Last summer, Elainna Ciaramella’s husband was diagnosed with stage 3 esophageal cancer and only given three to six months to live, unless he chose to undergo treatment. After the diagnosis of her husband, Ms. Ciaramella’s world came crashing down. Recognizing the strain this kind of family-crisis would put on her mental health, and in turn, her performance at work, she knew it was necessary to open up to her employers about her struggle but felt hesitant to do so.

She’s not alone. According to a survey from Marketwatch, as many as 85 percent of employees aren’t comfortable opening up to their employer about mental health issues such as depression or anxiety due to perceived stigma. And their employers are equally wary. Regulation and fears about lawsuits and legal costs can make the managers themselves anxious when they become concerned about an employee’s wellbeing, says Sharon Cook, a program administrator specializing in supported employment and mental health recovery at the Utah Division of Substance Abuse and Mental Health.

But with a little education, it doesn’t have to be that way. Experts say addressing mental health in the workplace doesn’t need to be intimidating or costly, and that creating an open, supportive workplace environment can be beneficial for both parties.

“It’s a big topic, and I don’t think it’s going away,” agrees Sean Morris, a licensed marriage and family therapist as well as the CEO of employee assistance firm, Blomquist Hale. “And it certainly becomes a challenge for many employers, partly because of the sensitivity around it—employers have this uneasiness of ‘what do I do now?’”

Are Your Employees Struggling?

It can be difficult to be sure when an employee is struggling with mental health because symptoms can vary widely—not only from a variety of different conditions but also from one person to the next. But the main cues to watch for, Mr. Morris says, are sudden changes in the employee’s appearance or behavior—especially several changes happening all at once.

“People don’t usually change drastically,” Mr. Morris says, “and certainly don’t have a number of changes.”

“When it comes to mental and emotional health, the tricky part is it’s this silent thing that no one wants to say a whole lot about.” – Sean Morris | CEO | Blomquist Hale

For example, a manager may notice that an employee who was once outgoing has withdrawn from their coworkers, and may seem irritable or even tearful at work. They may become suddenly emotional at their desk or on the job, without an obvious reason why. Or their attendance may change—they may show up late often, frequently leave early, or they may be absent entirely.

“Maybe this is an employee who used to do well, and now I’m seeing that boy, there is a slip—they’re not producing the work they produced in the past,” Mr. Morris says. “Those can be some indicators.”

Appearance can also be a cue—but Mr. Morris says he’d watch for differences in grooming to coincide with other factors. “Someone might get a new hairstyle,” he says, “but that’s different from you’re not doing your hair anymore and you’re coming in late.”

Corroborating what you’re seeing with other supervisors or colleagues can be wise, Mr. Morris says, not only because it can confirm that you have in fact observed something unusual, but because employees may drop critical clues in conversations with their coworkers. “It could be alarming if they said something very concerning, very out of character,” he says.

An employee who begins giving away possessions, telling coworkers that others would be better off without them, or even indicates that they may be in danger of harming themselves or others is giving off some serious red flags. These are key indicators of suicidal ideation, according to Ms. Cook, and those kinds of behaviors should be addressed immediately.

How To Talk About Issues

The trouble with mental illness, Mr. Morris says, is less that it’s difficult to detect, and more that it’s uncomfortable to discuss. A manager may suspect that an employee is at risk, he says, but they may choose to stay silent about their concerns for fear of saying something wrong. Or they may worry that a conversation would uncover challenges that could be difficult, or even costly, for the company to address.

“We aren’t that uncomfortable with asking about physical health,” Mr. Morris says. “If someone comes in with an injured leg, we’d certainly be like, ‘hey, what happened? What do we need to do to help?’ and it’s acceptable. When it comes to mental and emotional health, the tricky part is it’s this silent thing that no one wants to say a whole lot about.”

Legal concerns make it even trickier. Employers could, potentially, face lawsuits if a manager essentially attempts to diagnose an employee and asks something along the lines of, “’wow, it looks like you have depression,’” Ms. Cook says. “That would not be a legal thing to ask.”

But that doesn’t mean an organization can’t be open about mental wellness, Mr. Morris says. It would be appropriate for a concerned manager to meet with an employee in private and ask how they are doing, “without judgment, without assumptions attached.”

Once they’ve asked the question, he says, managers need to be ready to listen—no matter the outcome. If the manager responds to the employee in a way that says, “’you are important to us, how can we be helpful?’ The employee feels ‘this is great, my manager has always been caring, they’re demonstrating that again now.’

If, on the other hand, a “manager downplays observations or minimizes experiences and makes comments such as, ‘hey, I noticed you’re coming in late and, gosh, you’re not dealing with one of those mental health issues, are you?’” that can make the situation worse, Mr. Morris says.

There is one circumstance in which employers legally can address a question of mental health directly, says Ms. Cook. If a manager ever suspects that an employee may be considering suicide, they should inquire directly whether the individual plans to take their own life. “That’s important—suicide is up very high,” Mr. Morris says. “And so, the fact that someone might be contemplating suicide is not uncommon, unfortunately. The more we can be asking questions and not be afraid to ask that kind of specific question when we have reason, the more we can prevent suicide.”

Corporate Solutions For Mental Health

Managers who’ve been there say the key to starting these conversations is to build a supportive company culture—one where employees feel comfortable to ask for help without fear of retribution.

“It’s an issue that takes trust between employees and their managers,” says Andrew Graft, vice president of corporate marketing at Access Development, a West Valley-based discount network that the American Psychological Association has recognized as one of the most “psychologically healthy” workplaces in North America.

Earning a designation like that didn’t happen overnight, says Lisa Oyler, director of human resources at Access Development. The company has always valued employee wellness, she says, and offers a number of wellness-related perks. As their wellness program was formalized, she says, addressing mental health seemed like a natural next step, and the company began bringing in on-site counselors and writing about mental health in their internal newsletters.

Then, last fall, their CEO decided to host a special event with a screening of a documentary about anxiety and a panel discussion of mental health. During that conversation, Ms. Oyler said, company executives spoke out about their own struggles with anxiety. “That was one of the biggest aha moments for us as a management team, was the power of leading by example,” Mr. Graft says. “If you are waiting for your employees to reach out to you, it’s not going to happen. You’re going to have to reach out first to show that it’s okay to talk about. Approaching it with anything other than openness and honesty closes off that dialog.”

But encouraging mental health awareness in the workplace need not require anything exceptionally flashy or expensive, Ms. Cook says. It could be as simple as hosting a company training over lunch—the Utah Division of Substance Abuse and Mental Health offers a variety of free trainings on topics such as mental health in the workplace, suicide prevention, and implementing the American Disabilities Act. Ms. Cook says employers could start by simply posting phone numbers for their Employee Assistance Program, if they have one, or local and national crisis hotlines around the office.

“If you are waiting for your employees to reach out to you, it’s not going to happen. You’re going to have to reach out first to show that it’s okay to talk about. Approaching it with anything other than openness and honesty closes off that dialog.” – Andrew Graft | Vice President of Corporate Marketing | Access Development

In some cases, Ms. Cook says, employers are afraid to talk about mental health because they fear employees could disclose a disability, which may require costly accommodations. While Ms. Cook does advise that employers take immediate action to ensure accommodation takes place in the event of a disclosure, she says that her office has found that most accommodations are relatively painless, and generally cost less than $500. Requests for additional office lighting, a new seating arrangement, noise-canceling headphones, or a more flexible work schedule are common solutions.

Ms. Cook said her division is able to help employers design effective accommodations should managers find themselves at a loss.

Ms. Oyler believes opening a dialog about mental health in the workplace has increased use of the company’s on-site counseling services and its Employee Assistance Program. The overall emphasis on wellness, she says, has increased employee performance and retention. But it’s not just the employer who stands to benefit from focusing on mental wellness, Ms. Cook says.

Obtaining employment is a critical piece of recovery for individuals with mental illness, Ms. Cook says—and not just because it puts money in their pocket and helps to reduce rates of poverty. Employed patients experience fewer psychiatric symptoms, have better self-esteem, and are less likely to become socially withdrawn.

For Ms. Ciaramella, she ultimately did decide to disclose the challenges she and her husband faced with her employers. As a freelance writer, she was able to work around her husband’s treatment schedule. Sometimes working until 10 PM at night.

“Since he was sick I couldn’t afford to stop working,” she says. “I was afraid that my employers would think I couldn’t handle my workload so I was hesitant to tell them at first. Eventually, I had to tell them because I wanted to accompany him to all of his medical appointments and that would affect my work schedule. My employers were very supportive in every way imaginable, which was critical in getting through our family crisis. I don’t know what I would have done without their support. I felt reassured that no matter what, I could do what I had to do and they’d be there for me. They’d have my back.