AUSTIN —  Most employers know what to do when an employee requests an accommodation for a broken leg. But when employees want to discuss mental illnesses, many in HR are suddenly at a loss — unsure what language to use, how to approach the subject or what can appropriately be done, Rachel Shaw, principal consultant and president of Shaw HR Consulting, told attendees Tuesday at the 2018 Disability Management Employer Coalition (DMEC) Annual Conference.

But employers have an obligation to get it right — for employees and for the bottom line. Between 2011 and 2030, the cumulative economic cost of mental disorders is projected to reach $16.3 trillion worldwide, comparable to the impacts of cardiovascular diseases and higher than the costs of cancer, chronic respiratory disease and diabetes, according to a study cited by Shaw. Mental disorders "are going to cost you more money" than other disabilities, Shaw said.

A good accommodation process will be able to support those who truly need help and stop those who try to take advantage of protections — but what does that look like?

What triggers accommodation?

Workers may request accommodation in ways that are not explicit or direct. Something as innocuous as an employee saying "I’m stressed" — or as clear as "my meds aren’t working like they should" — could be a quiet call for help that an employer needs to address, Shaw said.

The onus to approach is often on the employer, however. "If you see someone who is psychologically disabled, you must approach them," Shaw said. The employee may be trying to send a message, and a lack of response could make an employee feel unheard and worsen their relationship with the company.

Reaching out from an HR perspective often looks like being a good, attentive manager: "I’ve noticed you’ve been missing deadlines. Is everything okay?" The problem, Shaw said, is that many managers feel they aren’t allowed to address a potential problem due to stigma or privacy issues. HR must "be willing to be wrong" and reach out anyway; the risks of not reaching out — loss of productivity, work disruption, even terminations due to inappropriate work behavior, including violence or harassment — are high, Shaw said.

Don’t forget your EAP

Many of the issues that may prompt such a conversation can be accommodated by encouraging employees to use the company employee assistance program (EAP).

"Your EAP is your best friend," Shaw said. "It is the most important and cheapest thing you could ever do."

An EAP can go a long way in teaching employees how to cope with difficult work situations that may cause legitimate mental pain, including bad bosses or poor coworker relationships, as well as catch major mental health issues before they become unmanageable.

EAPs are especially effective for helping manage mental wellness issues. The problem is that use of such tools remains low due to a lack of knowledge in the employee base about what they are and how they can be used, Shaw said. HR may have to actively direct employees to it, when appropriate.

Tips and tricks to ensure accommodation and stop cheaters

For accommodation beyond EAP usage to be effective, employers need to keep the process specific and focused on what an employee really needs to do their work, Shaw said. A number of establishing questions should be kept in mind, including:

• Is this a mental illness or a mental health (wellness) matter?

• Is this a disciplinary issue?

• What was the trigger?

• What can an employee expect?

• What does the employee need to do?

• What will you do?

Supervisors should be taught to reach out to HR immediately regarding accommodation. Documentation can go a long way in keeping everything clear and above board, especially for cases that may involve disciplinary action.

Shaw suggested use of a medical supplemental questionnaire to get to the heart of what needs to be accommodated. The forms Shaw provided included questions for doctors like:

• Does Mr./Ms. Name have a medical or psychological impairment that limits his/her ability to engage in a major life activity, such as the ability to work, care for oneself, perform manual tasks, walk, see, hear, eat, sleep or engage in social activities?

• If yes, does the impairment currently affect Mr./Ms. Name’s ability to perform one or more of the essential functions of a POSITION as described in the job description provided?

• What work restrictions or functional limitations does his/her disability produce that are in need of accommodation?

Giving such questionnaires to employees' doctors can determine which aspects of an employee's behavior is motivated by a mental disability, if any — key to catching both hidden issues that employees feel they can't talk about and potential cheaters, Shaw said.

"Even if it frustrates you, you still have to do the questionnaire," she said. "They might be lying to you. But you'd rather find out now than during trial."

Focus on specificity, too. If the performance issue at hand is caused by a medical issue, what specifically can be done to accommodate it? Keep in mind that the point of the whole process is to get an employee back to work; constant communication will ensure everything moves smoothly.

"You are not giving them permission to perform less well," Shaw said. "It's about figuring out how to show up for that person and manage them in the right way."

Medication management plays a particular role in mental health accommodation. An employer cannot force an employee to keep up with their medication. If you have someone who refuses to properly manage their medication, you are not obligated to keep that person employed, Shaw said, but employers do have to check in with employees before acting. Medication is not a perfect science, and issues that spring up may not be an employee's fault, she added.

Just like with physical health issues, HR should keep in mind a guiding question: "How do you help people be their best?"

"Mental health matters have always been there," Shaw said. "Employers have been managing this for a long time. It’s time for us to talk about it and get comfortable with it."