By: Jean Leslie and Naomi Leslie, M.D.

The COVID-19 pandemic, political turmoil, productivity paranoia, and economic stressors have heighted the awareness of workplace mental health. Simply asking your direct reports, “Are you okay?” can imply something is wrong, and that, as their boss, you are equipped to help them with all aspects of their lives. In many organizations, interest in employee well-being extends beyond the boss-direct report relationship. Bi-weekly leadership team meetings, for example, begin by going around and answering the question, “How are your teams doing?” Though never explicitly stated, the expectation is to share emotional, mental, and overall well-being information on employees.

As the recipient of this vulnerable information, I (the first author who has not had workplace mental health training) struggle with how best to respond, and I am not alone. A recent survey found nearly two-thirds of supervisors feel ill-equipped to provide helpful mental health support to their team members¹. However, survey results show that employees appreciate and are seeking mental health support in the workplace². One study showed an increase in employees talking about mental health challenges in the workplace, from 23% in 2021 to 46% in 2023 (63% shared with a manager). Perhaps less time in the office and more time working from home has encouraged self-disclosure in the workplace at higher levels than before the pandemic³. Opening up to others is a way to build relationships and connections to combat social isolation.

As a manager, you may have a preference for action, but it can be challenging to determine how involved you should be in assisting employees with their mental health challenges. What is expected of you in the workplace? What are appropriate responses for front-line HR staff who want to support employees while respecting their privacy and boundaries?

To address these questions, I consulted with a psychiatrist certified by the American Board of Psychiatry and Neurology (the second author) on how to respond to employees in the moment. Below, Dr. Leslie provides guidance on handling employees’ mental health compassionately and effectively while in the workplace.

When Employees Communicate Extreme Stress

Scenario: “I am burned-out. I don’t feel like myself. I don’t have the energy and motivation I used to have. I am irritable and frustrated with things around here. I need a break.”

Expert Advice: Start with validation. Acknowledge the employee for speaking up and being willing to admit they/them are not at their best and that their work has been affected. This person is making a direct ask for a break, so in this case, I would suggest looking at Paid Time Off (PTO) or leave of absence options if your organization offers this benefit. Refer the employee to HR for a full list of available options. Addressing the source of burnout is a more difficult prospect. Much has been written about the components leading to burnout. Some common themes are autonomy, workload, control and predictability over schedule and hours (not just quantity of total hours per week or month), ability to take breaks for personal and family needs (such as doctor’s appointments and important family events), and a sense of acknowledgement or recognition for the work being done. If it is in your power as a supervisor to affect any of these factors, then it would be advisable to discuss how any of these could be improved to reduce future burnout.

Scenario: “I am so lost. I will never recover from losing my husband.”

Expert Advice: Use a validating, empathizing statement, such as “I can see this has been so devastating. I’m worried about you.” This employee is dealing with significant bereavement. In this case, I would suggest that the employee talk with a grief counselor or psychotherapist. Many organizations have an employee assistance program (EAP) that includes grief counselors. Refer the employee to the EAP brochure and/or to HR for details.

When Employees Describe Addiction

Scenario: “Do you remember when I hurt my back and I started taking prescription painkillers? I can hardly admit this to myself, but I can’t live without them now. This is why I keep missing work.”

Expert Advice: This is a very serious scenario as it involves opiate addiction. Depending on the work setting and any ethical or safety standards in your field (such as health care or human services, transportation, etc.), this could require an immediate leave. In a setting where there is not an immediate safety concern for negative impact on others, a mental health professional would still make a referral to an opiate treatment program for this person. There are numerous treatment options available, including residential programs and intensive outpatient treatment. In general, if an employee makes this type of statement, the employee should be referred to HR immediately.

Resources for Substance Abuse Treatment:

FindTreatment.gov – website run by Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services). You can input your location and find substance abuse providers and programs.

Not in the U.S.? Look for similar sites in your country.

When Employees Speak of Anxiety

Scenario: “My life has changed since COVID. I don’t want to be around people. I don’t want to come into the office. Just thinking about it makes me sweat.”

Expert Advice: This employee is giving indication of a mental health disorder in the form of anxiety. Desire to work from home for reasons of schedule or flexibility are different from fear of being in an in-person, social environment. If in-office work is absolutely required for the employee’s position, you may suggest a gradual re-entry. An example would be that the employee works in office one day per week for two weeks, increasing by an additional day per two week period until at the required in-office work quota. This is a common strategy utilized for social anxiety. If the employee signals that this seems too overwhelming to handle, then a recommendation to consult with a psychotherapist about anxiety treatment would be the next step. Refer the employee to an EAP to find the best trained professional for them.

Scenario: “We need to talk. I can’t handle this new assignment. There are so many tasks, and I don’t know where to start. I am so stressed out that I can hardly breathe.”

Expert Advice: This person is describing a significant level of anxiety. I suggest starting by exploring measures that could reduce burnout – help with prioritization of tasks, workload change or redistribution, allowing flexible schedule for personal needs or events if possible, and acknowledging the employee’s hard work and accomplishments (if this feels sincere). If these options are not successful, then a referral to a counselor or therapist through an EAP would be the next step.

When Employees Expose Trauma

Scenario: “I like my job, I really do but, my boss seems only to see me as an angry, difficult, and aggressive black woman.”

Expert Advice: This employee has described an interpersonal conflict that appears to involve issues related to racism. A mental health professional may try to gently confront such patterns of belief in a long-term relationship, but this is more of an HR concern. It seems this employee can’t get along with their boss who has racist biases that present an obstacle to an amicable working relationship. As a supervisor, you would need to find a clear but non-argumentative way of stating that the interpersonal conflict needs to be addressed irrespective of the boss’s race. Further steps could be suggesting efforts to improve the working relationship as addressed through performance management with an HR representative.

Scenario: “I was spit on, called all kinds of derogatory names, and was told to go back to my country.”

Expert Advice: I am assuming that this did not occur in the work setting, and that the employee experienced this in their personal life. This experience sounds traumatic. I would advise a supervisor to say just that, to offer empathy and validation of this person’s terrible experience. The supervisor should be aware that memories of such trauma can be intrusive and distracting, affecting a person’s concentration and lingering to cause emotional distress long after they occurred. Making a genuine statement of support is a good start here. Say something like, “I am so sorry that happened to you. It must have been terrible.” And a follow-up statement of welcome into your work team would be the next good step. “We value you here and are so happy you are with us.” Avoid saying things like “I can’t believe that happened to you.” Though it may express genuine shock, it contains the words “can’t believe” and distances you from the person’s experience. Also avoid making any excuses for the perpetrators, such as “They might have thought you were from X,” etc. Beyond those types of statements, a supervisor could engage the person 1:1 meeting about possible Black, Indigenous, or a Person of Color (BiPOC) mentor options or a therapist for support through an EAP.

When Employees Talk about Dangerous Situations

Scenario: “I’m in a really bad place. I am talking with a professional, but I can’t seem to stop the suicidal thoughts.”

Expert Advice: Even seasoned mental health providers are not fully able to predict when a person is a danger to themselves or others. We can identify risk factors and engage clients in safety planning and treatment. We cannot always cure suicidal thoughts or prevent suicidal actions. In the role of supervisor, this is a time to indicate that you are worried and concerned, with a focus on how any change in the workplace could be of help.

I suggest the following steps:

• Ask if the employee is in immediate danger. If so, assist with calling 911 and getting them to a hospital. Contact HR.
• If not in an immediate danger, encourage the employee to share these ongoing thoughts with their treating provider (consult an EAP for providers).
• Offer available options for the workplace, such as a reduced schedule (to attend more intensive treatment or leave of absence, if supported by the organization).

Scenario: “I’m going to kill her.”

Expert Advice: Many of us casually use the phrase “going to kill” someone when feeling frustrated. However, we are now culturally more aware of the concern for workplace violence existing on a spectrum from verbal intimidation to worst-case scenario mass shooting events. As indicated above, none of us will have perfect predictive power about whether an employee is actually going to act on threats of violence. It should be made clear to the employee that such language is not tolerated in the workplace, that expressing frustration should never include imagery of death or violence. If a supervisor feels truly concerned about violence risk from an employee, this is absolutely a reason to escalate that concern to HR and up the company hierarchy. If indeed this is simply an expression of frustration, then HR and the supervisor have work to do regarding improving the relationships of members of their team and they/them colloquial language.

Scenario: “I am so tired of Jim talking about what I am wearing and how good I look. The other day he said if I were candy, he’d eat me.”

Expert Advice: This is a clear case of an employee being in a hostile work environment. As the direct supervisor, you should make clear that such comments are not okay and that you support this person coming forward. Then indicate that this situation must be handled by HR according to the company’s sexual harassment policies and procedures. As the supervisor, you should seek advice from HR as well, particularly if “Jim” is also your supervisee.

Scenario: “I know I told everyone that my black eye was from playing ball with my nephew. To be honest, my partner hit me. I am so afraid it will happen again.”

Expert Advice: This scenario involves interpersonal violence within a household leading to injury. As an adult, the employee would have to make a police report if they want to pursue legal action. You do not have the ability or obligation to make a report as a supervisor. However, if the employee is ready to admit this information, the employee may be willing to talk with a trained counselor about it further. Again, and EAP can assist the employee. Depending on your relationship with the employee, you might want to make them aware of the National Domestic Violence Hotline: 800-799-7233. If you give this number to the employee, do not label it as such. Just write the number down or put a fake business name on the paper so that the potential abuser will not discover its purpose. Support this person’s agency to help him or herself.

Not in the U.S.? Look for similar hotlines in your country.

Boundaries to Remember

Do:

The safest starting point is to validate what your employees are going through and ask what type of help they would like from you. State clearly what you are able to do. Boundaries help everyone feel safe. Your employees are coming to you not as friends, family members, or mental health providers. Let them know if you have the ability to help within the workplace or with providing resources you are aware of.

If an employee makes statements about needing mental health treatment:

• make use of any Employee Assistant Program offered by your company
  • If there is no EAP, then employees should be directed to HR for benefit details, their insurance company’s behavioral health phone number, and can use PsychologyToday.com to look for local providers
• offer and support flexible schedules for mental health appointments, use of PTO, or leave of absence if available through your organization and as necessary

If a problem is not something you feel comfortable discussing or if there is no clear path to help via workplace authority, then I suggest the following:

• Express empathy for what the person is going through.
• State a desire to help, but also lack of knowledge about what steps to take next.
• Ask permission to connect with either HR or your company’s Employee Assistance Program.

Don’t:

Ask employees to expand on intense emotions regarding personal issues in a large group setting. If they have offered such information in a large meeting, indicate your concern and ask to check in one-on-one to talk about workplace options.

Act on behalf of the employee. Empowering the person with resources and next steps is the best course of action.

Ask or encourage the employee to reveal extensive details of any traumatic experiences.

A Word about Health Insurance Portability and Accountability Act (HIPAA)

HIPPA is a US federal law that protects the privacy of individuals’ health information. Many countries have data protection laws under different names (e.g., General Data Protection Regulation in the European Union). HIPAA does not specifically address the issue of supervisor advisory of employee mental health. However, it does require covered entities, such as healthcare providers and health plans, to safeguard protected health information (PHI) and only use and disclose it for specific purposes, such as treatment, payment, and healthcare operations. In the context of mental health, if an employee seeks treatment from a healthcare provider for a mental health condition, the provider is required to protect the employee’s PHI and only disclose it with the employee’s written authorization or as otherwise allowed by law.

Employers also have a responsibility to provide a safe and healthy work environment for their employees, which includes addressing mental health concerns. However, employers must balance their responsibilities with the privacy rights of their employees and should only seek information related to an employee’s mental health on a need-to-know basis.

In summary

When employees disclose mental health challenges, it can be challenging to know how to handle the conversation. A good starting point is to validate the employees’ experience and ask what type of help they need, while being clear about what you are able to offer. If employees express needs for mental health treatment, it’s important to encourage them to use any available resources, such as an Employee Access Program, HR, insurance company’s behavioral health phone number, and offer support for flexible schedules and time off if necessary. Avoid discussing personal issues in a large group setting, acting on behalf of the employee, or encouraging the employee to reveal extensive details of traumatic experiences. The best course of action is to empower the person with resources.

References

1. Lyra (2023). 2023 State of workforce mental health. https://www.lyrahealth.com/2023-state-of-workforce-mental-health-report/
2. American Psychological Association (2022, July). Workers appreciate and see mental health support in the workplace. https://www.apa.org/topics/healthy-workplaces/mental-health/train-managers
3. Cooks-Campbell, A. (2023, February 20). Self-disclosure at work: Strengthen team bonds and communication. BetterUp https://www.betterup.com/blog/self-disclosure-at-work

About Naomi Leslie

Naomi Leslie, MD is a graduate of UNC Medical school who completed residency and fellowship training at UCSF and Stanford University. Dr. Leslie is double board-certified in Adult and Child and Adolescent Psychiatry.  She has been in psychiatric practice for 11 years. She is an Assistant Professor of Psychiatry and serves as Program Director for Child and Adolescent Psychiatry Fellowship at Atrium Health Wake Forest Baptist.