Why suicide prevention must figure in your employee assistance program

With the rising amount of stress we face in our daily lives, the workplace has become a crucial space for suicide prevention. In this article, the second in a series of four on preventing suicide at the workplace, Sriranjitha Jeurkar explore how organizations can prevent suicide and offer support to employees who may be vulnerable. 

Most workplaces have an Employee Assistance Program (EAP), or an employee health plan – a program that is designed to offer medical support for their employees. A mental health program or a suicide prevention program can be integrated with the EAP. Given the stresses of jobs today, all employers must realize the need to include mental health in their health policies. However there are some organizational scenarios, as per mental health experts, where the inclusion should not be optional, but an absolute must. Some important factors that may indicate potential risks or vulnerabilities are:

• The nature of the industry: What kind of work is carried out, and in what atmosphere? How stressful are the tasks that the employees are required to do? How high are the risks involved in their daily tasks?
• The profile of the employees: Where do they come from? Have they had to make significant adjustments to fit into the company (moving cities, staying away from family, etc)? What are their strengths and weaknesses?
• Cultural and ethnic diversity: Are there some employees who have to try harder to fit into the culture? Are any measures being taken to help them feel welcome?

Each organization’s suicide prevention program, which has to be created in consultation with mental health professionals, will need to be customized keeping these and other specific organization-related factors in mind.

Experts recommend that an efficient suicide prevention plan, created as a part of the EAP, should address some specific aspects:

1. Stigma reduction

The more stigmatizing a condition, the less likely it is that a person who suffers from it will speak up and reach out for help. With suicide and mental health, the stigma is so strong that people are wary of talking to others about their problems. It’s because of this that stigma reduction is ideally the first and most important aspect of any suicide program.

Including the mental health or suicide prevention plan into the EAP helps reduce stigma around mental health issues. This, in turn, increases the chances of a person reaching out for help when they need it. Incorporating the mental health program in the organization’s health scheme offers several advantages:

• Mental health support can be included in the annual health check-ups by including mental health assessments, or discussions with a mental health professional. This helps in identifying individuals who need help, or are vulnerable (to mental health disorders in general and suicide in particular).
• Having access to an in-house mental health professional, just as the organization would have a doctor-on-call, ensures that employees can easily access care when they need it. It also gives employees an idea about what mental healthcare facilities will be available to them should they need it.
• An employee mental health support plan also enhances the coping skills of the employees, reduces vulnerability and prevents suicides by addressing stresses such as work pressure, competition, workplace conflicts, or other issues that affect their wellbeing.
• A clear confidentiality agreement (as would be present in any health assistance program) gives employees a sense of safety.
• By communicating that mental health issues are not vastly different from physical health issues, the employer reduces stigma associated with mental health issues and encourages employees to seek help.

The organization can also encourage employees to speak up about any mental health issues they have faced, and share how they were able to overcome them, as a way of communicating that mental health issues are not taboo, and employees will not be discriminated against if they speak up.

2. Sensitization programs

For employees to have the confidence and trust to reach out, it is important that an organization has a sensitization module for managers, team leaders and top executive officers. Such a program helps the overall mental health program be more effective in terms of maintaining confidentiality and reducing stigma.

Employees are also reassured when managers or executives from the higher levels share their own experiences relevant to mental health, and particularly suicide. Open discussions about how suicidal thoughts and tendencies are a cry for help, makes employees more willing to report their own troubles, and trust that they will be received in a non-judgmental way.

3. Creating awareness

Programs can be designed to bring mental health and suicide prevention into conversation at the workplace. This could include fliers, posters, lectures, discussions, movie screenings, or other activities around the theme of mental health or suicide prevention. Encouraging more open communication is likely to indicate to employees that it’s perfectly okay to speak about mental health.

It is also important to address common myths about suicide: that a person who has suicidal thoughts is weak, or does not want to live; or the misconception that asking a person if they have suicidal thoughts can make them attempt suicide.

4. Recognizing persons in distress

Mental health experts say that suicide doesn’t happen all of a sudden. There is usually some event or phase that makes a person think of attempting suicide. When the organization is able to identify persons in distress, it can act to ensure that the person receives whatever support is needed to help them cope.

Having gatekeepers in the organization can be an effective way of recognizing employees who are in distress. A gatekeeper is a person (who does not necessarily have to be a mental health expert) who is trained to watch out for signs of distress, provide initial emotional support and refer the person to a mental health professional for additional help. The organization can train its employees to be gatekeepers, and in doing so, create a wider network of people who will be able to pick up red flags, or signs of distress. Nimhans Centre for Wellbeing conducts workshops to train people in gatekeeping.

The program can also provide information relevant to gatekeepers, that helps them support their colleagues, if necessary:

• Practical and helpful information for gatekeepers: If they discover that a colleague needs help, what do they do next? Whom do they inform? What help is available to the employee?
• Other information addressing the gatekeepers’ possible concerns: What are the gatekeeper’s obligations? What can the gatekeeper do when they feel overwhelmed? What support is available for the gatekeepers? What are the limitations that a gatekeeper needs to be aware of?

5. Crisis Management

The organization must have in place, a protocol or recommended action plan for crisis situations – what can be done when a person is identified as being in distress? What plan can be followed when someone seems to be in a vulnerable state or reaches out for help? What can be done in the event of an actual suicide?

6. Referral system and follow-up services

An essential part of any mental health or suicide prevention program would be to have on board a part-time or full-time mental health professional who employees can contact when they need support. This professional is usually available for consultation, and can refer employees to additional support if necessary. They can also assist the organization in identifying the more vulnerable groups, or persons in distress and make sure that they can avail help as early as possible. The organization can also tie up with the EAP care provider to include a mental health professional in the EAP system.

The employer can clearly provide information (in the form of posters, handouts or prominently displayed notices on the intranet; or discussed during manager-employee or employee-HR meetings) about mental health and suicide prevention support that are available to the employees. This will empower employees who have suicidal thoughts to reach out and seek support.

7. Confidentiality clauses

An employee who wants to ask for help may hesitate to do so because they are worried about how discreetly or confidentially their case will be managed. The suicide plan should feature

Confidentiality clauses that address the employees’ concerns: Who will the employees’ personal information be divulged to? On what grounds will the information be shared? If an employee reports a mental health issue or suicidal thoughts, how will it impact their position or their job security?

Accurate information on these will reassure employees that their organization cares about them, and that the information will be handled with due sensitivity, and that they will not be discriminated against for their mental health issues. This makes them more likely to ask for help when they need it.

8. A module that addresses the concerns of vulnerable groups

Some of the vulnerable groups in an organization may include:

• Employees who suddenly exhibit a change in their work patterns (Eg., drop in efficiency, punctuality or quality of work)
• Employees who are under threat of being fired or having to cut down on their job responsibilities and/or pay
• Employees who have migrated from their hometowns, and have trouble fitting into the system and may feel threatened by the environment
• Employees who are in financial or emotional distress, irrespective of whether the cause of distress is directly related to their employment.

Organizations in which employees face exposure to factors that increase vulnerability (violence, in the case of the armed forces or security), or access to means of suicide (pharmaceutical companies, or those which use heavy machinery) will need to take these factors into account while creating their plan.

9. Action plan

In order to be effective, a suicide prevention program must have a specific action plan. This includes:

• The list of activities that are part of the suicide prevention plan
• Names of employees from within the health, HR or other departments who are responsible for executing each activity
• A timeline of activities for each year
• Specific resources allotted to the activities, so that the department executing each activity can function independently, without paperwork delays in crisis situations
• A system of monitoring the impact of the plan: ensuring that the activities are planned out in time, and to evaluate how efficient or effective their performance is.

This series has been curated by White Swan Foundation with inputs from Dr Gururaj Gopalakrishna, head of the department (epidemiology), NIMHANS; Dr Prabha Chandra, professor of psychiatry, NIMHANS; Dr Seema Mehrotra, additional professor of clinical psychology, NIMHANS; Dr Poornima Bhola, associate professor, department of clinical psychology, NIMHANS; and Dr Senthil Kumar Reddi, associate professor of psychiatry, NIMHANS.