The trillion-dollar taboo: why it’s time to stop ignoring mental health at work
This story is outside the FT’s paywall (you do not need a subscription to access it) so it can be shared freely.
Gabe MacConaill was working on a life-defining case. The 42-year-old junior partner at global law firm Sidley Austin had been put on the bankruptcy of a company called Mattress Firm. The process was complicated and multipronged, taking 41 subsidiaries down with it.
In the months leading up to the bankruptcy filing in October 2018, many people surrounding MacConaill noticed he was isolating himself. He closed his office door more often. His friends rarely saw him. He worried aloud to his wife, Joanna Litt, that he didn’t have enough debtor experience and would be sued for malpractice.
MacConaill stopped sleeping regularly. He stopped laughing and going to the gym. At one point, Litt suggested he see a therapist but he told her he could barely get his work done, let alone find time to start counselling. Later, later, he promised her. After the filing.
But as the date got closer, MacConaill began to break down. He told his wife that he believed his body was failing him but feared that if his bosses saw weakness, it would be the end of his career. A heart-attack scare sent him to the emergency room but he powered on, gathering his energy to fly to Delaware and file the case. He came home. Litt thought they had made it through.
A week later, MacConaill died by suicide in the parking lot of his law firm.
“So many things happened that created this perfect storm, but the slightest thing could have saved my husband,” Litt tells us in the Los Angeles home that she and MacConaill shared, her mother in a chair beside her. The house is modern and immaculate, covered in flowered vines and surrounded by lemon trees. It is up for sale. Litt can’t imagine living there without MacConaill.
Last October, she published a letter in American Lawyer magazine called “Big Law Killed My Husband”. It was shared widely within the legal world. We are sitting in her living room because Litt believes MacConaill’s story holds lessons for leaders, legislators and companies across the world. Though the causes of suicide are always complex, experts say that the 21st-century workplace can exacerbate issues that lead to it, such as overwork, burnout and depression.
Litt says that MacConaill lacked essential coping mechanisms and had an occasional problem with binge drinking. There was a history of mental illness in his maternal family line, though she had never seen signs of it in him before. But as she wrote in her letter, “These influences [were] coupled with a high-pressure job and a culture where it’s shameful to ask for help, shameful to be vulnerable, and shameful not to be perfect.”
Experts in workplace psychology overwhelmingly agree that burnout is a growing public health crisis. In December, Ryan Keith Wallace, a 27-year-old associate at a Houston law firm, died by suicide after a particularly stressful day, his death a total shock to those who knew him. “I sit here and blame myself every day and wonder what I lacked as a wife to not help him,” says his widow, Kyrie Cameron. “But the truth is he was just so happy until he felt that pressure. It seemed like work was at least the trigger for him.”
Cameron, who is also a lawyer, believes that her husband’s perfectionist personality and fear of failure was so daunting to him that he didn’t feel he had another way out. “Our profession has lost perspective,” she says. “We think being a lawyer defines us. That success means being the highest- billing, highest-earning, most productive person there at the expense of taking care of ourselves. That we can’t show vulnerability or reach out for help.”
Fields such as law, finance and consulting seem particularly prone to intense, demanding workplace cultures but the issue affects people in all sectors. One doctor dies by suicide every day in the US. Stress, depression or anxiety account for 44 per cent of all work-related ill-health cases in Britain, and 57 per cent of all working days lost due to ill health, according to the government’s health and safety executive.
When the FT set out to investigate this issue, we asked readers to describe how their employers handle mental health issues, including stress, burnout, anxiety and depression. More than 450 people responded from 43 countries. Although they were a self-selecting group, their responses were significant: the majority felt unsupported, alienated or discriminated against on the basis of their mental health. Two-thirds believed their work had a somewhat to extremely negative effect on their health, and 44 per cent said they did not think mental health was taken seriously by their organisation. Half said they either didn’t know where at work to go, or had nowhere to go if they needed support.
Even as many companies strengthen their policies to close the gender pay gap and end sexual harassment, mental wellbeing often remains an afterthought. “This is not about buying Fitbits for employees and teaching them deep breathing so we can pile on more work,” says Donna Hardaker, a workplace mental health specialist at Sutter Health, a not-for-profit healthcare network. “You must address the micro and the macro. There is a deeply entrenched cultural idea that workplaces are fine; it’s the employees who are the problem. But employers have a social responsibility to not be harming the people who are working within their walls.”
A failure to support employees is also costing companies a fortune: an estimated 615 million people suffer from depression and anxiety and, according to a recent World Health Organisation study, this costs an estimated $1tn in lost productivity every year. Companies that do not have systems in place to support the wellbeing of their employees have higher turnover, lower productivity and higher healthcare costs, according to the American Psychological Association. They also face significant legal risks.
According to friends, colleagues and family, Gabe MacConaill was a warm, generous person with an infectious laugh and time for anyone seeking mentorship. “He would make you feel like you were the smartest person on earth, and that you had come up with every solution,” says one former colleague. (Many former colleagues who spoke to the FT requested anonymity to protect their job prospects.)
Litt believes there were clear moments in MacConaill’s last few months when a proactive corporate mental-health strategy could have made a difference. In early 2018, his bankruptcy team lost two senior partners, mentors whom he had often gone to for advice. Called by former colleagues a “natural born leader” and “the obvious choice”, MacConaill took over to unofficially lead with little support above him.
In the summer of 2018, MacConaill took on the debtor side of the Mattress Firm bankruptcy. Colleagues say MacConaill was not passing work down to associates on his Los Angeles team despite the case’s complex nature. Some thought this was an edict from the top, though one person close to Sidley Austin’s senior management suggested MacConaill may have wanted to file more billable hours to prove his value.
Shawn Luna, a former colleague of MacConaill’s at Sidley Austin who recently left big law for a government role, describes working at Sidley Austin as stressful “because everything was an emergency, and there’s tons of money at stake. The biggest culture shock after I left was the ability to shut it off. I had weekends; it blew my mind.”
When the FT approached Sidley Austin for comment on MacConaill’s case, the firm offered an interview with Dan Clivner, managing partner of Sidley Austin’s Los Angeles office and a representative for the firm. Clivner tells the FT that the firm is still grieving the loss of MacConaill.
He says MacConaill did not go to any of his senior partners about his mental health or workload, and that for Sidley to be able to provide support, an employee would need to be willing to ask for help. To illustrate his point, Clivner references his own personal struggle at the time: his husband had terminal cancer, and the firm was supportive of his needs.
“When you call in with something like cancer or stress, in a discreet and professional way the firm will respond,” he says. “On the first day of every orientation that I’ve done for decades, I say, ‘You have to raise your hand.’ In a place like this, you have to be able to say, ‘I haven’t done deals, I’d like to do deals,’ or ‘I’d be interested in travel,’ or ‘I’m overworked.’ You have to trust somebody.”
One former colleague believes that after the departure of MacConaill’s two mentors, “I just don’t think there was anyone left at work that he could have gone to with that level of stress.”
A week before the filing, MacConaill called Litt from work and said he thought he was having a heart attack. At the ER, his initial results came back showing normal vitals but severe dehydration. “We’re leaving,” he told her, before the doctor was able to see him. Dehydration could be fixed, and he had work to do. They went home before he was fully reviewed.
That evening, Litt called one of MacConaill’s close colleagues. “I said, ‘My husband’s in crisis. What do I do?’” she remembers. “And she told me, ‘I don’t know.’ I said, ‘Who do I call?’ She said, ‘I don’t know.’ ” Litt arranged a mobile IV to come to their home, give MacConaill fluids and prepare him for the final stretch of the case. He then flew to Delaware to file. When he returned to LA, he called in sick from work, stayed at home and stopped answering his work emails.
On Sunday morning, MacConaill told Litt he was going into the office. A few hours later she received a call from Clivner. They had found MacConaill’s body in the Sidley Austin parking lot, next to his car.
The day after his death, the firm sent out an email to inform global employees. A week later, they organised a luncheon to reflect on his life, which Litt, her mother and nearly the entire LA office attended.
Despite these efforts, Litt is still angry. In the months since, she feels Sidley Austin’s response has been minimal. “The two managing partners of the bankruptcy division did not call me, email me, send me a letter,” she says. “I still haven’t heard from either partner. I also didn’t hear from the slightly senior partner who Gabe was working Mattress Firm with. None of them.”
Sidley Austin stands by its actions as appropriate. “Simply put, I’m exceptionally proud of the way the firm handled the announcement and communication of his death without stigma, without embarrassment, without hiding it,” says Clivner. “They don’t teach you this in law school and for myself personally, and for the firm, we did it right.”
In the months since MacConaill’s death, a number of employees have left Sidley Austin’s Los Angeles office, according to people with direct knowledge of these departures. Some colleagues told the FT that they thought that the firm’s leadership did not respond sufficiently in the wake of MacConaill’s death. They felt there was no clear commitment to support employees who, like MacConaill, found Sidley Austin’s demanding corporate culture an unwelcome environment in which to raise a hand.
“There are resources available, of course,” says a former colleague. “But there is not a culture or feeling of safety right now in that set of offices. You can have resources in place, but unless you have the right culture, people aren’t going to feel safe using them or approaching someone to ask for help.”
Asked if the firm has taken longer-term mental health measures in response to MacConaill’s death, Clivner says no. He points to initiatives the firm already had in place, from generous insurance coverage for mental health to anonymous hotlines and wellness programming, which includes serving fresh fruit and encouraging fitness.
“Our programming is better attended, because [MacConaill’s death] hit home,” he says. “We have a resiliency programme but people were busy with their daily lives. Today they’ll go.”
Many of the themes in MacConaill’s story were also prominent in the responses from FT readers. People shared concerns about four big issues: overwork, cultural stigmas, pressure from the top and a fear of being penalised. We contacted several respondents to understand the recurring problems. Some agreed to speak on the record; others asked to use their first name or a pseudonym.
Sarah Bertram joined the trading floor at Citigroup in London in June 2012. She was fast-tracked up the ranks, from a Women of Tomorrow programme to a trading internship to a full-time job as a sales analyst. “I thought, this thing called the trading floor sounds pretty great. You’re out with clients. It’s fast-paced. It’s like the films,” she says. “And I loved my first year. It was exciting and there was a huge learning curve.”
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After a few years, however, Bertram received a frightening health diagnosis, and the competing pressures of work and health left her in a cycle of stress. “Being out late with clients and getting limited sleep may have contributed to my poor health diagnosis,” she says. “It became this perpetual cycle of not sleeping, then worrying about not hitting my targets and not getting paid or promoted . . . It was draining me. I wanted to learn and grow but I just felt like a hamster in a wheel.”
One morning, Bertram collapsed before work. She never told her boss. “I look back at pictures of myself from that time and I look half-dead,” she says. “I’d lost so much weight. I was grey. I thought, surely somebody noticed this and should have spoken up. But I think that side of management was neglected. They might check in if you are underperforming but because I was still doing OK, no one seemed to care.”
Citi says it has implemented significant changes since Bertram left in March 2017. “We regret the experience that this former colleague had while working at Citi and we endeavour to do much better,” says Lori Zimmerman, Citi’s global medical director, in an email to the FT.
“We continually strive to understand challenges that our colleagues face and we make the physical and mental wellbeing of each colleague a top priority. In particular, we’ve enhanced mental health resources and support available to our colleagues in a number of ways since 2012 and are always looking for ways to further expand these offerings.”
Many experts point to overwork as being at the heart of the mental health crisis: employees are expected to be available 24/7 to answer emails across time zones and respond to demanding clients. In his book Dying for a Paycheck, Stanford professor Jeffrey Pfeffer posits that this crisis is getting worse over time, amid stagnating wage growth and an increasing reliance on the gig economy. “We are on a path that is completely unsustainable,” Pfeffer says. “The CDC [Centers for Disease Control] tells you that chronic illness is 86 per cent of the $2.7tn US healthcare spend. Many come from stress-related behaviours. If you’re going to solve the healthcare cost crisis, a piece of that solution has to go through the workplace.”
Studies show that burnout is a characteristic of employees who care the most about their work. Like Bertram, Wallace and MacConaill, these are often not an employer’s worst employees but their best. “These are the people who are so committed to you that they don’t know when to stop,” explains Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions and a leading advocate for mental health.
Bertram left finance for an MBA at London Business School. She now runs mental health awareness initiatives based on her experience. She describes leaving as the hardest but best decision she has ever made; although she excelled, the costs of continuing felt too high. “To these big organisations, I was a top candidate. I was a woman, driven to succeed, and would have loved to climb my way up a big corporate. But I don’t want to sacrifice what I would have to of my mental health to do that.”
In workplaces across the world, senior managers are often unreceptive, or even hostile, to conversations about mental health. Many FT survey respondents who did tell managers about their issues felt they were discriminated against or given less meaningful work in response.
Tim Clayfield was an employee of Dow Chemical in Switzerland for nearly 30 years as a senior scientist in plastics and rubbers. As is often the case, his bout with depression was triggered by a personal circumstance (a divorce) and exacerbated by work.
After his marriage broke down, Clayfield began taking antidepressants in the spring of 2015, but did not feel comfortable mentioning it to his colleagues or superiors. As he adjusted to the medication, he missed a few deadlines. He remembers staring at his computer screen, unable to concentrate, not knowing where to start.
The closest Clayfield got to opening up was in 2016, when he told a senior colleague in passing that he had been sitting at his computer in tears earlier that day. He remembers the response with piercing clarity: “You know, my father used to tell me, ‘Stop crying or I’ll really give you something to cry about.’ ” In that moment, Clayfield felt there was no place for him at Dow Chemical.
This period of difficulty put Clayfield behind in Dow’s employee ranking system — in which one bad year can follow you for several — until, as he puts it, “I just burned out.” He left his job in 2016.
“I think if I had been offered three months off to get myself better, or a bit more empathy, I could have held it together and been a productive employee of that company again,” he says. “And I know that if I’d had a physical ailment that could heal, I would have been offered all the time and support I needed.”
In an emailed statement, Dow Chemical says: “Dow is committed to promoting a healthy workplace for all our employees, offering a breadth of programmes and services that are inclusive of physical safety and mental wellbeing. In Switzerland, we offer a holistic programme that ranges from healthy food options to Employee Assistance Programmes where employees can confidentially work with experts to address the stresses that can impact their work and/or personal lives.”
Eva (not her real name) was a long-time senior partner at a law firm in London who suffered a significant personal trauma. A self-defined workaholic who loved her job, Eva jumped back into 12-hour days. After three years, she burned out. She describes it not as depression but as debilitating exhaustion. She felt a brain fog. On some days, she was unable to get out of bed.
Eva’s firm offered her several weeks of leave. On return, she recalls senior management telling her that they felt uncomfortable with her being alone with her team. Her therapist wrote a memo to say she was fit to return to work and have normal interactions but she was kept at arm’s length.
“It was just awful,” she says. “What you don’t know is much worse than what you do. You start overthinking everything.” It became a cycle; Eva took more time off, and upon each return faced more barriers. She feels that her firm’s public commitment to mental health was not sustained behind closed doors.
“It’s easy to look good and be seen doing the right things,” she says. “You can offer in-house counselling and wellbeing seminars for the easy cases. But also having the proper infrastructure in place for the more complicated cases is essential.”
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Eventually, the firm asked Eva to leave. She brought in a lawyer and they settled out of court. As part of the settlement, she signed an agreement that concealed her claim. A number of people we spoke with suggested that the use of non-disclosure agreements in mental health discrimination cases is on the rise.
The pressure on individual employees to disguise any sign that they are struggling can reflect a broader pressure on an entire business to outperform — from shareholders, directors or private owners. Jonathan (whose name has been changed) is the chief financial officer of a subsidiary of Acadia Healthcare, a publicly traded multinational mental health company.
Acadia treats a wide range of mental health issues, from acute inpatient psychiatric cases to outpatient therapy, and operates in the US, UK and Puerto Rico. Jonathan responded to the FT’s callout not because of a personal mental health crisis but because of a visceral discomfort with how little support his own company provides to its employees.
“Ironically, mental health takes a back seat at one of the world’s largest mental health companies,” he says. “I feel like my skillset has stalled, my career growth has stagnated and my health has declined.”
Jonathan has a unique perspective as CFO, where his biggest moral struggle is that appeasing his parent company and its shareholders is often at odds with patient care.
“As CFO, I’m very concerned with our financial position, but my office is next door to one of the [inpatient] units. I can hear everything,” he told the FT. “So which master do you serve? Do you serve your boss, who has control of your job, or do you serve what you think is the morally right thing to do? There’s not really an outlet to talk about that.”
As is common in many American companies, Jonathan’s hospital offers new employees just 10 days of paid time off a year and the baseline health insurance required by law. “I’ve never heard anyone actually say that we should be aware of our mental health, or that someone is available to talk to,” he says. “And people are burned out. They don’t know where to turn. They don’t know how to navigate their benefits. It just floors me.”
Acadia did not respond to multiple requests for comment.
Only 16 per cent of respondents to the FT survey who received health insurance through work felt that their benefits were as good for mental health as for physical health. In America, this is against the law, thanks to former US Congressman Patrick Kennedy, who passed the Mental Health Parity and Addiction Equity Act in 2008. Kennedy’s advocacy for mental health stems from his own struggles with addiction and bipolar disorder.
According to the Parity Act, insurance companies cannot discriminate by imposing higher co-pays, higher deductibles or lower lifetime caps on mental health claims. But the country’s biggest insurance companies often violate the act egregiously, and when they are found guilty suffer tiny penalties.
Meiram Bendat of the US law firm Psych-Appeal, which specialises in mental health-related cases, says that insurers and big corporations often work together to deny services to patients with mental illness. Because symptoms are less measurable than in physical illness, they use the grey area to pay less in claims, keeping their costs and premiums down. “If you show up to a hospital and you’re bleeding out of your leg, that’s easy to see. But if you show up to a residential treatment centre and you’re bleeding out of your soul, that’s harder to physically assess,” says Bendat. “It’s easier to discriminate.”
In early March, he co-led a case against a subsidiary of UnitedHealth Group, the largest healthcare insurer in the US. A federal court in California ruled that United had unlawfully denied mental health and substance use treatment to approximately 50,000 insured clients. It may set a new precedent and force insurers to take the Parity Act more seriously.
Kennedy tells the FT that unless top executives across America start ordering their heads of human resources to ensure their insurance providers respect parity laws, there will be more lawsuits. “I know that the only thing that often moves people anywhere, whether it’s Wall Street or Silicon Valley or Washington DC, is the threat of liability.”
In 2013, Canada became the first country in the world to have a national standard for workplace psychological health. Overseen by the government-funded Mental Health Commission, it gives companies a step-by-step methodology for building a psychologically healthy workplace — from finding a senior leader to champion the cause, to measuring the outcomes of new initiatives.
“Every organisation will implement this differently,” says Donna Hardaker, who was involved with the guidelines and is working to introduce the approach in California. “The idea is that we must address issues systemically. This is not a one-off. We can’t just have one workshop and say, ‘OK, we’re good on this.’”
Companies around the world have tried radical things to improve employee mental health. Some employ on-site therapists. An insurance company in New Zealand tested a 32-hour workweek and reported lower stress and higher staff engagement. In Germany, Volkswagen set its internal servers to not route email to employees between 6.15pm and 7am. Under France’s “right to disconnect” law, if an employee is not reachable by smartphone outside work hours, it cannot be considered misconduct. But most experts believe there is still a long way to go.
Poppy Jaman, CEO and programme director for the City Mental Health Alliance in London, says that for a workplace to improve, employee mental health must be baked into a company’s metrics. “What is the big hairy goal number around wellbeing that goes to your board, which will have an impact on your bottom line?” she says. “[Until] this becomes a boardroom agenda, it will never be a priority.”
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António Horta-Osório, CEO of Lloyds Banking Group, has become an evangelist for fighting the workplace taboo around mental health. In 2011, he checked himself into a hospital with stress-induced insomnia and was off work for two months. Since his return, he has aimed to make Lloyds a model for mental wellbeing. “What we are trying to do now is to make a call for other companies to also lead by example to break this taboo,” Horta-Osório tells the FT.
Lloyds now covers private mental health treatment of up to £50,000 a year, on a par with its physical health coverage. It also has line manager mental health training, initiatives encouraging colleagues to speak openly about their mental health, and a programme to build resilience — including nutrition training, sleep management and psychological analysis.
Horta-Osório says his main incentive is moral, and that he has never received pushback from shareholders. “Our shareholders more and more understand that companies have to have a purpose beyond just being profitable. [But] engagement of our employees has doubled since 2011, and shareholders see financial results as well.”
At Prudential, chief medical officer Andrew Crighton began measuring productivity and wellbeing using an employee questionnaire. In 2015, the results showed a high percentage of employees with financial stress and low life satisfaction, so the company began providing budget coaching. When they saw a rise in childcare concerns, they increased the number of hours available for backup childcare. In 2017, they saw a 47 per cent increase in life satisfaction.
According to Crighton, these data-informed initiatives are not expensive; rather, they have helped direct spending more effectively. “It’s already costing companies money in productivity, and probably in health benefits,” he says. “They’re just not recognising it.”
More than anything else, Joanna Litt wants her husband’s death to open people’s eyes to the cost — and danger — of considering stress, burnout and mental health issues a workplace taboo.
Sitting on the couch in Los Angeles, surrounded by silver-framed photos of her and her husband smiling, Litt passes across a binder of emails she has received from colleagues and strangers since MacConaill’s death. “There are so many stories where people say, ‘I was feeling exactly the way Gabe was. I didn’t think I could reach out for help,’ she says. “And that’s got to change.”
This story is outside the FT’s paywall (you do not need a subscription to access it) so it can be shared freely.
Lilah Raptopoulos is the FT’s US head of audience engagement. James Fontanella-Khan is US corporate finance and deals editor
Photo artwork by Anthony Gerace; Stock imagery, Shutterstock
If you are having thoughts of suicide, confidential help is available for free. Consider calling your local hotline, or having a conversation with someone you can trust. You can find a list of international resources at speakingofsuicide.com/resources