Donna Hardaker was a star employee. In 2000, then 39 years old, she worked as a project coordinator at an academic institution in Toronto. She nabbed promotion after promotion, quickly made friends and was, in her words, the “go-to person” for her team. She was on the fast track.

Then things began to change. Beginning in 2001, the quality of her work slipped, she seemed sluggish and she began missing days from work. “I went from being a rising star to being in the dog house,” she says now. Her coworkers treated her differently. They left her off email chains, they stopped inviting her to meetings and then isolated her socially. Soon, she says she was “openly despised.”

Within a year, she lost her job. From the outside this looked, to her boss and her coworkers, like a simple case of a lazy employee who had stopped performing. Yet it had a root cause: clinical depression. No one asked her if she was OK, no one offered to help and so she says she felt very alone. But she is not alone. One in five adults has experienced a mental health issue, according to the U.S. Department of Health and Human Services, making it a near mathematical lock that you know someone affected.

According to a 2010 study from the Journal of Clinical Psychology, the cost of mental health in the workplace is a jaw-dropping $210 billion, and yet there aren’t any easy fixes.

Hardaker eventually got help. And after the devastation of her on-the-job experience, she devoted her career to educating companies about mental health in the workplace. In 2013, she moved to Sacramento to serve as director of Wellness Works, a workplace mental health training program of the nonprofit Mental Health America of California. Her challenge is daunting: According to a 2010 study from the Journal of Clinical Psychology, the cost of mental health in the workplace is a jaw-dropping $210 billion, and yet there aren’t any easy fixes. Thankfully, there are smart things that a company can do to identify the problem, find the right resources, and help both the employee and the bottom line.

The Cost of Depression

Dennis Miller, a leadership coach and author of Moppin’ Floors to CEO, once wrestled with depression. He says social stigma keeps people from talking openly about depression, especially as it relates to the workplace. “Most people, particularly men, still view it as a character flaw or a weakness, but it’s not,” Miller says. “It’s a health issue, no different than if you had a broken arm.” He eventually got help in the form of Monday-through-Friday therapy sessions and rebounded to become a CEO of Somerset Medical Center in New Jersey and ultimately a motivational speaker. “And if you’re a businessman, you need to know that it’s having a big impact on the bottom line.”

While many of us are blissfully unaware of depression’s prominence in the workplace, those in HR, who are on the frontlines and can see the disease’s broader impact, have a more clear-eyed perspective. “It’s a big issue in the workplace, and it continues to grow,” says Kim Silvers, an HR consultant in Granite Bay. “I have one or two calls a week from employers about employees who are struggling with it personally, or they have a family member who is struggling.”

The most important cost of depression is, of course, the health of the actual employee, which is impossible to quantify. Yet depression can ripple through an organization and take a larger toll. “It takes more energy for a manager to manage that [depressed] individual, and that can take time away from other employees. It can take time away from other clients,” Silvers explains. The employee’s productivity plummets. He might take more sick days, poison client relationships and potentially get fired. Turnover isn’t cheap. An analysis from the Center for American Progress found that replacing an employee, on average, costs an extra 20 percent of that person’s salary — more recruiting, more rehiring, more retraining.

Since companies tend to perk up when hearing things like billions of dollars, the Partnership for Workplace Mental Health — a program from the American Psychiatric Association Foundation — even has a “cost calculator” that they use to help pin down the expenses. “When employers first look at their mental health spend, at first it looks like very small,” says Clare Miller, the organization’s director (no relation to Dennis Miller). “But when you look at the actual cost, it’s much higher.”

Depression bumps up the costs of both absenteeism and “presenteeism” — when an employee is physically in the office but not cognitively present. Pharmaceutical costs also increase — while it can take six to eight weeks for antidepressants to kick in, without the proper education and help, patients often get frustrated after two weeks and stop the treatment, leading to more waste and higher costs. “If you really peel away the layers, you see that there’s a huge amount of waste,” Clare says. “People are getting on medication, but not staying on medication.” And the bills keep adding up.

How to Spot It

A broken leg will cause a limp. The flu will cause a fever.  Depression is trickier to identify. In many cases it can look just like a lousy employee, “like employee disengagement,” Hardaker says. “Like someone who’s no longer a team player.”

The key is to look for changes in behavior. Maybe someone used to be prompt and now they’re chronically late. Their attention to detail suffers. They flub deadlines. They take longer lunches. They used to be confident and now they’re meek, full of self-doubt. Changes in physical appearance, and even hygiene, can serve as clues. “For someone depressed, sometimes literally standing under a shower can feel painful,” Hardaker says. Their eating habits might change. When at her bleakest, Hardaker would gag if she put food in her mouth. “I was talking [to my co-workers] about how I couldn’t eat. People never asked what was wrong. Instead they just said, ‘You’re so weird.’”

“When managers call us, in most cases they really want the person to get better. But many times they’re also asking, ‘Am I going to be sued?’” Kim Silvers, founder, Silvers HR

There’s actually some good news here. Because depression often manifests itself as a decline in performance, objective and data-driven criteria can help identify the problem.  At work, there are often more concrete things that need to get done than at home. And if an employee fails to accomplish those tasks, it’s something that can be logged and reported. “You just don’t have as many opportunities at home as you do in the workplace to say, ‘I’m having trouble completing this task,’” says Clare. Or, as Hardaker puts it, “At home you’d never say, ‘Honey, the report is late.’ At the workplace we have objective measures.” Ironically, this makes the workplace the perfect environment for sussing out the hidden problems. We just need to start looking.

The Fix

There are no easy solutions. “It’s really hard to reduce this to a soundbite,” Clare says, pointing to both a lack of awareness and resources. “With the Affordable Care Act, many people now have access to mental health care, but we know that’s only a fraction of the issue. And stigma prevents people from reaching out when they need help.” A recent study from Columbia University found that of those screened and diagnosed for depression, less than a third (28 percent) received any treatment. It’s either ignored or overlooked.

If you’re a manager, it can be scary to ask an employee about depression. Is that crossing a line? “When managers call us, in most cases they really want the person to get better,” says Silvers, the HR consultant. “But many times they’re also asking, ‘Am I going to be sued? How much leeway do I need to give the employee?’”

Clare says the key is to “keep things focused on performance.” Be clear about what you’re seeing and stick to the facts. For example: Hey, I’m noticing that the reports have been late all month. Is everything OK? And then follow up after that conversation. Listen, I see this is still happening. I’m getting concerned. Clare also stresses the importance of consulting with HR from the beginning.

It’s a daunting situation — bosses are not therapists. What do you really do in that situation? It’s tempting, and far easier, to just shrug off the possible mental health issue and blame poor performance on a lack of effort. But there’s one very simple thing a manager can do, and it doesn’t require her to pretend she’s a psychiatrist: Call for help.  There are organizations that exist to help managers in this very scenario. Clare estimates that 90 percent of small businesses have access to some kind of Employee Assistance Program. (It’s usually somewhere in the health care brochure.) “The EAP is a great avenue for managers to say to an employee, ‘You’re having some problems. I’m not a psychologist, but [the EAP] can direct you to someone who might be able to help you,’” Silvers says.

Tackling the root of the problem requires a broader focus on company culture, and it needs to come from the top. “Relationships in the workplace start with the CEO,” says Dennis Miller. He says CEOs can create a less-threatening environment for discussing mental health by having regular meetings to check in with staff. “I know from personal experience that when employees feel that the boss cares about their lives, and they’re treated as a human being, then productivity goes way up.”

This is why groups like Partnership for Workplace Mental Health are focusing on educating companies, changing the culture and expunging the stigma of mental health.  “One thing I say to companies is that they shouldn’t wait for something awful to happen,” Clare Miller says. “A lot of times, companies only take mental health seriously when there’s a tragedy, like an executive dying by suicide.” Just as companies are now doing more to foster a culture of physical health — office yoga, gym memberships, serving fruit instead of donuts — they can do the same with mental health. Hardaker is beginning to see the early signs of progress. “There are now CEO roundtables happening across the country,” she says, with the CEOs swapping notes on how to create a better culture.

Hardaker says that we have a long way to go before the stigma is gone and all employees get the help they need. But California is taking baby steps. Prop 63, the Mental Health Services Act, put $3 million into workplace mental health training and will fund the start-up phase of the Wellness Works program. Hardaker is also part of The Stability Network, a group of working professionals who have identified a mental health issue and speak openly about it. On the group’s website, they take ownership of issues like bipolar disorders, alcoholism, eating disorders and schizophrenia.

“That’s an initiative that gives me great hope,” she says. “There’s a strong group of us. We have a collective voice. We are here. We are successful. We are thriving. And you can learn from us.”