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Working Minds: Investing in Suicide Prevention
The workplace is the last crucible of sustained human contact for many of the 30,000 people who kill themselves each year in the United States. A coworker’s suicide has a deep, disturbing impact on work mates. For managers, such tragedies pose unexpected challenges no one covered in management school. (Shellenbarger, 2001)
Few of us get through this life without periods of acute distress or being touched in some way by mental illness. Twenty percent of the American workforce experiences some form of mental disorder, and depression and substance abuse are among the most common problems (U.S. Department of Health and Human Services, 1999). About every 15 minutes someone dies by suicide, and about every minute someone attempts suicide (Centers for Disease Control and Prevention, 2010; Suicide Prevention Resource Center, 2010). Just about every one of these people is currently or recently in the workforce or is loved by someone who is employed.
Suicide among working-age people is a growing problem. A five-year analysis of the nation’s death rates released by the Centers for Disease Control and Prevention found that the suicide rate among 45- to 54- year-olds increased 20% from 1999 to 2004, a larger increase than was found for any other age group during the same period (rates for youth and elderly persons are decreasing) (Barber, n.d; Cohen, 2008). The burden of suicide is carried by the working-age population.
The Surgeon General’s National Strategy for Suicide Prevention specifically targets employers as critical stakeholders in the prevention of suicide, “It is in the interests of employers to prevent suicide and suicidal behaviors…A suicide in the family of an employee may result in such grief that the employee becomes incapacitated.” (U.S. Department of Health and Human Services, 2001, p. 67).
To address this growing concern, we need to engage a wider circle in the suicide prevention movement. Workplaces are a critical partner in preventing suicide. Workplaces have an opportunity to give people a sense of purpose and community, both of which are psychological buffers to distress. Many employers may have built-in mechanisms for disseminating information about health risks and for linking employees to resources such as employee assistance programs (EAPs). Coworkers usually have more face time than neighbors or even family members and may be better able to pick up on changes in appearance, behavior, or mood.
Starting the Conversation About Suicide Prevention
Approaching employers about training their staff and building policies and procedures around suicide prevention often gets a furrowed brow:
“We don’t have a suicide problem here. No one has committed suicide here as long as we’ve been in business.”
“We don’t have time/money for this.”
“Show me how this is relevant to my company’s bottom line.”
Because suicidal behavior often runs underground, many executives and human resources professionals may not be aware of how it impacts productivity. According to the experience of Working Minds, stories of the effects of suicide often emerge at the frontline staff level because workers at lower levels in an organization may be much more aware of worker distress than those in senior positions. Sometimes this disconnect is purposeful, as when coworkers protect one another. For example, in one workplace, an employee attempted suicide by taking an overdose in his office. Coworkers found him in an altered state and discreetly helped him out of the office and to the hospital before anyone noticed and before the pills had taken their full effect. This incident was never reported to supervisors.
While barriers to building a comprehensive workplace suicide prevention program exist, the benefits of creating a culture of health and safety are substantial. Depression is a major driving force of healthcare costs and the leading diagnosis for suicidal behavior; absenteeism and presenteeism increase when people experience high levels of distress; and suicidal behavior results in medical costs and lost productivity costs (Centers for Disease Control and Prevention, 2011; Research America, n.d.; Simon, 2002).
Statistics on Suicide's Impact on the Workplace:
Lost earnings from suicide cost workplaces $1.3 billion per year.
For each suicide that is prevented, an average of $1,182,559 is saved, including $3,875 in medical expenses and $1,178,684 in lost productivity.
These numbers speak volumes, but the benefits of creating a mentally healthy work environment go far beyond these cost savings. Supporting workers through tough times fosters a sense of unity and loyalty that helps lift employee morale and retention. The promotion of mental health is an investment in a company’s greatest asset: its people.
Tips for Employers
While suicide prevention may seem to be an endeavor that is too intensive for workplaces to take on, there are many prevention strategies that do not require much effort but nevertheless yield tremendous results.
Here are seven simple steps employers can take to promote mental health and prevent suicide:
Seven Steps for Universal Suicide Prevention
1. Build a Better Workplace: Establish a flexible workplace in which “mental health days,” telecommuting, and flexible scheduling are part of the culture of a mentally healthy workplace and are written into policy. Develop a proactive, prompt, and consistent approach to work-related problems, as this is essential in helping employees feel safe, protected, and able to do their best work. Define a clear no-tolerance policy for harassment, bullying, or intimidation, and ensure that the policy is communicated and enforced at all levels.
2. Develop Fully-Engaged Workers: Encourage employees to work in areas of strength and in ways the allow them to be strongly committed to meaningful work (Buckman & Clifton, 2001). Workers who feel connected to their teammates and feel they belong to something bigger than themselves often take turns making sacrifices for the greater good. When people are given permission to be vulnerable, trust relationships deepen, and when people show up as their genuine, whole selves, authentic leadership emerges (Covey, 2006).
3. Reward Mental Wellness: Just as workplaces offer incentive programs for nutrition and fitness, workplaces can also create motivation and opportunities to obtain optimal mental health. For example, employees can earn points when they take workshops on how to reduce stress or improve sleep. One workplace in the human service industry in Denver, Colorado, encouraged employees to create blueprints for how they would improve their overall wellness, and then worked with supervisors to identify any work-related barriers that might be obstacles to mental wellness goals.
4. Change the Conversation through Social Marketing: Develop a multimedia campaign that lets people know they are not alone if they are thinking about suicide and that many resources exist to help. Links to organizations such as National Suicide Prevention Lifeline can be displayed prominently on the company’s intranet, and employees can be encouraged to make use of resources such as the Lifeline’s 24-hour, toll-free, confidential suicide prevention hotline.
Effective and Early Intervention
5. Offer Educational Programs on Mental Illness: Employee assistance professionals or other local mental health service professionals can provide “lunch-and-learn” sessions that increase awareness about the signs and symptoms of depression, bipolar disorder, alcohol dependence, and other mental illnesses that can lead to suicide. By offering stories of recovery and successful treatment, these presentations offer hope and modeling that treatment works.
Furthermore, misperceptions dissipate when workers interact with providers and are able to ask questions about concerns that may pose barriers to care, such as:
“Will my employer have access to my counseling records?”
“Will a diagnosis hinder my chances for a promotion?”
“What will this cost?”
“Who will know if I use the employee assistance services provided by my workplace?”
“What does counseling entail? What should I expect?”
Compassionate and Careful Crisis Response
6. Reintegration and Return to Work: When people have experienced a suicide crisis — a suicide attempt or the loss of a loved one — their lives are often turned upside down. When a workplace is sensitive to their return-to-work needs, the transition supports their recovery rather than adds to the distress. People may know what they need to get back on their feet, and, by empowering them to be part of the reintegration plan, workplaces demonstrate respect that builds trust. Consultants may help facilitate difficult conversations in workplaces where an employee has lost a loved one to suicide. Staff may feel they are walking on eggshells and may not know how to help. Simply asking the returning employee what support they need may be effective. Employers may wish to review their legal requirements, such as accommodations, that may be relevant.
7. Support Safe Bereavement: When a suicide affects a workplace, employers should not underestimate the impact of this event. Vulnerable employees who over-identify with the deceased person may become more at risk for suicidal behavior themselves. On the other hand, thwarting bereavement and memorialization efforts usually backfires. For example, employers who are unsure of how to handle the trauma and grief that comes with a suicide death may try to get things “back to normal” as quickly as possible. What comes across to staff in these circumstances is a feeling that the incident has been ignored, and gossip and confusion can often result. Thus, workplaces should honor the life of the person lost without glamorizing or romanticizing the death. Rather than avoid dealing with this form of death, workplaces should treat a death by suicide as they do other types of death that impact their staff. If it is the culture of the workplace to send cards and flowers for other types of death, then cards and flowers should be sent to the grieving family bereaved by suicide. If the tradition is to put an obituary of a deceased colleague in the company newsletter, then the same practice should be allowed for a colleague who died by suicide.
The current Governor of Colorado, John Hickenlooper, quoted on the Working Minds website, was impacted by the suicide death of a young man who had been serving as an intern while Hickenlooper was Denver’s mayor. Hickenlooper states, “I do think that it’s important if you’re in a management position…that you create an environment where these kinds of things can be talked about and not let people feel they will be ridiculed or in some way diminished…” As our workplaces accelerate from the industrial age to the information age to the conceptual age, we come to increasingly rely on our mental muscle to get us through our work day. Like any other muscle, our mental muscle can get injured or fatigued, and we can consequently experience high levels of distress, sometimes leading to a suicide crisis. Workplaces can prepare for this in many ways and develop a comprehensive approach to reduce suicide risk and promote mental resiliency.
In a little more than a lunch hour, employees at all levels of a workplace can be taught how to identify warning signs and risk factors and help link distressed coworkers to appropriate care. For more information visit: www.WorkingMinds.org.
Screening for Mental Health
Like most health issues, the earlier someone with problematic levels of distress or emerging mental illness can be identified, the more likely they can be helped to get off a debilitating or deadly trajectory. Screening tools give employees an anonymous means to self-assess their condition and link to local, high-quality resources.
National Suicide Prevention Lifeline
This toll-free hotline, 1-800-273-8255, is free and accessible 24/7. Calls are answered by certified crisis call centers and are routed locally; thus the call centers are able to connect callers to resources in their communities. Post a link to the Lifeline website prominently from your company intranet and make use of free education posters and brochures. For free materials visit their website.
Sally Spencer-Thomas, PsyD, is a clinical psychologist, mental health advocate, faculty member, and survivor of her brother’s suicide. Currently, she is chief executive officer and cofounder of the Carson J Spencer Foundation and coauthor of the Working Minds Toolkit. She is also chair of the Survivor of Suicide Loss Division of the American Association for Suicidology. She can be reached at [email protected];
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