As day-to-day urgencies with COVID-19 subside even a little, our customers are recognizing the need to address a number of health issues that have been left untended and have often gotten worse during the pandemic. At the top of the list – mental health. For answers to some of the questions we’ve been getting, Dr. Hoffman interviews Noah Wayne, PhD, VP of Clinical Programs for NexJ Health, a partner of WorkSTEPS.

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

COVID-19 and Mental Health – An Interview with Dr. Noah Wayne

Take-Aways

1. The pandemic has been a global traumatic event that has tripled rates of depression and other mental illnesses.

2. While we’ve made progress on mental health stigmatization, people still tend to hide their struggles. Employers should assume employees are struggling and take action to address mental health.

3. At a high level, organizations need to message against the stigma and make sure employees are aware of available resources.

4. At the individual level, it is ideal for employers to promote the use of screening services, coupled with the availability of counseling services to help people better understand their mental state and access help as needed.

5. As we move away from the constant crisis mode of the pandemic, we need to return to a holistic, person-centric approach to employee wellbeing that emphasizes physical and mental aspects.

Mental Health in Focus

As day-to-day urgencies with COVID-19 subside even a little, our customers are recognizing the need to address a number of health issues that have been left untended and have often gotten worse during the pandemic. At the top of the list – mental health.

For answers to some of the questions we’ve been getting, I turned to Noah Wayne, PhD, VP of Clinical Programs for NexJ Health, a partner of WorkSTEPS. Edited for length, below is the record of my recent Q&A conversation with Noah.

Q&A with Noah Wayne

Dr. Ben Hoffman: We hear a lot about COVID-19 and how it has been such a struggle for many in terms of mental health. What does the data tell us about who is being impacted and what specifically they’re struggling with in terms of mental health issues?

Dr. Noah Wayne: COVID-19 is very much being experienced like a global traumatic event that has changed our way of life. It has instilled fear, created significant economic challenges, and has killed our loved ones. So, fundamentally, people are experiencing higher than normal rates of mental health issues, such as depression and anxiety, post-traumatic stress disorder, substance abuse, and in some cases, general feelings of hopelessness.

The pandemic has sparked a lot of research in the mental health area. A paper in JAMA last year compared depression rates amongst a snapshot of the American population with another snapshot taken pre-COVID-19. The results indicated a threefold increase in depression rates at all levels – mild, moderate, and severe. Those findings are consistent in Canada, in the UK and around the world. And the people that have been affected the most are those who are most vulnerable. So those in lower socioeconomic strata communities with fewer economic resources and greater exposure to stressors report greater levels of depression and trauma.

Ben: Do you think that HR leaders or company executives understand the magnitude of the mental health challenge that some of their employees are under at this point in time?

Noah: The thing to remember about mental health issues is that they’re typically not visible to employers and colleagues until they reach the point of burnout, leading to significant decreases in work output. Or issues are hidden until there are visible signs of anxiety and distress.

What is really important for an HR executive to know is that – statistically – the people working in their company are experiencing higher than normal levels of stress, anxiety, and depression. It’s gone up across the board and includes people who have been able to keep their jobs and maybe had to pivot to work remotely. Working remotely is stressful, especially if people are raising a family and have all the other sides of their life now coalesced in one living unit. Are employees underplaying the stress? They may be, and that should give leaders even more reason to be aware of what the research is showing as far as what the increased burden is during COVID-19 on mental health.

Ben: Right now, the news is pretty good on the COVID-19 front in terms of vaccine efficacy and case rates. Assuming things continue to improve, do you expect the mental health picture to improve in a sort of straight line, or will there be a lag? How can we expect a return to some level of normalcy to be reflected in mental health improvement?

Noah: There is reason to believe that mental health will improve. Research done over the summer and the fall showed that the lockdowns and other measures we’ve had to take as a society to help curb the spread of COVID-19 had a significant negative impact on people’s mental health and wellness. And you can see that as those lockdowns eased, people’s depression went down; and when lockdowns ramped back up, we’ve seen a ramping up again of depression symptoms.

These trends would indicate that once people are vaccinated and once the infection rates go down enough so that the economy opens up, people can see their loved ones and can get out of their houses and start to interact in a more normal way, there will be some corresponding improvements in mental health. Having said that, there will be some people who have been more specifically affected by the lockdown or by the pandemic – say, by a personal illness or the death of a loved one – who may suffer some lingering mental health impacts.

Ben: Different people have been undergoing different types of stresses and experiencing different types of mental health issues. For instance, the experience of somebody working from home is different than a factory worker who has been reporting to work every day, which is different from somebody working a cash register… What should employers be doing at a high level to help people better cope with the varied stresses that they encounter? And then, what should employers be doing to make sure that each individual employee feels that they have the support that they need?

Noah: When it comes to mental health, it’s great that we’ve taken these inroads to start talking about things like stress, depression, and anxiety because traditionally, they haven’t been talked about. With that said, there is still a lot of stigma for employees around talking about their mental health. There is concern about: “How will my employer react if I talk about my mental health issues?” So first of all, it’s important to make sure employees know that they have a nonjudgmental and open work environment where they can talk about mental health issues if they are struggling. It’s about creating a culture that promotes and is centered around the health and wellness of employees.

The CDC actually does a really great job outlining a framework for what companies can do to create an atmosphere of openness around mental health (Mental Health in the Workplace – CDC). Among their recommendations is to be transparent and clear in communications to employees, such as emailing policies around support for mental health and access to resources. Such communication should be standard across the organization.

At the individual level, one of the first things is to make mental health assessments available to employees, and to educate employees about what they are, what they measure, and how to access them. So, if an employee is feeling down and not sure if it may be depression, they can complete an assessment and receive a report that gives them a better understanding of how their feelings represent their actual mental state, as well as information about accessing available resources.

Layered on the assessment, the next thing is providing free and subsidized health coaching, counseling, and self-management programs that help employees address their mental health issues. Finally, especially in this remote working environment, managers and supervisors should be having regular check-ins with their direct reports.

Ben: Throughout this pandemic, we’ve seen some front-line employees who’ve had to navigate challenging workplace environments – whether it’s a customer who won’t heed a policy or different attitudes among employees about the need for masks or social distancing. What are the psychological impacts of these conflicts, and what should employers be doing to help mitigate the impacts of these conflicts?

Noah: Those conflicts can be traumatizing. When an employee is simply trying to uphold the policy that their bosses tell them to uphold, it can feel very lonely. It can feel dangerous when someone doesn’t comply with the risk of exposure, but also at another level, it gets terrifying when somebody becomes aggressive and potentially violent.

It really is up to employers to not only enact policies around preventative measures, but also to provide proper training to prepare employees for situations that could get escalated. The employee’s first experience dealing with an aggressive patron or an aggressive coworker should not be their first time confronting the situation. Their training should prepare them to know the right ways of de-escalation, but also the right time to just walk away.

Ben: In a recent article, we talked about how employers should use employee input to create a shared vision of what life will be like “someday” when things get back to normal. We can make “someday” come sooner if we keep doing the things that we need to do from a prevention and vaccination standpoint. Any thoughts on this sort of tactic of shared visioning?

Noah: Absolutely. It’s important that plans are open to adjustment but planning out what the next year could look like is important. So, you can say that by summer if the CDC recommends we can open up, then this is what that might look like in terms of capacity and the measures that we would take to be able to ensure a safe to return to work. Then, as we head into fall, this is what it could look like.

Being able to rely on authoritative sources and articulate a plan in a dialogue with your employees not only gives employees a bit of a heads-up in knowing what they can expect, but what they can do now to help encourage that vision. These things help reduce uncertainty (though – as I said – it needs to be clear that plans can change) and provides some sense of control over how things will turn out.

Ben: Any other final advice?

Noah: Before COVID-19, we talked about diabetes and cardiovascular disease, and then when COVID-19 came – and rightfully so – the conversation shifted. As we are able to turn away from the urgencies of the pandemic, it will be important to emphasize again these person-centered programs, seeing each employee as a whole person who may have a family, that has a physical health profile as well as a mental health profile. We can’t forget all of those elements. So, providing a form of support and intervention that can cross the digital landscape and address mental health, physical health, and concerns around COVID-19 in a very empathetic and compassionate approach will be important.

Ben: Finally, if our readers are interested in learning more about mental health resources offered by NexJ Health, what should they do?

Noah: Companies interested in learning more about mental health resources available through NexJ can send an email and we will follow up.

Read the full interview on WorkSTEPS.

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