Employees are any employer’s most valuable asset. That’s why I’m always encouraged whenever I hear professionals from outside the Behavioral Health field educating and informing employers about the business and organizational impact of untreated mental health conditions. In this case, it was an article appearing in the Society of Human Resource Management’s HR Daily newsletter. In that article, Mr. Jathan Janove, JD, discussed the workplace impact and costs of a common type of Attention Deficit Hyperactivity Disorder (ADHD) that persists into adulthood. It’s often called Adult ADHD.
Mr. Janove pointed out that ADHD is a treatable condition is often undiagnosed and untreated, despite the existence of effective treatments. This fact should not surprise anyone. It’s true of most types of mental health conditions in the US and the world. It results in unnecessary suffering for adults, families and children, and additional costs for employers, consumers and taxpayers.
It’s likely that sometime in our lives 100% of us will experience some type of physical illness or injury. Most of the time, we will recognize the need for treatment of that illness or injury, we’ll know that treatment exists and how to access it. But this is often not the case with mental health conditions.
A few years ago the Harvard Mental Health Newsletter published the findings of a mental health study of 9,000 Americans. Over 40% of those surveyed had – at some point in their lives – experienced symptoms indicative of one or more mental health conditions according to the diagnostic manual in use by physicians and behavioral health professionals at the time. However, whether it’s a failure to recognize the need for treatment, denial of the existence of a problem, or lack of awareness of treatment options and accessibility, many of those with mental health conditions will fail to obtain treatment. That failure leads to substantial and often unnecessary human suffering, as well as significant cost and risk burden falling on employers. ADHD is a good example.
ADHD is often thought of as a childhood disorder, but actually it’s very common in adults. The National Institute of Mental Health estimates the prevalence of the adult form of the condition at around 8%, with men being more affected than women. Most of these adults who experience ADHD are in the workforce.
ADHD is experienced by adults along a range from mild to severe symptoms. The major symptoms are inordinate difficulty staying focused and hyperactivity. The symptoms affect all aspects of a person’s life – work, social, familial and health.
Many people cope with the chronic condition very well. Those who do have usually done so with the assistance of treatment and education or counseling about managing the condition and their lifestyle. (Many effective treatments exist and they are improving.) In fact, people who experience Adult ADHD are often very successful people who enjoy long and rewarding careers. They include CEOs of large corporations, professional athletes, engineers, physicians, attorneys, law enforcement officers, professional drivers, teachers and many others. For these people, the condition can seemingly result in enormous energy, creativity and focus.
More often the challenge in the workplace involves those employees experiencing undiagnosed and untreated ADHD or in assisting those who need a little help. It is a condition that has the potential to have serious impacts on workplace productivity and employee morale and it can present special challenges for managers and human resource professionals.
Many employees with untreated or poorly treated ADHD struggle with distractibility, poor time management, poor memory and deficient communication skills. While all people experience these issues at times, those with Adult ADHD, experience them frequently and to the degree they interfere with daily life. They are often the employee that comes to managers’ attention due to tardiness and absenteeism, high error rates, or having difficulty with change. These employees often have a challenge completing complex tasks and projects on time, or with juggling competing priorities. In fact, they often find it difficult to accurately estimate the time required to complete a task and thereby earn an unwanted workplace reputation of scrambling at the last minute to finish an assignment. Interpersonal skill deficits often associated with the untreated condition can result in conflict with team members, supervisors and customers. They can become the targets of bullying or suffer discrimination and bias. They are sometimes perceived by their peers as “the last person I want on my project team.” A pattern of job and financial instability can be the result. If this isn’t enough, imagine the parallel problems these symptoms generate in their social and family life. These can add another unwanted and substantial challenge that threatens to further degrade their health and wellbeing.
In my role as a behavioral health and employee assistance professional, I once had an HR manager tell me that she wasn’t really sure she wanted to learn that a particular problematic employee might have ADHD. She said that was because that information would trigger a cascade of onerous and costly accommodations that added another burden to her job. Her initial perception and concern may have been driven by misinformation or stereotyping. My experience has been that this concern is often overblown and not a starting point for HR professionals who might encounter this situation.
On the other hand, I’ve had multiple employees tell me that they have been afraid to come forward to their employer to say they had recently been diagnosed with ADHD and to ask for accommodations to help them get their work done. They have feared reprisals from managers and social stigma from their peers. They may not have known that their employers can often provide support as well as simple and straightforward accommodations that can greatly assist them in their jobs.
Adult ADHD can be a condition afforded protection by the Americans with Disabilities Act, the Family and Medical Leave Act and various state laws. Ignoring it is unwise and creates risk of litigation against employers. Progressive employers appreciate that it’s best to understand if a worker has Adult ADHD that is affecting performance and conduct, and who may need accommodations. Employers can usually create reasonable accommodations once they understand the employee’s job, the tasks that are challenging the employee and relevant information from the employee’s medical provider. As Janove pointed out in his article, accommodations are often simple and inexpensive, and along with diagnosis, treatment and education they can help employees function at an optimal level. Workplace accommodations could include:
Employers have a strong business incentive involving productivity and risk mitigation to act, but employees with unrecognized Adult ADHD pose different challenges. We know that the combination of treatment, education/counseling and (sometimes) simple workplace accommodations can help these employees to function well at work and in other areas of their lives. What should employers do and what resources are at their disposal? They should examine two areas:
Most employers offer some type of EAP. The EAP can be a valuable access point to engage employees with education, guidance, counseling and referrals to treatment. But EAPs are often underutilized, not connected to other employer-sponsored wellbeing programs, and they can be inherently passive – waiting for employees to come to them. They seldom screen workforces for the early warning signs of possible behavioral health issues. Plus, many employers are simply poorly engaged with their EAPs. This lack of engagement does little to create greater awareness and acceptance of people with behavioral health conditions in the workplace.
On the employees side, to benefit from the EAP they must first recognize the need for taking action. They must recognize and want to eliminate the problems that their untreated symptoms are generating. Then they must be aware of and recognize the EAP as an accessible means to a solution. Finally, they have to muster the courage to take action to access the EAP, which can present logistical barriers even if the social barrier is overcome. To help address this dynamic, Espyr has added technology-enabled outreach, advocacy and coaching services to reach more employees in need and to do so earlier in their struggles.
Human Resource professionals must be the leaders in their organizations in creating a workplace that values diverse employees, reduces the social stigma often associated with accessing care for mental health conditions, and equates physical health and wellbeing with mental health and wellbeing. This includes examining policies and practices concerning how the work organization messages information about benefits, wellness programs, and it’s EAP. HR professionals must be the voice for such important issues when communicating with their senior leaders who ultimately shape the overall workplace culture. And, of course, they must constantly communicate the culture to all employees.
To Learn More
To learn more about Adult ADHD and the stake employers have in assisting workers with this and similar conditions, visit the National Resource Center on ADHD, a program of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD®) supported by the Centers for Disease Control and Prevention (CDC). You can reach this center online at https://chadd.org/nrc or by phone at 1-866-200-8098. You can also learn more by visiting the National institute on Mental Health’s Help for Mental Illness page at www.nimh.nih.gov/findhelp.
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Norman Winegar, LCSW, CEAP, is the Chief Clinical Officer at Espyr, a national behavioral healthcare company that provides employee, student and member assistance services and a variety of coaching programs that improve organizational effectiveness and employee health, safety and wellbeing. He is also the author of four books related to the behavioral health industry. To learn more about how Espyr can help your company or organization, call us at 888-570-3479.