From the Editor

Recently, I spoke with a woman I hadn’t met before – a friend of a friend, gathered over coffee by a kitchen table. When she found out that I was a psychiatrist, she talked about her daughter’s struggle with mental illness and I thought how rarely people spoke to me about such things just a decade ago.

As people grow more comfortable talking about their experiences and their family’s experiences with mental illness and as stigma slowly fades, these conversations on Main Street, so to speak – at our kitchen tables and at our kids’ baseball games – are growing more and more common. But people in the corporate world are also growing more aware of the need for us to address mental health problems. No wonder. Consider that the single biggest reason for people to be on disability in Canada is mental illness. And so, there are conversations on Bay Street, too.

In this week’s Reading, we consider a new essay from the Harvard Business Review. In it, CEO Kelsey Meyer talks about her company’s development of a mental health policy.

Also in the Reading: journalist Scott Stossel reviews Dr. Peter Kramer new book on antidepressants – and his own experience with medications.

Please note that the Readings will be “going fishing” for the next two weeks, returning on 11 August.


Mental Health and the Corporate World

“How We Rewrote Our Company’s Mental Health Policy”

Kelsey Meyer, Harvard Business Review, 11 July 2016

Imagine how you’d react if one of your employees crawled her way into your office with a broken leg or became visibly ill at her desk. You wouldn’t ignore her physical health or tell her that she really needs to keep her personal problems at home; you’d help her to the emergency room and ask how you can help during her recovery.

The truth is that your employees’ health is rarely as obvious as a broken bone or the flu. Sometimes, your employees silently struggle with illnesses that you never see — but their need for inclusive, supportive healthcare and adequate accommodations is just as great.

Last year, the National Institute of Mental Health estimated that one in five adults in the U.S. — about 43 million people — lived with a diagnosable mental illness within the previous year and one in 25 had a “serious functional impairment due to a mental illness.

Regardless of whether you acknowledge it, at least one person on your team is living with a mental illness right now…

Kelsey Meyer

So opens an essay by Kelsey Meyer of Influence & Co., just published in the Harvard Review of Business.

Meyer describes how her company drafted and implemented a mental health policy. She notes the personal reason for this effort: she is “someone with a family history of mental illness.” But she also makes a business reason. “Without a proper mental health plan in place, your company is not only neglecting the well-being of its employees, but it’s also missing out on the significant returns that fully healthy employees can deliver.”

This is article is written by an American for an American audience (specifically, CEOs). But it has strong relevance north of the 49th parallel too. Consider:

· On any given week, more than 500,000 Canadians will not go to work because of mental illness;

· In Canada, more than 30% of disability claims and 70% of disability costs are attributed to mental illness;

· There are costs associated with people not going to work (the disability claims) but there are also costs associated with people going to work when ill (the concept of presenteeism).

She discusses the five steps her company took to drafting and implementing a mental health policy.

Step 1: Define Your Goals

Meyer writes about her goals when drafting a policy for her company: “we wanted to acknowledge that mental illness affects everyone differently, to use inclusive language, and to ensure all employees feel supported by the new plan.” She emphasizes the importance of involving employees in this process.

Step 2: Research and Write

She notes the importance of looking to other companies and their HR policies.

Step 3: Consult Your Attorney

This step is very practical (and very American).

Step 4: Consult a Mental Health Advocate

Meyer notes that consulting a mental health advocate was, in her view: “ the most important component of this process.”

Step 5: Introduce Your Policy and Offer Training

Meyer writes here about the importance of training – both company leadership and employees.

She closes with a call for action (and common sense):

“Employee wellness is not a new concept. Companies around the country offer employees free gym memberships and yoga classes and incentives for healthy diets; what’s sorely lacking is an equal focus on mental health programs. As a company leader, you have the power to change your organization’s attitude and support system around mental health for the better — and at least one of your employees is waiting for you to realize it. The time is now.”

A few thoughts:

1. A sign of the times: HBR runs a thoughtful paper on mental health.

2. Of course, much is being done already in the corporate world.

3. Bell Canada managers, for example, now receive mental health training, allowing problems to be identified early and addressed; redesigned HR programs better accommodate people with these problems. To date, short-term disability cases are down 17%, due to mental illness with employees away for shorter periods of time and with fewer relapses.

4. And others have taken a leadership role. The Mental Health Commission of Canada drafted voluntary psychological safety standard for business, similar to initiatives for physical safety. It suggests training managers to look for the signs of common problems like depression. That effort, by the way, was profiled in The Economist in a recent article discussing mental illness.


Stossel on Kramer

“Should We Still Listen to Prozac? Peter D. Kramer Jumps Back Into the Antidepressant Debate”

Scott Stossel, The New York Times, 7 July 2016


In 1993, the psychiatrist Peter D. Kramer erupted into public consciousness when he published his second book, Listening to Prozac, which became one of the signature cultural artifacts of its time, fodder for cartoons and humor pieces in The New Yorker (most notably Louis Menand’s classic “Listening to Bourbon”) and for dinner-party and ­medical-school-lounge conversations across the country. Though the book was controversial in some circles — Sherwin Nuland savaged it in The New York Review of Books, and it provoked a slew of opposing books (including, inevitably, Talking Back to Prozac) — Listening to Prozac helped reframe the context in which patients and physicians thought about what was then a new class of drugs, the S.S.R.I.s, or selective serotonin reuptake inhibitor antidepressants. The book wove together science, history, literature, philosophy and case studies and remains one of the best philosophical meditations on the age of biological psychiatry.

The book made Kramer famous — or at least famous for an academic psychiatrist. People referred to him as ‘that Prozac man’ or ‘Dr. Prozac.’

Scott Stossel

So opens a book review by writer Scott Stossel, published recently in The New York Times, about Dr. Peter Kramer’s new book.

Stossel does a nice job of not simply reviewing Ordinarily Well: The Case for Antidepressants, but putting it into a larger context.

To that end, Stossel writes about the history of the debate over drug treatment. He notes strong criticism of meds:

· In the 1950s, psychoanalysts worried that medications would impede psychotherapy.

· In 1998, psychologist Irving Kirsch wrote an academic-journal essay “Listening to Prozac but Hearing Placebo,” in which he argued that antidepressants were much less effective than was generally believed.

· In 2011, Dr. Marcia Angell, the former editor of The New England Journal of Medicine, published a series of pieces in The New York Review of Books, arguing that: “psychoactive drugs are… worse than useless.”

Stossel summarizes Dr. Kramer’s argument, which includes his belief that end-stage depression is less common.

He then goes on to personalize the discussion:

Perhaps more relevantly, I have copious experience with taking antidepressants. Can I say with 100 percent certitude that they’ve worked? No. In fact, some of those drugs definitively did not work for me, and sometimes made my anxiety worse, or created inconvenient and, at times, intolerable side effects. But I’m pretty sure that without the tricyclic antidepressants of the 1980s I wouldn’t have made it through middle school without inpatient hospitalization. And Paxil gave me the closest I’ve ever had to full remission from anxiety and depression symptoms for about eight months in 1997 before it lost its effectiveness. Could this all have been placebo effect? Coincidence? Or even something as ineffable as the quality of my personal interactions with my psychopharmacologists, which some studies have shown can have a significant effect on a patient’s response? Perhaps. But I don’t think so.

This is an excellent book review, and well worth reading.

Further Reading

For more on Dr. Kramer’s book, take a look at my recent Reading:

(Note that past Readings are archived on this website.)

Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.