Employee with mental health issues.
April 25, 2011 9:24 AM   Subscribe

Need advice on handling an employee's mental health issue.

I supervise an employee (we'll call him Steve) who is growing increasingly unstable. IANAD, but after looking up a few mental health conditions, he exhibits nearly all the traits of paranoid schizophrenia; it flares up in cycles, and he is only getting worse. Of course I wouldn't presume to diagnose him, but these are the symptoms he appears to have in spades.

Currently he feels that another employee (Dave) is "against him": sleeping with his ex-girlfriend, making rude gestures at him, and trying to take his job. This morning he claims Dave kicked him for no particular reason. Dave is passionately adamant that he has never done anything to be "against" Steve. We tend to believe Dave, as this is a pattern we've seen with Steve and other employees, and the fact that no one has ever witnessed any of it.

We think Steve started going downhill after botched plastic surgery a few years ago, which would be a serious blow to anyone's self esteem. Irregular sleep, accusing everyone under the sun of sleeping with his ex-girlfriend, thinking people are "against him". We think he might truly believe that Dave is doing these physical (hand gestures, etc) things, when he definitely isn't.

The problem is approaching him about getting help. He has a serious fear of doctors. A few years ago I had to get very angry with him and take him myself to the ER with a bad chest infection. He is also very important to the company. He has over 20 years here, and I worry about alienating him, and him thinking we are now all "against him". Plus I consider him my friend, and I know he needs professional help before he ends up hurting himself or someone else.

Your advice please!
posted by anonymous to Health & Fitness (21 answers total) 2 users marked this as a favorite
What kind of an environment do you work in? If it's a larger company, you should really leave this to someone in the HR department -- anything else is bound to lead you to violating some non-discrimination or privacy law.

If it's a smaller place and you're towards the top of the management hierarchy, I think your only real choice is to confront the employee and have a discussion with him about his health. Just like if any employee constantly came to work in the nude, or with open wounds, or smelling like garbage, you need to address this (seemingly obvious to everyone) issue. If you don't, you risk showing other employees that you lack the spine to tackle this problem that's probably affecting their work.

In this smaller-workplace scenario, though, I'd seek the advice of some labor lawyer just to make sure you're not crossing some line in your jurisdiction. There are certain things you can terminate for, and certain things you cannot. There are also certain things you probably can't do (say, order your employee to see a doctor).

Good luck -- this sounds like a very tough and unfortunate situation!
posted by haykinson at 9:41 AM on April 25, 2011

I was like this when I was drinking, so don't discount drinking or other drugs here. I do though have a brother-in-law who almost perfectly meets this description and I'm very sure he doesn't use alcohol or drugs of any kind. We've tried many things to reach him and nothing has worked 100% yet, but I can say that being non-condescending and treating him as my equal has made the most difference. Others in his life tiptoe around him or treat him differently but when I joke around with him and act like he's just my brother-in-law and not my brother-in-law-with-some-kind-of-problem he reacts very well and we've become good friends.

I wish I had some better advice about getting him help and I'll be watching for others with a better idea, but the best thing I can say is: Treat him like you would anyone else. This may mean praise or discipline. Also be aware that people are all different and he may need somewhat different treatment, but from what I've seen people want to be treated like they're just a part of the crowd.

I'm not sure how you can get an employee into any kind of treatment since a few former bosses of mine tried (and failed) to help me. Many people seem to look at bosses and jobs differently than any other relationship in their lives.

There may come a time when you can't help and I think you have to be able to notice that, but it's hard to know when that time is.

Best of luck to you and Steve.
posted by Clinging to the Wreckage at 9:42 AM on April 25, 2011 [2 favorites]

I'm sure I won't be the only person to say that people who truly are paranoid schizophrenics can be quite dangerous. alienating him, and him thinking we are now all "against him" are the least of your worries. My neighbor got punched in the face hard enough to break his nose by his best friend (who had schizophrenia, and who now lives in a care home) for some imagined threat.
posted by salvia at 9:45 AM on April 25, 2011 [1 favorite]

Consult with HR if possible.

If you don't have HR, I think honesty is the best policy here. Write up a letter or email which he will receive at home, so he has time to digest it. Tell him he's a valuable employee and friend. Say that you have seen no evidence of the serious allegations he is making, and it appears to be in a pattern of serious team disruption on his part. Tell him you are worried about him and that he needs to deal with his personal issues for the good of the team. Don't threaten to have him sacked. Maybe suggest taking some time off to deal with the problem. Tell him that you know he is opposed to consulting medical professionals, but you think it could help in this situation.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 9:47 AM on April 25, 2011

I had a similar situation a number of years ago, but not with an employee, with a tenant. It's a sticky situation. Here's how I dealt with it and why.

#1. Consult a lawyer about your options.

You must know the parameters of the situation before you can act.

#2. I made a last ditch effort to get the tenant's family to intervene. Sadly, they declined.

You have a history with Steve. Perhaps you know someone closer to him who can help him? Don't contact anyone until you clear it with legal - but this could be one way to go.

#3. I used the full power of the law to get this person evicted, even though it was expensive.

I did this because without drastic measures, this person would NEVER have gotten help. She went to a half-way house type situation where she was sure to take her much needed meds regularly, which I knew before starting was a strong possibility for her based on her particular background and resources. We proceeded as fairly and humanely as possible with the eviction. We refunded all deposits and negotiated a vacate date (I had to call the police to be present on the day she vacated, but it worked out) and we cut her a deal on the remaining rent. It was awful. But the eviction did lead her to get help in the end. Overall, I feel great about it. You can't watch people suffer and refuse action. You just can't.

You know Steve. You know his resources. I did heaps of research about worse case scenario options for this tenant before taking action. You could look into similar options for Steve. It's likely he does NOT have to lose his job to get help - but getting help isn't optional - and he must come to understand this.

Look into all the resources in your jurisdiction and don't fear being the bad guy. People generally tend to look away from mental illness, which prolongs suffering. I commend you for being willing to deal with this.

posted by jbenben at 9:48 AM on April 25, 2011 [13 favorites]

I'm surprised that I'm the only one that is worried about Dave, and other folks that have been/will be targeted by Steve. I really would encourage you to contact an attorney right away to determine what responsibilities you might have not only to Steve, but also to the people that Steve is targeting.

This may not only be a legal matter (covering your company in case of X), but also a safety matter for you, Dave, AND Steve. Think of it this way: how much worse would it be for Steve, personally and legally, if he attacked or seriously injured Dave?

I know he has worked at your company for two decades, but it is HR time. He needs to not be at work until he can behave appropriately in the workplace. If your company is quite small, I would, again, consult a lawyer to make sure you are abiding by local law, and if s/he ok's it I would put Steve on indefinite leave until he consults a psychologist. I would also contact his family and express your concerns to them, make it clear the matter is escalating and ask if they can also help.
posted by arnicae at 9:57 AM on April 25, 2011 [4 favorites]

HR if you got it, employment lawyer if you don't. (And HR will almost certainly want to contact an employment lawyer for help.)

I worked on a case like this (I'm not an employment lawyer, but was assigned to take the case pro bono) and it was a mess for all involved. I don't know what the solution is, but if people in my case had been more careful at the stage you're at now, at least there would probably have been less litigation.

Early legal intervention probably won't help Steve (IANAD, and I don't know what you're supposed to do with people like that) but at least you don't have to compound the problem with a messy lawsuit.

posted by spacewrench at 9:58 AM on April 25, 2011

I'm sure I won't be the only person to say that people who truly are paranoid schizophrenics can be quite dangerous

Actually, although it can happen, we really only hear about this small minority -- we rarely hear about those who are on medication and living well. They are more often victims of violence rather than the perpetrators (there will always be exceptions, but again, these people are in the minority). (I work for the National Alliance on Mental Illness and have a sister with schizophrenia.) I know many people through my work and the work of others who have schizophrenia and are on meds and living well. Even when they were off their meds and psychotic and paranoid, they tended to withdraw and pull away from people -- none of them were violent.

See here:

Schizophrenia is often mischaracterized as an untreatable disease associated with violent behavior and many untrue and unfortunate stereotypes have developed. Most individuals living with schizophrenia are not violent; risk of violence is associated primarily with factors such as psychotic symptoms or substance abuse. Even then, violent behavior is generally uncommon and the overall contribution of schizophrenia to violence in a community is small. When engaging in treatment, schizophrenia is a manageable disease.

anonymous, do you know any of his family members? They may be able to help. Unfortunately, if you're in the US, it is almost impossible depending on the state you're in, to get someone help unless they express suicidal or homicidal intentions.

I've learned through hard experience that you will not be able to convince the person that their delusion aren't true - for them, they are reality. If you can respond to the emotion, underlying them (usually fear) you may have better luck. For example, in this situation, you might say something like "It must be really scary to feel like someone wants to hurt you" or something similar.

Thank you for what you've done in the past to help this person.
posted by la petite marie at 10:03 AM on April 25, 2011 [4 favorites]


And neither are you, right? Right. So, rather than making a decision based on the diagnosis, focus on the man's behavior and how it's unacceptable at work, because truthfully, that's all you know. Maybe he has an organic mental illness, maybe he has a personality disorder, maybe he has a substance abuse problem, maybe he has personal or family stress, maybe he's just a cyclic asshole. You don't know. What you DO know is that his behavior is disrupting the team at work and making other employees uncomfortable, and that shit has got to stop.

I would consult with an HR professional (either one in your company, or a consultant if you don't have an HR department) and an employment lawyer and see what your options are. It might be that you can have a meeting with him where you say "This shit has got to stop, but we recognize that there may be underlying factors that are complicating your life. We're going to put you on a probationary plan that involves making a mental health professional available to you. If you see this person, anything you discuss will be confidential, because the reasons for your behavior aren't relevant to us; however, if those evaluations uncover circumstances that are expected to get better over time, we're happy to look at accommodations based on that schedule. But you need to know that right now, your behavior is incompatible with continued employment here. Ball's in your court."
posted by KathrynT at 10:04 AM on April 25, 2011 [6 favorites]

If you're in the US, your company likely has someone in HR who is designated as a disability representative (or similar). That person may be the only person who is legally able to discuss medical issues impacting work unless Steve brings them up himself with a supervisor.

Of course, you can discuss the ways in which his behavior in general is impacting his work (and the work of people around him), but if you're going to bring a diagnosis or the need for an evaluation into the situation, that's probably where you should go. Please take time to consult the appropriate legal options.

You say Steve is very important to the company, with 20 years' experience. I get that. But at some point you have to say, "Okay, is what we could get from his institutional memory more important than the health and well-being of people who work here now -- including Steve himself, Dave and everyone else who is drawn into the vortex of what's going on instead of getting their work done?"

Also, consider checking in with a counselor on your own. You sound like a very caring and responsible person, and I bet that trying to do what's best for Steve -- your friend -- is weighing very heavily on you. Take care of yourself first; you'll be able to provide more clear-headed advice and help if you know you've gotten things settled in your own mind.
posted by Madamina at 10:04 AM on April 25, 2011 [2 favorites]

I am an employment lawyer but I am not your lawyer, employment or otherwise. You're on sticky legal ground. Please please consult with HR and an employment lawyer in your jurisdiction if you don't have HR. As an employer with the knowledge that an employee may be suffering from a disability, all sorts of issues are triggered (possible reasonable accommodation requirements, for example.) It is a bad idea to put anything in writing (like the letter suggested above) until you do so.

To give you an idea of the issues I'm talking about, there are some links to Equal Employment Opportunity Guidance documents on some of these issues linked below. These documents can give you an idea of the issues you may be dealing with but they are not a replacement for HR and/or an employment lawyer's advice.

EEOC Guidance on Disability-Related Inquiries,
EEOC Guidance on Psychiatric Disabilities,
EEOC Guidance on Reasonable Accommodation
posted by wuzandfuzz at 10:05 AM on April 25, 2011 [7 favorites]

So, rather than making a decision based on the diagnosis, focus on the man's behavior and how it's unacceptable at work, because truthfully, that's all you know.

This. Document times and descriptions of all unacceptable behavior. Talk to a lawyer about what to do next.
posted by small_ruminant at 10:43 AM on April 25, 2011 [2 favorites]

I'm sure I won't be the only person to say that people who truly are paranoid schizophrenics can be quite dangerous. alienating him, and him thinking we are now all "against him" are the least of your worries. My neighbor got punched in the face hard enough to break his nose by his best friend (who had schizophrenia, and who now lives in a care home) for some imagined threat.

People with schizophrenia may be slightly more violent than people without, but that's a gross exaggeration. People with schizophrenia are rarely violent. People with schizophrenia are more likely to be victims of violence than perpetrators.

As for the question, unless the guy is homicidal, suicidal or so functionally impaired he can't shower or use toilet paper, your best bet is to contact his family. I don't know if there is legal complication with you being his employer.
posted by namesarehard at 11:30 AM on April 25, 2011

I've had a similar-but-different situation, which turned out to be alcohol abuse (which someone above mentioned, too, I think). Please remember that yours is a position that has rigid legal definitions and implications. Treat this as you would any other inappropriate office behavior, without referring in any way to a "diagnosis" or underlying justification. The only person/people to whom you should speak about this is your HR representative or your legal counsel - not coworkers, not his family, no one.
posted by OneMonkeysUncle at 11:34 AM on April 25, 2011

Very timely question. I was recently advised that one of my team was admitted to the local mental health facility over the weekend.

I am lucky enough to work for a large corporation so we have a Health Advocate to any and all health/life issues that are effecting an employee's quality of work.

When faced with these issues I focus on what's happening with their work (we have quality metrics) not what I think may be going on in their own lives or any apparent health issues (physical and mental). I don't speculate or try to guess. Part of my 'coaching' process is to ask 'what is keeping you from being successful' or 'think about things that may be keeping you from hitting your metrics, let me know if I can assist with anything'. At that point I offer the Health Advocate card or their 800 number regardless of how they answer.

Hopefully you have such a great resource available to you!
posted by tar0tgr1 at 11:36 AM on April 25, 2011

IANAD. IANAL. IANAP. And neither are you, right? Right. So, rather than making a decision based on the diagnosis, focus on the man's behavior and how it's unacceptable at work, because truthfully, that's all you know.

This is an important point. You say that you would not presume to diagnose him, but that you think he's suffering from paranoid schizophrenia. You also say he's worked with your company for over 20 years... making him a man in his forties, at least. Usually, paranoid schizophrenia begins in the late teen years to early thirties. By throwing around your diagnosis, you are shading the advice you will get here, and the actions others (also not doctors) take in your workplace.
posted by Houstonian at 11:37 AM on April 25, 2011

Thanks to those correcting my fearmongering re: violence above. Noted.
posted by salvia at 12:26 PM on April 25, 2011 [1 favorite]

Ignoring Steve's mental problems for a moment, one reason you're so concerned is that he's been with the company so long. You obviously feel if he left for any reason the company would be in trouble.

Forgive me for saying, that's your main problem.

Mentally ill or not, Steve could get hit by a bus, or win the lottery, tomorrow. If your company can't get by without him, or any other single employee, that's something you really need to fix.
posted by AmbroseChapel at 3:01 PM on April 25, 2011 [1 favorite]

It's somewhat unusual for someone to develop schizophrenia so late in life -- the usual onset is in the early 20s. So maybe he always had it and is off his meds, or maybe something else drug-related or neurological is going on?

Anyhow, regardless of what the problem is, you want him to get help before he makes it impossible for him to work there. Follow the advice above about checking with HR, legal, etc., but if/when you or someone else approach him, emphasize that you value him as an employee and want him to continue working there but you need him to get help for whatever the root cause is of his problem behaviors. Can you offer him paid time off in addition to his FMLA protection?
posted by Jacqueline at 9:43 PM on April 25, 2011

As the asker said, s/he wasn't diagnosing Steve, merely using that as a description for Steve's behavior.

Violence in the workplace just can't be acceptable. Steve needs to be sat down and told in no uncertain terms, that he needs to figure out what is going on and fix it. You and the company will offer whatever you can to help, but it is on him to take the necessary steps. ADA or not, if he threatens or commits violence again, he's got to go.
posted by gjc at 5:32 AM on April 26, 2011

Document really thoroughly. Meet w/ HR. You want to achieve a balance between compassion and the needs of the job. "Steve, your behavior in X instance caused Y effect in workplace. How can ABC Co. assist you in finding resources to deal with this problem, which cannot be tolerated?" You get to describe Steve's behavior, and you get to describe the desired behavior, but you may not manage what you see as an employee's mental health, unless the employee has asked for accommodation. You are not a/his health care provider.

Does the company have an Employee Assistance Program? They can be really helpful.
posted by theora55 at 12:35 PM on April 26, 2011

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