The Working Wounded

by Andre Picard, The Globe and Mail (Toronto)
June 22, 2008

Appearing in the Dana Foundation's Brain in the News
July 2008


The day Sylvie Giasson lost her job at the National Gallery of Canada - a victim of restructuring - it was as if a black hole opened up to swallow her.

The Gatineau, Quebec, translator began stuttering and crying. The tears wouldn't stop. She couldn't sleep. Suicidal thoughts overwhelmed her.

It took all the energy. Giasson could muster to get herself to hospital, where she was diagnosed with severe depression and anxiety disorder. She spent seven months in the Royal Ottawa Hospital, being ,treated with medication, counseling and electroconvulsive therapy. And she endured it all virtually alone.

"Nobody wants to visit a loved one in a mental hospital," Giasson said. There were no flowers or get-well-soon cards. No one called.

Society's silence about mental health is deafening. When you are diagnosed, you disappear. Yet the vast majority of Canadians suffering from mental illness-such severe conditions as depression, bipolar disorder and schizophrenia-are not in a hospital but in the community and at work.

Mental illness accounts for a stunning 40 percent of disability claims and sick leaves in Canada. While employees jest about "mental-health days;' they are no joke. Every day, 500,000 Canadians are absent from work due to psychiatric problems; the most recent estimate pegged the annual economic burden of mental illness at a staggering $51 billion.

The World Health Organization estimates that by 2020, depression will be the leading cause of disability on the planet.

"Depression is a colossus;' said Bill Wilkerson, CEO of the Global Business and Economic Roundtable on Addiction and Mental Health. "It's one of the biggest killers and one of the biggest disablers."

And it carries a cruel stigma. "There's this attitude out there that if you come back from cancer, you're a hero, but if you come back from depres­ sion, you're damaged goods;' Wilkerson said.

Most people do return to work after bouts of mental illness. Yet few employers are accommodating, and fewer still reach out to help staffers before they descend into crisis.

"We can't afford to be tossing any workers overboard;' Wilkerson said. "We have a brain economy and we can't let all these brains go to waste:' The situation, he added, is a "national calamity:'

Giasson, now 51, was one of those who clawed her way back. Doctors discovered the combination of medications that controlled her symptoms, including antidepressants and the Pill to deal with the violent mood swings linked to her menstrual cycle.

She left the hospital with $35 to her name. After a stint on welfare, she found employment, first as a temp, then doing contractual work and finally landing a full-time government job. Since 1992, Giasson has risen steadily through the ranks of the civil service, where she now works in employee assistance services at Health Canada. Over that time, she has had two bouts of severe depression, each necessitating a few months off.

"Depression was not part of my career plan;' she said wryly.

While she does not consider herself any different from workers with chronic illnesses such as diabetes or heart disease, she knows she faces far different perceptions.

"In terms of dealing with an individual with mental illness;' Giassoll said, "we're still in the Stone Age."

Economic impact

There is no doubting the scale of the problem. A poll commissioned by the Great-West Life Centre for Mental Health in the Workplace found that 18 percent of workers in Canada had, at one point, a diagnosis of clinical depression. At any given time, about 8 percent of those on the job are taking drugs for a mental-health condition, and 6 percent are under the care of a physician.

And because mental illnesses tend to afflict people in their prime working years, they have a huge economic impact.

The estimated $51 billion in annual cost to Canada was the conclusion of a study by Carolyn Dewa of the Centre for Addiction and Mental Health in Toronto. The study estimated direct medical costs at $5 billion, while loss of productivity due to long-term disability came to $8.5 billion a year and short-term sick leaves rang in at $9.3 billion annually. The balance, about $28 billion, was attributed to "reductions in health-related quality of life" -a method used to put a dollar figure on pain and suffering.

Phil Upshall, national executive director of the Mood Disorders Society of Canada, can rhyme off these stats with alacrity. He believes the figures are essential to understanding the scope of mental illness and the folly of not dealing with it.

"I have to use the numbers. They're all I have. I don't have a Timmy," Upshall said, referring to the way causes such as breast cancer and muscular dystrophy capture the public imagination by putting a human face on the conditions. But mental-illness sufferers are reluctant to come forward because they fear the stigma.

"There's this assumption that people will 'go crazy' on the job," Upshall said. "An employer would never ask a diabetic if he expects to slip into a diabetic coma soon. That would be unthinkable and crass. But they ask that type of question all the time to people with mood disorders."

According to the Great-West poll, employees feel the workplace is where they are least likely to get support. It's no wonder the majority of those with mental-health problems-64 percent-keep their condition secret from employers.

Renea Mohammed, a 37-year-old peer support worker at Vancouver Coastal Health, said secrecy is a defense mechanism: "Mental illness shatters your confidence so the last thing you want to do is tell your boss. You don't want to be judged and you don't want to lose their trust."

Mohammed was diagnosed as paranoid schizophrenic while studying for her master's degree in library sciences a decade ago. She attempted suicide three times in four years and was hospitalized on numerous occasions.

Despite it all, Mohammed held down several jobs as a librarian. With the help of medication and counseling, she's now healthy and her condition is stable. Along the way, she changed careers.

"If I was still working in a library I would keep this quiet. I'm not sure everybody believes in recovery, even intelligent, educated people," she said. But in the mental-health field, Mohammed says, she feels shielded from stigmatization and believes it's important to speak out on behalf of those who can't.

Michael Pare, a family doctor and coordinator of the Medical Clinic for Person-Centred Psychotherapy in Toronto, says professionals are particularly leery about admitting they suffer from mental illness.

"My clients are all working people;' he said.

"They have really good jobs and provide for their families. But they are also the walking wounded." Pare says he urges people to be discreet. "I tell them: 'You're not keeping it secret; you're keeping it private."

Still, he has been open about his own diagnosis of depression and his suicide attempt in university days. He's still in therapy, but not taking medication. He can be candid because he's self-employed, he said, but "there are still pockets of stigma in a society like medicine. It's a paradox: The healer can't be sick."

Mamta Gautam, an Ottawa psychiatrist dubbed the "doctors' doctor" because she treats only physicians suffering from mental illness, said the "culture of medicine perpetuates the notion of doctors as always being healthy, capable and available." She said physicians tend to minimize their symptoms and continue to work at a high level; as a result, they often seek help later. "The ability to function well is often the last thing to be impacted," Gautam said.

But there is a price. The late treatment, severity of symptoms and easy access to potentially lethal drugs -along with the pervasive stigma in society­ means the rate of suicide among male physicians is about twice that of the general population. Among female physicians, it is about four times higher.

Upside-down lives

Jacqueline Beaurivage was holidaying in Ontario's Algonquin Park in January 2003 when an emergency call came from one of her teenage son's best friends.

Her son, she was told, was sending out goodbye notes by e-mail and seemed poised to kill himself. Beaurivage phoned her son, and her husband dialed police.

Her son, Jonathan Singh, was diagnosed with severe depression. Even though Beaurivage was not the patient, the illness turned her personal and professional life upside down. A senior executive at CIBC, she called her boss and said she needed time off.

"He said: 'Take all the time you need,' and I'll never forget that," Beaurivage recalled.

She ended up taking three months off work, getting educated about mental illness and caring for Jonathan. "It was overwhelming. Every ounce of me was invested in my son. There was no way I could work," she said.

But when she did go back to the office, it was cathartic and also a positive message to Jonathan that life was returning to normaL "Three months off was a good investment for my employer," Beaurivage said. ''I'm a damn loyal employee now because I experienced the human side of CIBC."

Wilkerson says that, unfortunately, too many employers are short-sighted.

"We have a knowledge economy, where the heavy lifting is being done by the brain," he said. "We can't treat mental illness as a secondary or tertiary issue any more. Dealing with this issue in the workplace is essential to our economy and our quality of life."