Concerned About Employee Mental Wellness? Here are Some Solutions

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By Shana Palmieri, LCSW, December 6, 2022

The ongoing impact of the pandemic is clear: There are drastic increases in the rates of anxiety and depression and a growing need for access to behavioral health treatment. Prevalence rates of anxiety and depression rose 50 percent and 44 percent, respectively, according to an article in Translational Behavioral Medicine.

This rate was six times higher than in the pre-pandemic year of 2019. The most significant impact was found for those aged 18 to 29, with rates of anxiety and depression jumping to 65 percent and 61 percent, respectively. Also, rates of stress are increasing for Americans. The American Psychological Association reports the top sources of stress include rising prices and inflation (87 percent), supply chain issues (81 percent), and global uncertainty (81 percent). Stress about money is the highest it has been since 2015.

[Editor’s note: Shana will present the 60-minute webinar Grappling with Employee Stress in the Workplace: Improving Performance and Morale in Your Agency on March 23.]

In alignment with the increasing rates of stress and mental health symptoms, there is a critical workforce shortage in healthcare. The country is on track to be short 31,109 psychiatrists within a few years, per an AAMCNews blog post. The clinical workforce shortage was well-documented throughout the pandemic, and we continue to see healthcare staff leave the field altogether.

The average hospital turnover rate is now 25.9 percent – an increase of 6.5 percent, according to the 2022 NSI National Healthcare Retention & RN Staffing Report. 

The American Psychological Association found that a third of individuals reporting mental health symptoms during the pandemic who did not receive treatment believed having treatment would have been helpful. Forty-five percent of these individuals reported access to care (including location, provider availability and timing) prevented them from accessing treatment. Twenty-seven percent of individuals reported the thought of reaching out and trying to find help was too overwhelming.

The impact of rising rates of mental health symptoms and increasing reports of significant stress levels has a critical impact on employers in terms of absenteeism, productivity, and office morale.  Creating a workplace environment that promotes mental wellness and eliminates barriers to accessing behavioral health treatment provides great benefit to the employees and the employer.

Even given the significant challenges, there are a variety of solutions employers can integrate into the workplace as solutions.

Access to care

Finding a behavioral health provider through an employer’s health plan can be tedious and very challenging.  Individuals are often left with a list of psychiatrists and therapists and start calling and leaving messages trying to find someone to at a minimum to return their call and hopefully with a call back and open availability. For an individual already suffering and feeling overwhelmed, trying to navigate this process can be extremely frustrating.

Employers can help in one of two ways:

  • They can provide better resources directly to their employees to help them find a provider.
  • They can contract with a telehealth company in an agreement with specific access to care expectations to ensure their employees can receive timely access to behavioral health treatment.

Contracting with a national telehealth provider that offers access to outpatient therapists and psychiatrists can greatly improve the ease and length of time for employees seeking providers. Platforms, such as Ginger, Lyra Health, and Spring Health, charge insurance premiums plus a per member fee. Array Behavioral Health does not have per-member fees.

Employers can also provide resources directly to their employees. For example, employees can schedule an appointment on the Array Behavioral Health website, find providers through Psychology Today, or access options to book online appointments through Zocdoc.

Stress and mental wellness

Employers seeking an overall approach to improving mental wellness and reducing employee stress levels can consider a variety of resources and programs.

Employers may want to offer employees a mindfulness-based stress reduction program (MSBR). MSBR is an eight-week evidence-based progress secular mindfulness-based training to reduce symptoms of stress, anxiety, depression, and pain. There are also a collection of digital tools available to offer employees such as Calm for Business and Headspace for Work.

Improving access is one critical aspect for employers to address the overall mental wellness of their workforce.  It is also important to maintain a commitment to employee wellness through the workplace culture and environment. Employers’ dedication to employee wellness will lead to a more productive, healthy, and happy workforce.

Important note: In instances of a psychiatric crisis, including suicidal thoughts or thoughts to harm others, there is the 988 mental health crisis line and 911 to access more immediate and emergency assistance.

[email protected]

Tools, Techniques Needed: Conducting Investigations When Trauma is Involved

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By Shana Palmieri, LCSW, September 14, 2021

The goal of Federal workplace investigations is to collect information in an objective manner through a series of techniques that provides information to uncover the ‘truth,’ allowing the agency to make appropriate decisions and actions. Unfortunately, the human mind and memory is tricky business. Since the 1960s, social scientists have produced numerous studies that demonstrate eye-witness testimony and memory are unreliable.

To make matters more complicated, memory is formed and stored differently in individuals under extreme stress from trauma. To conduct proper investigations, it is pertinent to understand the underpinnings of memory retrieval and have a toolkit of evidence-based techniques that will allow the investigator to obtain accurate, reliable information. [Editor’s note: Shana will be a presenter during FELTG’s upcoming Workplace Investigations Week (December 6-10) and will share guidance on interviewing witnesses who have experienced trauma, de-escalating emotionally charged interviews, and more during Conducting the Investigation, Part I on December 8.]

Memory includes three primary processes:

Encoding. Individuals receive information based on what they see (visual), hear (acoustic), and understand (semantic). The brain then encodes the information deemed important and lets go of what it considers less important information.

Storage. The brain takes these selected details and consolidates them into a memory in the brain based on the details selected from the encoding process combined with our current knowledge to reconstruct what we ‘think’ happened in the past.

Retrieval. Retrieval involves the recall of old memories to form a narrative of past events and our recollection of what we ‘think’ happened. People are only able to retrieve a portion of their actual memories, and these memories when retrieved are combined with additional memories, events, and beliefs that have occurred since the initial memory was consolidated.  What this means is that when we retrieve a memory, we are not retrieving the initial memory that was encoded and consolidated, instead we are retrieving a memory that has been reconstructed and changed over time.

Memory systems in humans are not like replaying a video or audio recording that gives us a play-by-play of the exact details that occurred. Rather, the human memory selects what it believes the key factors are to encode, then uses current beliefs to consolidate a narrative that changes over time. This creates problems for obtaining an objective account of what occurred in the past built on a memory-based interview.

Add in other complicating factors, such as trauma, to impact the functioning on the memory systems, and the interview process becomes more challenging. Due to the activation of the stress response system, memories are often fragmented. Additionally, the type of memories the brain decides to encode differ than that of individuals not under extreme stress. And, finally, individuals under extreme stress as a result of trauma often do not store memories in a chronological fashion, making the retrieval of the incident difficult for the purposes of an investigation.

Therefore, specific investigative tools and interview techniques need to be applied when working with individuals that are impacted from extreme stress or trauma.

These techniques allow investigators to ask questions in a way that aligns with the way individuals store, retrieve and process information, allowing for a more objective investigation. [email protected]

Impact of COVID on Stress, Mental Health

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By Shana Palmieri, May 19, 2021

A comparative analysis completed by the NHIS and U.S. Census Bureau shows an increase of 11 percent of adults reporting symptoms of an anxiety or depressive disorder in January-June 2019 compared to 41.1 percent in 2021. A variety of stressors as a result of the pandemic contributed to this increase and continue to impact stress levels including:

  • Financial stressors
  • Social isolation
  • Fear and uncertainty of the future
  • Remote school learning
  • Loss of loved ones to COVID

As the stressors continue, the initial acute stress experienced as a result of the pandemic can transition into chronic stress causing a lasting impact with serious symptoms for many.  Chronic stress is a prolonged state of stress that does not give the body an opportunity to activate the relaxation response.  There are numerous negative consequences from a constant state of physiological arousal caused by the body maintaining a chronic stress response.

Symptoms of chronic stress include aches and pains, decreased energy, insomnia, fatigue, difficulty with concentration, gastrointestinal problems, headaches, anxiety, depression, decreased immune response, irritability, nervousness, feeling a loss of control and helplessness.

If chronic stress is left untreated, it can turn into more serious conditions including major depressive disorder, anxiety disorder(s), diabetes, heart disease, high blood pressure, hyperthyroidism, ulcers and weight changes.

[Editor’s note: On July 21, Shana will present Dealing With Employee Mental Health Challenges During and After the COVID-19 Pandemic.]

Returning the body to a state of relaxation is pertinent for the healing process to begin. Healing the body from the impact of chronic stress takes consistent effort and the constant practice of healthy habits.  Stress reducing habits to heal from chronic stress include:

  • Healthy sleep patterns – at least 7-8 hours a night
  • Daily exercise
  • Yoga/mindfulness meditation practice
  • Healthy diet
  • Connection through healthy relationships
  • Setting boundaries to maintain work/life balance
  • Talking with a therapist

Keeping the body in a healthy, relaxed state through the practice of healthy habits will create a state within the body better able to fight illness and will reduce the physical and mental symptoms of chronic stress. If you are a loved one are experiencing suicidal ideation, help is available at the National Suicide Prevention Lifeline at 800-273-8255. [email protected]

Managing Employees With Narcissistic Personality Traits

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By Shana Palmieri, August 4, 2020

Do you have an employee who refuses to accept feedback, is always right, monopolizes the conversation and feels entitled to special treatment within your agency? Are these traits creating a challenge for leadership to engage this employee to collaborate with the team to achieve the mission, purpose and goals?

Individuals with these traits often create a struggle for supervisors and leadership within organizations, the struggle can be even more severe if the individual within the leadership position embodies narcissistic personality traits.

Let’s first review: What exactly is Narcissistic Personality Disorder and how prevalent is it in our society?

Narcissistic Personality Disorder

Narcissistic Personality Disorder is noted to be the least studied of the psychiatric disorders. Patients with Narcissistic Personality Disorder are often known for coming to therapeutic treatment ‘by force’ or as a last resort and often do poorly in therapeutic treatment.

The research indicates that the underlying roots of narcissism are often due to negative developmental experiences such as being rejected in childhood, or, in contrast, excessive praise during childhood leading the individual to believe he has exceptional traits.1 A 2009 study found narcissistic personality disorder was a fairly prevalent personality disorder in the United States, occurring at an estimated rate of 6.7%, with rates in men at 7.7% and in women at 4.8%.2

An individual may have traits of the disorder or meet full diagnostic criteria for the disorder. The typical presentation of Narcissistic Personality Disorder includes:3

  • An exaggerated sense of self-importance.
  • A sense of entitlement and a consistent need for excessive admiration.
  • Expectation to be recognized as superior without achievements that indicate the need for recognition.
  • The individual exaggerates his or her achievements, abilities and talents.
  • The individual has a preoccupation and obsession with success, power, beauty, brilliance or being the perfect mate.
  • The individual believes he or she is superior and only desires or agrees to associate with people he or she views as equally special people.
  • The individual tends to monopolize conversations and belittle others who they perceive as inferior.
  • The individual expects to receive special favors for his or her expectations to consistently be met, and for unquestioning compliance in his or her demands and requests.
  • The individual is unable and unwilling to recognize the feelings and needs of others.
  • The individual is both envious of others and also believes others envy them.
  • The individual behaves with arrogance.
  • The individual insists on having and deserving the best of everything.

Likely the most challenging aspect for employers is that individuals with narcissistic traits or narcissistic personality disorder have an incredibly difficult time accepting feedback or criticism. They often have the following reactions:

  • Become irritated, angry or emotionally distressed when they do not get their way or view themselves as not getting special treatment.
  • Are unable to regulate their emotions and struggle to tolerate stressful situations.
  • May react with rage and then direct their anger toward criticizing others and demonstrating their own superiority.
  • Have frequent interpersonal conflict, especially with the individuals who provide the feedback (perceived as criticism).
  • Significant difficulty adapting to change or adjusting their mindset.

Managing and Setting Boundaries

Employees with these traits can be challenging at best to manage within an organization and ultimately may be toxic to the overall success of the organization. Some of the tips below may help minimize the impact these individuals have on your organization.

1. Check yourself. Prior to assuming the individual you are seeking to manage is narcissistic, take a look at yourself and your approach to ensure your management style is not creating a defensive reaction in your employees. Key tip: If you struggle to manage all your employees and think they all have significant pathological personality problems, it may be an appropriate time for self-reflection.

2. Clearly identify your objectives. What are the goals and objectives you need to accomplish to meet the mission of your agency? In which areas is the employee demonstrating an inability to perform? What needs to change in order for the employee to be successful? Attempt to be objective and separate your own emotional reaction to the employee. What specifically do you need the employee to do/change in order for the organization to be successful?

3. Be concrete and clear with expectations. Engage in all conversations with respect and empathy, but stay focused on what needs to change in order for the employee to meet the goals and expectations of the organization.

4. Align with the leadership team on expectations and boundaries. If the employee is able to go above the supervisor’s head and get an exception or special treatment, the situation will be exacerbated and create further toxicity within the organization. The rules and boundaries must be clear, consistent and aligned with the leadership team.

5. Be consistent. The expectations need to be consistent not only for the employee causing the challenging dynamic, but for all employees. Attempt to keep rules, boundaries and expectations consistent across the board with employees to minimize special treatment and favoritism.

6. Follow through on consequences for not meeting expectations. Ensure goals and expectations are being met. If the expectations are not met, follow up promptly.

7. Stay focused. Do not let yourself be swayed by emotion or manipulation. Stay focused on the facts and the key tasks, objections and goals of the organization. Refer back to the facts and make the decision off the facts, not the emotional persuasion of the employee.

8. Remember your role. As a supervisor or leader, your role is to support the mission, purpose and goals to be accomplished. Stay focused on supporting your employees with the key objective being to meet the goals and objectives of the agency, not the personal goals of individual employees.

9. Be willing to part ways. If the employee is unable to collaborate with the team to successfully perform the functions of the job, be willing to part ways. Excellent leaders and supervisors will provide empathetic, respectful and considerate support to their employees to ensure their success. However, they must also understand the appropriate time when an employee has personality traits that are interfering with success of the organization and may need to make the decision to part ways.

Note: Shana will cover personality disorders and several other topics during Managing Employees With Mental Health Challenges During the COVID-19 Pandemic on August 26, 1-4:30 pm ET. [email protected]

1 Mitra, P. (2020, April 15). Narcissistic Personality Disorder. Retrieved July 20, 2020, from https://www.statpearls.com/kb/viewarticle/27055

2 Stinson, F., Dawson, D., Goldstein, R., Chou, S., Huang, B., Smith, S., . . . Grant, B. (2008, July). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the wave 2 national epidemiologic survey on alcohol and related conditions. Retrieved July 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669224/

3 Narcissistic personality disorder. (2017, November 18). Retrieved July 20, 2020, from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662

7 Tips for Coping With the Stress of a COVID-19 World

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By Shana Palmieri, April 15, 2020

The coronavirus pandemic has thrown the globe into a sudden, unexpected and intense trauma.  As a result of the global pandemic, lives for people around the world have changed in an instant. Within the first three months of 2020, our societal structure and lives were dramatically altered, causing our entire population to shift course in ways the majority of people have never experienced.

If you are struggling as a result of these sudden, intense changes in your life, you should know it is an expected and normal reaction to an abnormal and challenging situation.

Some common reactions you may be experiencing as a result of the COVID-19 pandemic include:

  • Disbelief
  • Emotional numbness
  • Sleep disturbance and/or nightmares
  • Anger, moodiness and irritability
  • Forgetfulness
  • Denial
  • Guilt
  • Panic
  • Emotional withdrawal/isolation
  • Crying
  • Grief
  • Questioning typically held faith or religious beliefs

Implementing strategies to manage stress and anxiety during these challenging times will allow you to stabilize your mood, stress level and improve your overall health.  Times of extreme stress are typically those times we call upon our closest friends and family for connection and support. The COVID-19 pandemic creates the added stressor of requiring us to physically distance ourselves away from our social supports and connections.

While physical distancing is currently critical to mitigate the spread of COVID-19, social connection continues to be key to reducing stress and anxiety. It is important to stay connected to key social supports through available technology to help cope with the current crisis. [Editor’s note: Shana is one of several instructors participating in the Emerging Issues in Federal Employment Law virtual training event April 21-23. Her session Strategies for Stress: Effective Coping in the COVID-19 World will provide more guidance on how to manage change and stress for you and your employees. For more information or to register, click here.]

In addition to staying socially connected while maintaining physical distancing, here are a few additional tips to help manage stress and anxiety through the crisis:

TIP 1: Allow yourself the time and space to feel the emotions caused by this sudden change. It is important to give yourself permission to process emotions related to this current crisis.  Repressing your feelings can, in the long run, create further anxiety, stress, and cause pressure to build.

TIP 2: Socially connect to positive supports and/or schedule a telehealth visit with a therapist. Connect with your friends, family and, if needed, a therapist to talk. Social supports can be helpful to create a community going through a shared difficult experience in unison. It can also be helpful to engage in social connections (while physically distancing) that include conversations or shared activities that are not related to the current crisis to maintain elements of your normal life. (Have dinner together over video chat, play a game over video chat, have a Netflix party.)

TIP 3: Develop a new routine. The majority of society experienced a sudden and dramatic change in their routine.  Kids were sent home from school, workers were furloughed or sent home to telework, all non-essential businesses were closed and the majority of the country has been mandated to stay at home. With the entire family now at home 24/7, it is important to develop a new routine and healthy boundaries in the household. Think about and implement a routine that will help you reduce stress.

TIP 4: Exercise. The gyms are closed and depending on where you live, getting out for exercise can be a challenge. However, exercise is key to reducing stress and anxiety. Consider running/walking outdoors if that is an option, or taking an online workout class.

TIP 5: Limit watching the news to a specific amount of time each day for updates. Constant news watching can increase anxiety and stress. Create a plan to get the needed news updates and information and limit the times spent watching the news. Please remember that Facebook and similar social media sites are not valid sources of the news. Get the facts from a valid source.

TIP 6: Eat nutritious meals. It is well-documented that unhealthy eating habits have a significant impact on poor mental health, including depression and anxiety. Eating nutritious meals will improve your mental health and keep your immune system functioning well.

TIP 7: Engage in healthy sleep habits. Sleep is critical to keep stress and anxiety levels low. Sleep has numerous benefits, including keeping a healthy immune system, reducing the risk of chronic disease and helping with weight loss. A good night’s sleep should include 8 hours a night. Develop a positive sleep routine that is consistent.

The COVID-19 pandemic has presented our society with an unprecedented crisis in modern times. While we must physically distance ourselves, we must also continue to unite to support each other, our families and our communities to reduce the spread of the virus and mitigate the emotional toll of the crisis.

We all must do our part to stop the spread of COVID-19 and engage in self-care to keep ourselves and our communities physically and emotionally healthy during these challenging times. [email protected]

*There are situations in which individuals experience serious complications from a stress reaction and have symptoms such as thoughts to harm themselves, aggression towards others, and paranoia/psychosis. If you experience any serious symptoms, please reach out immediately to a mental health professional for assistance. The suicide hotline can be reached at (800) 273-8255.