Employers struggle to deal with mental health issues in the workplace. There’s a stigma associated with these problems, and few employers understand how to approach the subject. I sat down with an expert, Dr. Gerald Koocher, to discuss some important topics regarding mental health and employers, specifically employee burnout and how to address it.

Dr. Koocher is currently dean of the College of Science and Health at DePaul University in Chicago. He is also a senior associate in psychology at Boston Children’s Hospital and a lecturer in psychiatry at Harvard Medical School. He served as president of the American Psychological Association (APA) in 2006.

Mental health is a sensitive issue. What can you tell us about the mental health situation in the workplace?

The first thing to remember is that the incidence of mental health in the workplace is no different from what it is out in the population in general. The two most common mental health issues in the U.S. are depression and anxiety. Behavior problems may or may not be related to mental health issues (behavior such as rudeness, inconsiderateness, etc.).

The two most serious mental health issues that may compromise performance in the workplace are probably burnout and substance abuse. Some work environments can predispose people to burnout. The problem with substance abuse, aside from degradation of performance, is that it’s disinhibiting — meaning people can’t control their behavior.

Let’s talk a bit more about burnout, because that seems to be a common issue employers face.

Some of the symptoms of burnout are anger and hostility, chronic frustration, depression, apathy and exhaustion. There are factors in the workplace that predispose employees to burnout such as role ambiguity (vague or inconsistent expectations), conflicts, big discrepancies between real and ideal work, unrealistic expectations and lack of support.

One time I was doing rounds in a cancer hospital, and I stopped to talk to a nurse who had been crying. She had been doing postmortem care for the third night in a row; one of her patients had died each of the prior three nights, which is not uncommon in a cancer hospital. A resident walked by and said, “If you can’t stand the heat, get out of the kitchen.” So if your colleagues and supervisors aren’t supportive, especially in a stressful workplace, that’s a problem. You can’t do process improvement if people are stressed or scared.

How do you help with stress recovery?

There are insulating factors for burnout in the workplace, such as role clarity, positive feedback and recognition, enhanced staff autonomy and social support. In high-stress environments like a hospital oncology ward, opportunity for staff recovery might be having meetings at the end of the day where people can decompress and talk about the obstacles they faced. In Silicon Valley, notoriously, they have pool tables in the rec rooms and quiet spaces for timeouts. It varies depending on the type of workplace.

What about at the employee level? Which kinds of employees are subject to burnout?

People who have perfectionistic personalities, who have to get everything right, are predisposed to burnout. Also, people who have losses in their family — and a loss could be a divorce or a death. This puts familial stress on them before they even get to the workplace. Other examples include people who feel chronically helpless (meaning they don’t think anything they do will affect the outcome) and people who have bad boundaries and can’t separate a personal relationship from a work relationship (or get into an intimate relationship with a coworker). Substance abuse and overly high personal expectations also put employees at risk for burnout.

There’s also a personality measure used by psychologists called the Internal-External Scale. People who are high Internals would agree with statements such as “I have a lot of control over what happens in my life.” People who are high Externals might instead say “Nothing I do in life makes a difference.” People who believe they have more control in life will be more resilient to burnout.

What could a middle manager or an HR/benefits manager do to help employees avoid burnout?

At DePaul, we have a formal strategy for recognizing people who have exceptional performance with cash awards. Formal recognition can help. We also have a wellness program where employees can get rewards for engaging in activities that promote health and wellness. Our HR department has mandatory training for managers, and this shows managers good practices. We also have shorter hours when things slow down in the summer to reward staff and faculty after long, hard winters. Letting people out early on Fridays isn’t a big commitment, but it feels meaningful to the employees.

Look for Part II of this interview, where we’ll discuss more issues, including how mental health can lead to better physical health — and lower costs for employers.

Andrew Reinbold has been engaged with the health care marketing and communication space for over five years. He currently focuses on business-to-business content for Anthem, Inc. that is relevant to employers and brokers as they navigate the changing health care environment.