One - Notice

The first step is about paying attention to your staff, noticing any changes in their usual behaviour. "A manager will not know whether the change they're observing is related to a mental illness, an addiction, or something else altogether," says Mary Ann. "But the important thing is to notice when an employee exhibits changes or challenges. Currently, it is often only in retrospect that these changes are recognized as early signs that something was wrong. The initial response may be that the employee has a bad attitude or performance issue."

Step Two - Discuss

It is that first conversation that causes most managers a great deal of anxiety. They are concerned with invading an employee's privacy, breaching professional protocol or opening themselves up to more personal information than they are comfortable hearing. The best strategy is for managers to remain neutral and non-judgmental; don't indicate that you suspect that substance use is an issue. Mary Ann suggests starting with a phrase like, "I've noticed that you haven't been yourself lately. I'm worried about how you're doing." Training helps managers gain confidence in holding these conversations where traditional management strategies may not be effective.

Step Three - Hear

The next step is critical to getting the employee the help they need, as well as meeting the organization's legal obligations. Managers need to understand the employee's perspective clearly before trying to engage in problem solving. As Mary Ann notes, "Listening can be the most difficult part for managers who are trained and rewarded for problem-solving and quick decision-making. The problem with this approach when addressing employee distress is that if you don't understand what your employee really needs, how can you help them?"

Step Four - Act

Once you are able to accurately describe the situation from your employee's perspective, as manager, it's your job to find solutions at work. This does not include assuming the role of therapist; in fact, this type of relationship with someone over whom you have power and control is unethical. Rather, managers should focus on letting employees know about the support that is available through your organization or in the local community. As Tom puts it, "You need to identify clearly what the work is and make clear that other people depend on it - this isn't complicated stuff. And then say, 'You are the one who does this for us. We want to help you do it.' You relate it to the goal, the product."

Tom has another key piece of advice for managers; don't treat addiction or mental health issues like a dirty secret. "Where possible, the company environment should be that the person with addiction isn't shamed but helped," he says. "Normalize the process for asking for help. I think addiction should be talked about in the same way as if you broke your leg."

Like Mary Ann, Tom is also working to develop awareness of addiction and mental health issues. He is the founder of CAST Canada, an organization that does training primarily for professionals who work with individuals with addiction, loss and trauma issues, as well as anti-stigma education. One of his favourite jobs is going into schools and speaking to students about addiction. He has relished the opportunity to help young people learn from his experiences. "One of the best things that happened to me after I started visiting high schools was that someone asked me, 'Did you smoke all the drugs because of how it made me feel?' At first I said yes, but then, it hit me and I said, 'No, I did those drugs because of how it made me not feel.'" In his work with CAST, Tom is spreading the word that addiction is often a mask that people in pain use to disguise their mental health issues.

Tom's success at his work, particularly in building CAST, illustrates that recovery is possible, when the support is available. "He's an inspiration," says Mary Ann. As for Tom, he has hope that one day, addiction and mental illness are treated like any other health issue in the workplace. "It is possible," he says. "It is happening."