The COVID-19 pandemic has had a profoundly negative impact on behavioral health in the United States. Early evidence of this includes huge increases in the number of calls to the federal Disaster Distress Hotline and local suicide hotlines; large upturns in the number of prescriptions filled for anxiety, depression, and insomnia; increased alcohol consumption; and a worldwide surge in domestic violence.
For some, the effects of 2020 are even leading to post-traumatic stress disorder (PTSD).
PTSD is a mental health condition in which a person exhibits symptoms of distress after a traumatic event that was perceived as life-threatening. Caused by either having experienced trauma or having witnessed another person experience it, PTSD can cause distress and functional impairment. As a result of the ongoing pandemic, evidence suggests that the United States will see a significant increase in the number of people struggling with PTSD, affecting the workforce as a whole.
In addition to a population that is feeling anxious and scared, the United States also has a significant shortage of behavioral health providers, with approximately one-third of all Americans living in an area with no behavioral health providers within a reasonable travel time, meaning there is likely a perfect storm on the horizon: a sharp increase in the need for mental health services and limited resources to address that need. For these reasons, employers are well-positioned to help employees struggling with PTSD. They can help identify the symptoms and provide support through benefit programs to assist their employees.
The United States will probably see a significant increase in the number of people struggling with PTSD caused by the pandemic. Those people will likely fall into four categories:
- COVID-19 survivors: These are people who develop PTSD in response to their own experience of the trauma of surviving COVID-19. One study of patients who survived COVID-19 found that 96% met the criteria for a diagnosis based on a standardized test for PTSD. This reflects both the traumatic nature of the disease itself and the trauma of mechanical ventilation.
- COVID-19 healthcare providers: Healthcare providers, like other first responders, have a higher incidence of PTSD than the general population, reflecting the group of people who develop the condition in response to their exposure to traumatic situations as part of their professional duties treating a truly horrific disease.
- People with preexisting PTSD: People previously diagnosed with PTSD for another trauma are likely to feel “triggered” by the experiences of living through this pandemic—that is, specific details of the pandemic, or even just the pervasive experience of fear and uncertainty, can reactivate PTSD symptoms.
- People who develop PTSD in response to the pandemic: Likely the largest group of people at risk for PTSD are those who develop it in response to the uncertainty, stress, and fear associated with living through a pandemic. This group will likely range from people who witnessed family members or friends survive the disease to people who are traumatized by an infectious disease spreading in their community. The isolation associated with safer-at-home orders will also contribute.
The Role of the Workplace in Managing an Increase in PTSD
Employers face challenges when addressing behavioral health conditions in the workplace in three main ways: They don’t recognize the signs; they don’t know how to approach employees who are showing signs; and they lack an understanding of what to do to help an employee who is struggling. People coping with PTSD frequently hide their struggles in the same ways other mental health and substance use conditions are hidden. Denial is common, with people often claiming they didn’t experience any trauma. With this pandemic, it’s likely many people will minimize the impact the crisis had on them by saying things like “I didn’t go through anything different from anyone else” or “I had it much easier than a lot of people.”
While it’s a challenge, it’s important for employers to be aware of the signs of PTSD in the workplace. PTSD symptoms may include irritability and mood swings, negativity and avoidance of positive activities, social avoidance and isolation, and an exaggerated startle response in reaction to sudden noises or movements in the environment. The overall picture is often of a person who appears to be “on edge” and seems unable to enjoy life. These issues are particularly prevalent in tasks requiring team collaboration, and though these signs may be harder to spot while working remotely, frequent check-ins with employees are a good place to start.
Shame is also pervasive with PTSD, often in the form of blaming oneself for not handling the crisis well or labeling oneself as “weak.” Individuals may be embarrassed by their symptoms and blame themselves for their difficulty. While not specific to PTSD, common behaviors linked to all types of behavioral health conditions—tardiness, absence from work, deteriorating productivity, or trouble concentrating—should also be considered to help identify employees who may need help.
As with all behavioral health conditions, there is a natural inclination to avoid talking about the topic, and employers frequently ignore the situation rather than approach the employee directly. People mistakenly believe even mentioning the topic will make things worse; however, the best approach is to be direct. To start the conversation, employers should encourage managers to follow these five steps:
- Identify the problem, focusing on objective descriptions of any behavior that is leading to concern.
- Determine a dedicated time/place to have the conversation in a private setting.
- Ask questions in a nonjudgmental, empathetic manner, such as “How can I help?”
- Listen with minimal interruptions and questions.
- Connect the employee with appropriate resources to help him or her cope.
Because these conversations can be difficult, it’s also beneficial to train employees in mental health first aid to help identify workers who are struggling with PTSD and direct them to appropriate resources for support and treatment. Anti-stigma campaigns can reduce the fears employees feel about being seen in a negative light because of their medical conditions.
Effective accommodations exist for employees experiencing PTSD, and it’s important for employers to partner with experts to identify and implement them. A disability insurance provider or the Americans with Disabilities Act Amendments Act of 2008 (ADAAA) compliance service is often the best choice for assisting with these issues, given that the staff specialize in accommodating a wide range of medical conditions.
Looking Long Term
Despite all the bad news around the pandemic and behavioral health in the United States, there is hope. PTSD is treatable, and most people recover from it.
For employers, those that provide training to identify and address PTSD are likely to increase the chances that workers struggling with it will receive appropriate treatment early, leading to better outcomes. Those that accommodate employees for the limitations and restrictions related to PTSD are likely to find that those employees will demonstrate better attendance, lower turnover, improved morale, and higher productivity. Long term, that means not only a healthier workforce but also a healthier society.
The term “post-traumatic stress disorder” is used for any such condition that has been formally diagnosed by an appropriate healthcare provider in compliance with the most current diagnostic criteria applicable. This article is for informational purposes only and not for the purpose of providing legal advice. Employers should discuss their ADA obligation and accommodation requirements with their legal counsel.
Daniel N. Jolivet, PhD, is the Workplace Possibilities Practice Consultant at The Standard, where he provides leadership, analysis, and consultative insights into the Workplace Possibilities service line. He is a designated subject matter expert on stay-at-work and return-to-work services, the ADA, and behavioral health. He is a clinical psychologist licensed in Georgia and Oregon and has worked in behavioral health since 1980. Before joining The Standard, Jolivet worked and managed behavioral healthcare organizations for 20 years in a variety of management roles, and he was in clinical practice as a child psychologist until 2003.