The existence and impact of depression in the workplace has been, and continues to be, the focus of many global studies. It is also a subject much spoken about in the life insurance industry and by those who wish to mitigate risk via the engagement in Employee Assistance Programmes (EAPs).

There can be no doubt that this human condition affects many worldwide, with a costly knock-on effect on productivity and the economy.

The World Health Organisation reports that the cost of depression and anxiety to the global economy is US$1 trillion per annum*  and local statistics report that the number of people suffering from major depressive disorder rose by
58% from 1990 to 2013 affecting 407 578 people in South Africa.**

While the reasons for, and causation of, depression are multi-faceted the health of the employment environment has a significant role to play.  Although much good advice can be found with regard to the need to de-stigmatise the condition, encourage more open discussion with Human Resources departments, bolster the use of EAPs and so on, years of professional experience in the assessment and management of workplace incapacity have provided a different perspective.

My experience has repeatedly confirmed that two of the most effective means of preventing the slide into depression emanate from a relationship of trust between employer and employee and the investment in the provision of a personal case management service.  Both are topics of considerable depth, which this short article can only touch on in order to assist in illustrating these points and encouraging a shift towards a new conversation around managing depression in the workplace.

Organisational leadership

The value of trust in leadership ought never to be overlooked or under estimated.  Simply put, when leadership is seduced into being ‘too busy’ or their jobs are believed to be too high up the management chain in the office hierarchy to show personal interest in the lives of their employees, take them for granted and or distance themselves from the energy their staff bring to work, it is only a matter of time before disengagement occurs. There is no upside to employee disengagement.  The inevitable slippery slope of ‘corrective’ performance management, often devoid of addressing the underlying trust issues in the relationship, can quickly morph into a dark mental space for both parties as well as those surrounding them. More so where there had possibly been hope that the workplace would provide some form of respite from home and other environmental pressures.

In fact, leadership – or the lack thereof – has such a direct relationship with the mood of an organisation, its well-being, productivity and profit that it should probably be added to the list of risk criteria used for the rating and pricing of group disability benefits.

Case management

The reference to case management of employees in this context does not refer to the availability of employee support through an EAP or the contact an employee has with such a programme, the take-up of which is generally rather poor at shop-floor level.  Sadly, the well-intended and theoretically well-structured EAP approach simply does not meet the requirements of employees who:

i. have no access to telephones during the working day;

ii. do not have airtime to call the EAP service after hours, if available at that time;

iii. are signed up to an EAP programme non-inclusive of paid supportive counselling, or;

iv. do not have the time, social support or financial capability to travel the distance required to access the help that is on offer.

Case management refers to the engagement of a suitably qualified independent professional who goes into the work environment on a regular basis to consult with those in need of advice, guidance, practical support and a listening ear without the employee fearing being seen in a dim light by in-house management.

Having worked in this type of unique case management role for close to a decade as a member of a global team for a large international organisation in South Africa, it became evident that the combination of independence and real-time assistance encouraged an over-50%-take-up by 400+ employees over time – i.e. over 230 consultations per annum.  Some employees consulted once, others more often, but all knew that help was at hand and did not hesitate to make use of it.  Work days were not lost in making use of the service as employees had to come to the workplace to do so.

Whilst clinically diagnosed depression itself constituted a small percentage of the issues dealt with in case management, the avoidance of disengagement, despondency and low mood through assisting employees with their personal, social, emotional and financial concerns in an entirely confidential on-site process was considerable. Although annual data was collected and analysed in order to assess the impact of the service, the measurement tool in this regard was not so much statistical and experiential in nature as it was good old-fashioned feedback from the very people whose lives and mental health benefited from the service.

A combination of the above-mentioned two strategies can play out when leadership implements a case management system that, by its very existence, verifies organisational care, value and understanding of their employees.

Depression is a human condition which, alongside the need for medical intervention when warranted, is best avoided, managed and treated by honouring the basic right to human dignity to which all are entitled in the Bill of Rights enshrined in our Constitution. There are few (if any) simpler or less costly methods and models to avoid incapacity and disability arising from this global epidemic.***




*** The financial cost of engaging part-time case managers is neither expensive nor complex and can be structured to include a small union member contribution per month.

Elise Burns Hoffman specialises in disability in the workplace.




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