Attorneys and Mental Health

On October 10, the world recognized Mental Health Day, an entire day intended to raise awareness of mental health in an effort to destigmatize these conditions. In keeping with my commitment to discuss practice management in addition to the intersectionality of law and technology, overall mental health and well-being should be considered as an important aspect of practice management as a sound mind is critical to the effective functioning of any law office. It was also important for me to delve into mental health generally as I found that as a society, we still struggle to be outspoken on this issue.

In the legal profession where billable hours and/or overtime are highly encouraged or valued, where we are expected to work often under extremely tight deadlines and in high stress environments to our eventual detriment, all of these factors may eventually lead to developing mental health issues.  As I learnt in conducting these interviews, Attorneys-at-Law are particularly vulnerable to developing mental health challenges.

I had the pleasure of interviewing Reverend Anderson Kellman of Network Services Centre, which provides counselling services to various organisations and individuals and Dr. Sharon Harvey, Psychiatrist, who both have extensive experience in helping persons navigate mental health challenges. Both experts are based in Barbados.

I first wanted to find out from Rev. Kellman and Dr. Harvey what were the most common mental health issues that they saw affecting society and more particularly, professionals today.

Both Dr. Harvey and Rev Kellman cited depression and anxiety as the most common mental health issues that they saw. In citing some statistics of the World Health Organisation (WHO) Dr. Harvey noted from those statistics that generally 40%-60% of the causes related to disability in the workplace were depression and anxiety related that cause absenteeism at work or may even cause early retirement. Dr. Harvey went on to indicate that even among professionals, anxiety and depression will be the major challenges they face. Dr. Harvey also explained that in effort to combat these feelings that they are struggling with, persons may turn to alcohol as a form of self medication - persons believe that having a drink may help them feel better. But she stated, "the paradox is that alcohol is a depressant and as such may make you feel even more depressed”. Taking this self medication route Dr. Harvey notes may lead to alcohol abuse.

For Rev. Kellman acute stress issues such as burnout, was also a common mental health issue that he saw professionals struggling with.

In speaking of depression, anxiety and stress related issues as Rev Kellman stated that these mental health issues were the most common he saw amongst professionals, I asked him whether there were ways in which developing any of these mental health challenges could be reduced?

He stated that persons needed to create a balance in their lives. In relation to depression, he indicated that this is a mood disorder and that creating a balance between work and recreation helps to keep that person sharp and reduces the chances of their productivity diminishing.

 Persons also needed to find others they could be open with and share with or find a safe space. Rev. Kellman noted that in the legal profession there was a lot of competition and so an attorney may not have that space to go to where they feel as though they can share openly and not be judged. "Sometimes we need another perspective and sometimes the act of sharing can get things off of our chest which can go a long way".

The 3rd thing he believed persons could do was to look for complement in their lives. By that, he explained that there are persons who for instance value family life highly, but they fail to make the necessary time for their family. Attorneys work for long hours, go to court, they stay at the office, attend meetings and "before you know it, the children are home, they've gone to bed and there ends up being little interaction and you may feel guilty." Rev Kellman therefore stressed that a work life balance was important.

I wanted Rev Kellman to delve a bit further into the concept of safe spaces as that was something he highlighted as being important for professionals to seek out. In addition to Network Services, which provides counselling, Rev. Kellman also mentioned Evergreen Associates, his own counselling company which he is seeking to establish, general counsellors around the Island and, if you are religious, you can also seek out your pastor or priest. Generally, however, he stated that whoever you decide to speak to, it should be someone that you are comfortable with. He stressed that he hopes persons recognise that it is not a weakness to find someone to talk to, that it's ok to share and be vulnerable and open with the right person.

Dr. Harvey highlighted anxiety and depression as being the major mental health challenges she saw persons and professionals struggling with. I also asked whether in her opinion the ways in which these mental health issues arose could possibly be reduced?

Dr. Harvey pointed out that these mental health challenges could be better managed. Sometimes however, genetics could play a part in depression or anxiety developing but this was only one factor. She indicated that generally, one of the major reasons we may become depressed or anxious is as a result of stress. She further noted that rather than speak about reducing the "causes" of depression and anxiety it is more appropriate to find better ways of managing stress as we will always experience stressful situations in life

Burnout

I wanted to delve more into stress related mental health issues such as burnout and I asked both Rev. Kellman and Dr. Harvey to explain what burnout was and what were the signs of this.

Rev Kellman described burnout as "a kaleidoscope of illnesses or symptoms”. The issue of burnout he explained was where one was pushing themselves hard but not being able to achieve much results. In describing the symptoms, Rev. Kellman noted that persons dealing with burnout may be anxious, hypervigilant or lead to persons becoming disengaged from others. Burnout is a chronic issue and coming back from that may prove to be very difficult. He added that persons experiencing burnout may even have feelings of depression or suicide.

Dr. Harvey explained that burnout was the level of stress that someone experiences and not necessarily a mental illness but rather a description of the consequences of stress or a stress response. "We get burnout when the level of stress is greater than our ability to cope. To the point where you're feeling a level of mental exhaustion and lack of motivation which can be frustrating." She went on to say that burnout could affect an individual to the extent that even if you were employed in a field that you enjoyed and were committed to that work but that level of stress may be  more than your ability to cope, this will lead to you feeling demotivated and your productivity will drop.

Q: For those who might not know, what is depression all about and how can we spot the signs?

Rev. Kellman described the condition as a "number of features that can conflate or come together". He listed those features as things like not sleeping well, appetite disturbances, prolonged sadness, low libido and low activity enjoyment such as fun. "It's really a number of symptoms that come together to create that sense of feeling down or sadness.”

Dr. Harvey:

She explained that depression is a common word that we all use however clinical depression is a bit different. Depression as we commonly use the word, tends to be used to describe 'normal misery; where we may feel miserable in the morning but by the afternoon, we feel a bit better.' To make a formal diagnosis of clinical depression, Dr. Harvey stated that the person needed to be experiencing feelings of feeling down most of the day or every day for at least 2 weeks. She further described other symptoms of depression as have a loss of interest in things that used to excite you, where nothing makes you laugh anymore, you withdraw from the activities that you use to enjoy doing, loss of sleep or sleeping for extensive periods of time and loss of appetite or eating more than usual. For her, she described depression as "life changing from colour to black and white” or when it turns grey. Some persons may even have thoughts of death which may sometimes lead to suicidal thoughts.

Depression causes a disruption to one's occupational, educational and or family life. Dr. Harvey emphasised that it is important to recognise that the symptoms she just described and categorised as clinical depression or major depressive disorder was not the same as feeling down or moody for a few days. Depression was a physiological condition that affects the chemistry of the brain and how messages are passed in the brain. "It is not something that someone can just snap out of" and persons need to understand that "this is a medical condition" which required a course of management.

Anxiety

Dr. Harvey cited anxiety as one of the common mental health issues she saw persons struggling with today and so I asked her to explain anxiety further and talk a bit of what the signs of anxiety were.

"Anxiety is our response to anything that the brain perceives as a threat" she explained. She provided an example of when we see a dangerous dog, our heart rate will go up and we'll try to run away from that dog. It's easy to identify the threat of that dog because we are in a physical setting and that's a threat that we can see. However, she noted that with anxiety, that threat is not always concrete or external. For instance, a person may be feeling stressed because they have a deadline and they're not sure if they will complete the task in time. "The brain still perceives that feeling as the dog coming to get you" and so those symptoms of your heart racing, your chest feeling tight and having difficulties breathing may present in that person's stressed state when faced with that threat of not completing your task for instance.

In addition to the other symptoms mentioned, Dr. Harvey also listed other symptoms of anxiety as general worrying, not sleeping well, decreased appetite and difficulty concentrating.

Q: Are there any specific mental health issues that attorneys struggle with that are different from what other professionals struggle with?

Both Rev Kellman and Dr. Harvey stated that they could not make a distinction between the mental health issues attorneys struggled with versus that of other professionals and that based on what they've seen, the common mental health issues they raised earlier, generally affected attorneys as well.

Dr. Harvey in stating that lawyers are more susceptible to developing depression cited American data which stated that within the last year Attorneys were likely to suffer from symptoms of depression at 4 times the rate of the general population. Further, Attorneys were more likely to deal with depressive symptoms at some point in their career at up to 10 times the level of the general population. So, in respect of depression, which she again noted was a common mental health issue, lawyers are at greater risk of developing those symptoms. Further, in her experience she found that the legal profession was one of the main occupations susceptible to burnout.

Q: Do you think that the work environment could contribute to persons having worsened mental health challenges? 

Both Dr. Harvey and Rev Kellman stated that the workplace was a major driver of our stress. Rev. Kellman further noted that because of an attorney’s work in environment that stress may be driven by the level of trauma they’re exposed to such as some criminal or personal injury matters, time issues and deadlines and lack of support especially if one is a sole practitioner.

Q: What can, or should employers do to reduce the likelihood of their employees becoming susceptible to these challenges? 

Dr. Harvey believed that employers can create a workplace culture that helps employees feel comfortable to seek help. The workplace can support the employee by providing time to that employee to seek that necessary help in a confidential environment. Unless that happens Dr. Harvey states, presenteeism may arise. That is, where the employee is fearful to see anyone, so they just remain at work, but they are unable to function effectively or productively.

Dr. Harvey also mentions that employers having seminars on stress reduction to equip employees with the ability of being able to practice those techniques would also be helpful.

Rev. Kellman believed that employers should be doing a lot more to advance the mental well being of their employees. "To me they are missing an excellent opportunity not to just retain their employees but also to create a connection between themselves and their employee" which can lead to inspiring those employees to work. He also noted that employers should wherever possible create linkages with companies who can offer support to their teams especially during difficult times or conditions such as where a death has occurred. "When an employee knows that their employer cares enough to have those kinds of parameters put in place, they are far more loyal to their employers."

Rev Kellman also expressed the need for employers to have some kind of after school or after-hours programme for employees' children. “It will go a long way in building employees' commitment to an organisation if employers are able to provide those kinds of services to their employees. "

Rev Kellman's other recommendations over his years of experience included employers having briefing sessions for those on the front lines who are exposed to trauma such as nurses, police officers and doctors. He believed that those persons should be regularly briefed so that later they don’t suffer from illnesses such as post-traumatic stress issues

I asked Rev. Kellman whether in his opinion employees could take steps to take care of themselves or at least limit the likelihood of becoming susceptible to mental health challenges. Rev. Kellman broke down his advice into the "4 R's

1st R - Rest. “Don’t expect that your practice will suddenly take off and you will be earning the same amount of money as your seniors who were practicing for the last 30 years."

2nd R - Recreation. "Persons who have a good exercise regimen are able to manage stressful situations a lot better than those who don’t

3rd R - Relationships. Rev Kellman discussed the need for us to get out and enjoy other people. "Make time for light-heartedness".

4th R - Religion. He noted that persons should find a space in their lives for your faith. "Connect with God so that you are able to manage the vicissitudes of life a lot better".

I asked Dr. Harvey whether in her opinion employees could take measures to lessen the challenges of dealing with or being vulnerable to mental health issues especially when they work in a difficult or toxic work environment.

Dr. Harvey emphasised having balance in one's life. "You have to be able to separate yourself from work and have a balance outside of work". She explained that there were also exercises persons could learn called detachment activities. She described some of those activities as going to dance classes or learning a musical instrument. The key was to find an activity that does not give you the chance to think about work; something preoccupies or required all of you to accomplish the task.

She also stated that where the situation was appropriate, it would help if employees had a say in the direction or management of the company.

Dr. Harvey also mentioned exercise in helping our brain chemistry - "Remember that depression and anxiety are triggered by our brain chemistry".

Lastly, foods such as caffeine, which winds us up and alcohol (a depressant) should be avoided.

Q: What would you like to see happen or change in terms of how professionals/society tackle and deal with mental health? 

Dr. Harvey wanted to see mental health being brought into the realm of medical conditions. She noted that especially with insurance, mental health does not share parity with more physical conditions in terms of coverage and payout. We continue to treat mental health as an outlier.

Rev Kellman believed that a greater effort needed to be made in the de-stigmatisation of mental health. For him, more needed to be done in schools and universities to provide education on mental health

Every workplace should also have counsellors that employees can connect with in order to assist them with their mental health challenges. He also extended this to organisations even providing first line counsellors so that they can recognise when serious mental health problems present themselves in individuals.

Having heard some of the statistics cited by Dr. Harvey in our interview especially those that highlighted that Attorneys at law were more at-risk suffering from depression or depressive symptoms and burnout, mental health should be prioritised in the legal profession. Further, Bar Associations should also consider taking a more active role in addressing mental health among its members. Both experts raised the issue of Attorneys who practice certain areas of law being exposed to traumatic or jarring evidence which may inevitably lead to mental health issues. Bar Associations that offer wellness sessions or seminars for its membership could go a long way in addressing mental health within the profession. Law firms and chambers should also consider whether they are doing enough to address the mental health of their employees and/or Attorneys. Does the work environment allow for Attorneys to feel comfortable in seeking out professional help when they are struggling? As an employer are you able to recognise when your employees are suffering from burnout, depression or anxiety? Do you foster an environment where discussions of mental health are encouraged and treated seriously?

I hope that you are encouraged to take mental health more seriously and that as a legal profession, more deliberate efforts need to be taken to address mental health concerns.

Dr Sharon Harvey is a Psychiatrist who completed her medical training at the University of the West Indies, followed by postgraduate studies in Psychiatry in London, England, obtaining the Membership of the Royal College of Psychiatrists in 1986.  She worked as a Consultant at the Psychiatric Hospital and the Queen Elizabeth Hospital in Barbados from 1991 – 1999. She has worked primarily in Private practice since 1999. She is also an Associate Lecturer with the University of the West Indies, a Member of the Barbados Drug Formulary Committee, and formerly a Committee Member of the World Psychiatric Association.

Reverend Anderson Kellman is a Senior Counselling Psychologist at Network Services Center with over 20 years’ experience.  He obtained a master’s degree in Counselling Psychology from the Caribbean Graduate School of Theology and a bachelor’s degree in Theology from the Caribbean Nazarene Theological College.

 Image credit - Gillian Blease/Getty Images