By Adele L. Abrams, Esq., CMSP
In recent years, there has been a marked increase of mental health issues impacting the workplace. In some cases, there may be a suicide (or attempt) that occurs at work and these tragically have the potential to claim multiple victims where the worker decides to settle scores with managers or co-workers in the process. Sometimes, the worker’s stressors off the job prevent them from being fully fit for duty mentally, and accidents occur due to stress, distraction and fatigue. Sometimes interpersonal conflicts in the workplace, harassment or bullying, or witnessing (or being involved in) a workplace accident, can be the final straw.
As discussed below, Psychological First Aid (PFA) can be an essential tool in addressing and mitigating mental health crises occurring in the workplace, as well as being a critical technique used to assist survivors of natural disasters, mass shootings and other traumatic events that occur off-the-job. It is especially important if there is a workplace fatality or serious accident – not only to assist the victim(s) of such event but also those who witnessed or were involved with the circumstances and may themselves be traumatized or feel they are to blame (or being blamed by the employer) for the mishap.
The threat is real. In the U.S. there are approximately 123 suicides per day, or one death every 12 minutes. While the construction industry has the highest suicide rate (53.3 per 100,000 workers), other sectors such as manufacturing and service sectors are not far behind. Every year 20% of Americans experience some form of mental illness, and 5% experience a serious mental illness. Moreover, there are 17 million Americans who are “dual diagnosed” – they experience both a substance abuse disorder and mental health condition. The majority of these people are in the workforce and may be employed by you!
There are also millions of U.S. workers who now suffer from “Long COVID” and experience depression, PTSD, anxiety and sleep disorders as a result that can impact their workplace safety and health performance, or even their ability to work at all. The EEOC has classified “Long COVID” as a condition covered by the Americans with Disabilities Act (ADA), and therefore employers with 15 or more workers must consider reasonable accommodations for those workers and others with diagnosed mental health disorders that have a significant impact on major life activities. Those accommodations could include remote work, hybrid or flexible schedules or other options that might be offered by the employee/applicant or coordinated with their health care professional.
While employers can raise a “direct threat to safety” affirmative defense under the ADA, the EEOC is clear that simply having a mental health crisis or a diagnosed mental illness is not enough to declare the person a “direct threat.” A case-by-case analysis will be required, including consideration of what the illness is, what medications or treatments may be required and any side effects or adjustment period needed, and other relevant factors. For employers with 50 or more workers in a 75-mile radius, unpaid leave under the Family and Medical Leave Act may also be mandated for treatment of, or recovery from, mental health and addiction issues (or to care for a family member undergoing such a crisis).
Too often, employers put blinders on to the mental health challenges impacting workers or tell them to “leave the personal stuff at home” when they enter the workplace. Of course, it isn’t that simple. UPS was in the headlines in October 2022 when a pregnant employee who had sought mental health assistance at work was told she was “overreacting” – the worker then jumped to her death from a ledge as other workers were clocking in. No doubt many of those who observed this will be permanently traumatized. Employers must accept that total worker health is their concern. It is also the law.
Under the Mental Health Parity and Addiction Equity Act, all health plans with 50 or more participants must apply similar rules to mental health and substance use disorder benefits as they do for physical health benefits. It is worth checking your company’s health plans now as renewals for 2023 are underway, to make sure that your existing benefits plan meets the new legal requirements. In addition, how strong is your Employee Assistance Program (EAP), if you even have one? Do employees know of its availability as part of a benefits package, and that it can be utilized for things other than substance abuse issues? Many plans remain underused while workers suffer in silence.
So where does Psychological First Aid come in, and what exactly is PFA? It is defined as a compassionate and supportive presence to mitigate acute distress and to assess need for continued mental health care. Because the goal is to stabilize the individual, it is not the PFA provider’s role to be a diagnostician or therapist. It is more akin to physical first aid, where one might put ice on a bruise or a temporary splint on a suspected broken ankle. PFA is designed for employers and community volunteers, trainers, and disaster responders who must respond and provide initial care in the wake of adversity or when faced with a person in crisis.
PFA intervention has been found to be more effective than multi-session psychotherapy post-disaster and should be considered where a workplace incident is the triggering event. Those impacted in terms of mental health after witnessing a workplace tragedy or violent event will normally be entitled to worker’s compensation, in which case reduced need for treatment means reduced costs and insurance premium hikes. A work-related mental illness is OSHA-recordable if it results in reassignment, restriction, medical treatment or days away from work, and reportable if it results in immediate hospitalization. OSHA says: a mental illness will not be considered work-related (for reporting/recording) unless the employee voluntarily provides the employer with an opinion from a physician or other licensed health care professional with appropriate training stating that the employee has a mental illness that is work-related.
Psychological First Aid rests on several key concepts:
• Reflective listening
• Differentiating the benign, non-incapacitating psychological/behavioral crisis from potentially incapacitating
• Prioritizing (triage) psychological/behavioral crisis reactions
• Mitigating acute distress and dysfunction, as appropriate, and
• Facilitating access to further mental health support, as appropriate.
The final key component is to practice self-care, as safety and health professionals or supervisors who must manage the workplace event as well as the workers who are in crisis may be stretched thin, engage in self-blame and even need PFA themselves.
In the wake of a crisis, PFA can assist employers to aiding their workers during a crisis, help them establish brief or ongoing contacts with primary support persons and other sources of support, including family members, friends. The employer’s EAP can also provide workers with information about stress reactions and coping to reduce stress and promote adaptive functioning. Employers can also use the workplace resources – the intranet, a company newsletter or even the bulletin board – to link workers with available services that they may need in real time or in the future.
Positive workplace mental health is important because it allows individuals to cope with challenges, even good ones, and setbacks in their lives, both at work and at home and ultimately be safer and more productive workers. Positive mental health at work helps teams remain agile when changing roles and responsibilities, including during challenging times as we have experienced in recent years.
Finally, the U.S. Department of Labor’s Benefits Advisor can assist individuals/companies with more information on mental health and substance use disorder benefits. Visit askbsa.dol.gov or call 1-866-444-3272.
Adele L. Abrams is an attorney and safety professional who represents companies in litigation with OSHA and also provides safety training and consultation. The Law Office of Adele L. Abrams PC has three offices: Beltsville, MD; Denver, CO; and Charleston, WV. She may be reached at www.safety-law.com or 301-595-3520.