Blue Cross Blue Shield of Michigan Trains Its Leaders to Recognize Depression and Intervene Effectively

Even though depression may directly impact only 20% of the people in the workforce, its impact on the professional and social relationships around those suffering from depression may be 100%.— BCBSM Depression Awareness Workbook

It’s one thing for clinicians to say that employers should train their leadership in recognizing depression in the workplace; it’s quite another to see an employer actually put that recommendation into practice.

This summer Mental HealthWorks attended a training session for team leaders, supervisors, managers, directors, and vice presidents at Blue Cross Blue Shield of Michigan (BCBSM) and watched as company trainers led participants through a series of steps to increase their knowledge about depression and, most important, to build their confidence in knowing how to intervene effectively.

The Depression Awareness Workshop presented by BCBSM is offered throughout the year by the company’s Corporate Education and Employee Development Department. BCBSM began offering this four-hour workshop about eight months ago; now it is required for all BCBSM leaders. Each workshop is limited to the first 20-25 individuals who register, and all participants receive the BCBSM “Depression Awareness Workbook.”

The workshops are co-facilitated by a professional company trainer and a psychiatrist. The session described below was led by Miriam Shaw and psychiatrist Beth Goldman, M.D., M.P.H.

First, Combat Stigma

When the session began, participants found dozens of cards on their tables; each card showed the face of a famous person (see photograph). Participants were surprised to learn that the one thing all these people had or have in common is depression. Furthermore, when asked, all participants said that they personally knew someone with depression. The point was made: depression can strike anyone and is prevalent.

Second, Present the Clinical Picture

Goldman described the clinical signs of depression, such as fatigue, diminished ability to concentrate, sadness, lack of joy when hearing good news, suicidal thoughts, etc., and asked participants to think about how those symptoms might play out in the workplace. Together they came up with a list of possible signs of depression in the workplace.

Goldman noted the distinction between someone who is truly depressed and someone who is just lazy or has a bad attitude. “Look for a change in the employee’s behavior,” she said. She emphasized that the more you know about the people who work for you, the better leader you can be. “Observe how the employee is behaving in other areas of her work life and how she responds to good news.” According to Goldman, even good events, such as a promotion, can trigger depression in some.

Goldman reminded participants that the vast majority of people who suffer from depression may be safely and effectively treated in an outpatient setting and that they are able to remain at work. She cautioned leaders, however, not to expect employees to “get better” immediately after treatment begins. “Most people take from four to six weeks for their symptoms to resolve.” The participants bombarded Goldman with specific medical questions, which emphasized the importance of having a practicing psychiatrist in the room.

Third, Focus on Intervention Techniques

The heart and soul of the workshop focused on how leaders should intervene.

Participants viewed an in-house video of a BCBSM director who described her struggles at work while suffering with untreated depression. The video also included an interview with the director’s vice president, who described her frustration during this time. Because both individuals were well-known to the participants, the video hit home. The director has now received treatment and has been a driving force in educating others at BCBSM about depression.

To intervene with an employee effectively, Shaw suggested the following approach.

• Intervene early.

• Engage the employee in a private place where there will be no interruptions.

• Listen to what the employee has to say.

• Respond appropriately.

• Share your observations of the problem and give details.

If the above recommendations don’t work and the employee does not respond, Shaw suggested leaders try the following “support, confront, support” model.

Support: Use a support statement to initiate the conversation. Watch your body language—keep your eye contact steady, facial expressions neutral, gestures open and receptive, and tone of voice encouraging and nonjudgmental.

An ineffective statement: “Look, you haven’t been doing your job, and I want to talk to you about it.”

An effective statement: “Joan, you have been a very valuable part of our team for many years. I feel that you’ve changed. Can we have a chat soon?”

Confront: Address the problem directly. Explain your expectations for the job and state ways in which the employee is not meeting them. Attempt to get the employee to explain why he or she has not been able to perform adequately.

An ineffective statement: “I need you to do a better job.”

An effective statement: “I noticed that you have come to work an hour late three times this month. When you’re late, you know that others have to cover for you, so it’s important to start on time. Let’s talk about why it’s been hard for you to get to work on time this month.”

When confronted, an employee may respond with anything from a vague explanation to a very frank and, sometimes, emotional response.

The BCBSM workbook included a chart to describe how a leader should react to an employee’s emotional response (see table below). This is the time for leaders to be especially alert to the possibility that the employee may be suffering from depression.

Shaw stressed the need for leaders to be empathic when talking to the employee, identifying with and understanding their situation, feelings, and motives. The BCBSM Depression Awareness Workbook itself defines empathy as the ability to put yourself in someone else’s shoes and communicate that you understand the situation.

About reiterating understanding and empathy, Shaw warned, “Be careful, however, not to use the same language as the employee or it will sound as if you are not listening.”

For example:

Employee: “I don’t see why you are always picking on my deadlines. I am a hard worker. I am doing the best that I can!”

Ineffective response: “I hear that you’re feeling picked on.”

More effective response: “I hear you’re feeling singled out.”

“Shaw said, “You can relate to the employee, but you do not have to agree.”

How a Leader Should React to an Employee’s Emotional Response

Anger

Leader's Response: Acknowledge the anger, but switch the focus back to the specifics and seriousness of the current problem.

Apology

Leader's Response: Acknowledge the anger, but switch the focus back to the specifics and seriousness of the current problem.

Blames Others

Leader's Response: Offer to include others in the discussion and acknowledge that some responsibility may lie with others, but emphasize that the employee is ultimately responsible for his or her own work.

“Everyone else does it.”

Leader's Response: Focus back on the employee’s individual behavior

Excuses/Sympathy

Leader's Response: Acknowledge problems and offer support, possibly referral, but focus the attention of the employee on work behaviors.

Resting on Laurels

Leader's Response: Acknowledge the excellent work done in the past; focus the employee on improving current work behavior.

Tears/Helplessness/Muted Response

Leader's Response: Offer support, reiterate that you value the employee, make sure the employee knows that you want to help.

Source: BCBSM Depression Awareness Workbook

If you suspect the employee may be depressed, ask whether he has thought about harming himself. “It’s a common misconception,” Goldman told participants, “that if you put the idea of suicide in someone’s head, he or she will do it. This is usually not true. Most often the person will be relieved someone asked.”

Behaviors of an Employee Who Might Be Depressed

• Impulsive or indecisive actions

• Irritability or hostility

• Late arrival

• Withdrawn, avoids co-workers

• Extreme dependence on others

• Frequent absences

• Frequently missed deadlines, procrastination

• Poor morale

• Distracted behavior

• Working more slowly than usual

• Accidents

• Working below potential

• Inability to organize tasks

• Suspicious

• Intolerant

• Blames others

• Oversensitive, reactive

• Moody

• Resentful

• Pessimistic

Create an Action Plan

Without a plan of action, the problematic behavior will not be resolved, and this is the piece most often missing from good leadership, according to Shaw. Here are suggestions for how to create an action plan:

• Brainstorm ideas with your employee. Write the ideas down together.

• Get a commitment from the employee that he or she will improve his or her work performance.

• Ask what you can do to assist.

• Set up a time for a follow-up meeting.

• Ask the employee to consider using resources, such as the employee assistance program (EAP), a cleric, or a physician.

Make sure the employee writes down the plan. It’s been Goldman’s experience that the more involvement the employee has in developing the action plan, the more the buy-in.

Support

After the initial conversation, leaders should continue to support the employee by giving feedback and scheduling follow-up meetings. They should state clearly, though, that if the employee has personal or medical problems, they do not need to know about them. A suggestion to call the EAP or another referral service is all that is needed. It’s helpful for leaders to have the EAP brochure readily available.

NOTE: Leaders should not try to diagnose the problem if mental illness or substance abuse is suspected.

Role Playing Is Critical

Workshop participants had no problem absorbing the suggestions; however, when it came time for them to role-play various scenarios between leaders and employees, they found it took practice to keep the “conversation” flowing well to reach an effective solution.

“Role playing is key to the success of this workshop,” said Goldman. “Most don’t realize how difficult it is to confront an employee effectively until they try it themselves, and if people don’t try it, they won’t have the necessary confidence to make it work.”

Link Training to EAP Services

The workshop concluded with a word from the company’s EAP representative from Magellan, Alonzo Mitchell. He emphasized that the EAP is there not only to help employees but also to support leaders. “Before you meet with an employee to discuss a difficult situation, call us,” he offered. “We’ll be glad to run through a practice scenario with you.” In summary, Goldman and Shaw believe that training leaders to deal effectively with depression in the workplace requires an active—not passive—learning experience.

The participants must have agreed. Nearly all of those who participated gave the BCBSM Depression Awareness Workshop an “excellent” rating. In addition, Mr. Mitchell commented that employee use of EAP services at BCBSM has doubled since the seminars began.

If you would like more information about the BCBSM Depression Awareness Workshop or its history, contact Dr. Goldman at Blue Cross Blue Shield of Michigan.

About Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to 4.5 million members residing in Michigan, in addition to 1.6 million members of Michigan-headquartered groups who reside outside the state.

By Sandra Hass Yamhure

Last Updated: October 2007