A few years ago, Troy Underwood noticed a problem with one of his accountants. The man’s work performance and personal appearance had deteriorated, he talked constantly on the phone with his children and agonized about his domestic life. 

Finally, Underwood, CEO of Rancho Cordova insurance software provider BenefitsConnect, approached the CPA. “We’re looking at your work. You’re showing up to work disheveled. You haven’t shaven. What is going on with you?” Underwood asked his employee. 

The conversation was unproductive. The accountant slipped further and was eventually dismissed. Upon hearing the news of his firing, the man was relieved. “Thank you,” he told Underwood. “Now I have one less stress in my life.” 

“He was a mental case,” Underwood recalls. 

About a quarter of the U.S. adult population has a diagnosable mental disorder, according to the National Institute of Mental Health, and approximately 22 percent of those cases are considered “severe.” These issues can seriously impact a company’s bottom line. 

One survey by the World Health Organization found that workers with depression reported missing the equivalent of 27 workdays due to absences and lost productivity. That makes depression the most costly health condition, ranked above obesity, arthritis and back pain. 

Yet social stigmas and legal questions can prevent employers from discussing mental health with their workers. Managers that do approach the subject must focus on work performance and not behavior, say legal experts, and they walk a delicate line between identifying the problem in order to improve productivity and invading individual privacy. 

Under the federal Americans with Disabilities Act, companies must provide a “reasonable accommodation” for workers with a mental illness that qualifies as a disability, which can be broadly defined. But other state and federal laws prohibit employers from inquiring too deeply into an employee’s personal life. 

Despite an understandable urge to ignore the problem and hope it corrects itself, untreated mental illness can grow into an office crisis. The best approach, say legal and psychological experts, is for employers to immediately call attention to the apparent disorder — whether the behavior is impacting an individual’s work or the work of their colleagues — and create a customized plan that meets the needs of the distressed individual and the company. 

Managers can start the conversation by asking the employee what they need in order to improve, says Mary Ann Baynton, author of “Preventing Workplace Meltdown: an Employer’s Guide to Maintaining a Psychologically Safe Workplace.” Managers can also ask how the employee will protect his or her own wellbeing at work, and how they would prefer to discuss this issue.

“There’s not a cookie cutter approach,” says Baynton, who works as a workplace relations consultant in Ontario, Canada. “It’s really about respecting the ability of the individual to engage in a conversation about solutions that will allow them to be productive in the workplace regardless of their disability.” 

If the employee is responsive, his or her supervisor and human resources representative can create an accommodation that satisfies both the worker and the company. This might allow the employee to start at a later time in the day, take time off, move to a quieter part of the office or change supervisors.

Workers with depression reported missing the equivalent of 27 workdays due to absences and lost productivity. That makes depression the most costly health condition.

Although people have a natural inclination to help someone in need, managers should avoid acting as a colleagues’ mental caregiver or personal confidante, warns Derek Decker, a Sacramento attorney with Radoslovich Krogh PC. 

“You don’t need to get into, ‘Is there something going on at home?’ It should be focused on, ‘Your work performance is slipping. You’re late. Is there anything going on that we can do to accommodate you? Is there anything that we need to know that would affect your job?” he says. 

From a legal standpoint, “getting any deeper into it is where you start to get into trouble,” Decker says. “You don’t want to find out their history of mental illness or how long they’ve been treated or what’s causing the mental illness. It should be relatively clinical — supportive, but clinical on what accommodations are needed.” 

In order to comply with state and federal laws, employers must ensure they make every reasonable accommodation possible. This decision can be tricky, since it is up to the employer to determine whether the requested accommodation presents too great a financial burden. Employers are not bound to accept an employee’s request, but before any request is deemed unrealistic, employers should first understand exactly why the worker believes the accommodation will help them, Baynton says. 

For example, Baynton once consulted a depressed woman who asked to be moved into a corner office when all other employees worked in cubicles. While that request seemed absurd, the woman was experiencing seasonal affective disorder and simply sought access to sunlight. The problem was solved with a move to a different cubicle. 

“We were able to give her what she needed without giving her what she asked for,” Baynton says. 

If the distressed employee declines to acknowledge the problem or work to fix it, an employer has a legal right to move forward with disciplinary action if they can prove that every attempt was made to accommodate the worker, though they may wish to seek legal counsel beforehand, says Decker. 

If the accommodation doesn’t work out, Decker suggests documenting everything in order to avoid losing a lawsuit. Managers can explain their position on paper and even run the company numbers to prove the accommodation was unsustainable. 

“It’s great evidence after the fact to come back and say, ‘We looked at everything. We did what we could,’” Decker says. “If you think it’s an undue hardship, make sure that it truly is, and you can show that.” 

Decker also recommends that companies provide employee handbooks and written policies to articulate the process for requesting accommodations. This enables employees to seek help while avoiding a difficult discussion with their superior.

Firms can also take a progressive stance on mental health by providing an employee assistance program, a benefit that provides medical care in areas such as emotional distress, substance abuse and work/relationship issues. Human resources representatives and managers can direct a distressed client to an EAP, but they cannot mandate attendance unless the employee has failed a drug test and the company has an existing drug policy. 

If an EAP is not available, workplacementalhealth.org, which provides additional tips and mental illness resources for employers, is a free service from the American Psychiatric Foundation.