Chances are that you’ve heard an employee make an off-hand comment about self-harm. These comments can range from an innocent hyperbolic expression of frustration (e.g. I’m going to kill myself if I have to do that procedure one more time!) to a serious expression of active suicidal ideation. What if you suspect the employee is being serious or having some kind of mental health crisis short of suicide? What, if anything, might you consider doing as an employer to intervene? As the AMA points out in their STEPS Forward literature:
It is vital to take action if you suspect a colleague is demonstrating warning signs for suicide. While not every suicide may be preventable, people with suicidal feelings can be helped. Speaking directly with your colleague is a good first step. You can say, “I’m concerned about you.”
In this article, we are going to focus on what your obligations are when it comes to taking a few reasonable and proactive steps if you suspect someone’s remarks about suicide warrant a work intervention.
Suicide in Healthcare
Employee suicide is probably more common than you think. Suicide rates among the general population, including dentistry, have risen 30% in the last 20 years. The outlook is even worse for those in the medical industry. It is well known that physicians are extremely at risk for suicide, a fact which has been attributed to burnout, compassion fatigue, and depression. COVID-19 has magnified these issues and, if the recent suicide of two healthcare workers in New York is any indication, the healthcare industry, and its workforce, is on the precipice of a major mental health crisis.
Moreover, in our work with more than 2,500 member offices and associations of all sizes and types across the country, we are getting more requests for resources that help managers cope with mental health issues among employees recently. Under these circumstances, employers should pay attention to every comment about self-harm in order to meet their obligations of maintaining a safe workplace. In addition, bona fide comments about suicide trigger your duties under the Americans with Disabilities Act (ADA) to engage in the interactive process and provide employees experiencing mental health struggles with an opportunity to seek treatment.
How to talk about it
If your employee doesn’t appear to be making an inappropriate joke, sitting down in private to talk about it may feel awkward, but it’s part of necessary due diligence. When it comes to intervening in the event of a mental health crisis, the National Suicide Prevention Lifeline suggests taking the following steps to help organize your very difficult conversation.
- Begin by asking how they are doing
- Reserve judgment and allow the employee to answer
- State that you are concerned about them
- Mention changes in their behavior or comment(s) that triggered the discussion
- Suggest they speak with someone**
- Offer to help arrange an appointment or follow-through
- Continue to stay in contact with the person, and pay attention to how he or she is doing
** If you have an EAP program through your benefits provider, suggest your employee reach out to them. You can also suggest they speak with someone in the human resources department, their emergency contact, a clergy member, or directly with another mental health professional.
Through your first conversations with your employees, it might be helpful for you to use the FIRR Method to organize your thoughts in a judgment-free manner. In the FIRR Method, owners and managers are instructed to focus on the facts and refrain from offering opinions when confronting employees about problematic behavior. If an employee is having difficulty focusing, saying, “You’re not paying enough attention lately, Alex,” may cause the employee to feel judged and become defensive. Using the FIRR method, employers focus on stating the facts and leaving judgment and value statements behind. Like so: “Alex, you trailed off while I was speaking to you in yesterday’s huddle and seemed upset about something. Today, I am seeing you being uncommonly quiet, and it has me worried. I’m always concerned when I see someone not at their best. Is there anything going on that you want to discuss? I have time, what about lunch?”
Notice how many steps the National Suicide Prevention Lifeline devotes to following up with the employee! Though talking about these issues with your employee is important and helpful, don’t just stop there. Those in crisis have trouble following through with treatment plans. Try to get your employee to take action right then and there.
Here are some helpful resources for employees :
- National Suicide Prevention Lifeline
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- SAMHSA Treatment Locator
Here’s where you may run into some serious difficulty. While there are emergency services like these available to those who pose an immediate risk to themselves or others, those who are experiencing minor suicidal ideation but don’t pose an imminent threat to themselves or those around them may find themselves stuck in a gray area in which there are few resources. In these cases, your employee may find some guidance by reaching out to their local NAMI chapter.
As we mentioned in an earlier article, “Is it Poor Performance or a Crisis?” those who are experiencing a crisis but are not in a position to qualify for emergency resources and services may find themselves hitting a wall when seeking help. Even for fully insured employees, treatment is not always readily available due to the fact many mental healthcare professionals don’t take insurance, and there are not enough qualified professionals to meet the needs of the large number of people seeking care.
Remember that it is not your job to solve the American mental health crisis, nor should it be. As we mentioned in the previous article, keep in mind your interaction with your employee is simply one small piece of the puzzle. The rest may involve the employee reaching out to family, consulting their family doctor, looking into community resources, seeking religious counseling, and other complementary services. Your job involves helping the employee understand their comments were upsetting and will not go unnoticed in the workplace.
Assess the Situation
You’ve pulled your employee who has made a comment about self-harm aside, and, let’s say, she admits that the pressure of her custody battle with her kids coupled with the stress of working has resulted in feelings of depression and hopelessness. She discloses that she has been thinking about ending her life. Now what?
Like any medical issue, your first objective is to assess the situation to determine whether emergency action is required. Unfortunately, ADA makes this assessment tricky. Generally, employers may not directly ask employees if they have a mental illness or make other disability-related inquiries. In most cases, your safest option is simply to ask the employee to explain their comment and base your assessment on the information freely disclosed by the employee.
Generally, a situation constitutes a crisis warranting immediate medical attention if the employee has disclosed that they have planned where, when, and how to end their life. Even if the employee has not made a plan, the following disclosures could indicate a crisis:
- The employee’s suicidal ideation is direct and immediate (employee is threatening self-harm that will occur within a definite period of time)
- The employee has access to guns, knives or medication, and other substances that can end a human life
- The employee has a history of suicide attempts
- The employee has been exposed to a suicide
After the Assessment
If the circumstances suggest an immediate and obvious crisis (such as talking about guns, medication, or other ways of hurting themselves or others), employers should not leave the employee alone and should offer to contact the employee’s emergency contact. Experts suggest if no contact is available, consider calling 911 to report that the employee is in danger of attempting to harm themselves. If you are unsure as to whether the situation constitutes a crisis, you should contact emergency personnel to make an assessment.
In non-crisis situations, or in situations where an employee is refusing to disclose information that would allow you to determine whether emergency measures are appropriate, employers should affirm the importance of mental health treatment and provide employees with mental health resources including information about their Employee Assistant Program (EAP) if one is offered. Employers should also initiate the interactive process under the ADA by informing employees of their ability to take paid or unpaid time off for treatment under your leave policies. Employers can help by notifying employees of their willingness to accommodate the employee’s medical needs and facilitate time off for treatment, even if that means rescheduling patients. Employees who have taken a medical leave of absence for treatment can also be asked by employers to provide a Fitness for Duty Certification from their doctor prior to returning to work.
By now, it’s becoming common knowledge that most people who commit suicide usually tell at least one person. Occasionally, this happens in the workplace. If it does, the guidance in this article can help you assess the situation and take appropriate action. As an employer, it is not your due diligence to solve the American mental healthcare crisis, but by performing an assessment and offering resources, there are actions you can take that can maintain safety in the workplace.