Globe and Mail -Mental Health 2008

From Monday's Globe and Mail

June 22, 2008 at 10:22 PM EDT

GATINEAU, QUE. — The day Sylvie Giasson lost her job at the National Gallery of Canada – a victim of restructuring – it was as if a black hole opened up to swallow her.

The Gatineau, Que., translator began stuttering and crying. The tears wouldn't stop. She couldn't sleep. Suicidal thoughts overwhelmed her.

It took all the energy Ms. Giasson could muster to get herself to hospital, where she was diagnosed with severe depression and anxiety
disorder. She spent seven months in the Royal Ottawa Hospital, being
treated with medication, counselling and electroconvulsive therapy. And
she endured it all virtually alone.

“Nobody wants to visit a loved one in a mental hospital,” Ms. Giasson said. There were no flowers or get-well-soon cards. No one called.

Sylvie Giasson, a Health Canada worker in Ottawa, suffers from severe depression/anxiety disorder. (Brigitte Bouvier for the Globe and Mail)

By the numbers

1 Rank of depression among !the leading causes of disability! in the world.

8% Percentage of workers taking medication in Canada to treat
depression and other mental-health conditions.

20.6% Percentage of workers who suffer a bout of mental illness,
most in the prime of their working lives

40% Percentage of short-. and long-term disability claims that
involve a mental-health problem.

60% Percentage drop in family income when a breadwinner is
diagnosed with mental illness.

500,000 Number of workers off sick each day in Canada with
mental-health problems.

$8.5-billion Amount that employers and!
insurers spend each year on !long-term disability claims !related to
Mental illness.

$9.3-billion Annual cost of short-term leave for mental-health
problems.

$51-billion Amount that mental illness costs the Canadian economy
each year.society's silence about mental health is deafening. When you are diagnosed, you disappear. Yet the vast majority of Canadians suffering
from mental illness – such severe conditions as depression, bipolar
disorder and schizophrenia – are not in hospital but in the community
and at work.

Mental illness accounts for a stunning 40 per cent of disability claims and sick leaves in Canada. While employees jest about “mental-health
days,” they are no joke. Every day, 500,000 Canadians are absent from
work due to psychiatric problems; the most recent estimate pegged the
annual economic burden of mental illness at a staggering $51-billion.
The World Health Organization estimates that by 2020, depression will be
the leading cause of disability on the planet.

“Depression is a colossus,” said Bill Wilkerson, CEO of the Global Business and Economic Roundtable on Addiction and Mental Health. “It's
one of the biggest killers and one of the biggest disablers.”

And it carries a cruel stigma. “There's this attitude out there that if you come back from cancer, you're a hero, but if you come back from
depression, you're damaged goods,” Mr. Wilkerson said.

Most people do return to work after bouts of mental illness. Yet few employers are accommodating, and fewer still reach out to help staffers
before they descend into crisis.

“We can't afford to be tossing any workers overboard,” Mr. Wilkerson said. “We have a brain economy and we can't let all these brains go to
waste.” The situation, he added, is a “national calamity.”

Ms. Giasson, now 51, was one of those who clawed her way back. Doctors discovered the combination of medications that controlled her symptoms,
including antidepressants and the Pill to deal with the violent mood
swings linked to her menstrual cycle.

She left hospital with $35 to her name. After a stint on welfare, she found employment, first as a temp, then doing contractual work and
finally landing a full-time government job. Since 1992, Ms. Giasson has
risen steadily through the ranks of the civil service, where she now
works in employee assistance services at Health Canada. Over that time,
she has had two bouts of severe depression, each necessitating a few
months off.

“Depression was not part of my career plan,” she said wryly.

While she does not consider herself any different from workers with chronic illnesses like diabetes or heart disease, she knows she faces
far different perceptions.

“In terms of dealing with an individual with mental illness,” Ms. Giasson said, “we're still in the Stone Age.”

ECONOMIC IMPACT

There is no doubting the scale of the problem. A poll commissioned by the Great-West Life Centre for Mental Health in the Workplace found that
18 per cent of workers in Canada had, at one point, a diagnosis of
clinical depression. At any given time, about 8 per cent of those on the
job are taking drugs for a mental-health condition, and 6 per cent are
under the care of a physician.

And because mental illnesses tend to afflict people in their prime working years, they have a huge economic impact.

The estimated $51-billion in annual cost to Canada was the conclusion of a study by Dr. Carolyn Dewa of the Centre for Addiction and Mental
Health in Toronto. The study estimated direct medical costs at
$5-billion, while loss of productivity due to long-term disability came
to $8.5-billion a year and short-term sick leaves rang in at
$9.3-billion annually. The balance, about $28-billion, was attributed to
“reductions in health-related quality of life” – a method used to put a
dollar figure on pain and suffering.

Phil Upshall, national executive director of the Mood Disorders Society of Canada, can rhyme off these stats with alacrity. He believes the
figures are essential to understanding the scope of mental illness and
the folly of not dealing with it.

“I have to use the numbers. They're all I have. I don't have a Timmy,” Mr. Upshall said, referring to the way causes like breast cancer and
muscular dystrophy capture the public imagination by putting a human
face on the conditions. But mental-illness sufferers are reluctant to
come forward because they fear the stigma.

“There's this assumption that people will ‘go crazy' on the job,” Mr. Upshall said. “An employer would never ask a diabetic if he expects to
slip into a diabetic coma soon. That would be unthinkable and crass. But
they ask that type of question all the time to people with mood
disorders.”

According to the Great-West poll, employees feel the workplace is where they are least likely to get support. It's no wonder the majority of
those with mental-health problems – 64 per cent – keep their condition
secret from employers.

Renea Mohammed, a 37-year-old peer support worker at Vancouver Coastal Health, said secrecy is a defence mechanism: “Mental illness shatters
your confidence so the last thing you want to do is tell your boss. You
don't want to be judged and you don't want to lose their trust.”

Ms. Mohammed was diagnosed as paranoid schizophrenic while studying for her master's degree in library sciences a decade ago. She attempted
suicide three times in four years and was hospitalized on numerous
occasions.

Despite it all, Ms. Mohammed held down several jobs as a librarian. With the help of medication and counselling, she's now healthy and her
condition is stable. Along the way, she changed careers.

“If I was still working in a library I would keep this quiet. I'm not sure everybody believes in recovery, even intelligent, educated people,”
she said. But in the mental-health field, Ms. Mohammed says, she feels
shielded from stigmatization and believes it's important to speak out on
behalf of those who can't.

Michael Paré, a family doctor and co-ordinator of the Medical Clinic for Person-Centred Psychotherapy in Toronto, says professionals are
particularly leery about admitting they suffer from mental illness.

“My clients are all working people,” he said. “They have really good jobs and provide for their families. But they are also the walking
wounded.” Dr. Paré says he urges people to be discreet. “I tell them:
‘You're not keeping it secret; you're keeping it private.'”

Still, he has been open about his own diagnosis of depression and his suicide attempt in university days. He's still in therapy, but not
taking medication. He can be candid because he's self-employed, he said,
but “there are still pockets of stigma in a society like medicine. It's
a paradox: The healer can't be sick.”

Mamta Gautam, an Ottawa psychiatrist dubbed the “doctors' doctor” because she treats only physicians suffering from mental illness, said
the “culture of medicine perpetuates the notion of doctors as always
being healthy, capable and available.” She said physicians tend to
minimize their symptoms and continue to work at a high level; as a
result, they often seek help later. “The ability to function well is
often the last thing to be impacted,” Dr. Gautam said.

But there is a price. The late treatment, severity of symptoms and easy access to potentially lethal drugs – along with the pervasive stigma in
society – means the rate of suicide among male physicians is about twice
that of the general population. Among female physicians, it is about
four times higher.

UPSIDE-DOWN LIVES

Jacqueline Beaurivage was holidaying in Ontario's Algonquin Park in January, 2003, when an emergency call came from one of her teenage son's
best friends.

Her son, she was told, was sending out goodbye notes by e-mail and seemed poised to kill himself. Ms. Beaurivage phoned her son, and her
husband dialled police.

Her son, Jonathan Singh, was diagnosed with severe depression. Even though Ms. Beaurivage was not the patient, the illness turned her
personal and professional life upside down. A senior executive at CIBC,
she called her boss and said she needed time off.

“He said: ‘Take all the time you need,' and I'll never forget that,” Ms. Beaurivage recalled.

She ended up taking three months off work, getting educated about mental illness and caring for Jonathan. “It was overwhelming. Every ounce of
me was invested in my son. There was no way I could work,” she said.

But when she did go back to the office, it was cathartic and also a positive message to Jonathan that life was returning to normal. “Three
months off was a good investment for my employer,” Ms. Beaurivage said.
“I'm a damn loyal employee now because I experienced the human side of
CIBC.”

Mr. Wilkerson says that, unfortunately, too many employers are short-sighted.

“We have a knowledge economy, where the heavy lifting is being done by the brain,” he said. “We can't treat mental illness as a secondary or
tertiary issue any more. Dealing with this issue in the workplace is
essential to our economy and our quality of life.”