It’s no secret that 2020 has been a difficult year so far, and the year’s not even half over. The COVID-19 pandemic and associated mitigation efforts, including government stay-at-home orders, have been associated with escalating rates of anxiety, depression, alcohol use and Post-Traumatic Stress Disorder. Adding the recent social unrest concerning racial injustice on top of that is likely to make the situation even worse.
These issues have had an especially strong negative impact on African Americans. Pre-existing disparities in employment and health, among other things, have contributed to a higher rate of infections, hospitalizations and deaths from COVID-19 for Black people than for white people.1 Protests, frequently under the umbrella of the Black Lives Matter movement, have galvanized the discussion of inequality in the United States.
While most employers are clear on some aspects of their response to these multiple crises, few have a clear plan for helping their workers cope. Right now, supporting Black employees is crucial, but the template for supporting workers during social unrest can be generalized across different crises and various marginalized groups.
Race-Based Traumatic Stress and Its Impact on the Workplace
This confluence of events has disproportionately impacted Black Americans, leading to an elevated discussion of race-based traumatic stress, also known as racial stress. Similar to PTSD, race-based traumatic stress is a mental health condition in which a person exhibits symptoms of distress in response to experiences with discrimination.2,3 Although not a formal diagnosis, race-based traumatic stress is generally understood to include symptoms similar to those of PTSD:
- Intrusive symptoms, such as nightmares or flashback
- Avoidance, such as behaviors to avoid reminders of the trauma
- Changes to thought processes or mood, such as extremely negative thoughts about oneself or the world, or difficulty feeling positive emotions
- Increased reactivity and arousal, such as hypervigilance or a heightened startle response
There is already evidence to suggest that the U.S. will see a significant increase in the number of people struggling with PTSD related to the pandemic. Beyond those who have survived COVID-19, healthcare providers who have treated COVID-19 patients, and people with pre-existing PTSD related to prior traumatic events, it appears likely that many people will develop PTSD in response to the sheer stress and fear associated with living through a pandemic. This group will probably range from people who saw family members or friends survive the disease, to people who are traumatized by the fact of an infectious disease spreading in their community, by what they see on the news or social media or by the isolation associated with the stay-at-home orders that have left many people sheltering in place alone.4,5,6
Research on racism and its effects has previously demonstrated that Black Americans experience significantly more discrimination than other racial groups in the US and that these events are linked to higher rates of PTSD.7
Previous research has also shown that police killings of unarmed Black Americans are associated with increased poor mental health of Black members of the communities within which the deaths occurred. The effect was strongest in the first two months following the killing. No similar effects were seen among white community members following the killing of unarmed white Americans or armed Black Americans.8 In recent cases, the posting of videos and widespread news coverage may have expanded the community impact to the entire United States, if not the entire world.9 The worldwide reach of this protest makes the issue more pronounced for Black Americans.
Although there is no research to date on the impact of race-based traumatic stress on work performance, the effects of PTSD in the workplace have been amply studied and may be illustrative. With PTSD, nonspecific signs or behaviors that are common to all behavioral health conditions are likely to predominate and may include tardiness related to sleep problems, deteriorating productivity or performance related to problems concentrating, poor hygiene, and absenteeism. With PTSD, the overall picture may be of a person who appears to be “on edge” and unable to enjoy life.10
People coping with race-based traumatic stress may hide their struggles in the same ways as those with mental health conditions. With PTSD, denial is common, as individuals minimize the impact of the situation by saying things like, “A lot of people have it worse than me,” or “I don’t let it bother me.”
Shame is also pervasive with PTSD, often in the form of blaming oneself for not handling the crisis well or labeling oneself as “weak,” and this seems a possible consequence of race-based traumatic stress as well. People struggling to cope with trauma are frequently embarrassed by their symptoms and blame themselves for their difficulty.11 This may be pronounced in those suffering race-based traumatic stress because discrimination is “an assault on the personhood and integrity of the victim.”12
Stigma associated with PTSD remains common, too, with many media depictions of trauma survivors portraying them as out of control or even dangerous. These messages are often linked to combat veterans with PTSD but can be generalized by laypeople to a belief that people with PTSD are “crazy” or violent.13
The Role of the Workplace in Managing Race-Based Traumatic Stress
Race-based traumatic stress and social unease reflect societal issues to a degree. This means that the ultimate solutions must be social and must be implemented by the majority population. Institutional bias is a white problem, although Black people bear the brunt of it, and employers and individuals must take responsibility for their participation in it. We* must do the difficult and uncomfortable work of learning about systemic racism and our roles in it.
The combination of multiple uncomfortable and “not safe for work” topics means that employers have been disinclined to talk about this situation. Employers generally avoid addressing signs of behavioral health conditions among employees, while race and politics are often considered completely taboo.
Despite this, the best approach when an employee appears to be struggling is a direct one, following four simple steps:14
- Identify the problem by focusing on objective descriptions of behavior that are leading to concern, such as frequent absences or irritability. However, do not suggest that the problem is related to a particular cause or medical diagnosis.
- Ask the right question in a private setting and in a nonjudgmental, empathetic manner. A good place to start is, after describing the behaviors that have led to your concerns, asking sincerely, “How can I help?”
- Listen with empathy with minimal interruptions and questions. Show your engagement through nonverbal cues like maintaining appropriate eye contact, nodding and giving the person your full attention. Avoid asking about specific causes or medical conditions. Instead focus on general expressions of support and encouragement. Remain calm, even if they’re in crisis, and be careful to avoid responses that may trigger denial, shame or fear of stigma.
- Connect them with resources to help them cope. In most companies, the first resource for mild to moderate distress is referral to the employee assistance program. Having a copy of an EAP brochure to give to the employee in private is ideal and it may be useful to point out the confidentiality of EAP services. Offering other employer-sponsored resources, such as health insurance benefits, a healthcare navigation service or community resources, is important, because people generally respond better when they are given options rather than a single choice. For employees in severe distress or crisis, contacting a representative from HR may help to connect the person with appropriate resources. After providing resources, it’s important to check back with the person to make sure they’re doing better and getting the help they need, without asking about medical conditions or treatment options.
Effective accommodations exist for PTSD and may be appropriate for people dealing with race-based traumatic stress. Most employers will need to partner with a vendor to identify and implement those, since few people have the expertise required to identify these issues. A disability insurance vendor or ADA compliance service is often the best choice for partnering on these issues, given that these vendors generally have professionals on staff who specialize in accommodating a wide range of conditions.
Accommodations are driven by the explicit limitations and restrictions experienced by the employee and documented by a treatment provider, not by a diagnosis.15 Although race-based traumatic stress is not a formal diagnosis at this time and cannot be the basis for either a disability claim or a request for accommodation under ADA, the issues and associated signs and symptoms of race-based traumatic stress impact other medical conditions and may contribute to limitations and restrictions that do raise ADA protections. Decisions about whether a diagnosed condition is disabling or if identified limitations and restrictions merit accommodation are legal determinations and, therefore, outside the scope of this piece.
The following suggestions are intended only to demonstrate that simple and effective strategies exist for many of the limitations and restrictions that may occur with PTSD and race-based traumatic stress. The identification and selection of an accommodation must occur in the context of the interactive process involving the employee and the employer.16
Further, in the absence of a request for accommodation, these suggestions may assist employers in finding ways to support employees who are struggling during what is a stressful time for everyone. In those situations, supervisors may wish to consider offering these as solutions to problems presented by employees when they’re asked how the supervisor can help.
One general approach to helping people struggling with traumatic stress is the use of mobile apps for PTSD, available as a supplement to formal treatment or for self-help.17 Although not specifically created to address race-based traumatic stress, these may alleviate various symptoms causing limitations and restrictions associated with it.
Other supports are tailored to the specific situation. For example, employees struggling with nightmares and other sleep problems may need a later start time to allow them to get enough rest before work.18
Interpersonal conflicts associated with increased irritability may be addressed with the following to maintain professional conduct:
- Changes to team assignments to limit conflicting relationships
- Shifts to written communications instead of verbal interactions
- Requiring a third party to attend meetings in which conflicts have occurred19
Sensitivity and bias training delivered to teams may help as well.20
There are a variety of ways to assist with the general impact of irritability and mood swings. Modifying the employee’s schedule, so they can take more frequent breaks to refocus, may be helpful. Apps for mindfulness and anxiety or stress may give the employee tools to better cope with their feelings.21
Mindfulness apps can also assist with negative thinking, as can exercise and affirmations.22 Affirmations may be individually tailored to combat the underlying trauma. Allowing breaks for the worker to utilize these positive coping skills may be a reasonable approach.
Reducing noise can help mitigate the exaggerated startle response associated with PTSD and this may assist people experiencing other forms of trauma. Employers can accomplish this in an office setting with cubicle doors, sound baffles, noise-canceling headsets, white noise machines or even a fan.23
Social avoidance and isolation may be accommodated by identifying a teammate who can partner with the employee or by providing a job coach.24 Psychological safety, important in every business, is key in helping workers with PTSD overcome their tendency to isolate,24 and it appears likely this would be true as well with employees struggling with race-based traumatic stress. Approaching conflicts collaboratively, rather than in an adversarial style, is one essential element required to help people feel safe in the work environment.
The COVID-19 pandemic has made isolation a widespread issue in business. Stay-at-home orders that have led to many employees working remotely and other mitigation efforts (especially social distancing and masks) reduce interpersonal contact in virtually every sphere of life. The current social unrest almost certainly exacerbates the sense of isolation some Black employees feel at work,25,26 which may be further compounded by work-based discussions of systemic racism or the current social unrest.27
Companies, including their HR professionals and people managers, must intentionally explore and implement new approaches to interpersonal relationships between coworkers and between workers and their supervisors. Employee input is essential in developing ways to express the range of emotions that come with a pandemic and social turmoil, so companies can develop approaches that are both meaningful and professionally appropriate.28
Race-Based Traumatic Stress and Re-Opening
These considerations are important both during the stay-at-home period and during the re-opening process. While re-opening may reduce individuals’ experience of isolation and loneliness, it is also likely to increase fears and anxiety.29
Employers must be mindful that as government orders are relaxed, the workforce returning to the office will not be the same as the workforce they had before the pandemic. It’s virtually certain that more employees will be coping with mental health issues, and it is incumbent on employers to appropriately identify those workers for whom ADA or other accommodations are required.30
Finally, it must be noted that PTSD symptoms may not be exhibited until months after the traumatic event, and it’s possible the same is true of race-based traumatic stress. If so, that will likely complicate employers’ efforts to address the impact of the current crisis on their workers.
There Is Hope
With all the difficulties in the world today, it’s easy to become pessimistic. After more than 400 years of racial injustice, it can seem like inequality will never truly be eliminated from America. Similarly, decades of police reform efforts have left activists exhausted and cynical. And, with more than 120,000 Americans dead in less than six months, we're still not done with the first wave of COVID-19.
Despite this, there are reasons for optimism. On the individual level, PTSD is treatable, and most people will recover from it,31 so it’s likely that similar conditions including race-based traumatic stress can be helped, too. Changes may allow employees to overcome the limitations and restrictions related to these traumas in order to function effectively at their jobs. As with other situations in which employers provide support to workers, businesses are likely to find that those employees who receive help subsequently demonstrate better attendance, lower turnover, improved morale and higher productivity.32
On a social level, both in the United States and around the world, there are early signs of progress in the struggle to systematically address racial injustice. There's much work to be done — and it’s early. But for the first time since the 1960s, seismic social change seems possible if we sustain the effort.
High performing employers know that a more diverse, equal and inclusive workforce allows each person to bring their best to work each day.
The world will likely never be the same after COVID-19 and the current social unrest, but it has presented an opportunity to create a new and more just normal.