DE Talk | Reality Check: The Role of Employers In Employee Mental Health

Season 3 • Episode 3

For years, employers have recognized the need for mental health support. Now, thanks to the pandemic pause in 2020, employers are looking to break the stigma of mental health care, assess how to make positive strides forward, and create an open dialogue in their workplaces. How can employers create a work culture that supports mental and emotional well-being? Tune in as psychiatrist Dr. Chris Bojrab unpacks the importance of mental health, how it affects the workplace, and steps needed to prioritize mental health and well-being as a business imperative.

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About DE Talk

For DirectEmployers, it’s all about valuable connections and meaningful conversations. This monthly podcast features honest and open dialogue between powerhouse industry experts on a variety of HR topics ranging from OFCCP compliance advice to emerging recruitment marketing trends, diversity and inclusion initiatives, and insightful solutions that help infuse new life into your HR strategies.

Hosted by Candee Chambers, Executive Director of DirectEmployers Association.

Episode Guest

Episode Transcript

Candee Chambers:
Welcome to the DE Talk Podcast. Tune in for dialogue between HR experts to amp up your HR strategies. Don’t worry, we’ll mix in a few laughs as we know you need it.

Welcome to the DE Talk Podcast. Tune in for dialogue between HR experts to amp up your HR strategies. Don’t worry, we’ll mix in a few laughs, as we know you need it.

There’s no denying that 2020 and 2021 have been tough, and tough in a variety of ways. But one area that’s taken a major hit, employee well being, including employee mental health. Everyone has mental health, much like physical health. And will experience periods of struggle and mental well being so much so that nearly one in four Americans struggle with our own mental health. The pandemic has brought the topic of mental health to the forefront. And renowned athletes like Simone Biles have reignited the ongoing conversation about mental health disclosure and stigma. For employers, this topic remains a priority. But why exactly is mental health at work so important? And how can you create a work culture that supports your employees mental health and emotional wellbeing?

Today I have the pleasure of welcoming Dr. Chris Bojrab to the DE Talk podcast. Dr. Bojrab is the president of Indiana Health Group, the largest multidisciplinary behavioral health private practice in Indiana. He’s a board certified psychiatrist and a distinguished fellow of the American Psychiatric Association. His areas of interest include, psycho-pharmacology, mood and anxiety disorders, ADHD, sleep disorders, pain syndromes, and gambling addiction. Dr. Bojrab has repeatedly been named one of the top doctors and top shrinks by his peers in Indianapolis Monthly Magazine. I have to tell you that made me laugh when I read that. But welcome Dr. Bojrab. It’s my pleasure to be able to chat one on one with you today. You are an amazing addition to our DE Masterclass Disability RoundTable Series in May. And I’m excited to continue the conversation with you today.

Dr. Chris Bojrab:
Well, thank you very much for the invite. I enjoyed participating in the round table and I’m looking forward to our conversation today.

Candee Chambers:
Oh, good. Well, let’s start by sharing a little bit about your background and your current area of focus. You have quite a lot of words that I had to read and I was afraid I would stumble over. So why don’t you tell us about yourself?

Dr. Chris Bojrab:
Sure thing. So I am a psychiatrist in private practice up on the north side of Indianapolis, up in Carmel, Indiana, with a group called Indiana Health Group. And I see patients across most age ranges. So I’ll see kids down to six, although I’m not boarded in child psychiatry. Most of my patients are adults. I do see some senior adult patients. I really primarily focus in psycho-pharmacology, which is the use of various medications or other types of somatic treatments for a variety of mental health conditions. I do a little bit of individual counseling therapy, sometimes some couples therapy, although I’m lucky enough to work with a great team of therapists who have sometimes greater availability than I do in those areas. So a little bit of this, a little bit of that. But I also enjoy doing a fair amount of consulting work with industry, either with companies looking at mental healthcare and the way that systems in place are affecting their workers and their workplace productivity, as well as doing consulting with the pharmaceutical industry.

Candee Chambers:
Wow. Do you have time to eat?

Dr. Chris Bojrab:
Yeah, I don’t sleep a whole lot.

Candee Chambers:
Yeah. I get that. Trust me, I had somebody walk in yesterday and say, “God, you look tired.” And I said, “I sleep about two or three hours a night sometimes, and it does build up sometimes.” So I don’t know how you do it. But I also understand that you’re the team psychiatrist for the Indiana Pacers. And you also provide some assistance as needed to the Indianapolis Colts and the Indianapolis Indians, right?

Dr. Chris Bojrab:
Yeah, that’s correct. I’ve been doing some things with some of our local sports teams for quite a while. Although I always tell people the job with the Indiana Pacers is probably not as exciting as it sounds. I tell people who are old enough to understand this reference, that I’m a little bit like the Maytag repairman. They’re a pretty psychologically healthy team, pretty well put together. They have a pretty good team culture, so I rarely have to be getting emergency calls.

Candee Chambers:
Well, that’s good to know. But we’re strong supporters of all three teams. So we have season tickets for the teams and everything. So I’m glad to hear they’re in good shape. So I think people are probably most familiar with the term therapy. A lot of people say, “Yeah, I go to a therapist.” Can you explain the difference, though, between therapists, psychologists, and psychiatrists? I mean, obviously I know that you can prescribe medicine and psychologists normally cannot, but how do you differentiate the levels of those three practices?

Dr. Chris Bojrab:
Certainly is a very common question. I think there’s a lot of confusion about these terms at times. So therapist is actually a more general term. So really people holding a wide variety of degrees can function as therapists. So more in the vernacular, I think most of the time, if people are referring to a therapist or a counselor, they’re typically referring to somebody who holds a master’s level degree.

Candee Chambers:
Okay.

Dr. Chris Bojrab:
These are typically either licensed clinical social workers, licensed marriage and family therapist, licensed mental health counselors. So these are two year degrees, two years beyond a bachelor’s degree, where really that time is spent primarily focused on learning how to do therapy, learning different schools of thought, and learning how to be of assistance to patients, primarily through talk therapy.

Candee Chambers:
Okay.

Dr. Chris Bojrab:
Psychologists are a doctoral degree. So these are folks who hold either a PhD or a Psy. D, P-S-Y D, degree. And this is a four year degree beyond a bachelor’s degree. And a psychologist also function largely as therapist. They do more individual, family, couples, group therapy or counseling. They’re also frequently trained in more formal assessments. So psychological testing, which oftentimes looks at personality structure, other aspects of a person’s psychological makeup that may help us better understand the way that they experience certain stressors or respond to stressors. Also involved in doing neuropsychological testing, which is a type of testing that are little more detailed and focuses more on looking at brain function, looking at cognition, concentration, focus, memory.

And then finally psychiatrists are medical doctors. So as a psychiatrist, after college, I did four years of medical school, just like your internist or your surgeon or your OB-GYN or your pediatrician would. And then after graduating from medical school with an MD or a DO degree, people that are pursuing psychiatry then go on to do an additional four year residency specializing in psychiatry, where we learn more detailed information about the brain. We spend some time doing neurology. There’s a little bit of cross training between neurology and psychiatry. And in addition to being trained to do therapy, we’re also trained in the more medically based treatments. So as you mentioned, prescribing medicines or the use of other types of treatments to be able to provide those types of services to patients as well.

Candee Chambers:
Wow. I do remember you telling me that you had four years beyond medical school in our round table, and I had actually forgotten that. But yeah, I went to school and I was originally going to go into clinical psychology, and the stats just stopped me dead in my tracks as an undergrad. So I was like, “I don’t think I’m going to do psychology,” so I ended up going a different route, but…

Dr. Chris Bojrab:
Yeah. Sometimes when I’m working with younger patients and they ask me how long I had to go to school, I tell them I had to go to the 24th grade.

Candee Chambers:
That’s good. Yeah, that’s a long time. So no wonder you have those special abilities that you can prescribe medicine and things like that, because you’ve obviously earned that right. Oh gosh. So the term mental health, and you and I had mentioned this before when we were talking about the round table, has become just a huge topic of discussion during this pandemic. And it continues to be present in virtually every conversation that direct employers has and any other employer has across the nation. Let’s just set a baseline for our listeners. What is mental health exactly? How do you define that?

Dr. Chris Bojrab:
Again, it’s a broad term. But I would think about mental health in much the same way that we think about physical health. So what do we consider physical health to be? Well, that’s essentially maintaining your body in such a way that you’re able to do all of the things that you need it to do in all of the different areas of your life. So I think there’s a good parallel there with mental health. So I would define mental health loosely as being able to maintain a mental state or a cognitive state that you are able to function adequately in all the different areas of your life, in terms of how you’re interacting with family, friends, your workplace setting, your social setting, the things you enjoy to do in your free time.

Do you have the mental or the psychological wherewithal to be able to do these things that most of us do to get through the day and most of us do as part of day to day life? And not only are you able to do it, but are you able to thrive, are you able to grow, are you able to continue to learn, to continue to enjoy things? So, it’s really about that balance, about maintaining your psychological well being in such a way that you’re able to handle the bumps in the road that life invariably throws our way.

Candee Chambers:
So, interestingly enough, what is mental health for one person isn’t the same maybe for another person, because they would have… And I’m talking more about in the employment setting because different responsibilities, so probably different levels of what would be considered mental health would vary from individual to individual then as well, correct?

Dr. Chris Bojrab:
Absolutely much in the way that physical health does. Certainly there are some among us that are like elite athletes and maintain themselves, and just outstanding physical shape compared to others. So I don’t know that you might call the average person unhealthy, but certainly they enjoy a different level of health than somebody who spends a good deal of their time and energy pursuing those things that increase their physical health. And I think you can see the same kind of variability in mental health. So you could probably put it like everything else in the world on a bell curve. And you see some people that maybe have higher baseline levels of mental health, who tend to be a little more stress hardy, a little bit more likely to roll with the punches as it were.

And then other people who may not enjoy as much buffer there, they may have a little less reserve. And when stressful things happen to them in the environment, they may be a little less well equipped to roll with those punches and maybe a little bit more vulnerable at having those life events wind up creating some sort of clinically relevant mood or anxiety problems.

Candee Chambers:
Actually, I think that’s probably one of the best explanations I’ve heard. I really. I think that that explanation, Chris, went a long way. I really do think that was very important for me to hear and probably for the listeners to hear as well. I think one of the positive attributes of the pandemic, if there can be, but I think it’s been the shift to bringing mental health conversations to the table. I know when we have our monthly staff meetings, I always try to end each meeting with, “Please, if this is a difficult time for you, we have an employee assistance plan. Please get the assistance you need. It’s free, blah-blah-blah.” Because I do know that this pandemic is difficult on everyone. In your opinion, what do you think is contributing to employees taking a more proactive approach to their mental health?

Dr. Chris Bojrab:
I think there are a number of things that are contributing to employees taking a more proactive approach in their mental health. I think part of it has just been the unprecedented levels of sustained stress that all of us have been under at the same time and from the same source throughout the pandemic. Everybody has stressors in their life. It’s hard to talk to anybody, and if you really drill down to it to not find something in their life that’s causing some degree of stress. I think what’s been so different in this time is, regardless of the other individual stressors that we may have, we are all in the same boat of the pandemic, and we’re all living through the changes that we’ve all had to make in terms of how we live our day to day lives, what we’re able to do, the stress related to a lot of just the news and the politicalization of so many of the things that we hear.

So I think it’s a different type of stress than most of us had to deal with in a very long time. It’s one thing when I’ve got my stress, you’ve got your stress, and we all go through these cycles of up and down, but there are the periods of recovery where things are a little bit easier. Now on top of that, that’s always existed. We’ve layered this rather unrelenting past year and a half to two years of constant stress that it’s almost inescapable, regardless of the degree to which it’s affected us personally, just from everything that we hear and read and see about it. So I think that’s been one of the things that has brought this more to the forefront. I also think, as well, that as time goes by, people just become more and more sophisticated about mental health. I think although we still have a fair amount of stigma that can interfere with people seeking treatment, I think that certainly is getting better. I think it’s better now than it was 10 years ago, and it’s not as good now as it will be 10 years from now.

Candee Chambers:
Yeah, I think you’re exactly right. I’ve been paying attention to conversations in my organization where when last year parents had to work from home, and their kids had to learn from home, and just the internet outages and everybody trying to be on Zoom at the same time in one household. I mean, I thought at that point, thank goodness my kids are grown. But then I have grandchildren that my older daughter had to deal with too. But now it’s like, yeah, well, we had a choice of sending our kids back to school or staying home. So we chose to keep them at home. And it’s like it’s no big deal now, because they’ve already been through it, dealt with that stress, and okay we know how to move forward. So, I guess, like I said, one positive in the pandemic has probably been trying to figure out how to best handle those types of stressors.

But on the flip side, what do you think about employers taking note and adjusting their policies and practices to accommodate those employees and create workplaces that support their employees health and wellbeing. Have you noticed that?

Dr. Chris Bojrab:
Yeah. And honestly, I think in general that across the country, most businesses really ought to give themselves a pat on the back for the way that they responded to these changes. Just I would echo the same thing for school systems around the country. We were not prepared for this. We very suddenly found ourselves in a situation where we had to change our workflows so dramatically and so quickly. And thankfully, this occurred at a time where the technology, even if we didn’t all individually have it, at least the technology existed to allow us to pivot pretty quickly. So, although there are individual examples that you can point to where this did not go well or was not implemented in a smooth fashion, I really think that that’s the minority.

I think for the most part, we did pretty darn well in our ability to flex and to adjust. And at the very start of this, I actually had more concerns that were employers going to be so concerned about the impact on productivity, that there was going to be more resistance to this idea of telework. And I’m really pleased to see that that’s really been the exception rather than the rule. And I think it’s paid off well for them. I think most employers have been pretty surprised at how well they’ve been able to continue operations despite having to do so in such a dramatically different way than they were before.

Candee Chambers:
Well, you made me smile when you were talking about that. We had been toying with remote work, or working from home, I should call it, a couple years before this even started. And we had said, “Well, one day a week we can work from home. Well, then maybe a couple days a week.” And then boom, we made the decision. And the next day we all worked from home. Thank God as we all had laptops and that sort of thing. But I have openly admitted that the entire association has proven me wrong, that you can be very productive and work from home. And then I was like, “Oh, geez, well now, how do I ever get people to come back to the office?” But it is a challenge, but I think everybody appreciated the opportunity to be able to still have a job and work from home and not lose their job.

So yeah, it’s been a learning opportunity I think for both the employers and the employees. So that’s just a personal situation with our organization. But what would you consider to be the biggest mental health issue in the workplace? Stress immediately comes to mind. I know you had mentioned stress. Can you explain the stress cycle?

Dr. Chris Bojrab:
Sure. Stress again is another one of these somewhat nebulous terms, meaning different things to different people. But sometimes I think of stress as being synonymous with anxiety, but I think it can encompass more than that. I think of stress as being basically anything that’s a change to our routine expectation of how things are supposed to go, some sort of violation in our schema, or our understanding of how things are supposed to go in each different scenario in my life. So when a person encounters something stressful, this operates at different levels. There certainly are the psychological impacts of stress where it raises our level of anxiety. It makes us feel more at risk. One of the best descriptions of anxiety I ever heard from a patient was, “I can’t tell whether or not I’m safe. I can’t tell whether or not I’m okay or things are going to be okay.” And I always remember that. I think that’s a nice description of stress, when it’s just, “Hey, this is not how things are supposed to go based on what I’ve done repetitively in this situation up until now.”

So I think from a psychological standpoint, it’s disquieting, right? It takes us out of our routine. It doesn’t allow us to put some things on autopilot that we’re normally able to put on autopilot with our expectation about what we’re supposed to be doing, or how we’re supposed to be responding, or how we’re supposed to be functioning. Physiologically or medically or neurologically, stress causes a lot of physiologic changes in the brain that have really incredibly far reaching effects that impact our health. Sometimes I think people think of stress as being this nebulous, touchy, feely thing that… Well, people are just feeling a little owie. They’re just out of sorts. They just need to somehow pull it together and just move past it. But that’s not the way that we are built.

People actually have definitive physiologic responses to stress. In the presence of some stressful stimuli, there are changes that very basic structures in the brain that change the way that your body controls the release of cortisol, which is our most important stress hormone. And when this is released for too long at too higher levels, it begins to have these trickle down effects on other brain chemical systems that actually escape the brain and have an impact on other parts of the body.

So with sustained stress, you see these secondary chemical changes in the body that make us less able to regulate our blood sugar. It makes us more susceptible to diabetes. It makes it less likely that we will be able to regulate our heart rate. It makes our heart rates more variable, puts us at higher risk for heart attacks or strokes. It changes the way that our immune system functions. And it can turn these parts of our immune system that are usually doing a good job warding off infections or surveilling our body for growing cancer cells. And it can change the way that system works. And stress can make us more vulnerable physiologically to certain infectious diseases, to certain forms of cancer. So there really is a lot going on under the hood, as it were, when people feel stressed. So it’s not just esoteric, all in your head phenomena, the way that I think some of us grew up thinking about stress.

Candee Chambers:
That is interesting. When you were talking about it, I mean, I’m a type 1 diabetic, and I know very well that a lot of stress will cause my blood sugar to rise. So I do have to just assume that things could always be worse. And I have my own little ways of dealing with stress, and for some I’m not that stressed, I have a great team. But yeah, I do recognize those issues that do arise sometimes.

Dr. Chris Bojrab:
Yeah. There was an interesting book that was written a number of years ago called Why Zebras Don’t Get Ulcers. And it was written by somebody like a veterinarian that was out and looking at zebras out on the Serengeti. And you would think, well, this is a pretty tough life, right? You’re running around, and you don’t know when you might be taken down by a lion. And so they probably have a lot of stress in their life. So they were wondering if they would see the equivalent of what we and humans have as stress related illnesses, including things like gastric ulcers. And they surprisingly didn’t. And this got them thinking about things.

And there’s a big difference in the way that animals and people respond to stress, because with animals, if you’re a zebra and you see a lion, and you guys all start taking off, and all of a sudden your friend, Charlie, next to you gets taken down by a lion, you actually stop running at that point. You’re like, “Oh, bad day for Charlie.” But I know the lion’s not like a serial killer, he’s just out for lunch. He’s got his lunch now, so I’m probably safe and I can stop running. Whereas if a lion came into our workplace, we’re going to keep running even if they got our coworker, Charlie, right? Because this is unprecedented. We don’t know what’s going on.

So humans, because there are well developed brain, we’re able to sit there and think, and obsess, and parse all this. And it contributes to a stress response system that doesn’t turn off as well as it does in animals. So, those stressful events for us are more likely to turn into these longer term kind of things that we’re going to continue to mull over and worry.

Candee Chambers:
Oh, yeah. I’m going to have to get that book. But Why Zebras Don’t Get Ulcers, I’m going to have to read that. So, arguably the biggest obstacle that we find in the way of creating healthier workplaces that support mental health and the wellbeing of our employees continues to be that horrible word stigma that surrounds mental illness, and mental health conditions, and mental health struggles in general. I mean, we’ve talked about neurodiversity in our round tables this year, neurodiversity, TBI, PTS, all of these various issues. And The Hartford recently surveyed employers nationwide and found that, of those that were surveyed, 72% said the stigma associated with mental illness prevents many United States workers from seeking help. What do you think can be done from an employer’s perspective to break that stigma?

Dr. Chris Bojrab:
Wow. That’s such a shocking and disheartening statistic for me to hear.

Candee Chambers:
Isn’t it that?

Dr. Chris Bojrab:
Because I was like, “Darn, I thought we were getting-“

Candee Chambers:
Better.

Dr. Chris Bojrab:
“… better at this more quickly.” And I always tell people, sometimes when I’m seeing new patients and they come in and they were talking about some of their resistance to coming in…

Candee Chambers:
Oh, yeah.

Dr. Chris Bojrab:
And I’m like, “Well, how long did it take you to get in to see me?” And it’s, “Well, I had a waiting list of like three months.” I’m like, “Why do you think that is? You think it’s because you’re the only person that’s experiencing this?” Our office takes 25 to 30 calls a day for new patient appointments scrambling to try to get in. Everybody is flooded. Everybody is overwhelmed. So, I think sometimes just helping to reinforce to people that, “Listen, this is not a you problem, this is an us problem.”

Candee Chambers:
That’s a nice way to put it.

Dr. Chris Bojrab:
Yeah. So I think there’s a number of things that can build to help break stigma. I think that just the availability of having these types of opportunities for communications that we make available to employees. I think that letting people know that, “Listen, there’s enough of this kind of problem out there, that we have systems in place to help with this.” I think when you hear messages from celebrities who’ve had struggles with mental health illness, I think that does a lot to help normalize this experience. I mean, it’s really part of the human condition.

Obviously I’m biased because I do this every day, but it’s always so shocking to me that people would somehow think that the part of your body that is absolutely the most complex and complicated system in your body at times needs attention just like your heart or your liver or your kidneys do. It’s just shocking. It’s like, “Boy, this is the toughest part,” right? This is the part that is responsible for doing the most things, and we demand the most of it, and it has the most far reaching effects. It’s like, “Oh my gosh. Yeah, of course we have to be paying attention to that.”

Candee Chambers:
Yeah. That’s a true. I mean, I’m literally sitting here with a smile on my face. I mean, you have a hamstring issue and you don’t mind telling people I’ve got a hamstring issue. , If you have a stress issue that you can’t somehow navigate and you need to talk with somebody about it or need some assistance, we’re afraid to tell anybody that. And you really just put it in logical terms for me especially, but for everyone who listens. I mean, that really made a lot of sense, the way you described that. So what do you-

Dr. Chris Bojrab:
Yeah, sort of like if you were having problems with your car and you took it to the mechanic and say, “Listen, just don’t look at the engine. Don’t do anything with the engine.”

Candee Chambers:
Okay.

Dr. Chris Bojrab:
“That’s what’s responsible for anything else. I know because you just look at the tires.” “Well, but it won’t start.” “Well, could you just look at the air conditioner then?” Yeah.

Candee Chambers:
That’s a great analogy, actually. It really is. Well, what do you think employers can do to be more proactive to help support the mental health of their employees?

Dr. Chris Bojrab:
I think one thing is certainly education. I know there’s always the risk of the eye roll effect, right? It’s like, “Oh, here’s something else from our employers telling us something we got to be doing to take care of ourselves.” But I think that you’ve got to have that base, background messaging out there, because what something gets and tosses in the trash or files in their trash folder and their email, one day or week later something might happen in their life and they’re like, “Now, where is that again? Oh my gosh, where am I.”

Yeah, right? So, even if it feels like we’re beating our heads against the wall at times, I think it’s good to have that baseline level of messaging that, “Listen, these are real conditions. There’s help that’s available. Your employer has specific things in place to help with this.” You need that kind of background messaging. It’s just like with marketing 101, right? You have to tell somebody something or put something in front of somebody seven times on average before it will start to sink in or they’ll start to know it. So I think one thing is those ongoing low level educational pieces. And then I think certainly there are specific programs that employers can utilize that are helpful. I think over the past few decades, we’ve seen the development of a number of employee assistance programs that grew out of this increasing recognition of the need for mental health or substance abuse services.

And there are other types of programs beyond EAPs. Now there are some that try to take the more proactive approach that work with employers to provide a little bit more hands on ongoing education. Sometimes employers will wrap these types of educational opportunities into part of their ongoing professional development programs. I also think that’s a nice way to capture some hearts and minds. I mean, I think we’re all sensitive to doing things that can affect worker productivity and how much time are we taking away from people’s days. But if a company has a certain amount of time dedicated to ongoing education or professional development every year, I think that’s a great opportunity sometimes to have these types of conversations or bring in people to talk on these topics. If it’s already time that is essentially earmarked or carved out, I think this is a great use of time under the broad category of employee education or professional development.

Candee Chambers:
I like those ideas. I think I’m good. You have to talk with my employees in the next year and see what I did. I really think that that’s a great idea. What happens though with the work environment if mental health continues to be put on the back burner? Because you know there are a lot of companies that are like, “We got to hit productivity and profit,” which I’m all about profitability and assisting our members and that sort of thing. But I also know that the health of my employees is a driver to the organization’s success.

Dr. Chris Bojrab:
Yeah.

Candee Chambers:
And so what happens if companies don’t get it?

Dr. Chris Bojrab:
Taking care of employees this way is not only the “right thing to do” from the standpoint of just caring about other people as people, it’s also the right thing to do just purely from a business sense. Mental health conditions are extraordinarily costly in terms of lost productivity. Most major organizations, if you look at the CDC, if you look at the world health organization, if you look at surveys that are done by universities around the world, depression typically ranks third among all health conditions in terms of the cost to annual productivity.

Candee Chambers:
Wow.

Dr. Chris Bojrab:
The top two are cancer and bronchitis, cancer because it can take you out of the workplace for so long, and bronchitis because, well, although it’s not often not terribly severe, it’s so prevalent.

Candee Chambers:
Yeah.

Dr. Chris Bojrab:
And then depression follows closely on the heels there, because this is something that can affect people at any point in their life and can oftentimes be recurrent, and the costs are not just… And this is really exclusive of the direct medical cost to care for these patients. This is purely just productivity issue, and oftentimes we think about the impact of lost work days or absenteeism. And that is the tip of the iceberg. Presenteeism, the reduction in work productivity that people have as a result of how they’re feeling, even though they’re physically located at work that day is estimated to be 10 times higher than the cost of absenteeism.

Candee Chambers:
Wow.

Dr. Chris Bojrab:
One recent report I saw from a few years ago said that the estimated cost in the US of absenteeism because of depression is about 150 billion dollars a year.

Candee Chambers:
Oh my gosh.

Dr. Chris Bojrab:
But the cost of productivity due to presenteeism, the reduction in productivity of people who are physically at work but not working up to their capacity is 1500 billion as opposed to 150 billion.

Candee Chambers:
Wow.

Dr. Chris Bojrab:
So it’s in employer’s best interest because you’re going to be… It’s like if you had a delivery service and you were never doing any maintenance on your vehicles. So not only is it the right thing to do in terms of taking care of one another, it’s the right business decision to make.

Candee Chambers:
Wow.

Dr. Chris Bojrab:
Your employees are better tools for your industry if they’re maintained and if they’re working well.

Candee Chambers:
Wow. Boy, I’m learning something every time you open your mouth, Chris. Let me ask you, is depression one of the bigger issues you’re seeing as a result of the pandemic?

Dr. Chris Bojrab:
Yeah, I would say depression, anxiety, sleep disorders.

Candee Chambers:
Interesting.

Dr. Chris Bojrab:
Those are probably the things that… And they all feed off one another, right? These are traveling companions. So when having any one of those three things increases the likelihood of having the other two or increases the severity of the other two.

Candee Chambers:
That makes sense. Yeah.

Dr. Chris Bojrab:
So, yeah. And again, although there certainly are more disabling mental health conditions, I mean, arguably illnesses like bipolar disorder, like schizophrenia, like post traumatic stress disorder, have perhaps an even higher impact on the individual. It’s a numbers game. So, the number of people who will have an episode of major depressive disorder or an anxiety disorder at some time in their life is much greater than the percentage of people who will eventually be diagnosed with illness like schizophrenia or bipolar disorder. So even though those are in some ways more persistent and severe mental illnesses, they’re a little more contained. Whereas depression, anxiety, sleep disturbances, these are things that we’re all so much more vulnerable to.

Candee Chambers:
Yeah. Well, I mean, and I can certainly understand that. But geez, I don’t think people really understand all of the types of issues that psychiatrists run into, but more importantly, what the pandemic has brought upon us. So, that’s pretty interesting. Let’s turn the tables a little bit. So if employees aren’t open about their mental health struggles, how can team leaders or supervisors step in if they notice that their employees just seem to be stressed or overwhelmed or just not handling things well? I mean, what does that look like?

Dr. Chris Bojrab:
I think there’s a bit of an art to this. Obviously in the current regulatory environment, we’re all very cautious about HIPAA and patient privacy. And sometimes we’re fearful of overstepping. But I think you’re always on pretty solid footing if you’re expressing concern. So, I certainly coach people sometimes to say, if you’ve got an employee and you are concerned about this, approach them and say, try to start off from the positive standpoint of where your concern is coming from, “Listen, you are important to our organization. And some people have been concerned about how you seem to be feeling. People who know you and who’ve worked with you for a long time, they just feel like something is different. And your happiness here is important to us. Your health is important to us because we care about you as a person, and quite honestly, we care about you as a part of this company. And if there’s something that’s going on that’s impairing your ability to function in the way that you can normally function, we want to work with you to figure out how to fix that.”

So, I think if you can approach it from a standpoint of concern, a standpoint of care, and from the standpoint of you are important to us, your wellbeing is important to us… And it doesn’t have to be pollyannaish. I think it’s perfectly reasonable to say, “Because also this affects all of our success, right? If you’re a part of our team here, your efforts is part of what keeps this ship going. So, we have invested interest from our point, as well as our interest on your behalf to figure out what we can do to help you feel and function better.”

Candee Chambers:
And I’ve always heard sometimes just saying, “How can I help you?”

Dr. Chris Bojrab:
Yeah.

Candee Chambers:
And that’s exactly what you were saying. And I think that can open up some willingness maybe to share. Any examples on what an employer can do to encourage their employees to take that time and space that they need for their own mental health? I’ve heard of a couple of companies and I don’t know if… If you can answer it, then I’ll tell you what I’ve heard other companies are doing.

Dr. Chris Bojrab:
I think this is a tough thing. And I think this is probably one of the weak points of the system in terms of… Okay, once you’ve identified somebody who may be in distress or who may need something, how do you make effective use of whatever resources you have to bring to bear to help? Because where I see this on the treatment side or as a physician, I got to tell you one of my least favorite things is when I get a request for disability paperwork, or time off for paperwork. Well, not partially because I don’t like going on paperwork, but mainly because I feel like there’s a huge disconnect in what’s being asked on those forms sometimes and what I know about the patient as somebody who may see them for these small snippets of time every once in a while, and how are people most effectively using that time off.

So one of my concerns is I sometimes see people saying, “Well, how much time should I take off, or how much time are you going to give me off?” And I struggle. I’m always at a loss with that. It’s like, “Well, I don’t know. It’s so different for each person.” But the important thing is what you’re doing with that time. I’m all always concerned when companies are saying, “Well, how long should they have off and how many appointments are they going to have then?” It’s like, “Well, my belief is if there are things that are going on that require you to be off work, then during that time off, you should be doing more than just coming to see me in the office for 15 minutes once a month or once every few months.”

And probably more than maybe seeing your therapist every once a week or once every few weeks, it would make sense for me to say, “That’s precious time that we’ve got, time away from work. How can we be maximizing the efficiency of that towards really getting people back up and running?” So almost some sort of expectation that, “Listen, if things are bad enough that you’re off work, we want to work really intensively this time.” Because sometimes just being away from the stressor for a bit doesn’t change things much, especially if you’re going to go back to a very similar situation.

So, I would love for there to be a way to try to increase the type of services that are provided to people during the time that they’re off work, with some life coaching, some things to build up their stress hardiness, for identifying what is going on at work that’s particularly stressful, and seeing if there are things that can be done in terms of accommodations. It just feels like we’re wasting some precious time away from work and not doing as much as we could be. And we’re just giving people a little bit of respite before throwing them back on the front line.

Candee Chambers:
That is really interesting, because what I was referencing when I started the question was, what we’re seeing in the news now… I think it was Nike that gave a week off to their employees. And there’s an organization here in Indianapolis that gave a day off. But basically what you’re saying, I mean, yeah, it’s nice to have that time off. But for the people who aren’t, I guess, experiencing the stress issues, it’s an extra vacation if they have the whole week off. But somebody who’s really having some difficulty, it might not be providing exactly what they need, right?

Dr. Chris Bojrab:
Yeah, exactly. One of my biggest struggles with this is maybe I’m a bad psychiatrist because I always try to…

Candee Chambers:
No, I don’t think that.

Dr. Chris Bojrab:
But I try to take the employers perspective into account because I’m a business owner myself. And I think we pay an awful lot of attention to culture. And with the size of the organization as we are, it works for us to be very flexible. So in terms of time off and things, we don’t have really hard boundaries or strict guidelines. But it’s also a size of a company where this is tribal enough that there’s an expectation there that people feel like, “Man, I’m going to work really hard when I’m here, because these people really care about me and they really…” It’s like, “Wow, I had more days off last year than maybe I really should have from my contract because my kid sick so frequently. And they never said anything about that, there wasn’t a problem. So that motivates me on the flip side to do my best job for the organization that was doing good by me.”

Now that’s harder to translate into sequentially bigger and bigger companies. But I think there is this need to try to show employees that you care about them. And hopefully the expectation is that they care about the company for whom they work. But in managing those absences and managing that time off, I think there are opportunities to really make much better use of that time efficiently so that you’re going to maximize the chances that when people come back to work, they’re not going to be participating in that tenfold increase loss of productivity due to presenteeism. Well, I’m back now, but I’m still feeling badly enough that my work productivity is so poor that I’m still struggling. Yeah.

Candee Chambers:
with you though. If you show your employees that you care and you give them that extra piece of time that they need or whatever, they’re going to reward you as well by doing that extra work that you need sometimes. I had a boss like that then. I mean, all she had to do was say jump and I would say how high, because she always appreciated. And it really does make a huge difference to any employee, I think, at any level as well.

Dr. Chris Bojrab:
Yeah. I think at the start of this, I was talking to some business owners. And I think there was so much fear about, are people going to take advantage of working from home? I think that was an overriding fear. And I said, “We’re going to have this conversation again six months down the road. And I bet you that that will not be your chief complaint.” I’m like, “I bet you, at that point, your chief struggle is not going to be, how do I make sure that my employees aren’t taking advantage. You’ll be saying, how do I make sure that my employees aren’t burning themselves out.”

Candee Chambers:
Exactly.

Dr. Chris Bojrab:
Because I think this work from home thing, it’s ended that strict boundary or definition. So people are more likely to be returning emails in the middle of the night, checking things in the middle of the night, working on the weekend.

Candee Chambers:
Yeah.

Dr. Chris Bojrab:
And really, I think that’s become the bigger obstacle. It’s not so much, “Oh, are people getting things done?” It’s like, “Wow, I don’t want people burden themselves out because there’s no distinction now between home and work.”

Candee Chambers:
Well, I have to tell people that report directly to me, “I thought you were on vacation, get off of slack.”

Dr. Chris Bojrab:
Yeah.

Candee Chambers:
Or, “Why are you emailing me, go on vacation,” or whatever. Or then I’ll say, “You know what? Do not count this as a vacation because you’ve worked almost all day. So you can take another day.” I mean, I have to tell them stop. So it’s been interesting. Just a couple more questions. Under the Americans with Disabilities Act, I know we all know about that, you can’t discriminate against somebody for having a disability, and that does include mental illness. And that means that you can’t fire an employee or reject them for a job or promotion, or force them to take a leave because of their mental illness.

But you also don’t have to hire or keep people in jobs that they are not able to perform, or employ people who are a direct threat to safety. And we get a lot of questions about that. And it’s one of the things with a human resources background, like I have. You can still counsel a person if they have various issues based on their disability. There’s a lot to unpack with all of that. Where do you, or do you get involved with that? Where do you begin with that?

Dr. Chris Bojrab:
Yeah. And as you were saying that, I was just thinking I might have to reach out and ask you to come be a speaker at some point at one of our conferences, because I was thinking, “This is something that as physicians, as healthcare workers, that we are not well trained in.”

Candee Chambers:
Oh, okay.

Dr. Chris Bojrab:
Unless you’re doing occupational health, it’s very hard for us. I mean, we’re aware of HIPAA laws and we’re aware of the Americans with Disabilities Act, but I think one of the things that most of us struggle with is, if this person is off because of this condition, how long does that go on? How long can they be off? Because obviously you don’t want people being discriminated against because of the present of the medical condition. But on the flip side, if this person is in an important high level position that the company really needs to function, and the person has a medical condition going on that’s going to take them out of service for three to six months, is it reasonable to expect that that job just going to be there waiting for them when they go back?

Candee Chambers:
Oh yeah.

Dr. Chris Bojrab:
In a perfect world, yes, but that’s not good for certainly the health of the company or the health of the economy. So, I think getting healthcare providers who are filling out these forms to be cognizant of that and of the impact… Because the thing is, we all worry about our patients. We all worry about the patient in front of us, and we want to act primarily in their best interest, which is appropriate. But at the same time, there has to be some balance there to say, “Well, listen, we have to live in the real world.” And I get a little uncomfortable if I have a patient and I’m like, “I’m not sure what they’re doing with this time off.” It’s hard for me to assess. And I worry sometimes that the employer thinks I have some magical insight into what’s going on, when a lot of times I’m seeing a person for a 15 or 30 minute snippet of time, at best maybe every eight weeks and I have no idea what they’re doing the other 99.99999% of that time.

Candee Chambers:
Go ahead.

Dr. Chris Bojrab:
So I don’t feel well qualified to be able to comment on, well, are they ready to go back, what needs to change for them to go back? And it’s like, “Wow, you either somehow need to find a way to reimburse me to spend more frequent episodes of time with the patient, or much longer periods of time.” Or we’re missing a piece of the system to say, “Well, how can I rely on this person that’s just seeing them for this snippet of time?” Yeah. I’m pretty smart, I’m not psychic or magic. So I don’t always know that I’m providing the best feedback to help people managing employee absence or presence. I don’t always know that I’m providing the best information that would really be helpful for them.

Candee Chambers:
Well, and it’s I think much more difficult with a mental health type illness, because it’s not like a person… I had a car accident a few years ago. I was in a wheelchair because of a broken tibial plateau and I had to have it for six weeks. But I could still work because it was just my knee. And I had a broken wrist, but I could still think and work and… You know what I mean? And it’s not like, “Okay, in six weeks, you’ll be fine,” with a mental health illness because you don’t know what maybe is causing some of those issues. If it’s depression, for instance, is it the workplace? Is it a coworker that they can’t stand? I mean, you don’t necessarily know right off the bat. I would imagine it’s hard to know when that person would be able to go back to work.

Dr. Chris Bojrab:
Yeah. And I think sometimes they look towards the physician to be the person that they want to hear from most when completing those forms.

Candee Chambers:
Oh exactly.

Dr. Chris Bojrab:
Because they’re viewed reasonably as the head of the healthcare team. But honestly, oftentimes what I’ll put on the form is please reach out to their therapist. Because of my schedule, maybe I’m seeing this person 15 minutes every eight weeks or 12 weeks, but they’re meeting with the therapist for an hour every week or two.

Candee Chambers:
That makes a lot of sense.

Dr. Chris Bojrab:
So they’re going to be in a much better position actually to tell you how this person is functioning on a day to day basis, or to have some standardization. I mean, this is my obsessive compulsive fantasy, is that we bring together healthcare people and HR directors and come up with some more standardized way that’s reasonable of assessing level of function and tracking that over time. So it’s not just, here’s the form you fill out when you go on leave, give us a new form every two weeks or every 30 days or over however long, and then here’s the form you fill out when you’re ready to go back. I think it needs to be a much more ongoing dynamic process so you can be looking at the chain. I mean the worst case scenario is, somebody’s been off for six weeks or six months, and then you find out you’re really not that much better and we’ve wasted all that precious time that we had where we could have done something more with a different type of intervention.

Candee Chambers:
Wow. You’ve provided a lot to think about. I’m going to recommend that. I think all of the… especially my leadership friends, listen to this. We’ve covered a lot of ground today, Chris. This has been wonderful. Do you have anything remaining that you think we should hear about mental health or that you’d like to mention?

Dr. Chris Bojrab:
Again, just that I really have been pleasantly surprised with the sensitivity and the awareness that most employers have had about this. Honestly, I think if you were to ask most of us, most of us would not have thought so charitably about how employers view this. And this was my experience on the round table too. It was like this is really refreshing. I mean, here I thought I was going to have to be the one pulling people begrudgingly into, “Oh yeah, we got to listen to the shrink a little bit and pay attention to these mind things.” And really far from it, it’s like, “Oh my gosh.” I feel like all the employers are being more mindful of this than some of our colleagues are.

Candee Chambers:
Oh, God, we do.

Dr. Chris Bojrab:
So, I do think that’s great. It’s one of those shocking areas of kindness that we’re lacking right now.

Candee Chambers:
You know what? I think truly that that’s what makes us a little bit different, our membership organization. And I think people come to direct employers just for a large part because of that. And we’re very customer service oriented, we’re very employee oriented. And I think that shows. So that makes me happy. So thank you for that. Before we end, we do this every podcast, we’d like to close out every single one of them with five rapid fire questions. So I’m going to give you a topic or a question, and I want you to say the first thing that comes to mind. So are you ready?

Dr. Chris Bojrab:
All right.

Candee Chambers:
All right. Where do you derive your inspiration?

Dr. Chris Bojrab:
Well, been having a conversation that we’re having right now, that I have a particular patient that flashes into my mind. This is a woman who lives with an illness called Schizoaffective disorder, which is a combination between schizophrenia and bipolar disorder. Meaning that she’s subject to having really significant mood swings, between episodes of profound depression and then sometimes escalating up into mania, and that she lives with fairly constant psychotic symptoms. She hallucinates, she has delusional thoughts. This woman works in a company where they work their people pretty hard. She has gone through periods of time where they’ve had unbelievable mandatory overtime requirements where she’s worked seven days a week for long stretches of time, or six days of work. And I frequently have had conversations with her saying, “I’m concerned about you. I don’t know how you can keep this up. I worry at times that it affects your ability to manage your health.”

And I think of all the people that I have, for whom I’ve helped fill out disability form or something… And I’ve had this conversation with her and she won’t have it. Work is important to her and she enjoys working, that’s a big part of who she is. So every time I’m feeling overwhelmed or stressed, I think about her and I think, “Oh my gosh, look at all the challenges she has and her degree of stick-to-it-ness.”

Candee Chambers:
Sticking to it…

Dr. Chris Bojrab:
Exactly.

Candee Chambers:
Wow.

Dr. Chris Bojrab:
Yeah. So, patients in those kind of situations. When you spend all day talking to folks that have such different types of stress and such different experiences and not all the resources that some of us are lucky enough to have, that’s one of the things that keeps me going.

Candee Chambers:
That’s neat. You should share that with her.

Dr. Chris Bojrab:
Yeah.

Candee Chambers:
So what is one important skill that you think everyone should have?

Dr. Chris Bojrab:
Oh, if I had the magical ability to give everybody on the planet a specific skill, it would be critical thinking.

Candee Chambers:
Oh, that’s good.

Dr. Chris Bojrab:
I think the absence of critical thinking is driving a lot of the difficulties that we have in our culture right now. And because the internet for better or worse provides all kinds of information-

Candee Chambers:
Exactly…around critical thinking…

Dr. Chris Bojrab:
Yeah. And so really now the task isn’t. It used to be that universities were where all the books were, right? And so people went to universities because that’s where all the books were and that’s where all the knowledge was. And now everybody has in their pockets the veritable Library of Alexandria. So it’s no longer about access to information, it how do you curate it and how do you assess the information, and is there any difference between.

Right. So just how do you evaluate all of this information and how do you learn to rely on the right experts. Boy, I think that would cure a lot of ills.

Candee Chambers:
All right. I had an attorney on the phone with me one time on behalf of a member of ours, with an OFCCP, office of federal contract compliance officer. And I was explaining the regulation to the attorney and he said, “Candy, I honestly didn’t know that.” And my daughter is an attorney as well. And I said, “Well, she said that a lot of times attorneys will just Google something.” And he goes, “Oh yeah.” He said, “I do.” I was like… You know that face palm emoji?

Dr. Chris Bojrab:
Yeah.

Candee Chambers:
I was like, “Oh my gosh, how do you do that?” He said, “Yeah, I rely on my paralegal.” I thought, “Oh, geez.”

Dr. Chris Bojrab:
Yeah.

Candee Chambers:
So, yeah. I like that critical thinking. That’s brilliant. Okay. So for Dr. Bojrab, vacation or staycation?

Dr. Chris Bojrab:
Oh, vacation. At this point in history, vacation. I mean, I think all we’ve had at best is staycation the past couple years.

Candee Chambers:
Exactly. And staycation all idea is keep working, but at home.

Dr. Chris Bojrab:
Yeah.

Candee Chambers:
Oh gosh. Okay. Coffee or tea?

Dr. Chris Bojrab:
I don’t have a Ted Lasso opposition to tea, but I still got to come down on the side of coffee, and strong coffee. Nothing worse than weak coffee.

Candee Chambers:
I agree. All right. No, this could make it or break it for you. Being an Indiana native, IU, or Purdue.

Dr. Chris Bojrab:
Oh, see, now you’re just trying to get me in trouble. So, I’m a Wabash grad, so that would be my write-in vote. But my wife went to IU.

Candee Chambers:
Yes.

Dr. Chris Bojrab:
And most of my family members have. But my daughter is currently a Purdue student.

Candee Chambers:
Oh geez.

Dr. Chris Bojrab:
And I will say both myself and my wife have been really impressed with a lot of the things that have been done at Purdue over the past several years. But in my heart of hearts, if I had to pick one, I’d still have to say IU.

Candee Chambers:
Well, you know what? And I’ll give you that. It’s funny you should mention Wabash, because I think several people on Jordan’s team here are Wabash grads. Three of them are Wabash grads. I’m sitting here talking with you in an IU quarter zip right now. And we have about 85 employees and we are literally split, almost 50/50, on IU and Purdue. So that was good. So, all right. Well, thanks a lot Chris. And really thank you for joining us so much. We really appreciate it. Sharing your knowledge and your insight on the topic of mental health has been important to all of us. With so many unexpected challenges thrown at players over the last year and a half, this is certainly something that requires a lot of special attention and careful consideration, and businesses both large and small. And if our listeners would like to connect with you, what’s the best way to get in touch with you?

Dr. Chris Bojrab:
Probably the best way is through our practice, Indiana Health Group. You can just Google that, or it’s IndianaHealthGroup.com, or I also do have a website that’s just my name with MD at the end, so ChrisBojrabMD.com. And everything is there linked together to reach me or to get to me through there or the practice.

Candee Chambers:
Well, I’m going to spell your last name, because the reason why I was hoping the first time I had met you that I could call you Chris was because I wasn’t sure I’d remember how to say Bojrab. But it’s B-O-J-R-A-B. And honestly, Chris, this has been wonderful. I’ve really enjoyed our conversation today. And again, you’ve added a great deal of value to our work here at DirectEmployers. So thank you so very much.

Dr. Chris Bojrab:
Well, thank you. I really appreciated the conversation, and hope we can continue in some way.

Candee Chambers:
I do, too. Thanks again.

Thank you for tuning in for another episode of the DE Talk Podcast. Stay connected with DirectEmployers on Facebook, Twitter and LinkedIn and subscribe to our emails by visiting DirectEmployers.org/subscribe to receive notifications of new episodes each month.

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