Understanding the Cycle of Behavioral Health Conditions in the Workplace

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Dan Jolivet
Image of woman at desk with colleagues in the background

Due to the pervasiveness of mental health and substance use conditions, employers will likely experience an instance of a behavioral health condition in their workplace. In 2016 alone, 1 in 5 Americans experienced a mental health condition.1 While employers can’t control the occurrence of these conditions, they can choose how to respond.

Without supportive and targeted assistance, these conditions may go entirely unnoticed and work can suffer as a result. Understanding the typical progression of a mental health or substance use condition and its corresponding symptoms can help you better identify employees in need of help and connect them to available resources. The following five stages explain the cycle of behavioral health conditions that an employee may progress through and tangible ways you can help:

1. Risks emerge
A challenging aspect of behavioral health conditions is that they often begin without notice. While conditions may be hard to identify at this stage, it’s important for employers to create a safe climate and culture for employees to seek help.

All managers should be trained on how to document performance on a regular basis, noting any observed performance changes. Managers should also be familiar with resources the organization has available to support employees, such as management coaching and employee assistance programs (EAPs).

2. Symptoms escalate and impact performance
In the second stage, an employee’s symptoms may increase to a moderate level and are more likely to noticeably impact their work performance. An employee may be absent more frequently or request an accommodation under the Americans with Disabilities Act (ADA) to help them cope with the situation.

If signs are apparent, absence management and stay-at-work disability management strategies are best implemented at this point. By providing these options, employers can help employees address issues proactively and help them stay at work or return to work quickly.

3. The condition becomes more severe
In this stage, the employee experiences severe symptoms which could directly impact their abilities and work performance. Performance problems and employee absences may escalate to the point where they require a disability leave. In many cases, the need for accommodations to support recovery becomes more apparent.

For those who are able to stay at work, it’s important to work with the employee to develop accommodations tailored to their specific limitations or restrictions. Proactively implementing accommodations may help keep an employee engaged in their work, successful in their role and more supported by their peers.

4. Chronic impairment
At this point of an employee’s condition, he or she may continue to experience severe or chronic symptoms and apply for long term disability benefits. The employee may also start seeing themselves as “a disabled person,” struggling to find a sense of purpose or meaning in life.

During this stage, goal-directed case management and return-to-work strategies are generally initiated or continued. But the impact is generally lower than during the previous stages. With earlier interventions, there’s a better chance that the employee will return to work.

5. Recovery occurs
The last stage is when an employee begins to see their condition improve — either through treatment or as part of the natural course of the condition. But with the proper employer response and intervening strategies, recovery can occur at any stage in an employee’s journey.

Recovery before severe or chronic symptoms develop often depends on an employee connecting with timely and effective care and support. Effective support can empower the employee and rebuild confidence.

Unfortunately, behavioral health conditions are common in America. Given that employees spend a great deal of their time at work, employers have the opportunity to create a nonstigmatizing work environment and a positive culture that supports wellness. In doing so, this helps address, or even prevent, behavioral health conditions in the workplace.

Learn more about managing behavioral health conditions in the workplace by downloading the full white paper.


1 National Institute of Mental Health, Mental Illness stats, nimh.nih.gov/health/statistics/mental-illness.shtml.