In a glass conference room in midtown Manhattan, a few dozen employees from Beacon Health Options are taking turns asking each other an incredibly awkward question: "Are you having thoughts of suicide?" There's a right way to ask and a wrong way, and they're here to learn the difference.
The exercise is just one component of an eight-hour course in "mental health first aid," a relatively new kind of training that, like first aid or CPR, is designed to give ordinary people tools to help someone in need. And as with first aid and CPR, companies have begun to see the value in having employees who have the skills to say something, if they see something.
About 40 employers have trained more than 1,300 people over the last two years, according to the National Council for Behavioral Health, which imported the program from Australia in 2008 and adapted it for Americans. This year, it plans to train 6,000 workers through company-sponsored courses. Aetna Inc., George Washington University, real estate developer Lendlease Group and the healthcare technology companies Cerner Corp. and Netsmart Technologies have all sponsored workshops for their employees.
"There's a growing recognition that mental health and addiction problems are having an impact in many ways, driving up healthcare costs and absenteeism," said Betsy Schwartz, vice president of public education and strategic initiatives at the council.
More than a quarter of workers reported some level of depression or anxiety in a 2015 survey by the American Psychological Assn., but the most common workplace solution — employee assistance programs — is notoriously unpopular. Most employees don't want to call an employer-sponsored program for help. Beyond offering good benefits, employers tend to duck more holistic solutions to workers' mental stress.
"That challenging piece is really creating a culture where the organization is tuned in to employee well-being," said David Ballard, who leads the APA's Center for Organizational Excellence.
When Jessica Caskey was working in human resources at a national park in Alaska, an employee placed an explosive device outside his boss office. In many ways, things turned out as well as possible. The police came, nobody was hurt, and after the employee was released from custody, Caskey fired him.
Looking back, though, Caskey thinks she could've handled it better. The employee had showed signs of suffering from "some sort of mental health illness," Caskey said. "Nobody took the time to dive in and figure out what was happening."
The mental health first aid classes are designed to help people like Caskey do just that. Last year, she was one of 41 managers at Taos ski resort in New Mexico who took the course. "We're not making anyone a clinician," Schwartz said. "We're just teaching, as a clergy person told me recently, how to be good neighbors."
Employees at the Taos resort face specific kinds of emotional stress. At the end of the ski season, most of the 700 temporary staffers will be out of a job, noted Ashley Ryland, the employee wellness coordinator at the resort. Ski patrollers, most of whom are certified EMTs, act as first responders to accidents and other distressing situations, making them particularly vulnerable to mental illness.
The course covers the signs and symptoms of anxiety, depression and other common mental health disorders that people might observe among their coworkers. In one exercise, participants role-played what it feels like to hear a constant stream of paranoid thoughts. In another, groups were given art supplies so they could draw what anxiety looks like.
As a mnemonic device, the instructors teach an acronym called Algee: Assess risk, listen non-judgmentally, give reassurance and information, encourage people to get appropriate professional help and encourage self-help and other support strategies.
Since she took the training last year, Caskey said she's used her Algee skills. A housekeeper recently uncharacteristically missed two days of work in a row and then left an incoherent voice message for her supervisor. Before she took the training, Caskey would have probably started disciplinary action.
This time, she got on the phone. "Her voice was trembling, she was crying, and she kept saying 'I just can't do it anymore,' " Caskey said. "I jumped into action. I talked to her — again, using what the counselors had taught: calm words, very quiet, not too excited. I gave her a feeling of value and purpose."
A few weeks later, the housekeeper came back to her job.