Author: Nancy Breuer

Julia, 37, is a full-time pharmacist in a busy Alabama hospital. She received her schizophrenia diagnosis about 14 years ago, and once was out of work ill for seven months. When she returned to the work world soon after passage of the ADA, her first interviewer called her back after the interview and asked why she had been unemployed for seven months. When she pointed out that he hadn’t made an offer yet so the question really wasn’t appropriate, he replied, “Then I guess you don’t want the job,” and hung up. Julia then decided to be straightforward with subsequent interviewers. Most employers lost interest right away when she told them she has a mental illness that’s a disability.

Eventually she interviewed with her present supervisor, himself a pharmacist. He knew her supervisors at her previous jobs and knew her reputation as a worker. He agreed during the hiring process to reasonable accommodation in principle without stipulating what the accommodation would be until after her three months’ probation. Julia is one of only two night-shift pharmacists in the hospital, which runs a number of specialized intensive care units that keep the pharmacy busy. She works seven nights in a row and then has seven nights off, trading weeks with the other night pharmacist. Her accommodation is that she has an extra week off every nine to 12 months to adjust her medications. She never calls in sick and never misses work, and she gives one to two months’ notice when she needs the extra week off.

Julia enjoys her work and is proud she finished pharmacy school after receiving her diagnosis. “[My job] keeps my skills fine-tuned. Just me and my technician are there all night, which I like. I get uncomfortable when the day shift comes in.” Her accommodation has been successful throughout her five-year employment with this hospital. “Most people turned me away. My present boss was more receptive.”

Workforce, October 1997, Vol. 76, No. 10, p. 32.

Around the time the Americans with Disabilities Act (ADA) became law in 1990, an employee at MICOM Communications Corp., a computer company in Simi Valley, California, suffered a series of panic attacks- sudden surges of overwhelming fear that come without any apparent reason. The employee had what’s known as panic disorder, a mental disability. But the employee’s supervisor didn’t understand the condition and shared the general impression that the worker was using the panic attacks as a crutch. Sometimes the employee became so angry with the responses he was getting from his co-workers and supervisor that he walked out for two to three hours at a time. Because of the time lost when he had panic attacks, the employee received poor performance reviews. He responded with long, angry letters to management. Management began to fear the possibility of a workplace violence incident.

The employee did mention to HR that he had a medical problem, and he did go out for a short time on disability. He believed that when he had these attacks, he should be given some leeway. But the company’s stand was that in a lean and mean, competitive industry, if a worker didn’t carry his or her full share, it wasn’t fair to others. When a larger firm bought the company and insisted on staff reductions, the employee was downsized. After his termination, he came in once more to read his personnel file. While he sat in an unused office leafing through the file, the HR staff worried and wondered what was coming next.

They had good reason to worry. Had the employee chosen to sue the company for employment discrimination under the ADA, his case probably would have been successful. The company’s human resources staff had made no effort to accommodate the employee’s psychiatric disability. Having no clear understanding of what comprises mental disabilities was HR’s first error. Having no clear accommodation strategy was it’s second problem.

But, seven years after the ADA became law, HR is still wondering how to accommodate workers with psychiatric disabilities. Because so many business professionals, especially human resources managers, needed more guidance about the psychiatric disabilities that always have been covered by the ADA, the Equal Employment Opportunity Commission (EEOC) drafted a 40-page document of guidelines intended to answer the most frequent questions arising from attempts to accommodate psychiatric disabilities. Those guidelines were published in April 1997 as “Enforcement Guidance on the Americans with Disabilities Act and Psychiatric Disabilities.” They have been raising a dust storm despite the fact that they aren’t mandates and don’t add new provisions to the ADA. Instead they’ve renewed a simmering debate about how far an employer must go to accommodate a person with a mental disability.

Ever since passage of the ADA, segments of the business community have been critical of its requirements for reasonable accommodation of both mental and physical disabilities. Objections have focused on cost and complexity because every person with a covered disability requires consideration of his or her unique needs in a particular workplace. Now the criticism from business owners who have disliked the ADA from the beginning is mounting. What was the HR staff at MICOM supposed to do with the man having panic attacks? Clearly, they should have responded better than they did.

Under the ADA, business owners may not discriminate against otherwise qualified workers with mental illness. The act limits what employers can ask applicants about their history of mental illness, yet, requires they take reasonable steps to accommodate employees with psychiatric disabilities. Do the guidelines mean, then, that HR managers are required to diagnose or assess mental disabilities? No. But they offer a road map to employers managing an employee who has a mental disability. There are practical, tested suggestions for HR managers who may be uneasy about dealing with employees who have such a disability. Understanding the EEOC’s guidelines is a good place to start.

How can HR apply the guidelines?
The EEOC guidelines clarify the application of the ADA through hypothetical cases and indications of how the EEOC would likely rule on them. Assistant Legal Counsel for Coordination Carol Miaskoff at the EEOC’s Washington, D.C., headquarters, notes that questions from employers and EEOC investigators about the ADA and psychiatric disabilities led to the drafting of the guidelines. The guidelines don’t introduce new law, she explains. “It’s a fairly conservative document in that it doesn’t break new ground. The ADA and the Rehabilitation Act of 1973 before it have always covered psychiatric disabilities. The section on particular accommodations is meant to be a helpful guide for someone looking for ideas about how to accommodate a particular employee.”

Miaskoff believes much of the angry mail the EEOC has received since releasing the guidelines has been generated by media reports that are inaccurate, not by the guidelines themselves. Some writers apparently have the impression that conditions that aren’t disabilities would be protected, that “being ‘blue’ one day, or just being weird, would give someone all these special protections,” says Miaskoff. Being blue or weird aren’t protected conditions. The EEOC relies on the American Psychiatric Association’s 1994 revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for definitions of mental or psychiatric disabilities. Stated briefly, these disabilities represent the consequences of brain malfunctions, just as physical disabilities represent the consequences of physical malfunctions.

At issue is whether individuals will be able to feign mental illnesses and take advantage of the system. Also at issue is to what extent employers must go to accommodate what they can’t always see, or what they can see but can’t understand. Further, some are wondering if the requirement to reasonably accommodate an employee’s psychiatric disability is asking too much of HR professionals. Is obeying the law an automatic financial drain, a requirement to continue to pay a less productive employee?

“At first glance, it’s nothing but another nightmare money pit,” acknowledges Donald Hantula, an organizational psychologist whose teaching and research at Temple University in Philadelphia focus on human resources issues. But Hantula believes the greatest barriers to these accommodations are matters of attitude, not cost or difficulty. An employee who has a nonphysical disability is more likely to need closer supervision, more feedback and more conversation about the project at more steps along the way than an employee with a physical disability. The employee with a psychiatric disability needs an involved supervisor. “Accommodating most nonphysical disabilities isn’t as much a matter of arranging the environment as for physical disabilities (the accommodations are usually social), but these employees are as entitled to feedback and positive reinforcement as employees in wheelchairs are to wheelchair ramps.”

Often lost in the debate over how to accommodate psychiatric conditions is the fact that a disabled employee must be able to perform. “Managers shouldn’t lower the hurdles,” explains Peter Petesch, a management-side labor and employment attorney with Harrison and Ford LLP in Washington, D.C. “A company should hold the employee to the same standards for customer service as other employees in similar jobs. And mental illness isn’t a shield for making violent threats. I don’t think there’s a lack of freedom to fire someone who isn’t performing or who violates the employer’s workplace violence rules. HR should stick to managing performance, not diagnosing conditions or supervising medications.” How to achieve parity in accommodating individuals who have psychiatric disabilities, Petesch insists, is clarified by the ADA. He believes people object because of the learning curve on which these guidelines put everybody in our society. “Everyone is fumbling for answers, including the courts.” No clear shared understanding about psychiatric illness governs the conduct of American public life. How much do most of us really know about schizophrenia or clinical depression? Jokes that reveal our discomfort about mental illness are far more widespread than accurate information and attempts at understanding are.

How common is psychiatric disability in the workplace?
The idea that the EEOC guidelines force a new, unstable population into the American workforce is wrongheaded. People with mental disabilities are already in the workforce. They just may not be visible.

For example, in any given year, according to a 1994 report of the National Institute of Mental Health in Bethesda, Maryland, more than 51 million adults in this country live with a diagnosable mental disorder. One of those mental disorders is schizophrenia. Two million American adults have this mental illness, according to the Center for Mental Health Services in Washington, D.C., a division of the U.S. Department of Health and Human Services. Many of these people are in the workforce.

It’s a question of degree. The truth is, most people experience occasional panic. Most would acknowledge occasional depression or sometimes having feelings of uncontrolled elation. Many people would admit to feeling confused at times or having a poor ability to concentrate. Whether these conditions are disabling is a matter of degree. Employees who are disabled by these conditions experience them more often, or longer, or to a greater extent than the general population. Supervisors and co-workers accommodate these conditions in their mild forms as a matter of their daily business conduct with most people, writing them off as idiosyncrasies or bad days. In their diagnosable forms, these conditions cause great pain to those who suffer from them, and they’re truly disabling. When these conditions interfere with the employee’s ability to perform the essential functions of the job, they require formal accommodation by employers-even when these conditions aren’t visible to the untrained observer.

Nat Fuchs, vice president for human resource development at the entertainment company Showtime in New York City, believes HR’s job becomes more daunting when disabilities-physical or psychiatric-are invisible. He suggests that when the disability is easily observable, the observer crosses an important psychological barrier and accepts the disability.

That barrier remains when the disability can’t be confirmed visually. When the disability is mental, the barrier can feel insurmountable unless something in the culture has softened it, made it acceptable. “[Unacceptance is] born of ignorance. We [in America have] made it okay to say you have a learning disability. That’s cool. But if I referred to it as a mental disability, I’d get a different reaction,” Fuchs explains. “[For example,] I can’t keep directions straight-I continually confuse north, south, east and west. If I told people I had a mental disability, they’d respond completely differently from the way they respond to my claim that I have a learning disability.”

The even more challenging issue for businesses, and especially for HR, is when an employee isn’t willing to reveal the exact nature of his or her disability.

How does the employer learn that the employee has a psychiatric disability?
Much of the confusion about parity in accommodating mental disability arises over the employee’s legal requirement to self-identify as disabled to the employer if he or she wants to request an accommodation, whether the disability is physical or psychiatric. According to the EEOC guidelines, it’s sufficient for the employee to use “plain English” to self-identify. This means that the employee doesn’t have to say, “I’m having difficulty with this task and request reasonable accommodation because I suffer from a disability as defined by the Americans with Disabilities Act.” It’s sufficient for the employee to say, in the language of an example in the guidelines, “I need time off because I’m depressed and stressed.” The guidelines continue, “This statement is sufficient to put the employer on notice that the employee is requesting reasonable accommodation. However, if the employee’s need for accommodation isn’t obvious, the employer may ask for reasonable documentation concerning the employee’s disability and functional limitations.” Experts advise that the documentation should detail the employee’s functional limitations and recommended accommodations, not the disability itself.

Some employees choose not to disclose their mental disabilities because of the stigma attached to them. Darrell, 43, a computer programmer, learned in 1984 that he suffers from schizophrenia. He was in the Army when he became delusional and received his diagnosis-and a medical discharge. He hasn’t disclosed his diagnosis at work. “I think people have less trouble [dealing] with [someone who has] AIDS than [dealing] with [someone with] psychosis. When you say ‘psychosis,’ everyone thinks of the Norman Bates shower scene in the movie ‘Psycho,’ but it’s not like that. For the most part, I do real well at work. I doubt that any of my co-workers know or suspect what I have. People need to realize we’re already here. I’ve been employed as a civilian since 1984.”

Darrell hasn’t identified himself as disabled or asked for formal accommodations at work. Because he doesn’t wish to disclose his condition to his co-workers, he manages his own accommodation. His schizophrenia is controlled by medication, but when he becomes too stressed at work, he takes vacation days he has saved for this purpose, sometimes on short notice.

When Darrell has searched for work, prospective employers have asked him why he left the Army on a medical discharge, probing the nature of the medical condition. The question is illegal and Darrell knows it, but rather than challenge the interviewer, he just responds that he has a chemical imbalance. Anyone with a psychiatric disability could give the same response.

Darrell may not be aware that he can identify himself as having a covered disability without revealing his diagnosis. He copes very well, but in a company where employees haven’t been educated about the requirement to identify themselves if they need an accommodation, Darrell is understandably concerned about how he would be treated if he did identify himself as disabled. There’s no clear company policy about nondiscrimination based on psychiatric disability at his current workplace. This general lack of information about how the ADA works-and about what will happen if an employee does request an accommodation-perpetuates the workplace atmosphere in which Darrell believes he’s wiser just to keep quiet.

Is HR responsible for assessing a mental illness?
It’s HR’s responsibility to make sure all employees, including those like Darrell, are comfortable disclosing their needs, if not their diagnoses, and what they, as managers, can and will do to help when asked. Psychiatrist Richard Kunnis is head of the managed-care practice and a partner in the Boston office of Ernst & Young LLP, a large accounting consulting firm. Kunnis served for several years as head of the Social Security Administration’s disability evaluation program, bringing in panels of experts from medical faculties and surveying professionals to determine the capabilities of persons with particular diagnoses. He suggests that HR professionals who have felt burned by the disability assessment process may have undue expectations of themselves. HR professionals, he explains, can’t see if someone’s depressed, or if they suspect depression, how depressed the person is. Similarly, they can’t assess how much a person with congestive heart failure-a physical disability-can do. In fact, on his Social Security Administration medical panels, there was greater consistency among responses from experts about the functionality of a person with depression than a person with congestive heart failure. So where does that leave HR?

Assessment, he insists, isn’t human resources’ job. But MICOM managers, who didn’t accommodate the former employee who was having panic attacks, for example, could have done a better job without trying to diagnose and assess their worker who had panic attack disorder. Noting that, of course, he doesn’t have all the facts of the case, Kunnis explains what could have been done differently-on both sides. In short, “The employer has an obligation to minimally investigate, not just call the employee a liar.” According to Kunnis, the employer needs to get the facts.

First, the employee has the obligation to self-identify as a person with a disability. A reading of the EEOC guidelines suggest that the MICOM employee did that by telling HR that he had a medical condition and needed some time off for treatment. However, he could have provided documentation of his requests from his health-care provider rather than writing long diatribes to management. The documentation doesn’t necessarily include the specific diagnosis, but it should identify the condition as a disability and suggest possible reasonable accommodations.

Kunnis suggests that if the employee doesn’t provide this documentation, then the employer should approach the company’s health provider for a referral to an occupational psychiatrist to get an evaluation of an employee’s functional limitations. The occupational psychiatrist is a specialist whose report should answer these four questions:

1. How frequent and acute are the symptoms?
2. What are the prospects and the costs of treatment?
3. What are the employee’s functional limitations?
4. Are there recommended accommodations? If so, what are they?

The evaluation should cost approximately $300, Kunnis reports. It’s the first step to learning what the employee is capable of and is not capable of. From there, HR needs to assemble an accommodation team to help the employee succeed.

HR creates the accommodation implementation team.
Hantula recommends a clear course of action when an employee self-identifies as having a nonphysical disability: Create a team comprised of the employee, the employee’s supervisor, the medical practitioner, an HR manager and the employee assistance plan (EAP) representative if there is one. HR should bring together these resources to gather information and present all the options. Although these people don’t need to be in the same room together, the plan works best if they all work to plot a strategy to make the relationship work. Then human resources and the employee’s supervisor develop the eventual plan.

Hantula believes that managing the team is an appropriate role for an EAP representative because issues of medication compliance may fall under the purview of the EAP. HR needs to make certain the plan is consistent with the employer’s approach to reasonable accommodation and that it will work for the company. Hantula suggests the team review these four questions:

1. What is the employee capable of doing?
2. What in the work environment is allowing the employee do what he or she can do?
3. What in the environment is preventing him or her from doing what he or she can do?
4. What changes to his or her job or work environment can reasonably be made?

Petesch advises, “The accommodation implementation team needs to stick to job performance issues. It should only get into issues of accommodating a disability when an individual raises the issue and asks for an accommodation.” His advice on the best practice when a manager suspects a disability may be interfering with performance is to ask, simply, “Is there anything you need to be able to keep doing [your job] or to improve your performance on the job?” The question opens the door for the employee to identify a disability or ask for an accommodation, or to disclose any number of other problems, such as that his or her supervisor is harassing him or her. This, Petesch insists, is much safer than leaping in to suggest accommodations when the worker hasn’t requested them.

Then HR’s function, Kunnis explains, is to implement the plan, not to assess the disability. For example, if the MICOM employee’s panic attacks occurred only once a month and lasted about a half-hour, Kunnis explains, that could have been accommodated by having the employee make up the lost work time. If the employee needed to take a half-day off, he suggests the employer could have accommodated a significant portion of that lost time with annual sick leave. HR managers should think along the lines of how they usually accommodate a person with a physical disability, and then translate that into what makes sense for the individual in question and the employer as an organization. HR is a key player in the accommodation process, which can be a moving target.

HR sets the limits and decides on the accommodation.
In all of these discussions, HR’s key role is to remind everyone on the team of the requirement to keep information about a psychiatric disability confidential. Confidentiality is especially important because accommodation of a psychiatric disability isn’t a one-time event, but is more likely to be a process. People can be tempted to talk more casually about an ongoing process. Then HR has the final say on what the accommodation will be, understanding that the employer and employee may need to try several accommodations before they find one that works.

Petesch reminds HR professionals to consider that as technology changes the nature of all jobs, job descriptions will be changing along with accommodations and the competencies of the people in those jobs. Finding the best fit between people and jobs is one of the competencies that HR brings to the table. The complexity of accommodating psychiatric disabilities makes HR’s involvement critical.

What has changed since former President George Bush signed the ADA seven years ago? The atmosphere has become more charged as business owners take on the challenges of accommodating psychiatric disabilities. But American business continues to move up the learning curve on this troubling issue. At MICOM, the human resources staff believe that if they faced an employee with a psychiatric disability again, they would take it more seriously and make sure that everyone involved made an honest effort to understand. As the law requires, they would seek to accommodate the employee. The new EEOC guidelines will help.

Some HR managers who have an employee with a psychiatric disability have made compliance with medication a condition of continuing employment. Most experts in the field caution against that approach. Here’s why:

• Focusing on compliance can distract the manager from the real focus: the employee’s performance.

• Compliance with medication is an issue between the employee and the treating health-care professional. Whether the employee is compliant or not, the manager’s job is to evaluate performance.

Carol Miaskoff, assistant legal counsel for coordination at the EEOC’s Washington, D.C., headquarters, says that every time an employer monitors medications, the employer may have to justify that decision later.

Supervising compliance with medications can open the door to unanticipated legal liabilities. Donald Hantula, an organizational psychologist at Temple University in Philadelphia, points out that one potential side effect of some major psychiatric medications is the development of serious facial tics and spasms. If that happens, and the employer has enforced compliance with the prescribed medication, who’s liable?

There have been cases decided by the courts in which a person who refuses to take medications is still a qualified individual with a disability. Besides, holding an employee to a regimen not required of others can give the employee reason to file a complaint against the employer.

If the performance of an employee who has identified a psychiatric disability begins to suffer, the effective supervisor won’t ask, “Have you been taking your medications as directed?” The effective supervisor will ask, as Peter Petesch, a management-side labor and employment attorney with Harrison and Ford LLP in Washington, D.C., recommends, “Your performance is slipping. Is there anything that can be done to get you on track?”

Workforce, October 1997, Vol. 76, No. 10, p. 33.

There is no place on earth where death cannot find us—even if we constantly twist our heads about in all directions as in a dubious and suspect land … If there were any way of sheltering from death’s blows—I am not the man to recoil from it … But it is madness to think that you can succeed.

To begin depriving death of its greatest advantage over us, let us adopt a way clean contrary to that common one; let us deprive death of its strangeness; let us frequent it; let us get used to it; let us have nothing more often in mind than death … We do not know where death awaits us; so let us wait for it everywhere. To practice death is to practice freedom. A man who has learned how to die has unlearned how to be a slave.”
—Marcel de Montaigne (1533-1592, France)

Last May, Tom Terry first learned of his employee’s terminal illness. Bob Hamilton, 59, a veteran of 19 years in the shipping department, developed inoperable cancer. He then requested that Terry, manager of HR at Inglewood, California-based Zephyr Tools, tell his co-workers. Terry did more than that. He spoke with everyone he could find: those who had faced cancer personally or had faced it with an employee, family member or a friend.

Terry also provided Hamilton with a hospice referral and information about the company’s health-insurance policy. But in terms of human support, he pulled together a team of Hamilton’s immediate co-workers to be a support system during the illness. On many occasions, Terry also listened and asked Hamilton sensitive questions. He found out what Hamilton wanted and then determined his own role: “It was my job,” says Terry, whose company has 90 employees. “We’re all close and work together. But I was going to be the person here at the company who he could count on. I realized that everybody going through this needs compassion.” For eight months, Terry offered not only his human resources knowledge, but also his personal friendship. He often visited Hamilton at home once or twice a week. “He needed the human contact,” says Terry. “For Bob, the hardest part of his illness was the loneliness.”

In January, Hamilton died. Clearly, not everyone with a serious or life-threatening illness is diagnosed as terminal. But when one of your employees has accepted such a doctor’s determination, expect to enter a situation that demands the leadership of a compassionate, informed and skillful human resources professional. By thoughtfully managing the needs of the dying employee and the company, HR can enhance a dying colleague’s quality of life, positively influence co-workers’ morale and cast a healing light on the company’s cultural environment.

Who is terminally ill?
Facing death can be a frightening experience for anyone. Even the phrase terminal illness merits some clarification. “Heart patients, for example, can be just as terminally ill as a cancer patient. But we don’t consider them dying,” says Susan Mann, president of Pittsburgh-headquartered Hospice Nurses Association. “There are also people with [operable] cancer who become unnecessarily stigmatized in the workplace. That’s a major problem too.” So who is terminally ill? The definition is both objective and painfully subjective.

According to the Baltimore-based Health Care Financing Administration—the federal agency that regulates and monitors the Medicare program—an individual is considered to be terminally ill if the person has a medical prognosis that his or her life expectancy is six months or less—if the terminal illness runs its normal course. The definition has significant relevance for Medicare-qualified individuals who seek hospice benefits—most commonly, in the final weeks or months of their lives, says Mann. “Those of us in the hospice community have no aversion to the term [terminally ill]. But we recognize the general public does, so we also use the terms life-threatening or limited living.” The most important thing for HR managers to do is listen nonjudgmentally and work with the information provided at the time.

Now, if you’re still thinking you’ll avoid a terminal illness scenario, consider this: Although treatments continue to extend longevity, the U.S. rates of cancer and HIV infection that can lead to AIDS haven’t changed in recent years. Further, America’s aging workforce naturally is facing more health problems. And because of managed care, more terminally ill designated individuals are treated as outpatients and may choose to remain in the workplace until they’re only weeks or days away from death. Having a terminally ill employee at work challenges the skills and leadership abilities that are best drawn from the compassionate business partner—the HR professional—who can balance the needs of the employee, the co-workers and the company. Remember that everyone can grow in remarkable ways—especially when faced with adversity.

Avoid isolation.
Most counselors, senior managers and human resources professionals will likely agree on one thing: No manager facing a terminally ill scenario should wade through it alone. An HR professional facing this situation needs more than experts; this challenge demands an offsite confidante. Diana Dale, president of Worklife Institute Consulting in Houston, Texas, advises, “You need a confidential sounding board outside the company. Find someone you can talk to about both your feelings and your ideas.”

Dale says others at work may be going through the whole dying process with the terminally ill employee—the denial, the anger, the fear. Creating channels to talk about what’s happening, therefore, is vital. She recommends assembling a kitchen cabinet comprised of the immediate supervisor, the work team and key personnel to meet weekly with the terminally ill employee and talk honestly about these issues: Is the work getting done? How are they managing grief? How can the dying employee’s responsibilities be distributed so that projects continue? She stresses the importance of confidential meetings with just the work group, without the dying employee, to “get the snakes and toads out” so workers around the dying employee don’t harbor anger, resentment and frustration that surely will surface if not ventilated in a safe setting.

While taking care of the work environment, the HR professional will need to move quickly to handle the terminally ill employee’s legal and financial concerns.

Immediately address the employee’s benefits.
One of the most valuable ways of supporting a terminally ill employee is to review the benefits package. It’s crucial. Terry’s first business decision after gathering information and listening to Hamilton’s wishes was to review his benefits, seeking to maximize his choices. Terry then discussed those choices with Hamilton until he was able to make some decisions.

Another wise approach is to do a periodic benefits audit for several members of the employee’s department, thereby normalizing the process that the dying employee must undertake. HR staff can help pursue the ill employee’s appointments until the person’s beneficiary designations are current, marital status is clear, addresses are correct and until the employee understands how to use the company’s benefits when the prognosis is terminal.

HR also can create a time bank to which all employees may donate or deposit unused leave time for use by a co-worker facing a catastrophic illness. Under the leadership of James Hahn, city attorney for the City of Los Angeles, the Attorneys’ Associations and the city wrote an ordinance in 1991 establishing clear protocols for donation and use of vacation time. Because of the time bank, terminally ill employees won’t face any loss of their medical benefits when they’re unable to work the minimum number of hours to maintain those benefits. Hahn explains how this benefits co-workers as well: “We do feel helpless when we see someone with a terminal illness. This opportunity allows us to do something that’s needed. Many of us are so busy, we’re not able to use all our vacations days. It works. It really is an example of people caring about other people.”

HR needs to inform employees about the function of a Durable Power of Attorney for Health Care or of Advance Directives. Heartbreaking consequences can occur when these aren’t in place. A Durable Power of Attorney for Health Care is a legal document that assigns medical decision-making powers to someone who will represent an individual if he or she’s unable to speak for himself or herself. Without it, health-care providers will decide the extent and nature of one’s care, perhaps including use of life-support systems regardless of the individual’s wishes. The financial implications are considerable. Advance Directives is the name of a simple form that everyone should sign and make available to his or her health-care provider. It will explain how an individual wants to be cared for if recovery from a serious illness isn’t expected. The holder of a Durable Power of Attorney for Health Care should also have a copy of the person’s Advance Directives.

Few people also are aware of a new provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that allows early Life Insurance Rollout. Under the terms of the act, which became effective in January 1997, persons facing terminal illness may receive a portion of the value of their life insurance as nontaxable income. According to Peggy Wallace, chairwoman of the Board of Affirmative Lifestyles in San Antonio, Texas, the act defines a terminally ill person as “someone who has a life expectancy of less than 24 months as confirmed by an attending physician.” Affirmative Lifestyles has taken the lead in applying this feature of the act with a service that brokers the life-insurance policy to a qualified buyer, then provides a negotiated percentage of the policy’s value in a check to the terminally ill person. Because the money can be used for any purpose, the dying person can maintain dignity of choices and financial independence even in the face of terminal illness. Access to cash without draining family savings or other assets can make an enormous difference in quality of life for a terminally ill employee.

By being proactive, HR not only honors the dying employee, but also protects the company. Dale recalls a situation in which an employer didn’t guide the dying employee to put his paperwork in order. Consequently, documents that should’ve been signed over to his wife were left unchanged. After the funeral, the screaming widow, whose assets had been frozen, stood in the work area denouncing the employer, threatening a lawsuit and yelling at other employees while furiously cleaning out her late husband’s desk. Everything HR has learned about badly managed layoffs should be a source of insight about what can happen in this situation. An imminent death doesn’t have to derail the workforce. On the contrary, knowing more, earlier, helps HR anticipate the cycles of grief and plan accordingly.

Maintain employee dignity—socially and programmatically.
There are many ways HR can help a terminally ill employee retain his or her dignity. At the very least, HR should try to exercise creativity, confidentiality and flexibility. Maureen Siegel, chief of the Criminal Division in the Los Angeles City Attorney’s Office, recalls when Bill Tassie, a recently married, highly skilled attorney in his early thirties, told her he was dying of Crohn’s disease. (Crohn’s disease is an inflammation of the digestive tract, usually the intestine, that often spreads to the colon. It is characterized by diarrhea, cramping, loss of appetite and weight loss with local abscesses and scarring.) The illness robbed him of the ability to be a contributing member of the office and eventually led to the establishment of the company’s time bank.

But Tassie worked at the office longer than he should have-out of concern about losing his health-insurance coverage, says Siegel. That decision wasn’t in his or the city’s best interests. Now that the time bank is in place, other employees facing terminal illnesses have been able to take leave and receive pay. “They don’t have to use disability leave and incur those limitations,” Siegel says, praising Tassie’s inspiration. “There’s something to be said for employer-employee loyalty, in both directions.”

Siegel says Tassie’s death wasn’t her first encounter with a terminally ill employee. She often reflects on other losses in the Criminal Division during her tenure: a mother of a newborn who died from breast cancer, several attorneys who died from AIDS, another young mother who was lost to ovarian cancer. Siegel’s voice cracks as she describes the emotional pain managers feel when the work group is close: “When you lose them, it cuts a piece out of your heart. These employees have given the best years of their productivity to us, and we need to give something back.”

Another way to maintain dignity is to maintain employee confidentiality. Even when the dying person has disclosed the condition to colleagues, that’s not blanket permission to discuss every treatment and every indignity visited upon the person by the illness. When an employee shares his or her vulnerability, co-workers should allow the privacy they would want for themselves.

Another key element in assisting the terminally ill is flexibility. Although Hamilton was unable to return to his job in the shipping department, Terry already had decided that if Hamilton could return, he’d create a less physically strenuous position for him at the same rate of pay to help maintain his dignity during the remaining months. This is the sort of decision that may cause some to worry about setting a new precedent. James A. Autry, author and former Fortune 500 executive and holder of the Dean Helen LeBaron Hilton Chair in Leadership at Iowa State University in Des Moines, insists, “Don’t worry about precedent. Leadership must be of people, not of groups,” he says. “You don’t have to treat everyone the same. You have to give everyone fair and equitable treatment. A culture of prohibition creates worry about [setting] precedent.”

Managers, he says, need the self-confidence to respond to situations individually. HR should call in the rest of the team, lay out how things are going to work and also inform the dying person when things aren’t working. “You have to say, ‘I believe in you, but it’s not working. What else can we do?’ It’s so hard to be honest. It’s so hard to say, ‘You’re not doing a good job.'” Even better is to plan for contingencies with the terminally ill employee. By including him or her in the transition process, he or she will gain a sense of closure and preparation for what follows.

Anticipate setbacks; ensure succession planning.
In many situations, the dying employee may overestimate his or her ability to remain on the job. Then the HR professional needs to help the terminally ill employee and co-workers handle the sensitive transition—outside and inside the office. Outside, co-workers can set up a schedule of visits. They can be encouraged to call once a week to chat and keep the employee aware of company news. Linda Goldman, a certified grief therapist in the Washington, D.C., area and director of the Center for Loss and Grief Therapy, suggests that, with the dying person’s permission, co-workers may create a ritual that will “honor the person and sustain him or her in one’s grieving.” One group, she recalls “roasted” the dying man, who loved it. “It required courage from the dying person and from others, but people need to accept the individual’s dying while honoring his or her living.”

HR managers must also face the task of succession planning. It shouldn’t take an imminent death to alert HR to the importance of carrying out a plan. “People move on for any number of reasons. Death is just one,” says Siegel. “At our organization, we do succession planning all the time.” In fact, the dying employee will be the best one to know what’s needed when he or she no longer is there.

Autry has observed and participated in a number of successions due to terminal illnesses. At one company where he worked, managers were asked to participate in an annual exercise: They identified those employees who were ready or capable of being trained to take their place. “They weren’t restricted to their own department,” says Autry. From this annual list, HR developed a group that was considered the principal resource for future managers. “We set up a training program for potentials who weren’t ready yet.”

Clearly, the company benefits if the dying employee participates in the selection process. Co-workers see the individual being treated with respect and worry less about the replacement. The employee will also benefit because he or she will be active in passing on the acquired knowledge. However it’s done, HR can get the sharp edge off through honest conversation. The best parties to be involved, says Siegel, are the incoming person, the outgoing employee, HR and the immediate supervisor. “Everyone should expect transitions as an ongoing process,” she says.

Be both compassionate and resourceful.
When a terminally ill employee first informs the manager of his or her illness, the HR professional will want to be understanding. To be helpful, however, he or she will also need to be knowledgeable. Local and national organizations for a particular disease often have materials that can help people understand what the dying employee is experiencing. Hospice associations often have community counselors who can provide help to managers and co-workers. Industrial chaplains can lead kitchen cabinet groups and counsel co-workers individually. When the dying employee has a caregiver at home, HR can provide a referral to a caregivers’ association. For employees facing AIDS, Clinical Partners, a West Hollywood, California-based organization provides a case-management program that helps employers contain medical costs while offering a range of counseling services to the employee and co-workers.

Max DePree, chairman of the board for Zeeland, Michigan-based Herman Miller Inc. refers to “secondary sufferers,” of which HR and co-workers are examples. Secondary sufferers are those who ache for the dying employee and who may be picking up additional work because of the person’s illness. They need support and someone to talk to; they may need group meetings with a hospice program counselor or a hot line they can call to vent their feelings to a compassionate third party. They need someone outside the company who will help them through their own suffering.

Perhaps no other life event has the power of a terminal illness to isolate a person and relegate him or her to life’s fringe. Who’s better positioned than the human resources professional to honor the dying employee? It’s understandably awkward because no one wants to offend the individual. But standing by and ignoring death is actually harder on the living.

Experts advise co-workers to say things such as “I’m here for you if you need to talk”; “Help me to understand what this is like for you”; and “I’ll be here for you whatever happens.” It all boils down to compassion and resourcefulness. Autry summarizes this important role of business in a dying employee’s life in his book, “Confessions of An Accidental Businessman”: “I believe there is no stronger affirmation of the meaning of work in people’s lives than the intense desire of dying people to keep working. How does the manager support that person while still making sure the work gets done? Beyond that, how does the manager honor and recognize that the presence of this struggle every day in the workplace is just terrible for everyone else’s morale? There just are no absolutes in determining how to lead people through these situations. Sometimes I think that business educators believe that if a management problem can’t be charted or graphed or analyzed, and a solution put forth as a procedure or process, then the problem is not really a business problem. Any manager with real-life experience knows, however, that the most challenging situations require our wisdom, not our knowledge.”

Yes, I know my work hasn’t been up to my usual standards. But I’m having a very hard time concentrating. The truth is that … well, you’ve heard about that gang activity in town lately, the drug dealing? I hate to say this, but I think my child may be involved, and I can’t decide whether to turn her in. What do you think I should do?

If you heard an explanation of diminished job performance like this from an employee, what would you do? You know there’s a work-related problem in there somewhere, but the employee has framed it as an urgent moral issue requiring spiritual guidance or pastoral care, rather than management intervention. What’s more, the employee has confided private family business to you, even though as an employer you have no real need to know. And to top it off, the employee wants your help in solving the problem.

You’re at a crossroads: How do you determine whether this is a concern a human resources person should get involved in helping solve? Is this a situation in which an HR professional should give direct advice, refer the employee to someone else (like a spiritual adviser) or tell the employee it’s his or her own problem and must seek out his or her own resources?

More and more, employee problems that seem to cross the lines between the spiritual, the personal and the professional are knocking at HR’s door. In a more secular age, in a more diverse workplace, HR professionals face complex personal issues far more often than before the recent waves of downsizing increased the long, intense hours at work among the “survivors.” The line between employees’ professional and personal lives has blurred—and HR seems to be caught in the middle. And HR professionals are wondering: Why are these problems coming to us? Are they problems we should be solving? Or are they employees’ responsibilities? Where should we draw the line between being a spiritual counselor, a benevolent paternal figure and a work facilitator? It’s a complex problem requiring various strategies in different cases. Understanding why it’s even an HR issue is the first step in identifying, understanding and solving the problem.

What’s the source of the problem?
As Lisa Carp, director of human resources for Talbot Agencies Inc. in Riverside, California says: “The number of people having problems has escalated. Job loss, single-parent families, taking care of elderly parents, drug abuse—they’re all increasing. ‘Leave it at home’ is the old school of thought, and it doesn’t work now.”

Indeed, according to some experienced human resources professionals, more problems are now coming to the HR department that, in the past, employees might have taken to a minister, priest, rabbi or imam (a Muslim spiritual leader). Why? There are many reasons. In a post-downsizing environment, many employees now live their lives in only two places: home and the workplace. Time they once spent in community activities has been consumed by work demands. Sometimes people in a work group can behave like sequestered jurors, making the workplace their whole world.

Fran Sussner Rodgers’ experience as CEO of Work/Family Directions in Boston—which helps employers maximize employee health and performance by eliminating the barriers workers face managing work and life responsibilities—has shown her that for many, the workplace has become like a close neighborhood or the support system that extended families once provided. As the workplace absorbs more roles in employees’ lives, including becoming the primary source of affiliations and friendships, it carries the pressure of those roles.

Rodgers believes another factor contributing to a dependency on the workplace to solve personal problems is the diversity of the working population. “What the men [who represented the workplace of previous generations] brought to work when they were from similar backgrounds was different from what we have today. Diverse populations have different issues that they consider related to work, such as dealing with family situations at the workplace. Even 10 years ago, that would have seemed odd. Now there are a greater variety of things that people see as related to getting the job done.”

One example Rodgers states is how people from different backgrounds respond to reengineering of the workplace, a process HR usually manages. There are cultures in which the shame or the fear of losing one’s job prevents the person from talking about it at home, yet those feelings can certainly have an impact on job performance. Is that a work-related issue? A private, family issue? A cultural issue? Or is it really all three? If we’re out of touch, Rodgers insists, we tend to think of some single norm as the expected response to reengineering.

Work validates people’s lives.
Still another factor affecting the rise in workplace support of personal issues is that a growing number of people receive their full self-worth from their jobs. As a priest who has been a manager in a secular workplace, the Rev. Ted Karpf sees more people now developing a more intense relationship to the workplace. He worries that how people feel valued at work can become their whole sense of self-worth. Karpf has seen this trend increasing the complexity of the HR professional’s role. Before his current work as executive director of the National Episcopal AIDS Coalition in Washington, D.C., he managed a group at Aspen Systems Corp. which fulfilled Aspen’s contract with the Centers for Disease Control and Prevention’s “Business Responds to AIDS” program. “Invariably, if you saw low performance, you were looking at a whole complex of family issues as well. We had no employee assistance program. The health plan allowed for six counseling visits only, so managers and supervisors ended up doing counseling. Outside business hours, I ended up sitting and listening, asking the appropriate questions.”

Karpf says he believes that in most workplaces, “The only HR professionals whose work experience prepared them for dealing with the range of employees’ problems are benefits specialists, who can spot certain kinds of dysfunctions faster than anyone. They know how many times you’ve seen the doctor lately; they know how often your family members have been hospitalized.” Many benefits specialists spend more time with the employee than anyone else does in the workplace, explaining benefits and hearing about the employee’s problem in the course of that conversation.

When employees draw most of their identity from the workplace, the distinction between job-related issues and pastoral issues blur, not coincidentally, but because of the intense workplace focus. Karpf recalls a data processor in her late 50s who worked at Aspen. Although she didn’t report to Karpf, she approached him one day in tears, explaining that she tried hard to be valuable to her employer but didn’t feel valued. Under Karpf’s questioning, she explained that she had been promised a wage increase eight months previously, but the increase—from $7.40 an hour to $7.59 an hour—had yet to appear in her paycheck. Karpf asked about her situation in the next management meeting and found that she was one of eight people who hadn’t yet received a promised increase. When her next paycheck reflected the new hourly rate, she came to Karpf in tears again, saying, “Thank you for valuing my work.” Karpf explains, “For the first time, I understood what the American workforce is up against. I have worked much of my life in the church. Much of what I get paid for is intangible. I had never had the value of my life reduced to 19 cents an hour. This woman was in tears because someone had affirmed her worth at 19 cents more an hour.” Karpf saw that in this data processor’s eyes, her employer had become the key arbiter of her worth; this wasn’t just a paperwork hassle to her. As employees invest so much time and draw so much of their sense of worth from work, Karpf believes that HR professionals will confront more pastoral issues, not fewer.

Start with a “customer-driven HR” strategy.
Talbot Agencies’ Carp says that today, employees need to know they can come in and talk to HR about personal issues that may be affecting their work, that HR is a good place to blow off steam. “I keep books they can read. When I counsel employees, I try to get past the symptom that brought them in and get to the problem so that we don’t lose them,” says Carp.

In her previous position as HR director for Bird Medical Technologies in Palm Springs, California, Carp referred employees to the company’s EAP and worked to retain them. “If we did lose an employee, at least we knew we did our best. If we let the person go, we allowed a continuing relationship with the EAP. Every case was dealt with individually.” Carp says it’s more important than ever today to provide a support system for employees so they can do their jobs better.

Jan Iannessa, vice president for corporate HR at Universal Studios in Universal City, California, agrees: “We need to provide some support simply because the workplace has changed so much. Not responding can cost us a lot in lost productivity.” But does the company’s response sometimes create confusion about entitlement? Will an employee who receives help from an employer in solving a personal problem that affects the job feel that the job belongs to him or her no matter what? For some, it does, says Iannessa. “I see a sense of entitlement mostly when employees don’t take responsibility for getting to work on time or doing their jobs effectively. For some, once they’re hired, they feel entitled to their jobs. If they’re challenged, it’s not their fault; it must be their manager’s fault. Someone doesn’t like them.” Jackie Kittaka, senior vice president and director of HR for First Federal Bank of California in Santa Monica, says she believes “[employees] are confused between entitlement, a word we use loosely, and laws or regulations. There needs to be some clarity to employees, and communicating that is the responsibility of the employer. For example, employees need to know they have a right to overtime pay if they work a certain number of hours, but they don’t have a right to be promoted.”

Rodgers, in contrast, emphatically doesn’t see an increase in employees’ sense of entitlement; she sees a decrease. People are aware that they’re lucky to have a job, she explains. What’s being called a growing sense of entitlement is actually employees trying to tell the employer what they need to be productive, Rodgers insists. “It’s customer-driven HR: it’s HR’s job to figure out what people need to get the work done; and if they tell you, it’s not fair to call that a sense of entitlement.” Rodgers hears many pleas for work to be different so that employees can perform optimally. She explains, “Big companies have changed in what they say they can guarantee the employee. When they change the rules, they have to do three things: adapt to the changing labor force, provide services to employees to help them manage the transition, and invest corporate dollars in community-based organizations that provide support services such as child care and adult day care.”

These issues may sound pastoral, they may even sound like entitlement, but Rodgers insists that if HR can’t figure this one out, “Then they may as well stay with downsizing and administrative work. Human resources work is about motivation, figuring out how to meet people’s needs so that they can free up that motivation.”

HR needs to look for red flags.
After 20 years in the field, Lark Baskerville believes that employees have brought a full range of human concerns to HR professionals for a long time, but not to the extent that she sees now. As vice president/director of HR for Rubin Postaer and Associates, a Santa Monica, California, advertising agency, Baskerville is convinced that someone new to the field would need professional HR mentoring to establish a sense of when to deal directly with the problem and when to refer it to other resources. She offers practical advice to HR professionals by identifying several “red flags” in employee behavior that can alert a manager or a human resources person to problems that are best solved by resources outside the company.

Here’s one scenario: The employee seems depressed, even desperate. The employee tells you that you’re the only person she or he can tell. If it’s a business issue, that may be true, Baskerville notes. If it’s a personal issue, she recommends suggesting a relative, a best friend or a counselor.

In addition, if an employee’s absenteeism has increased, Baskerville suggests this is a major red flag, a behavior that’s certain to have consequences in the employee’s performance.

Kittaka adds to the red-flag list: When the employee shows evidence of being a danger to self, co-workers or others.

Obviously, if an employee isn’t functioning properly, there could be a variety of reasons why. Red-flag behavior should be a signal for the person’s manager or HR that someone should investigate further—without invading the employee’s privacy—and be helpful where indicated. After all, employees are investments. Just as a company would try to get to the heart of a machinery failure problem, it should also view employee failure in the same light. It often just takes a lot more finesse to diagnose and solve the problem.

What HR can do.
To the question of how an HR professional learns to do this, Carp has two guidelines: the Golden Rule and a mentoring system. Consider this dilemma: “Yes, I know my work has been falling, but it’s hard to work at maximum performance in the middle of this awful divorce. My life is a wreck. My kids need better child care and I can’t find it. I just can’t cope anymore. I guess I’m going to have to quit my job.”

Carp treated this employee the way she would want to be treated herself in that situation: She helped the employee restate the problem in manageable terms, then negotiated a one-week leave so that the employee could find better child-care arrangements. It worked. The employee’s sense of despair evaporated when she had the time and encouragement to find a solution to a problem that affected both her personal life and her work life. Carp managed the “pastoral” issue by helping the employee restate the problem so it was less overwhelming and by providing her adequate time to resolve it.

Such pastoral issues can overwhelm the inexperienced human resources person. When a new HR professional in Carp’s department found herself becoming deeply involved in employees’ personal problems, Carp provided her with an experienced mentor. According to Carp, preparation for this kind of decision making isn’t part of the curriculum in programs that prepare HR professionals; it has to be learned on the job.

Is it personal? Or is it professional?
Universal Studio’s Iannessa says she acquired some of her skills in figuring out what’s personal and what’s professional when she worked with hearing-impaired children. “You need to get all your senses working. You need to have developed your ‘sixth sense,’ that sense you’ll use in recruiting, hiring and in all the HR functions.” Iannessa defines the skill as learning to separate the emotional issues from the professional issues. “We always operate between the employee and the corporation, so people don’t always tell us right away what’s wrong. We need to have our sixth sense out there. Suppose an employee comes in complaining of being picked on at work, claiming that life is miserable. Something else is going on here, something the employee isn’t revealing. Being totally empathetic often isn’t the helpful response.”

What will be helpful to the employee and help the company maximize its investment in the person? First, focus on performance issues. Second, identify the appropriate referral for the personal issues that are affecting performance. Third, limit the time the employee has to improve the situation. Iannessa explains, “Until there’s a threat to their jobs, people often don’t get the help they need. We need to tell their managers, ‘Look at the job performance.’ [If there are problems,] then we find referrals for the personal issues. In the entertainment industry, that referral is EIRAC [Entertainment Industry Referral and Assistance Center], the industry’s own EAP.”

To illustrate the problem further, Iannessa talks about another recent job experience where the line separating personal and professional issues blurred completely for a while when there was a shooting incident at her company’s office building. Knowing that dealing with such strong emotions among the employees was beyond her professional expertise, she contacted a counselor who specializes in “post-traumatic stress disorder” and set up a crisis-intervention group meeting the next day. She scheduled times with the EIRAC counselors for a week and didn’t stop offering the sessions until people stopped coming.

Even after that experience, she explains, she has reached the point at which she understands the need for a daily balancing act between employees’ personal and professional issues as “part of the cost of doing business.” She adds: “You’re dealing with these kinds of significant things in people’s lives every day if you’re out there where you should be.” Iannessa believes that in the current business climate, it’s easier for employees to come forward than it once was. “Companies now are offering enough alternatives, whether it’s access to an EAP, to an employee-relations person or another resource. Both parents now often work; the number of single-parent families is increasing; we’re seeing women trying to deal with ‘having it all.’ Companies, in response, understand that these are productivity issues.”

Dealing with pastoral issues: guidelines for HR.
Beyond responding to these pastoral issues with the finely-honed sixth sense that Iannessa describes, there are guidelines that human resources professionals can use in dealing with them. These suggestions—from experienced HR professionals—may help you navigate the storm of employee problems for which they may ask for help:

• Encourage employees to build networks at the workplace to replace what used to be available in other places in their lives.
• Accept that for some people, there is a greater level of community and intimacy at the workplace than in any other place in their lives. Respond to their problems and complaints accordingly.
• Be a sounding board: Acknowledge feelings and act as a listener, but don’t try to solve a pastoral problem. Refer.
• Learn your limitations. Learn to say that the person needs more help than you or the company can offer. Once again, refer. (Even pastors must learn to do this when they confront problems outside their training.)
• Develop a file or a database of referrals that includes well-regarded spiritual leaders or organizations in the faiths represented among your employees. Under duress, an employee who hasn’t been active in his or her faith of choice since childhood may derive great benefit from reconnecting with one’s spiritual roots.
• Present employees with alternatives (or pros and cons), then encourage them to make their own decisions.
• Drop the phrase, “Deal with that on your own time,” from your vocabulary. Replace it with a referral from your well-developed collection of community resources.

No one’s predicting that this “pastoral” role of the HR professional will diminish in the near future. Employees who lack other deep roots in the community are likely to continue bringing to HR professionals problems that call for a pastoral response. But the well-prepared professional can avoid the pitfalls of this pastoral role and handle its responsibilities with skill and grace.

AIDS Dementia Complex is the result of the direct assault of the AIDS virus on the brain and manifests as the deterioration of memory. This debilitating disorder affects job performance because the person suffering from it no longer can remember important data for fulfilling the essential functions of the job.

Employers who must face the tragedy of an employee with AIDS Dementia Complex can learn from the experience of The Prudential Co., which recently helped a worker with the disorder smoothly transition to disability leave and his co-workers return to normal productivity. The Woodland Hills, California-based company suggests:

• Provide immediate, targeted workplace AIDS education for co-workers. The Prudential’s seminar occurred within a week of personnel manager Virginia Fleming’s assessment of the situation and focused on the effects of dementia. The employee, Andy, gave permission for his diagnosis to be disclosed so that the seminar would be most effective.
• Bring together, if possible, the affected employee and his or her closest support person outside the company, the employee’s supervisor, a few close co-workers and a qualified facilitator to process the emotions built up over the weeks or months of the employee’s deterioration.
• Explain the company’s benefits to the affected employee and his or her closest support person, then oversee the delivery of those benefits. Andy needed help completing the forms that bridged his working life and his disability. With help from his supervisor and personnel, he was able to take advantage of The Prudential’s Living Need provision of their group life-insurance policy. His diagnosis with a terminal illness availed him of 90-95% of the death benefit, a lump sum he has used to buy supplemental home nursing care now that he has lost motor function and is bedridden. Fleming emphasizes: “You’re going to pay the life insurance upon death; it costs nothing to pay part of it early.”
• Honor the employee’s contribution. At the group meeting at which Andy talked about realizing that he was losing the mental ability to perform his job, Fleming and others frequently acknowledged the high quality of his work and the many contributions that Andy had made to the company during his eight years there. They maintained Andy’s dignity throughout the process.
• Provide counseling/support for an employee in his or her relative youth who suddenly faces “retirement” due to disability. The loss of a job means the loss of much of some people’s identity.
• Treat the employee the way you’d want to be treated. Andy was losing his memory, not his humanity. Because co-workers continue to visit him at home, Andy still feels connected to the workplace that was a major part of his life.
• Structure your benefits package so that a terminally ill employee can move through the transition to disability leave relatively easily and with dignity. It costs nothing to allow early benefits from a life insurance policy to a terminally ill employee.

Are some of your employees functioning at roughly 70% of capacity, rather than the 100% you had in mind during the hiring process? It could be because of the crushing combination of business and personal pressures. They may be worrying about whether they have upward mobility in the company, how they’ll send their children to college, how they’ll retire someday and whether their own jobs will be obsolete soon. They may be reading articles suggesting that all of us are responsible for our own careers and can no longer assume that an employer will retain us in exchange for company loyalty and hard work. Many employees see an uncharted financial wilderness ahead of them.

In a changing climate, the challenge for every HR professional and corporate manager is to motivate each employee to give 100% at work and to help eliminate the nagging distractions that negatively affect productivity. One way to do that is to address the distractions head-on in efficient, effective ways that don’t trigger corporate liability issues and that don’t meddle in the employees’ private lives. Solutions include career counseling, financial-planning training and flexible schedules that allow workers to deal with family issues.

Career concerns head the list of stressors.
First, you need to identify the distractions. HR professionals are remarkably consistent in their replies when asked about concerns that distract their companies’ employees. At the top of their lists are career growth and employability, financial problems and work-life balance.

Employees troubled by these issues reduce the effectiveness of those around them as well as their own. Maxine McLean, whose company Awareness by Design in Tucson, Arizona, works with front-line employees in customer service and business protocol, has seen entire organizations hobbled by one 70% employee because that person is a manager or supervisor. She describes one manager who is under such great stress from financial worries, work-life issues and concerns about career growth/employability, that he must wear a heart monitor. His stress has caused him to treat his front-line managers with disrespect, sabotaging their and their workers’ productivity. However, he doesn’t realize that he’s doing it. Having witnessed front-line employees being rude to customers and seeing the slip in productivity, the manager called in Awareness by Design to counsel the employees on customer service. Those front-line managers told McLean that they find it difficult to treat others with respect when they aren’t being respected themselves. “This isn’t an unusual case,” McLean explains. “I think this happens frequently.”

Arthur Reedie, senior consultant with Dimension Five Consultants, Inc. in Monterey, California, believes that helping workers identify their career capabilities is the first step toward building their productivity. He sees HR responsible for helping employees identify their own strengths and get a better grasp of what it will take to use their talents to get ahead, either in their present organization or in another.

Unfortunately, notes Reedie, who founded an outplacement firm, most companies make their greatest investment in the individual needs of their employees when they lay them off. The companies help individuals being laid off deal with the job loss, build a marketing plan to get a better job, and cope with the financial consequences of job layoff through a “crash course” in financial planning. This can be enormously helpful, of course. But what if employers did all these things for the employees they retain? What if employers helped their employees market themselves internally? What if outplacement services could become “inplacement” services?

McLean has a positive example of inplacement from the same firm where the highly stressed manager is now getting individual attention to help him return to 100% productivity. Another bright young employee at the company was having difficulty recently in conforming to the corporate culture. In an interview, he explained that he had no financial worries—he made good money—but he hated his job. An entrepreneur at heart, he really wanted his own business. McLean helped him understand that he would have financial worries if he lost his present job, which was more likely than he supposed, but he could develop a plan to reach his goal of self-employment in several years. With her help, he made the commitment to being self-employed, set goals, made a plan, wrote a mission statement and set a time frame. They set those goals in the context of what he could learn in his present job to make him a more successful self-employed person eventually. The benefit of the process for the company is that, although the company may lose this employee later on, his current performance on the job has improved considerably. He has become a 100% employee.

Along with counseling, Hilary Kraft, an independent HR consultant associated with William M. Mercer, Inc. in Los Angeles, explains that many companies are beginning to define for employees what it takes to move to the next level by defining key behaviors, or competencies, needed in their work force. “Competencies cross over particular jobs. Competencies are the core for developing integrated HR systems,” Kraft insists. A focus on competencies shifts the emphasis from whether someone is the right person for the job to whether someone has the competencies for the task at hand. She believes that one management tool that helps put the emphasis on competencies rather than job descriptions is the 360-degree performance review, in which an employee’s evaluation is done by peers, subordinates and customers, as well as the supervisor.

According to Reedie, who now works in leadership enhancement and has an HR background, implementing solutions to concerns about career growth and employability means creating “learning organizations,” in which not just the individual, but the whole organization is committed to ongoing learning. “People want to be part of something that’s going somewhere,” Reedie points out, “and they want to see that they’re going somewhere.”

Sun Microsystems is a good example of a learning organization. The Silicon Valley-based firm has devised a creative response to the distraction of worrying about career growth by putting the issue on the table, not under it. Sun offers all of its employees “Career Management Services @ Sun: An Employee Benefit.” Every employee at Sun gets two hours of free career counseling yearly. The firm encourages each employee to think of herself or himself as self-employed within the organization. The philosophy is career self-reliance, according to Sun’s Lola Gerstenberger, project manager, Career Management Services. “In the 1990’s, you need the ability to actively manage your work life in a rapidly changing environment.”

To accomplish this sea change in employee attitudes about employment, Sun contracts with the Career Action Center, a not-for-profit organization that counsels Sun Microsystems employees to help them find their best work—the best investment of their abilities—within the company or beyond it.

Reedie believes the questions that distract employees can be reframed within a learning organization so that less distracted employees can pose a new, more important question: “How do I help the boss make decisions that will contribute to everyone’s growth?” That’s the kind of question that a “self-employed” employee in an organization is more likely to ask.

Employees today need financial-planning training.
After career stability, finances seem to be employees’ biggest stressor. Awareness of the employee’s dilemma in the new business climate is so pervasive that a new federal regulation, 404 (c), requires any employer who offers a qualified plan to educate employees about financial products and retirement plans. Why? Because employees have become, of necessity, their own financial planners in a world in which very few people work for the same employer from graduation to retirement.

Concern about the obsolescence of “lifetime” jobs with lifetime benefits packages has given most employees a new distraction; now they must be their own money managers and financial planners. Joseph Bonacci, a vice president with a large regional bank in New Jersey, is concerned about this development. “It amazes me how many people have no financial plan, no clue what they’ll live on when they retire,” he says. Bonacci manages corporate clients, and sees this problem from the banker’s and the employer’s perspective. He believes that helping employees understand and manage their finances better will increase the likelihood that the employee will be able to function at 100%. As a banker, he suggests employers provide financial planning education to their employees. “It will help get you some loyalty, improve the employees’ financial position and help employees become less transient.”

He comments that while many employers are probably offering a 401(k) plan, they probably aren’t explaining its benefits emphatically enough. Bonacci comments that most bank trust departments are willing to invest a great deal of energy in providing information about 401(k) plans to their corporate customers, such as putting on seminars and returning annually to answer questions about the plan.

However, Kraft believes few companies actually give employees investment education. “Companies have been doing more communication with their employees about investment options within their retirement plans, but we really need to sit down with small groups of people and give them an ‘Investments 101’ class.”

Recognizing the value of financial-planning services that can help a company create more “100%” employees, some firms have begun to tackle the issue. Prosper Marketing Group in San Antonio, Texas, markets innovative financial-planning products to corporations, banks and insurance companies. For example, “Financial Crossroads” is a personal financial self-development program that can be used as a self-study guide or as a workbook for onsite workshops administered by Prosper trainers or affiliated financial institutions. The program helps employees work through the financial aspects of life’s potential transitions: serious illness, death of a spouse or child, divorce, care of a parent, retirement or job loss in the family.

Mickey Batsell, president of Prosper Marketing Group, says: “When a company offers ‘Financial Crossroads’ to its employees, the guide doesn’t recommend specific strategies or products. It helps employees visualize their situations and possible consequences and identify potential defensive strategies. It then directs the employee to find an outside financial adviser to help him or her develop solutions. The employee becomes more responsible for his or her own financial health and becomes the owner of a plan that can relieve a great deal of distracting stress that could interfere at work.”

A second way to use the program, says Batsell, is for employers and banks to form a partnership to provide this education, customizing “Financial Crossroads” so the bank’s products are described and offered as part of the seminar. If the employee is satisfied with the bank products the seminar introduces, the employee is unlikely to sever the relationship with the bank, even if he or she leaves the company.

What’s the employee’s responsibility? They need to abandon the notion of employer as financial “parent.” No external force is responsible for doing an employee’s financial planning. HR, therefore, must communicate this responsibility to employees, and make resources available to give employees financial-planning help.

Balancing work and family is another stressful problem.
Employees troubled about financial planning or their own future employability are likely to have difficulty maintaining a work-life balance as well. Perhaps the greatest change emerging in the new workplace is the sense that each of us is self-employed, no matter where we work. Our colleagues are our internal customers. We’re responsible for upgrading our skills, knowing our options and thinking about our own future employability. This is all very exciting, but where is there any stability? If our family partners are going through the same reframing process, the strains on family can be enormous.

Linda Artel, a career consultant specializing in work-life issues with the Career Action Center in Palo Alto, California—and a working parent—believes that the most important message to employers who see employees struggling to balance work and family is, “Give them some flexibility so that they can avoid being distracted by personal needs.” She offers the example of a parent who could avoid arranging for a half-hour of child care before school every day if her work schedule could be adjusted to begin a half-hour later. The half-hour can be made up in a variety of ways. The point is that the employee whose personal needs are accommodated will be less “worried, distracted and resentful.”

Another suggestion that helps employees balance work and family is to put all the types of leave an employee earns—vacation, sick leave and personal leave—into one basket, allowing each employee to use it as she or he decides. This helps the employee avoid the dilemma of whether to call in sick when in fact his or her child is sick. Why not trust the employee to make the best use of leave time? The total number of hours of leave doesn’t change; only the administration of those hours changes.

A subsidiary of New York City-based American Express Co. Inc. is using a compressed workweek so that employees can take every other Friday off. In response to the predictable question—Why give them the 10th day off when in many places they’ll work 10-hour days anyway?—Artel stresses that a burned out 70% employee is the likely result of unbroken strings of 10-hour days.

Flexplace, a cousin of flextime, offers more options. Artel describes one San Francisco-area employer who gave an entire work group the opportunity to telecommute two or three days a week because their productivity went up so dramatically under that plan. Flexplace requires managers who can cope with not seeing employees for two or three days a week; indeed, the new business environment demands new attitudes and management styles.

What does the successful new manager look like? According to Swanie Schmidt, manager of corporate consulting at the Career Action Center, the new manager is a “mentor, expediter, arbitrator and facilitator”—not a parental figure. Artel stresses that managers must start managing people for results, not for how much time they work. There are few jobs where hours (“face time”) count more than product. She describes a focus on productivity as managing in the 21st century, not the 19th.

Artel summarizes the employer’s role in helping employees set work-life boundaries: “Many employees will work evenings and Saturdays for a while to meet a deadline or accomplish a project, but what puts people at 70% is constantly having to spend more than 40 hours a week at work.”

Many employees make “deals” with managers to accommodate family or personal needs, but unless such flexibility is company policy, the deals can collapse when the manager changes. If the new manager refuses to honor the arrangement, all the carefully crafted arrangements about child care, elder care, sharing of parental responsibilities, care for a seriously ill partner or exercise time can fall apart. If the flextime or flexplace agreement is perceived as fragile, Artel insists, it becomes a source of anxiety rather than relief from it. Employers won’t be able to retain the best employees in such a rigid environment.

Employees share responsibility with managers for avoiding burnout by setting boundaries and priorities, avoiding perfectionism and being flexible about the company’s needs. When the work group could make better progress if the employee taking a day off would spend 15 minutes on the telephone, then he or she must be flexible. Employees must “work smart,” recognizing most work is potentially infinite and that we all reach a point where return on extra effort is infinitesimal. Again, employees have to speak up for what they need.

Benefits of helping a 70% employee become a 100% employee.
One primary goal of helping a 70% employee become a 100% employee is improving productivity. Another, of course, is gaining and retaining the dedication of good employees. Reedie stresses: “Just giving them a better benefits package—that has no glue in it.” A company committed to implementing the kinds of ideas embodied in the practices of Sun Microsystems and the ideas of Prosper Marketing Group is committed to attracting and retaining high-performing employees.

Employers benefit when managers and their work groups develop more effective ways of producing. Creativity becomes a valued competency when everyone is freed up from distractions and has a role in shaping the work environment.

As the work force becomes more diverse, so too do the distractions. In the evolving business climate, it’s more important for each employee to be able to say, “I’m an investment for the company. The company is responding to my unique needs.” Then, Reedie believes, the employee gains a deeper sense of self-worth and the kind of peace of mind that allows full focus—100%—on the work.

Bill is a programmer/analyst in data processing for a major American bank. A few years ago, he hospitalized himself for clinical depression. He stayed for three weeks while the medication the hospital prescribed took effect and he learned a new way to manage his behavior to influence his feelings.

Bill is one of 17.6 million Americans who suffer from this debilitating disease. Yet, only one in three people within the work force who have clinical depression seeks treatment as Bill did, according to the Massachusetts Institute of Technology (MIT). This has wide implications for corporate America. According to a study of depression in the workplace reported in December 1993 by MIT, clinical depression costs employers approximately $44 billion a year in direct costs and lost productivity (see “The Economic Burden of Depression”).

Indeed, when an employee suffers from clinical depression, a silent thief is consuming sick days and robbing your workplace of productivity. A clinically depressed employee simply can’t perform to capacity. The employee can’t think clearly, may take no pleasure in his or her work and can’t contribute effectively to the efforts of a team.

According to Lori Altshuler, a physician at the UCLA Neuropsychiatric Institute in Los Angeles, a person who has untreated depression may suffer a diminished ability to process information or may feel that every part of the job is overwhelming. Symptoms may include headaches, fatigue, lethargy or anxiety, to the point where the person calls in sick.

Mana Kelly, a certified employee assistance professional, adds that a person with depression may show a decrease in motivation, isolate him or herself from co-workers, fail to contribute in meetings, avoid eye contact and show changes in personal appearance. He or she also may demonstrate low energy, lose concentration and the ability to follow directions, break into tears or present a generally “flat” (emotionless) demeanor.

You may have noticed someone at your company suffering from these things, but have felt too constrained by laws governing what you can and can’t discuss with the employee to confront him or her. Is there anything you can do?

Yes, according to directors of employee assistance programs (EAPs), psychologists who specialize in depression, insurance company psychiatrists and employees who have fought their way back from clinical depression to full productivity. But like many good outcomes, this one requires planning.

What is clinical depression?
Jonathan Aronoff, a psychologist in private practice in Stockbridge, Massachusetts, describes clinical depression like this: A person who normally operates on five or six cylinders now is operating on two or three. According to Rockville, Maryland-based National Institutes of Mental Health, “the highest overall age of onset [of clinical depression] is between 25 and 44, with an increasing rate for those born after 1945… .” The rate of clinical depression for women is roughly double that of men. For bipolar disorder—depression alternating with bouts of mania (excessive “highs”)—the rates are about the same for men and women.

A tendency to depression appears to run in families, so some people are more vulnerable to depression when major life stresses affect them. Researchers report that either chemical events in the brain, or life circumstances, can trigger depression. For example, the event that led Bill to treatment for depression occurred at work. He had always been ambitious for a management position, but when he achieved his goal, he discovered that his career success contrasted with his internal unhappiness. He suffered from anxiety and fear of confronting issues, problems that affected his work performance. Bill discussed the situation with his boss, and the two decided that Bill would step down. “It was devastating to my self-image. Part of who I am was gone. I got transferred to a more analytical job, but the feelings snowballed.”

A bout of depression such as Bill’s can last a few weeks to a few years; normally, Altshuler explains, untreated depression lasts from six months to a year. People suffering from depression do usually return to their regular state of functioning intermittently, but a subsequent episode quite often is more severe. Bill, for example, had been in and out of counseling several times, and even tried antidepressant medication once. The side effects of that first medication, however, were worse for him than the depression itself, so he abandoned the medication. His untreated depression returned at regular intervals, and each time it returned it was worse.

What’s more, Altshuler emphasizes that if a person has been clinically depressed one time, the likelihood of recurrence is 50%. If a person has been clinically depressed twice, the chances it will happen again is 75%. And if the depression occurs a third time, there’s a 90% chance that it will recur.

Ironically, most depressed people don’t recognize at first that they’re depressed. Kelly says that by the time depressed employees reach the company’s Employee Assistance Program, they’re usually in considerable mental pain. Kelly has directed the EAP for Rosemead-based Southern California Edison for eleven years and reports that, as with many physical ailments, most clinically depressed people don’t seek treatment until it hurts badly.

Fortunately, clinical depression is very treatable. Richard Kunnes, president of Prudential Psychiatric Management in Roseland, New Jersey, explains that although every person requires individual treatment, in most cases—especially moderate to severe depression—the patient responds best to a combination of medication and therapy.

Antidepressant medications do work, under proper supervision in a treatment plan. Normally the medications need three to six weeks to take effect, so early intervention is important. Altshuler explains that the literature on clinical depression tells us that if the person is in a clinically depressed state, a good response to medication is likely.

There’s a wide range of antidepressant medications appropriate for differing biochemistries. And, in fact, the more mild cases don’t require medication, Kunnes says. Also, not one professional interviewed for this article recommended medication alone, although all stated clearly that therapy alone may work. If there is to be medication, therefore, it must be with therapy or, in the long term, the investment in medication is wasted. Treatment with medication and therapy helps the patient return to work more quickly.

With appropriate treatment, the employer can expect most employees to return to work in about a month; there’s no reason to think that the employee will be unable to return at all. Some patients have difficult adjustments to medications and may need three or four months, but they’re likely to return to full productivity.

Kunnes also stresses appropriate follow-up. A patient who has returned to work following treatment for clinical depression needs to be seen once a month or once every two months, and may need to continue medication for a long time.

Treatment must be made available.
If one of your employees were diagnosed today as clinically depressed, would your health insurance plan cover the costs of medication? What about therapy? A combination of both?

Benefits managers bemoan the percentage of the health-care dollar that goes for mental-health coverage. Some say that mental-health treatment represents as much as 15% of their health-care costs. Because of this, and because mental-health treatment is so unlike a surgical procedure or a course of antibiotics—no clear beginning and end points, no confidence that it will ever be “over”—many benefits managers severely limit coverage.

In addition, an increasing number of managed-care companies are limiting coverage. Bob Bruner of Community Action/EAP, a national EAP based in San Bernardino, California, explains that managed-care companies have sold human resources managers on the idea that they’re going to limit expenditure of benefit dollars by limiting access to psychotherapy.

Some of these managed-care companies limit expenditure without notice. One EAP professional interviewed for this article, for example, described a company that has negotiated a health-care plan with its provider, an HMO, contracting for coverage for up to twenty sessions of psychotherapy per employee. But without the company’s knowledge, the HMO, upon receipt of a first claim, contacts the psychotherapist providing treatment and tells the professional that if the employee receives more than eight therapy sessions, the HMO will drop the therapist from its approved provider list. Not only is the company not receiving the benefit it pays for, but such an arrangement precludes effective treatment for most employees suffering from clinical depression, and adds greater cost to the corporate health-care budget. If an employee needs medication and therapy but under a particular managed-care agreement receives medication only, the depression is likely to recur and ultimately cost the company more money than full, effective treatment would cost in the first place.

Imagine the consequences of being denied treatment for Bert, a management consultant with an advanced professional degree who was guiding a large project for a major firm. Bert was waking up at three or four a.m., unable to get back to sleep, then suffering from mental dullness at work. Recognizing signs that no one else could see, Bert was motivated to seek treatment before the scenario he feared actually developed: that he would make a major gaffe and have to leave the organization. Edward Dunbar, Bert’s psychologist in Los Angeles, says something along those lines certainly was possible had Bert not sought treatment when he did. Through early intervention and treatment, however, Bert learned the skills he needed to focus his concerns about feedback and performance more effectively, and continued his 60-hour workweek. He believes that the employer never saw the problem before the intervention, or during the treatment. Bert was able to continue functioning as a key person in the organization, a partner in a happy marriage and an effective member of the community during treatment.

But for every Bert, is there another employee who abuses the system? Of course there are some, but no one interviewed for this article felt that occasional abuse was cause to not offer mental-health benefits to employees. Southern California Edison’s Kelly states, “Some people know how to manipulate the system, but there are many people who honestly need treatment. There are ways to make a difference, alternatives to simply seeing someone as a bad employee. I firmly believe that our employees are our best resource. If we don’t take care of them, we’re not taking care of business.”

How the human resources professional can plan for a good outcome.
Because receiving treatment is so important for workers who have clinical depression, one of the most important things an HR person can do is ensure that the company’s health-insurance covers effective treatment. If the insurer has a financial incentive not to treat, or to provide medication but no therapy, the insurer isn’t serving your long-term interests.

Next it’s important for HR to create an environment conducive for workers to receive help. Clinical depression often is widely misunderstood as a character flaw rather than as an illness, so it’s imperative to provide training to all managers and supervisors about the disease, as well as how to observe, confront and refer the employee to your company’s employee assistance program or similar available services.

If you have an EAP, arrange for EAP professionals to provide training in stress management, change management and related topics so that they become familiar and trusted. Fox, Inc. in Beverly Hills, California, brings an EAP counselor onsite once a week for confidential visits at the workplace. Usage of the EAP program soared when Fox began the practice. Regular visits also help managers feel more comfortable making a referral or calling the EAP to ask for advice in planning a confrontation with an employee whose performance has fallen off. Emphasize that the goal of these actions is to return an efficient employee to work, not to “dump” a “bad” employee.

It’s also important to provide easy access to care because the clinically depressed person isn’t able to function at his or her highest level. Make it easy for the manager to refer, and for the employee to contact the EAP independently. Provide a phone—and privacy—for that purpose.

Prudential Psychiatric Management gives members a 24-hour, seven-day-a-week toll-free telephone number answered by a mental-health professional. When an employee calls, if the person isn’t suicidal, the mental-health professional refers him or her to an appropriate therapist whose office is within 20 minutes of the caller, then sets up the initial appointment for the caller so that the employee doesn’t have to “cold call” the therapist.

Prudential’s Kunnes emphasizes that easy access works only when the employer has adequately informed employees about the EAP’s use, so distribute literature to all employees that explains how to contact the EAP or the psychiatric management service. (Dunbar’s patient Bert sought help through his spouse’s EAP because his own employer didn’t provide information about how to use its EAP, and his spouse’s company did. Without that resource, would he have sought treatment and avoided a major problem?)

What’s more, an employee who is unaware of the EAP or psychiatric services benefits may turn to workers’ compensation claims or lawsuits to address the problem of a deteriorating work relationship that has triggered his or her depression. This is especially true in a company going through downsizings. Employees at risk of depression will feel the impact more severely during this period, even if they keep their jobs. In one company cited by Bruner, 11% to 15% of the employees who had just survived a layoff filed workers’ compensation claims. These claims and lawsuits are more expensive than treatment and neither helps to get at the real problem of depression.

Along with setting up the structure for workers to get help—providing adequate insurance coverage and an accessible EAP or other service—it’s imperative that HR intervene. That doesn’t mean diagnosing or asking the employee about his or her mental state, but rather helping the depressed worker’s manager deal with work performance.

Managers and HR professionals should focus on changes in behavior. They should not try to diagnose the cause of an employee’s performance problems, but base comments on observable behavior. Example: “I’m seeing these changes in your ability to do your job.” Kathy Bruner of Community Action/EAP stresses that “human resources professionals need to know how to do appropriate observation and appropriate confrontation.” They don’t need to learn to diagnose clinical depression. She explains that the last thing an HR professional needs to be saying is, “You know, you need counseling.”

If the depressed employee is a supervisor, the human resources person needs to acknowledge that the supervisor’s depression affects the whole work group. According to psychologist Aronoff, a depressed supervisor will have difficulty organizing, leading, and identifying and following through with tasks—the essence of a supervisor’s job. Supervisees and colleagues may become anxious, confused and apathetic.

There are clear guidelines that are within the law for confronting workers, says Kathy Bruner. No manager or HR person should play amateur clinician, she stresses, but they need to initiate a conference about the employee’s performance. The language of clinical depression shouldn’t be part of the conference; if the employee brings up the feelings involved, the manager or HR person should listen, but not judge or comment.

One mistake that some managers and human resources practitioners make is assuming that because clinical depression is covered under the Americans with Disabilities Act, they must immediately make accommodations for a person with this diagnosis. Kathy Bruner says don’t do this: Use the EAP to validate the disability, with or without reference to the precise diagnosis, but stay focused on whether the employee is fulfilling all the essential functions of the job. Once the manager loses sight of that, Bruner explains, the clouds move in. Discussions of reasonable accommodation are appropriate only if the employee asks for it, with support from the psychotherapist.

Proper treatment reaps positive outcomes.
Thoughtful intervention from managers and HR people is key. Bill believes that the people around him in his work and home life gave him the courage to deal with the root cause. He began a course of medication and therapy. “That’s where the work really gets done—in therapy,” he insists. “Your behavior has to change. How you act affects how you feel, how you feel affects how you act. I think I act differently now, and that’s been hard to learn.”

Bob Bruner cites another example of positive results from a managerial confrontation with an employee whose eleven-year marriage was ending in divorce, whose mother had just died, and whose two young children were out of control. She was having panic attacks and was confused at work. Her job performance deteriorated, causing her supervisor to meet with her and issue a disciplinary memo. Because of good publicity and employer support for the employee assistance program, the employee turned to her EAP for help. She received medication and therapy, is again feeling in control of her life, and is now fulfilling all the essential functions of her job.

Bob Bruner explains that the constructive confrontation model—confront the employee with the behavior and give him or her the opportunity to do something about it—often saves the employee and changes the behavior so that productivity no longer is a problem. He points out that if a manager postpones the confrontation out of fear of hurt feelings or putting more pressure on an employee who’s already struggling, the problem gets worse.

Once a depressed person is in treatment, the company needs to take some pressure off the employee. UCLA’s Altshuler stresses that employers must recognize when dealing with an employee facing clinical depression that the employee already feels devastated, embarrassed, stigmatized. If the human resources professional knows the diagnosis, Altshuler suggests that simply acknowledging that the employee is facing biochemical events that must feel overwhelming can offer the employee immense relief.

Karen Z. agrees. The 30 year-old human resources development consultant found herself struggling with depression three years ago. She couldn’t sleep, was eating poorly, couldn’t make decisions and found no joy in anything. On the advice of her psychotherapist, she considered antidepressants.

When Karen began medication, she told her manager. At the time, her manager seemed not to know what to say, but Karen noticed that from then on, every time she made a questionable decision, her supervisor pushed and probed the decision past the point of Karen’s comfort.

Karen transferred to a new department and found her new environment more comfortable and supportive. Again, she elected to tell her manager—and the department’s vice president—about her diagnosis and treatment. “When I told them about the medication, they were primarily concerned about me, about Karen. It was clear: they cared about Karen.”

They didn’t ask about her treatment. Instead, they gave Karen steady feedback on her performance. “At one point, I got feedback from my manager that a memo was taking me a long time. I looked at how other things were going and decided I should increase the dose of the medication. Suddenly, I could write memos much faster. The feedback was that important, and that reliable.”

After offering performance feedback, the HR person must respect the employee’s confidentiality. After his hospitalization, Bill returned gradually to his full work responsibilities, and didn’t have to explain anything to his colleagues. “I had to work my way back into the flock. No one ever talked about it to me and I didn’t bring it up.” His absence and treatment weren’t the focus; performance issues were.

How has Bill’s performance changed? “I’m certainly a lot more comfortable with what I do. Data processing at my company is an unstable environment, but now I seem to be able to roll with the punches. My employer has been in a large cost-cutting process, something that could create a lot of anxiety, but my wife and others say I’m dealing with it now. I’ve learned that pretending there wouldn’t be a layoff isn’t the same as dealing with it. In fact, my attitude has probably contributed to my survival at the bank. I’ve maintained a high level of productivity and a good mental attitude.” Although Bill lost his father a few months ago in the midst of the major layoff at the bank, he feels that he now has the skills to keep an even emotional keel.

Karen reports that her performance now is at the highest level of her life. “My bad days now are better than my best days used to be. I feel much sharper than I did before. There’s a world out there.” Karen now runs an independent human resources consulting business.

Both Karen and Bill hoped that by telling their stories they might help human resources professionals understand depression as a workplace issue from the inside. Their advice to HR managers is to recognize that in each employee’s life, work and home issues are intertwined, and the spur to get into treatment has to come from one of them. What helped them the most is that their supervisors spoke to them frankly—and often—about their performance.

If you had an open position for someone who had sales and customer-service skills, you’d want to interview Mark Eiduson. Your first impression of Eiduson on the telephone would be that of a confident, sincere, friendly person who handles himself professionally. When you met him, you’d be impressed with his good eye contact, his readiness to laugh and his commitment to customer service. Eiduson is an attractive, apparently healthy man in his 30s who seems to have his life and his priorities in order.

He’d have a lot to offer an employer, including an excellent attitude. He’d tell you, “I have sales skills that I can use to sell photocopiers or cars or whatever you need to sell, but I want to do more than that. There’s so much happening in our culture now, so much disorientation and aimlessness, that I want what I do to make a positive contribution. I don’t just want to get mine and get out.”

As you talked further with Eiduson, you’d learn something else about him—he’s a person with a disability. He lives with chronic fatigue syndrome, a condition that he manages successfully with medication, a good diet, adequate rest and knowledge of his own warning signals.

Hidden disabilities such as Eiduson’s are quite common within the work force. Many analysts say that employers will hire and find more people like Eiduson among their existing employees as the decade progresses. Janna Calkins, a reasonable-accommodations consultant in Ventura County, California, says that there are three reasons to believe that during the ’90s, employers will be dealing with more persons with disabilities than ever. The reasons are:

• The Americans with Disabilities Act (ADA), which went into effect on July 26, 1992, for employers of 25 people or more, mandates equal opportunities in the workplace for people with disabilities
• The working population is aging, and this aging will cause increased numbers of employees with disabilities
• Medical technology is improving the chances that an injured person will be able to return to work after rehabilitation.

Myths hinder ADA compliance.
Although the ADA just went into effect recently, for some employers, compliance with its standards fits into their existing business practices. These employers state that they haven’t needed to make changes in their hiring practices or shift gears to be more alert to applicants who may have disabilities. For example, Samsonite Corp. in Denver has employed deaf workers for years. When Larry Winslow, vice president for HR, joined the company a year ago, he found that many Samsonite employees had learned sign language in order to communicate with deaf co-workers. He became accustomed to people signing during meetings—or to deaf applicants during interviews.

What jobs do the deaf employees do at Samsonite? Whatever jobs they’re qualified to fill. What accommodations has the company made? In the production area, there are lights in addition to the standard beepers on the forklifts to alert employees to the forklift’s motion. When asked what other accommodations the company has made for the deaf employees, Winslow looks puzzled, asking what else would be necessary? He explains that Samsonite does a good job of retaining employees—including the employees with disabilities—and that the company is glad to provide this simple assistance so that deaf employees “can remain viable, productive members of the organization.” He adds that hiring people with disabilities at Samsonite is “positive, supportive of all activities of the organization. It has become a way of life, not something that needs mandating or legislating.”

Unfortunately, not all employers share Samsonite’s attitude toward the hiring of workers with disabilities. The high visibility of disability issues has led some companies to hire attorneys to help them avoid compliance. Calkins suggests, however, that the changes created by compliance with the ADA won’t be as drastic as these people think—or fear—they will be. She points out that employers already accommodate special needs, such as those of parents who must leave early to pick up a child at school or employees who must have regular appointments with doctors.

Most employers also already employ workers with disabilities. High blood pressure, diabetes, heart disease and musculoskeletal difficulties, such as arthritis, all are disabilities. The ADA protects employees with those and more-visible disabilities from workplace discrimination. It covers all aspects of employment, including hiring, compensating, training, promoting and firing.

Cheryl Russell, director of development for United Cerebral Palsy Association in Orange County, California, says that employers who react to the ADA by avoiding compliance are responding from “fear about additional costs, fear about loss of productivity, and fear about what other people will think.” She sees the fear about what other people will think as “90% of the problem.” Russell stresses that most of these fears can be alleviated by talking to people who work with people with disabilities.

Samsonite’s Winslow also says that employers who resist compliance may be reacting from “fear of the unknown, fear that it will be used against me, fear that it will threaten the way I operate.” According to his own experience, those fears have no basis.

Russell says that a low collective consciousness about disabilities causes much of the fear in people and promotes the phenomenon of employers hiring lawyers to plot avoidance of the ADA. To squelch that fear, she routinely invites employers to visit work-activity programs. In one such program, people with cerebral palsy sort clothes hangers for Seattle-based Nordstrom. Based entirely on sound business principles—an employee must meet performance standards to stay in the program—the hanger-sorting job provides meaningful work and income to employees who have cerebral palsy. The United Cerebral Palsy Association interviews and manages these employees, who work off-site. The program provides Nordstrom with a means of incorporating persons with disabilities into the work force and to get necessary work done.

Understanding conquers fears.
Calkins says that many employers don’t know that the majority of disabilities are musculoskeletal injuries, specifically repetitive-motion and back injuries. Unpublished data from the California State Department of Rehabilitation indicate that 47% of the disabled population have musculoskeletal injuries, 15.75% have unspecified, endocrine, skin-or learning-disorder conditions, 9% have circulatory conditions, such as heart disease, 9% have respiratory or digestive disorders, 5% have head injuries, and only 3.25% have visual, hearing or speech impairments. She suggests that the fear that most people experience comes from an apprehension of those people with a mental condition—approximately 11% of the population of people with disabilities.

Many employers have come to positive terms—even with people who are mentally impaired—by making the required accommodations without considering them accommodations. If an employee has difficulty concentrating, for example, logic dictates management to:

1. Provide a less-crowded work area for the person.
2. Allow him or her to work for one supervisor rather than five.
3. Take distracting posters off the wall near the employee.

Most workers with mental conditions control those conditions with medication. If they don’t take the medication and consequently begin exhibiting unusual behavior, they’re asked to leave the workplace until the behavior is under control.

Reasonable accommodation can often be simple to implement. One employer cites the example of a schizophrenic/catatonic busboy who works in a fast-food restaurant. He occasionally freezes if his internal voices demand too much of his attention. Co-workers know that they simply need to tug on his sleeve to bring him back to reality—hardly a complex reasonable accommodation.

An employee with a disability often doesn’t need costly accommodations, despite employers’ fears that employees with disabilities may want or need expensive special equipment to help them fulfill essential job functions. Many people with disabilities needing special equipment actually prefer to own that equipment so that they can retain it if they change jobs. Sometimes when an employee acquires a disability, the employer develops a purchase agreement so that the equipment is available immediately. Then the employee buys it from the employer over time. Prices for many such products are decreasing, as the disabilities that they serve become more common.

Incorporate the employee with a disability into the workplace.
Once the fear is eliminated, companies must take a proactive approach in hiring people with disabilities. Samsonite and Nordstrom provide two examples of how it can be done. National Medical Enterprises (NME), located in Santa Monica, California, provides another. NME has instituted the Overcoming Challenges Employment Initiative, a program that focuses on the employment of qualified people with disabilities.

Cherrie Handy Pomerantz, program specialist with NME, interviews people with disabilities. Various rehabilitation agencies or service providers refer the candidates to NME. Currently, people with disabilities represent 3.2% of NME’s 50,000-employee work force.

Handy Pomerantz believes that a candidate with a disability should take the same tests as any other candidate, with a reasonable accommodation if necessary. “As you develop more special ways to test, you widen the gulf between regular employees and persons with disabilities,” she says. “Special becomes a negative word implying special treatment.” The accommodation of a person with a disability is reasonable treatment, Handy Pomerantz insists, not special treatment. “A working mom who’s a single parent will also need some accommodation,” she points out.

Handy Pomerantz does use special interview techniques when interviewing people with disabilities. She asks such standard questions as:

• What do you most enjoy doing in your job?
• What do you least like to do?
• What do you respect in a supervisor?
• What are your strengths?
• What are your goals?
• In what areas do you feel that you need to improve?
• How do you handle conflict at work?

However, it’s the way in which she listens that gives her information on the skills of people with disabilities. The program specialist gives the applicants every opportunity to talk about the disability in the context of successful coping strategies. She listens with the special skills of a person who knows disability from the inside. Handy Pomerantz is blind.

Occasionally, in an interview, the program specialist must ask such specific disability-related questions as, “What kind of accommodation would be helpful to you?” The person usually replies that he or she has had the disability under control for years.

Eiduson and Handy Pomerantz both say that they believe that applicants with disabilities should be candid with employers. For one thing, the employer who doesn’t know about an employee’s disability isn’t responsible for reasonable accommodation. Another reason for candor concerns medications. For example, when screening for drug abuse, such medication as that prescribed for epilepsy can trigger a positive drug-test result.

In addition to interviewing applicants with disabilities, Handy Pomerantz also serves as a consultant on reasonable accommodation to NME’s family of hospitals. For example, when an employee at a medical site developed macular degeneration—a deteriorating condition of the central portion of the retina—Handy Pomerantz found local support services. The employee now has a large-print computer screen with voice backup in the form of a speech synthesizer. After a couple of surgeries, the employee now works with great success, fulfilling all essential job functions. “We can demonstrate it,” Handy Pomerantz insists. “People who have all types of disabilities can work.”

Mitch Pomerantz knows this to be true as well. He has served as reasonable-accommodations officer in the Los Angeles City Personnel Department for years, hiring people with disabilities and developing accommodations for them. He agrees with Handy Pomerantz that learning what a person with a disability can do doesn’t require technology, just creativity on the part of the interviewer. He calls this behavioral interviewing. Its goal is to learn how someone would behave when faced with a particular challenge. “Suppose you’re interviewing a person with a visual disability for a job that requires providing information to the public,” Pomerantz explains. “Ask the person to describe ways to do the job successfully if someone came into the office when the computer was down and he or she didn’t have someone nearby who could answer the question right away. You’ll learn how creative the person is.”

Pomerantz disagrees with the technical-assistance section of the Americans with Disabilities Act that tells employers to rely on the person with the disability as the best source on equipment or software accommodations. “Not all persons with disabilities keep up with the latest developments in technology. It does a disservice to people with disabilities to make them the experts,” says Pomerantz.

Resources abound for accommodating people with disabilities.
Pomerantz suggests that employers look up other resources to learn what’s available for people with disabilities. One source is technology conferences for information on new products and prices.

The world of technological solutions to issues raised by employee disabilities is fascinating—and employees with disabilities aren’t the only ones who benefit from them. Pomerantz used one of the first talking calculators 15 years ago, an accommodation of his own blindness. Co-workers constantly were borrowing it, he reports, because it’s easier to use.

There are many software packages that help define essential job functions or translate selections of pictures into words in the form of memos and entire reports. The new software can solve many problems associated with hiring people with disabilities. Is all your job training narrated on videotape, making it difficult for you to hire someone with a hearing disability? There are several sources of open or closed captioning for existing videotapes. Is an armless person applying for a position as a computer programmer? Both Apple Computer and IBM have free product catalogs of readily available adaptive devices. Are you having difficulty determining the essential job functions of all the positions in your company? Two computer software packages, CrossWalk™ from Cascade Rehabilitation Counselling in Vancouver, Washington, and DescriptionsWrite Now! from the California Chamber of Commerce in Sacramento, help determine essential job functions and build job descriptions for thousands of job titles.

An important resource, the President’s Committee on the Employment of People with Disabilities, offers a compliance-and-referral hotline. Each state has local committees related to the President’s Committee, all offering different services. Callers to California’s Committee on the Employment of Disabled Persons, for example, can reach ABLEDATA, a data bank on reasonable accommodation, equipment for people with disabilities and background information on various disabling conditions. Various personnel-management associations also maintain referral services, such as the Association of Human Resources Professionals and the International Personnel Management Association, its public-sector counterpart.

In addition, each disability is represented by a diagnosis-specific information-and-advocacy organization, such as the Hypoglycemia Association or the Multiple Sclerosis Society. These organizations provide state-of-the-art knowledge of the condition they represent and its impact on work responsibilities.

Information regarding specific accommodations can be obtained from the national Job Accommodation Network, which operates out of the University of West Virginia. The Job Accommodation Network draws upon a data base of thousands of jobs that people with disabilities perform, and the accommodations that those disabilities require. An employer whose senior keypunch operator has just lost a hand, for example, can learn from the network what kinds of accommodations exist for one-handed keypunch operators in workplaces around the country.

Taking on an employee who has special needs doesn’t have to be an unsupported enterprise. An employer can find assistance everywhere. For example, the state Department of Rehabilitation provides job coaching at no charge to employers or employees. The job coach will work one-on-one with the employee, teaching the task and helping him or her interact with the supervisor, gradually easing off as the employee becomes comfortable with the task and the environment. Job coaches also help modify work practices if necessary, like helping a visually impaired employee label files in large print or in Braille.

During the 1990s, employers will have more workplace experience with people with disabilities than ever before. Dealing with the issue has become a necessary HR skill. One way to prepare an HR staff to handle disability issues is through a seminar called Windmills. This seminar helps broach the topic and enables people to face their fears about hiring people with disabilities. Used extensively for more than 10 years by Fortune 500 companies and small businesses alike, the curriculum is available from California’s Committee on the Employment of Disabled Persons.

In addition to offering resources for employers, this committee sponsors two major public-information conferences each year in April and October. Catherine Baird, executive director of the California committee, explains that disabilities in the work force aren’t “something for which we can look for a cure. This is our population, our employment pool.” She explains that although employers often feel overregulated and view the ADA as one more burdensome expectation, “We need to show them what’s in this for them.”

Realizing the benefits of hiring people with disabilities requires HR employees to keep current on issues regarding disabilities in the workplace. Pomerantz suggests developing a regular contact with someone at your state Department of Rehabilitation, or subscribing to the quarterly magazine published by the President’s Committee on Employment of People with Disabilities.

Companies benefit when they employ people with disabilities.
What are the benefits to the company of hiring a person with a disability? Handy Pomerantz points out that “everybody talks about the feel-good element,” but she says that this attitude isn’t respectful of people with disabilities. Essentially it means, “Aren’t we wonderful? We hired this person with a disability.”

The real benefit of hiring people with disabilities comes from their high loyalty, which reduces turnover costs and has a positive impact on everyone’s morale. Winslow offers proof of this fact. Samsonite, which employs a number of workers who have disabilities, hasn’t had employee-retention problems anywhere near the level of many other firms that Winslow has seen.

Eiduson points out that many people mistakenly believe that people with disabilities cause high turnover. He says, “The incorrect assumption here is that nondisabled workers are trouble-free. Has that been your experience? Probably not.”

He adds that by leasing employees through an agency such as United Cerebral Palsy Association, “Employers don’t have to pay health benefits or workers’ compensation costs. In addition, if you do decide to hire a worker with a cognitive disability, you may be eligible to receive tax credits for doing so.” There are more tax breaks and more governmental support than most employers realize.

Are workers with disabilities more expensive to employ than nondisabled employees? Lynn Franzoi, vice president of benefits at Beverly Hills-based Fox, Inc., points out that a small percentage of any group’s employees incur 70% to 80% of the benefits costs, and they tend not to be people with disabilities. Franzoi postulates an employee, for example, “who smokes a lot, drinks a lot, is seriously overweight, eats a diet high in fats and doesn’t exercise. The quadruple bypass [this person may require] will cost approximately $60,000, not counting the follow-up care.” By contrast, employing a person in a wheelchair requires minimal expenses. “After you’ve installed the ramp and made the work space accessible, there are rarely other ongoing expenses.”

Franzoi stresses that cancer and premature-birth costs far exceed costs related to any disability, “even AIDS. An employee whose disability is AIDS, to use an example that employers often cite, will cost the same as the quadruple bypass—approximately $60,000—if the case is well-managed. The birth and stabilization of a premature baby can easily cost $250,000 to $1 million. A bone-marrow transplant for cancer, performed at UCLA where they manage the costs well, runs $135,000 to $200,000.” She lists the major costs to a company’s benefits plan as “the smoker, the abuser of alcohol or drugs, the woman who gives birth to a premature baby, the person with cancer.”

Despite all these facts, Pomerantz points out that, at present, a person with a disability must interview ten times more often than a nondisabled person to land a job. To change this, HR people must start by changing their own attitudes. United Cerebral Palsy Association’s Russell lives by the motto: STOP—see the other possibilities. They’re out there.

Learning to assess the contribution that employees with disabilities can make to your company can give you a competitive edge in drawing on this under-utilized labor pool in an increasingly competitive market. And there’s far more help available to you in achieving this goal than you may have realized.