“As you move through this life and this world you change things slightly, you leave marks behind, however small. And in return, life — and travel — leaves marks on you. Most of the time, those marks — on your body or on your heart — are beautiful. Often, though, they hurt.” –Anthony Bourdain
This morning began for me with the news of Anthony Bourdain’s suicide in Paris. Earlier this week, the media buzzed with Kate Spade’s suicide at her Manhattan apartment. Both lived prominent, public lives that hid private pain and loss.
Escalating Suicide Rates
Just yesterday NPR reported that suicide rates have increased in nearly every state over the past twenty years, with half the states seeing suicide rates skyrocket more than 30 percent. According to the Centers for Disease Control and Prevention, suicide is the 10th leading cause of death in the United states, and one of just three leading causes that are on the rise.
CDC researchers note that more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of their deaths. Contributing factors for suicide risk include relationship problems or loss, substance misuse, physical health problems, financial stress, job loss, and legal issues.
At the time of his death, Anthony Bourdain worked with CNN as star of the network’s “Parts Unknown” series. He was on location in France, working on an upcoming episode. CNN broke the news of his passing, and social media quickly has been filled with stories of Bourdain’s close relationships with colleagues in the television and restaurant worlds.
With the rising suicide rates in the United States, employers are faced with challenges in how to address the impact of suicide on the workplace. The U.S. Bureau of Labor Statistics reports that the rise in workplace suicides is consistent with the rise in the overall number of suicides in the United States.
The BLS classifies a workplace suicide as meeting at least one of the following criteria: (1) the death arose at the employee’s work premises while he or she was there for work; (2) the employee’s death occurred away from the work premises but the employee was engaged in work activity; or (3) the death was related to the employee’s work status (e.g., a suicide at home that can be definitively linked back to work).
As humans, we instinctively want to reach out and help someone who seems sad or depressed, but we may not know how. As employers, we face additional legal concerns. Understanding the nature of the conditions that can lead to suicide, as well as the laws impacting the situation, can help employers diffuse potentially deadly situations, minimize risk, and assist employees in obtaining the help they need.
A mental or physical health condition that may lead an employee to become suicidal can be covered under the Americans with Disabilities Act (ADA). Generally, the ADA says it is unlawful to take adverse employment actions based on the employee’s condition.
The ADA also requires employers to reasonably accommodate an individual with a disability, where doing so will allow that person to perform the essential functions of their job. An employee who notifies their employer about a qualified physical or mental condition, may be entitled to a reasonable accommodation, and the employer may be obligated to engage in an interactive process to identify and implement a reasonable accommodation.
However, there is an exception under the ADA if an individual poses a direct threat to the health or safety of other individuals in the workplace. A “direct threat” is a “significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation.” The burden is on the employer to establish that an individual poses a direct threat.
If an employee appears depressed or exhibits changes in behavior or work performance that raise concerns, it is best to initially approach the situation with an assumption that a condition may exist that would be covered under the ADA. Management and HR staff should be trained to initiate a private conversation with the employee. Avoid asking if the employee has a medical condition. Instead, identify specific observations of their behavior that led to the concern, and ask if there is anything you or the company can do to help.
Asking the Right Questions
It is important to ask open-ended questions to encourage the employee to talk about whether anything at work is causing or contributing to their decline in performance. Also ask if he or she has ideas for things at work that could change. If the employee has reasonable requests for accommodation, then engage in a dialog with supervisors and management to determine whether the accommodation is likely to help matters.
The situation changes if an employee makes statements that show an intent to harm himself or others. A 2016 case from the U.S. Court of Appeals for the Seventh Circuit, Felix v. Wisconsin Department of Transportation, provides employers with a roadmap regarding the balance between reasonable accommodation and protecting the safety of the workplace.
The plaintiff in Felix was under the care of a psychiatrist and therapist for a variety of anxiety-related and major depressive disorder. She received a series of unsatisfactory ratings in one area of her job description and expressed concern about her evaluations and the possibility she would lose her job. She also experienced panic attacks at work and discussed her anxiety-related issues with her supervisor. The employer reasonably accommodated her condition. If the plaintiff felt a panic attack coming on, she would inform her supervisor that she needed quiet time, would go to a designated location to do some breathing exercise, and return to her work station.
One day, the plaintiff felt a panic attack coming on, followed the regular procedure, and went to calm down. Unlike prior incidents, during this panic attack the plaintiff attempted to cut her wrists and repeatedly said she wanted to die. The employee was placed on medical leave and the employer sent her for an independent medical exam (IME).
The physician concluded the employee remained at risk for potentially violent behavior toward herself and others at the workplace. Based on the results of the IME, the employer determined the plaintiff was unfit for continued employment and terminated her.
The Seventh Circuit upheld the termination, holding that the employee’s threats coupled with the IME results showed that the she remained at risk for repeating the behavior that supported the employer’s decision.
Does an employer have to fire an employee with a disability who threatens herself or others? Not necessarily. That decision depends on the severity of the threat, and the employee’s prognosis.
Indeed, in Felix, the employer did not terminate immediately — the employee was sent for an IME that confirmed the nature of the ongoing threat. The employer sought an additional medical option, considered other potentially suitable positions, and allowed the employee to take FMLA leave. The decision to terminate was made only after FMLA leave expired and the medical opinion confirmed the existence of a persistent threat.
Employee and Employer Resources
Anyone can help prevent suicide. Awareness and education are key. Knowledge of available resources can provide suicidal people with a lifeline. The CDC recommends a comprehensive public health approach to suicide prevention to address the range of factors that contribute to its rise.
Risk factors are characteristics that make it more likely that someone will consider, attempt, or die by suicide. They can’t cause or predict a suicide attempt, but they’re important to know:
- Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders
- Alcohol and other substance use disorders
- Impulsive and/or aggressive tendencies
- History of trauma or abuse
- Major physical illnesses
- Previous suicide attempt(s)
- Family history of suicide
- Job or financial loss
- Loss of relationship(s)
- Easy access to lethal means
- Local clusters of suicide
- Lack of social support and sense of isolation
- Stigma associated with asking for help
- Lack of healthcare, especially mental health and substance abuse treatment
- Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
- Exposure to others who have died by suicide (in real life or via the media and Internet)
Learn the warning signs of suicide to identify and appropriately respond to people at risk:
- Talking about wanting to die or to kill themselves
- Looking for a way to kill themselves, like searching online or buying a gun
- Talking about feeling hopeless or having no reason to live
- Talking about feeling trapped or in unbearable pain
- Talking about being a burden to others
- Increasing the use of alcohol or drugs
- Acting anxious or agitated; behaving recklessly
- Sleeping too little or too much
- Withdrawing or isolating themselves
- Showing rage or talking about seeking revenge
- Extreme mood swings
Know how and where to reach out for help. If you or someone you know might be at risk of suicide, here are ways to help:
Call 1-800-273-8255 to reach the National Suicide Prevention Lifeline. It provides free and confidential support 24 hours a day, seven days a week for people in suicidal crisis or distress. You can learn more about its services here, including a guide on what to do if you see suicidal language on social media. You can also call the same number to talk to someone about how you can help a person in crisis.
Call 1-866-488-7386 for the TrevorLifeline, a suicide prevention counseling service for the LGBTQ community.
Text HOME to 741741 to have a confidential text conversation with a trained crisis counselor from Crisis Text Line. Counselors are available 24/7. You can learn more about how their texting service works here.
For online chat, the National Suicide Prevention Lifeline provides a confidential chat window, with counselors available 24/7. Boys Town also provides counselors for youth-specific online chat at this link. It is available every Monday through Friday between 6 p.m. and midnight C.S.T.
For crisis support in Spanish, call 1-888-628-9454.
For support outside of the US, a worldwide directory of resources and international hotlines is provided by the International Association for Suicide Prevention.
Additional Ways Employers and Colleagues Can Help
Another way to help is by supporting the nonprofits that provide suicide counseling, prevention and education. Volunteers are needed, and some train to become counselors.
Beyond the formal referrals and resources, there are other ways to show compassion to someone who struggles with depression, anxiety, or suicidal thoughts:
- Be there for them when they need it.
- The corollary to #1 – go away when they need it.
- Listen without offering unsolicited advice or judgment.
- Be aware of potential triggers and try to avoid them.
- Don’t take it personally if they lash out.
- Validate feelings and emotions – people are entitled to feel what they feel.
- Help (if asked) identify healthy outlets for emotions (e.g., music, art, exercise).
- Ask “How can I help”?
- Be available as “moral support” if requested for a medical appointment, 12-step meeting or other professional intervention.
- Acknowledge the struggle. Don’t minimize their pain or make it all about you.
- Understand mental illness is a journey and doesn’t improve overnight.
- Refrain from enabling behavior.
The recent high-profile deaths of Kate Spade and Anthony Bourdain are a somber reminder that suicide can impact anyone. Knowing the warning signs and taking the right steps as an employer most importantly will potentially prevent someone from taking their own life and protect against future legal liability.