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Tools for Managers to Help Employees with Their Mental Health Challenges
A conversation with a psychologist and a management professor on helping workers address anxiety or depression.
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It’s a reality that more employees are discussing their mental health in the workplace. And proactive leaders can serve their teams better by listening and responding. At the same time, managers can’t play the role of a therapist or the HR department. Counseling psychologist Kiran Bhatti and University of Cambridge leadership professor Thomas Roulet argue that following the basic practice of cognitive behavioral therapy can serve managers well. The researchers explain the mental-health first-aid tool, how managers can help employees address emotional distress and negative behavioral patterns, and how that can strengthen the work culture and ultimately the business. Bhatti and Roulet wrote the HBR article, “Helping an Employee in Distress.”
CURT NICKISCH: Welcome to the HBR IdeaCast from Harvard Business Review. I’m Curt Nickisch.
One of the most marked changes in the workplace in recent years is the increased willingness to talk about mental health. That’s partly due to the pandemic and how hybrid work has changed the relationship between work and home. There’s also new research out that supports it, and also a generational shift. More workers today have gone to therapy, and many have different attitudes about mental health than previous generations.
This leaves managers with a challenge. It’s their job to support employees, but you don’t know what’s in someone’s mind or what’s happening in their lives. What’s more, you’re not a therapist. You have neither the relationship with that person nor the training for it. Instead, today’s guests talk of something more like first aid, the manager as an initial line of defense for employees dealing with mental issues like anxiety, mood, or depression.
Kiran Bhatti is a counseling psychologist based in Cambridge in England. Thomas Roulet is a professor at the University of Cambridge’s Judge Business School. Together. They wrote the HBR article, Helping an Employee in Distress. Hi Kiran.
KIRAN BHATTI: Hi.
CURT NICKISCH: Hi Thomas. Thanks for coming on the show.
THOMAS ROULET: Hello.
CURT NICKISCH: How have you seen mental health more front and center and something that needs to be talked about and dealt with in the workplace?
THOMAS ROULET: I have been studying mental health in the workplace for the last seven, eight years. And, there has been a massive shift with hybrid work. And what we saw during the pandemic is that our mental health really suffered from the difficulties to really separate work and our personal life. And there is a difference in what we expect from our managers, from our organizations, and we are as employees, more likely to seek help and support from our organizations.
CURT NICKISCH: Thomas, can you help skeptics understand how this is the role of the manager?
THOMAS ROULET: Yes. I think it’s a very common view. You are absolutely right. A lot of managers I talk to, they tell me, “This is not my role. Providing mental health wellbeing support to my employees should be the role of the human resources. They should go, like employees should go to wellbeing engagement programs.”
And I think that’s the wrong way to think about this. If you think about the role of human resources, it’s a very macro view. They have the perspective on the organization as a role. The managers are on the frontline. They see what happens directly in the organization and also they have, in most cases, the trust of their own employees. So there are no better people than direct managers to offer a safe space and a good connection of trust that employees can take advantage of to share the challenges that they are experiencing.
And the other reason, the other argument I use with managers to convince them that they should foster mental health skills in their teams and for themselves, is that their teams will be affected by mental health issues and they will have to deal with it.
If you have an employee who is in a situation of burnout, then they’re not going to be able to contribute. They’re not going to be able to engage, and you’re going to have to manage the situation. So if you cannot prevent those situations by supporting your employees, listening to them, creating a safe space in which they can express themselves and get the support they need, then it will get too late and you’ll be in a situation where people cannot work any more because of their mental health issues and the situation, as a manager, will become unmanageable.
CURT NICKISCH: What isn’t the role of a manager in this situation? I mean, we’re talking about stepping up the level of engagement here for some managers who are maybe uncomfortable with it. What is not their role, too, I think might be helpful to understand here.
KIRAN BHATTI: The main thing to say is that there’s no expectation for managers to act as therapists. The reality is they’re not trained. And actually that wouldn’t be fair on the manager to give that level of expectation and support to another person when they themselves may not feel confident doing that. And also it wouldn’t be fair on the individual in distress.
Managers are not expected to be therapists and to act as therapists. It’s more about acting as a source of support in perhaps having an encouraging, collaborative conversation about their experience; being perhaps that first port of call that might encourage them then to seek support elsewhere that would feel more appropriate and helpful to them.
CURT NICKISCH: And so that brings us to this idea of mental health first aid. Can you explain that for a little bit in the context of management?
THOMAS ROULET: Mental health first aid has become a huge part of HR development and training in the UK and in the U.S., you have more than 3000 companies recently that have declared that they have a mental health first aid training- among them bank of America, Starbucks, others. Very often, though, I think Kiran and I, we like to use the words well-being intelligence even more than mental health first aid in the sense that if we only think about mental health when someone needs support, very often it’s too late.
So I think managers need to think about mental health before it happens. They need to be sensitive to it. They need to be sensitive to their own mental health, be able to assess and understand the problems that they are experiencing, and then use that knowledge to help others. So we are trying here to be a bit more prescriptive.
KIRAN BHATTI: There’s something about that idea of mental health first aid where this is not going to solve all the problems. This is almost like a holding space while we get you, maybe, to the right support, the most appropriate people out there to help them perhaps get treatment or more support around them.
CURT NICKISCH: So what might this look like in practice, just so people can picture this? You two are both advocates for a practice called cognitive behavioral therapy.
KIRAN BHATTI: So I’ll just start by talking a little bit about cognitive behavioral therapy or CBT as its sort of shorthand. So that’s really about somebody’s thoughts, their feelings, their behaviors, and sometimes their physical sensations in the body and how they all interconnect.
So really CBT is thinking about how what we think about will impact how we feel. What we do will impact how we feel. If somebody at work, if we see that perhaps they’re not feeling very good about their work, so a classic example in a workplace context is maybe imposter syndrome. If we think about somebody who’s just graduated, they’ve started their first job and they’re working with lots of very interesting people who’ve got lots of experience and they’ve come along to this job, at the beginning, they might be feeling really good about that, feeling really stimulated by the people around them, and learning lots and feeling very fulfilled. And they might be engaging with the work, trying to get on lots of projects and feeling pretty good.
But if they’re feeling perhaps a little bit intimidated by the people around them, they might start to have thoughts about being good enough for, “Oh, I’m not qualified,” or “I shouldn’t be here,” – quite negative self-talk. And so those negative thoughts can impact how that person will feel. They’ll start to feel bad about themselves. They might start to feel a bit depressed or they might feel worried about going into the office, and then that would lead them to start acting in a way that would mean that they’re disengaging from other people. They might avoid particular projects at work and they might start to feel less fulfilled by their work. So when we are thinking about CBT or cognitive behavioral therapy, we’re thinking about how all those different parts of our experience interact with each other and can impact our wellbeing.
THOMAS ROULET: The strength of CBT as a method is that it is designed to help us challenge our negative thoughts and develop alternative, more balanced, more realistic perspective. And so it is a very concrete way to address our negative thinking patterns that drive anxiety and stress in the workplace.
So very commonly we have those negative cycles. If you think about avoidance, for example, “I’m stressed about going to give a presentation, so I’m going to avoid any form of public speaking opportunities because I think I’m terrible at public speaking.” And this will reinforce the thought, “I will avoid doing this,” and progressively I will basically be in a cycle of self-deprecation and avoiding those opportunities that will then affect how I am perceiving the workplace.
The only way to break that cycle is to try to address what drives this avoidance strategy and also be more realistic, thinking, for example, about moments where we have given great presentations. And by challenging our own thoughts, we can tackle those sources of stress and anxiety and confront ourselves with them and break those negative cycles.
CURT NICKISCH: So if you, as a manager, see some of some of these behaviors or you see some of this anxiety or some of the avoidance, and you are trying to step in to help to keep it from becoming a bigger problem for you and your team, how do you initiate the conversation? How do you actually get started with what could be a difficult conversation?
THOMAS ROULET: It is definitely a difficult conversation, but it is a difficult conversation to start. But once you have created that safe space, that trust, once you have shown that as a manager you’re not negating how people think about their issue, then you get a chance to really discuss this more openly. So a classic mistake, for example, if you have someone who is experiencing imposter syndrome and they are really struggling to see their value, and you tell them, “Well this is not true. You are great. You are the best.” This is, in some way, negating their feeling, their experience.
So it’s very important that the managers accept to listen and recognize what is the feeling experienced by the employees before they can help them because that’s the first step to building a relationship around those issues and a safe space to talk about it.
But I think it’s about the manager being able to use, for example, the principle of reciprocation, sharing their own experiences, for example, here in this case, their own experience of feeling inadequate or demotivated at work or experiences of avoidance – talking about their past experience to show that those experiences are more common than one may think and that there are ways to address them and there are ways out and that there are ways forward.
CURT NICKISCH: Kiran, I have to ask you. You’re a practicing counseling psychologist. If you are a manager, how would you say it? How would you start one of these conversations?
KIRAN BHATTI: I would say the first thing I would sort of just really open questions and sort of ask, “How have you been finding work?” I think sometimes having that open question is just the first way to start the conversation. There’s no pressure on how someone’s going to answer it or what they should or shouldn’t be saying.
I mean, they might turn around and say, “No, no, everything’s fine,” because they don’t want to talk about it. But I think just gently maybe reflecting what you’ve seen. It could be like, “Oh, I’ve recognized that you didn’t seem really keen to do this presentation. Is that okay,” or, “How are you feeling,” or, “Sometimes I get really worried when I have to do a presentation. I don’t know if you feel the same way.”
It’s really about having a conversation with someone on a really human to human level. It’s not really about work at that point, it’s just about connecting with someone and really trying to just demonstrate that, “I understand I’m not trying to be judgmental when I’m saying this and I just really want to understand your experience,” and validating that as you go.
And I’d say also just really practical things can be really useful as well in terms of making sure you are in a quiet place. You’re not going to be disturbed. You’re not going to have someone knocking on your door or you’re not in one of those glass offices where everybody could walk past and see that you’re having quite a serious conversation. It’s about even the practical things of making sure someone feels that they’re going to have your attention for the next five, 10 minutes can be really useful to demonstrate to someone that you do care and that it’s okay, and just sort of help to build up that relationship.
CURT NICKISCH: Yeah. You talked there about building up the relationship. Thomas talked about the trust that’s important to have there. What if that trust isn’t there already? A manager might not trust the employee yet or have doubts; the employee might not trust the manager yet. Do you have to have had a strong foundation of trust to get rolling with this? Or are you able to use some of this as a way to show your genuine empathy and build trust through this?
THOMAS ROULET: I think there are two challenges there. There is a cultural challenge potentially, depending on the organizational or the national culture in which you are operating. It might be very hard to talk about mental health issues. It might be very uncommon. It might be at odd with the culture of your organization, the culture of the country. So that’s one first challenge.
And then, as you point out, there is a difficulty in building trust. You are also correct that very often this is a way to build trust, by showing that you care about your employees, that you care about their wellbeing, that you are ready to share your own experience, what you have gone through, and also listen to what people are going through. We can build upon this trust to help people challenge their negative patterns of thought or their sources of anxiety.
CURT NICKISCH: What should companies do to make sure managers are trained appropriately for this?
THOMAS ROULET: Organizations can do many things to support employees and managers to understand the wellbeing challenges in the workplace, to understand what is stress, what is anxiety and what they can do about it. But what we know from several decades of research, and that is that wellbeing programs – wellbeing engagement programs, training programs around wellbeing – are not necessarily extremely successful. The level of engagement for those is low, and the main reason why it is low still is because people don’t see the benefits of those programs.
So I think reminding and showing to managers the challenges that their people might be facing in the workplace and how this is going to affect how their teams can operate is a way to remind them that, in understanding and addressing those issues, there are real benefits. The training is not enough. You need to generate engagement and enthusiasm around those trainings. You need to get people to realize that there are benefits in taking those trainings, in developing those skills, and also in the fact that they are ways to address mental health. It’s not only about just seeing and assessing it. It’s also about tackling those issues in the workplace by helping people identify the sources of their anxiety and stress and challenge them.
CURT NICKISCH: Does this make you a better manager?
THOMAS ROULET: For sure. I’m pretty sure that in the next decade or even earlier than that, your ability to be a wellbeing intelligence manager is going to be one of the crucial skill that is expected from leaders in the workplace because mental health has become such an important challenge, and we live in such fast-paced world where we have to adapt all the time. Mental health is going to become more and more important, and the way we address it, the skills we develop around that, are going to be a very important leadership skill that we’re going to be assessed on.
CURT NICKISCH: We talked about being able to share your own anxieties as an example of a technique that works. The active listening, I think, we mentioned. What other practices do you find are really valuable in this situation where you’re supporting an employee?
KIRAN BHATTI: So one that we talk about in the article is behavioral activation. The reason that we’ve included that, I suppose, is because when people start to feel low or stressed or overwhelmed, what we notice is that they stop doing fun things in the sense that they might withdraw from other people, so they lose their social connection. They might start to feel really tired, so they don’t engage in hobbies anymore, and we see at work, perhaps, they’re not as productive.
So something we talk about is behavioral activation, which it comes from CBT, is widely used there. It’s about increasing your activity levels to increase the opportunities someone has to experience positive feelings or joy. So that might be engaging in an activity that means that you get some sort of pleasure from it, that you feel productive or you feel connected with other people or with the hope of activating a more positive wellbeing state.
So within a work context, it might be instead of having lunch at your desk, you go and find another colleague to have lunch with or you take yourself out of the office and you go for a walk, just to give yourself that break, that sort of disconnect from work, but also connect to something outside of work that might be useful for you or helpful or provide some sort of good feeling.
CURT NICKISCH: What do you recommend for a manager if they start feeling like they’re a therapist of sorts, right? It may be the employee’s coming to them a lot. Is there a danger that you’re going to be too much of a resource or it feels like too much? Or does that rarely happen?
KIRAN BHATTI: No, I think that’s a really good point actually. And I suppose that’s why we would think about, right at the beginning perhaps, is thinking about yourself in this as well. So people talk a lot about the importance of self-care, but I suppose thinking about what that might look like in practice. So if, yes, you’re a manager and you notice that there’s a particular employee that often starts to come to you, maybe multiple times throughout the week, to just maybe offload. It’s about really having a conversation with that person. “Am I the best source of support for you or do you need something else?” Because I suppose it’s about being really mindful of what is the level of support that I can give that is appropriate, but also manageable for all parties involved.
So that might be about thinking about what your boundaries are, I suppose. So thinking about what you are able to hold. For some managers, they might have the bandwidth to meet with a particular person. They might formalize and say, “Okay, we’re going to meet twice a week for us to go through this, twice a week for half an hour to just check in on each other, check in on what needs to be done or how you’re feeling.” For other people that might not be appropriate or they might not feel comfortable doing that. So that would be about thinking what other levels of support are there here, because we don’t want managers to feel like they’re having to hold this on their own because, like I said, that’s not fair for anybody. And I think that’s where HR and the organizational culture can come in and support that.
And perhaps it’s also about the expectation that is given to the employee when they’re in distress. We use the word first aid thinking about that on-the-spot care. And maybe that needs to be continued as well in the sense that this is on the spot care. It’s not going to solve everything. It’s doesn’t mean that we’re going to keep having these conversations for months and months at a time. It’s about finding out how you’re doing right now and where can we get the support that’s needed for you.
CURT NICKISCH: There are definitely managers out there who, when they hear somebody needs to take a mental health day, they kind of jump to the conclusion that it’s an excuse. On the other hand, you might get a manager at the other end of the spectrum who gets too personal or pries too much or assumes wants to know more about an employee’s feelings when it isn’t their business.
What recommendations do you have for managers who are feeling like this is a new part of their job, perhaps, and they’re uncertain about it, and they’re also trying to find the right balance and know that it’s going to be a little bit different with each person. What do you recommend for them as they try to take on these new skills and be more supportive in a way that is appropriate?
THOMAS ROULET: I think they need to appreciate that this is a muscle that they need to develop. There is a normative element. Morally, supporting people’s mental health is going to become more and more crucial. And there is a bottom line, an instrumental aspect. If they don’t support their employees, their teams are going to struggle with performance, with achievement.
So they are two aspects, and two, I would say, rationales for developing wellbeing intelligence skills to better understand what is a mental health problem, what is anxiety, what is stress, to better help people identify those issues and address them.
And I would say they’re not going to get it right away. They might not find the right way to talk about this in the first instance. They might make mistakes, but by learning and practicing and trying to get people to talk about their mental health issues and to try to help people identify why they’re experiencing those issues and then make the changes that can enable them to be themselves at work and to perform at the right level and to not experience any mental health barrier to work, to social engagement, to social interactions in the workplace, all of this is something that is being learned that you need to practice, to observe, to understand so that you grow the skill and get better at it.
So I would invite people, not stressing, not being anxious, they need to apply this to themselves as well. They should not be anxious about doing the wrong things. They should try to do the right things, using the guidance that is out there, the training, this article, and many others that try to help people understand what is stress, what is anxiety, what you can do about it, getting the right vocabulary and the right way to approach it with your employees.
KIRAN BHATTI: Yeah. So to add to that, I would say, is to go with the person who’s sat in front of you, go at their pace. You might have employees who really want to get specific about what is happening for them and what their experience is. And you might have somebody who wants to talk in really general terms. And actually both are fine.
And, as we said, there’s no expectation for a manager to act as a therapist. So when they’re telling you, when someone is sharing their experience with you, we are listening, we are being empathetic, we are trying to understand their frame of reference, but actually sometimes we don’t need all the details. And actually it’s more about what that person is feeling as opposed to what has happened, the context around it. So I would say go at the pace the person in front of you feels they can go at.
And the other thing I would really stress is, for managers, is to make sure they’re looking after themselves as well. So like Thomas said, it’s about you can apply this to yourself, actually. You can use it to check in with how you are feeling, how you are doing. Are there any sort of avoidances that are happening? Are there things that maybe I need to address or maybe want to look at and change, just to keep yourself mentally well whilst you’re also in this position, this new position, of where you might be needing to support another person.
CURT NICKISCH: Well, Thomas and Kiran, it’s been great to have you on the show to talk about this new challenge and your recommendations for managers.
THOMAS ROULET: Thank you so much, Curt.
KIRAN BHATTI: Thank you. Thank you.
CURT NICKISCH: That’s Kiran Bhatti, a counseling psychologist, and Thomas Roulet, a professor at the University of Cambridge’s Judge Business School. They wrote the article, Helping an Employee in Distress.
And we have more episodes and more podcasts to help you manage your team, your organization, and your career. Find them at hbr.org/podcasts or search HBR in Apple Podcasts, Spotify, or wherever you listen.
This episode was produced by Mary Dooe. We get technical help from Rob Eckhardt. Our audio product manager is Ian Fox, and Hannah Bates is our audio production assistant. Thanks for listening to the HBR IdeaCast. We’ll be back with a new episode on Tuesday. I’m Curt Nickisch.