One in five Americans received treatment for their mental health in 2020. And yet the issue is rarely discussed beyond the most intimate circles.
“Unlike most physical health disorders, mental health problems remain deeply stigmatized,” said Matthew Ridley, a doctoral candidate in economics at MIT. Curious about this stigma, he set out to study how revelations about mental health might affect workplace relationships. Would they change how one person views another? And, if so, how? “There is a huge economics literature trying to understand discrimination based on gender and race, but very little of this looks at mental health,” he said.
In a working paper, Ridley demonstrates two key findings. First, people exhibit a strong desire to avoid working with someone they know has a mental health condition — in this case, moderate to severe anxiety or depression. Second, those who suffer from mental health challenges are strongly inclined to hide this fact from potential coworkers.
For companies and leaders, this means that establishing an environment that is supportive of mental well-being requires more than simply encouraging disclosure; companies must first focus on increasing awareness and crafting campaigns that shift beliefs and decrease stigma.
Uncovering a “deep-seated norm against openness”
Using the Amazon Mechanical Turk crowdsourcing service, Ridley recruited about 1,700 participants to take part in his study. Each person completed a survey to determine their degree of anxiety or depression in recent days. (The survey asked other questions, like education level and political affiliation, to obscure the fact that the experiment centered on mental health.) After this, two people were partnered together to complete a straightforward task: through an online chat window, one person with a map guided their partner from one point in a city to another. Successfully completing the task earned both participants $2.
In a paid online experiment, people were willing to pay 30% of their earnings to conceal symptoms of mental illness from a partner.
Within this setting, some of the participants could demand an extra payment for getting paired with partners they didn’t want to work with (or for not pairing with partners they did want to work with). If a potential partner acknowledged recent feelings of anxiety or depression, people on average demanded 70 cents more to work with them — more than 30% of their average earnings. When they were nonetheless forced to partner with someone who was potentially anxious or depressed, they sometimes invested more effort in completing the task. This result, together with survey data that asked directly about the relationship between mental health and productivity, suggests they thought their partner would be less productive — an incorrect belief given participants with anxiety or depression proved just as competent at completing the task as their healthy counterparts.
On the flip side, people were willing to pay roughly 30% of their earnings to conceal symptoms from their partners. “Even in cases where a person’s partner was unable to reject them, and even when their earnings were fixed no matter how badly they did, people still wanted to pay to hide any indication of mental illness,” Ridley said. “Given these are one-off anonymous interactions, it’s a bit dispiriting, as it suggests a deep-seated norm against openness.”
What leaders can do
The findings are particularly relevant as workplaces increasingly consider policies of transparency concerning mental health; while these efforts are likely well-intentioned, if the right foundation is not already in place then employees might be extremely reluctant to discuss their mental well-being, and those who do may face discrimination.
“There are, fortunately, some key strategies for changing beliefs and stigma in the workplace,” said Kana Enomoto, global director of brain health at the McKinsey Health Institute and former head of the federal Substance Abuse and Mental Health Services Administration.
At a most fundamental level, employers need to recognize the problem. This begins with explicit directives that forbid stigmatizing language (like “addict”) and mitigate discriminatory or exclusionary behavior by, for example, including “neurodiversity” in diversity, equity, and inclusion agendas. Enomoto also described the importance of training leaders and managers to recognize signs of emotional distress and mental health crisis, in the same way they are currently trained to respond to physical emergencies. “Someone has to know how to use the defibrillator,” Enomoto said. “The same type of mental health training should be given to employees.”
Next, when it comes to normalizing and encouraging disclosure, companies should lead by example, promoting champions of the issue who are willing to share their own experience with mental health challenges. This approach is especially fruitful when someone of status — a senior partner or the CEO, for example — steps forward to describe personal struggles with mental health. Such a move can establish a culture in which people might feel respected and supported for disclosing their conditions.
“These are contact-based education strategies for reducing stigma,” Enomoto said. “It turns out that if you know people who fall under a given category then you’re much less likely to be prejudiced or discriminatory toward that group. You can recognize them in their wonderful complexity as human beings rather than simply as a label.”
Third, employers should appoint a senior leader who is accountable for making progress, such as a chief wellness officer. Part of this job is assuring benefits for mental well-being are at parity with benefits for physical well-being. Enomoto described the common challenge of securing appointments with mental health providers — calling 40 offices and getting either no response or long waitlists. “No employer would tolerate that for cardiologists or oncologists,” she said. “It’s not acceptable for behavioral health.”
Finally, companies need to recognize that different subgroups have different needs. According to work done by Enomoto and her colleagues at McKinsey, Gen Z workers report more behavioral health issues than older generations and some communities of color report a greater fear of stigma around mental health treatment. Employers must listen carefully to their employees when devising mental health policies, recognizing that a universal response may prove insufficient in the face of different needs.
An effect on earnings
For Ridley, this paper is but a “proof of concept” — results that flow from a single and particular online task. He would like, and has plans, to study these strands of stigma and discrimination in a real workplace. But despite the limits of these findings, Frank Schilbach, an associate professor of economics at MIT and one of Ridley’s advisors, said they lay the groundwork for important future investigations.
For example, Ridley’s work is some of the first to look at discrimination as it applies to traits that are malleable and often able to be hidden (in contrast to characteristics like race). In the economics world, Ridley’s paper also contributes to an important but understudied aspect of the labor market. While people with mental health issues may earn less because they are less productive — though Ridley shows this is untrue for his experimental setting — other forces could equally contribute to lower earnings.
“Matthew’s work is important because it sheds light on some potential other channels in which subjective assessments, including discrimination, play a role in contributing to the earnings gap of people with mental distress,” Schilbach said. “People may earn less not because they’re working less well, but because, in this case, of how they are treated by their coworkers and bosses.”
Ridley’s paper comes at a moment when companies are reckoning with questions and concerns around mental health. “COVID-19 has opened the aperture on the issue,” Enomoto said. Though Ridley has hypotheses about what is causing his results — people may perceive coworkers with mental illness as a burden; those with mental illness may expect to be discriminated against and so hide their symptoms — getting to the root will be essential to relieving the stigma so many face.
“Eventually, people should be able to tell their employer that they’re going to see a therapist to feel better about themselves and the world, in the same way they might say they’re getting a tennis coach to improve their service and volley,” Schilbach said. “We need interventions that make workplaces more amenable to workers who are in mental distress, policies that normalize treatment. There is a lot of work to be done to improve people’s awareness and acceptance of illness and therapy.”