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    Polished.  Buttoned up.  Accomplished.  Funny.   This was how Sally Saba, MD was described.

    And on March 5, 2017 she attempted to take her own life.

    So it was only natural that the filled auditorium was hushed when Dr. Saba, Vice President of Operations, Performance and Compliance in Diversity and Inclusion at Kaiser Permanente Health Plan in California described her battle with depression and attempted suicide. Dr. Saba was speaking at the #Findyourwords Forum on Mental Health Stigma sponsored by Kaiser Permanente in Atlanta October 15.

    Along with Dr. Saba, the Forum featured a panel of distinguished mental health experts, one of which was Norman Winegar, Chief Clinical Officer for Espyr.  I interviewed Mr. Winegar who shared his valuable commentary on mental health stigma, depression and suicide prevention for this article.

    Golden: Mr. Winegar, why are people who suffer from depression and other mental health conditions reluctant to get help?

    Winegar: There is a pervasive social stigma associated with seeking help for behavioral health conditions. People fear negative repercussions, both professionally and personally.  They’re concerned about a potential lack of promotions at work or alienation from friends and family.

    Golden: Why should employers be concerned about mental health stigma?

    Winegar: There are many reasons. Undocumented and untreated behavioral health conditions can have serious outcomes. Mood disorders are the leading cause of lost workdays in the world according to the World Health Organization.

    Left untreated, behavioral health conditions can increase the cost of medical care. Compliance with treatment plans can be negatively impacted.   There is a high co-occurrence of mental health and physical health conditions, which can complicate and undermine medical care. Furthermore, people with undiagnosed mental health conditions use non-psychiatric healthcare services (including costly Emergency Department visits) 3 times more than those who do get treatment.

    Employee performance is affected via absenteeism, presenteeism, turnover, decreased safety and increased risk. All these issues can and will affect team cohesion, customer service and can create disciplinary issues. Depressed employees for example are 20-30% more likely to become unemployed.

    Overall, the cost of behavioral health conditions to US employers is estimated at $80-100 Billion annually (NIMH), so employers have a strong economic incentive to be concerned about mental health stigma.

    Golden: What can employers do to reduce stigma and encourage employees to get assistance?

    Winegar: Generally speaking it’s a combination of education and policy change.

    1. Use respectful language. Avoid terms like “crazy” or “he/ she is bipolar”
    2. Provide professional development opportunities for your employees (especially supervisors and managers) around diversity and mental health awareness
    3. Foster an inclusive workplace culture
    4. Create and communicate polices that make it safe for people in distress to come forward and access treatment. For instance, Kaiser Permanente has developed a Mental Health, Wellness and Resiliency Strategy to support the company-wide awareness of Mental Health issues and to create a stigma-free environment.
    5. Support educational programs in the workplace to educate about mental health issues and to encourage peer support
    6. Implement a suicide awareness and prevention program

    Golden: Do suicide prevention programs work?

    Winegar: Absolutely! Let me give you a few examples.

    • The US Air Force implemented a suicide prevention program and saw a 33% reduction in suicides over 6 years
    • The University of California, San Diego School of Medicine implemented in 2009 an online anonymous Interactive Screening Program after 10 physicians and medical students committed suicide over a period of 15 years. Since 2009, 300 physicians and trainees have accepted referrals to treatment via this anonymous, confidential program.
    • A large Federal customer of Espyr’s has since 2016 offered a similar Interactive Screening Program that has referred over 120 people to treatment in 2 years.

    Golden: Is there a correlation between type of occupation and the severity of stigma around mental illness?

    Winegar: Yes.

    Healthcare professionals experience stigma as it relates to policies that may cause them fear of losing their professional license.

    Government employees experience stigma as it relates to policies that cause them fear that if they seek treatment they may lose their security clearance, and hence their job.

    Attorneys (and law students) experience stigma as it relates to policies that may cause them fear of losing their bar status or not being able to take the bar exam.

    Law Enforcement and First Responders experience stigma as it relates to Fitness for Duty policies that cause them fear that disclosing a behavioral health condition may cause a temporary or permanent removal of their badge or weapon.

    Golden: How can employers measure the mental health of employees?

    Winegar: Employers have several tools at their disposal.

    • Holistic analytics can provide insight into the health of the workforce, beyond just claims analysis.
    • Health Risk Assessments (HRAs) should include not only questions about emotional wellbeing but also about employee awareness of employer-sponsored resources and whether managers are supportive of team members’ mental and emotional wellbeing.
    • Utilization of their EAP. For instance “free EAPs” usually have 1-2% usage, but employers know that 20+% of employees are having some type of mental health issue each year that can affect their work and therefore their employer’s profitability. So going cheap in this important area is unwise and poor business sense. Many factors can influence use of an EAP, but generally look for case utilization in the 8-12% range; look for your EAP to reach and impact 20-30% of your workforce through some form of activity.

    Golden: What should I say to someone who is reluctant to get help?

    Winegar: Have what I call a caring conversation. Ask if they are Ok. Note the behavioral changes you’ve seen. And it’s okay to ask someone if they are thinking about suicide or self-harm. This caring question will not “put the idea in their mind”.  Listen and be non-judgmental. Provide support and encouragement. Point out resources like a Primary Care Physician or the EAP. Keep faith-based resources in mind for some people. Follow-up and check in with the person.

    If you think the person is in imminent danger to themselves or others, call 911 or if you are at work, speak with a manager or call security.

    Golden: What was it that you wanted people to walk away with from your comments at the #Findyourwords event?

    Winegar: Stigma drives silence and silence prevents those in need from getting help. This can have disastrous personal and business consequences. Breaking this silence encourages people to get help. This starts with each one of us.

    When people feel safe, they are more likely to access sources of assistance and treatment.

    Businesses need to act in responsible ways when it comes to their most valuable asset, their employees. Employers need to pair robust healthcare services with proactive programs like comprehensive EAP services and other specialized programs to reduce social barriers to seeking help (such as Interactive Screening Programs; Peer Support programs, Mental Health Awareness education, etc.). This makes good business and people sense.


    To read more about addressing mental health stigma go to this prior Espyr post  See this post to read more about how employers can address the rise in suicides.

    As a leader in behavioral health, Espyr is frequently called upon to help our clients and their employees deal with depression and suicide prevention. For more information on how Espyr can help your company deal with these issues, or any other behavior health issue, call Espyr at 866-570-3479 or go to



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