The day Sylvie Giasson lost her job at the National Gallery of Canada - a victim of restructuring - it was as if a black hole opened up to swallow her.
The Gatineau, Que., translator began stuttering and crying. The tears wouldn't stop. She couldn't sleep. Suicidal thoughts overwhelmed her.
It took all the energy Ms. Giasson could muster to get herself to hospital, where she was diagnosed with severe depression and anxiety disorder. She spent seven months in the Royal Ottawa Hospital, being treated with medication, counselling and electroconvulsive therapy. And she endured it all virtually alone.
"Nobody wants to visit a loved one in a mental hospital," Ms. Giasson said. There were no flowers or get-well-soon cards. No one called.
Society's silence about mental health is deafening. When you are diagnosed, you disappear. Yet the vast majority of Canadians suffering from mental illness - such severe conditions as depression, bipolar disorder and schizophrenia - are not in hospital but in the community and at work.
Mental illness accounts for a stunning 40 per cent of disability claims and sick leaves in Canada. While employees jest about "mental-health days," they are no joke. Every day, 500,000 Canadians are absent from work due to psychiatric problems; the most recent estimate pegged the annual economic burden of mental illness at a staggering $51-billion. The World Health Organization estimates that by 2020, depression will be the leading cause of disability on the planet.
"Depression is a colossus," said Bill Wilkerson, CEO of the Global Business and Economic Roundtable on Addiction and Mental Health. "It's one of the biggest killers and one of the biggest disablers."
And it carries a cruel stigma. "There's this attitude out there that if you come back from cancer, you're a hero, but if you come back from depression, you're damaged goods," Mr. Wilkerson said.
Most people do return to work after bouts of mental illness. Yet few employers are accommodating, and fewer still reach out to help staffers before they descend into crisis.
"We can't afford to be tossing any workers overboard," Mr. Wilkerson said. "We have a brain economy and we can't let all these brains go to waste." The situation, he added, is a "national calamity."
Ms. Giasson, now 51, was one of those who clawed her way back. Doctors discovered the combination of medications that controlled her symptoms, including antidepressants and the Pill to deal with the violent mood swings linked to her menstrual cycle.
She left hospital with $35 to her name. After a stint on welfare, she found employment, first as a temp, then doing contractual work and finally landing a full-time government job. Since 1992, Ms. Giasson has risen steadily through the ranks of the civil service, where she now works in employee assistance services at Health Canada. Over that time, she has had two bouts of severe depression, each necessitating a few months off.
"Depression was not part of my career plan," she said wryly.
While she does not consider herself any different from workers with chronic illnesses like diabetes or heart disease, she knows she faces far different perceptions.
"In terms of dealing with an individual with mental illness," Ms. Giasson said, "we're still in the Stone Age."
ECONOMIC IMPACT
There is no doubting the scale of the problem. A poll commissioned by the Great-West Life Centre for Mental Health in the Workplace found that 18 per cent of workers in Canada had, at one point, a diagnosis of clinical depression. At any given time, about 8 per cent of those on the job are taking drugs for a mental-health condition, and 6 per cent are under the care of a physician.
And because mental illnesses tend to afflict people in their prime working years, they have a huge economic impact.
The estimated $51-billion in annual cost to Canada was the conclusion of a study by Dr. Carolyn Dewa of the Centre for Addiction and Mental Health in Toronto. The study estimated direct medical costs at $5-billion, while loss of productivity due to long-term disability came to $8.5-billion a year and short-term sick leaves rang in at $9.3-billion annually. The balance, about $28-billion, was attributed to "reductions in health-related quality of life" - a method used to put a dollar figure on pain and suffering.
Phil Upshall, national executive director of the Mood Disorders Society of Canada, can rhyme off these stats with alacrity. He believes the figures are essential to understanding the scope of mental illness and the folly of not dealing with it.
"I have to use the numbers. They're all I have. I don't have a Timmy," Mr. Upshall said, referring to the way causes like breast cancer and muscular dystrophy capture the public imagination by putting a human face on the conditions. But mental-illness sufferers are reluctant to come forward because they fear the stigma.
"There's this assumption that people will 'go crazy' on the job," Mr. Upshall said. "An employer would never ask a diabetic if he expects to slip into a diabetic coma soon. That would be unthinkable and crass. But they ask that type of question all the time to people with mood disorders."
According to the Great-West poll, employees feel the workplace is where they are least likely to get support. It's no wonder the majority of those with mental-health problems - 64 per cent - keep their condition secret from employers.
Renea Mohammed, a 37-year-old peer support worker at Vancouver Coastal Health, said secrecy is a defence mechanism: "Mental illness shatters your confidence so the last thing you want to do is tell your boss. You don't want to be judged and you don't want to lose their trust."
Ms. Mohammed was diagnosed as paranoid schizophrenic while studying for her master's degree in library sciences a decade ago. She attempted suicide three times in four years and was hospitalized on numerous occasions.
Despite it all, Ms. Mohammed held down several jobs as a librarian. With the help of medication and counselling, she's now healthy and her condition is stable. Along the way, she changed careers.
"If I was still working in a library I would keep this quiet. I'm not sure everybody believes in recovery, even intelligent, educated people," she said. But in the mental-health field, Ms. Mohammed says, she feels shielded from stigmatization and believes it's important to speak out on behalf of those who can't.
Michael Paré, a family doctor and co-ordinator of the Medical Clinic for Person-Centred Psychotherapy in Toronto, says professionals are particularly leery about admitting they suffer from mental illness.
"My clients are all working people," he said. "They have really good jobs and provide for their families. But they are also the walking wounded." Dr. Paré says he urges people to be discreet. "I tell them: 'You're not keeping it secret; you're keeping it private.' "
Still, he has been open about his own diagnosis of depression and his suicide attempt in university days. He's still in therapy, but not taking medication. He can be candid because he's self-employed, he said, but "there are still pockets of stigma in a society like medicine. It's a paradox: The healer can't be sick."
Mamta Gautam, an Ottawa psychiatrist dubbed the "doctors' doctor" because she treats only physicians suffering from mental illness, said the "culture of medicine perpetuates the notion of doctors as always being healthy, capable and available." She said physicians tend to minimize their symptoms and continue to work at a high level; as a result, they often seek help later. "The ability to function well is often the last thing to be impacted," Dr. Gautam said.
But there is a price. The late treatment, severity of symptoms and easy access to potentially lethal drugs - along with the pervasive stigma in society - means the rate of suicide among male physicians is about twice that of the general population. Among female physicians, it is about four times higher.
UPSIDE-DOWN LIVES
Jacqueline Beaurivage was holidaying in Ontario's Algonquin Park in January, 2003, when an emergency call came from one of her teenage son's best friends.
Her son, she was told, was sending out goodbye notes by e-mail and seemed poised to kill himself. Ms. Beaurivage phoned her son, and her husband dialled police.
Her son, Jonathan Singh, was diagnosed with severe depression. Even though Ms. Beaurivage was not the patient, the illness turned her personal and professional life upside down. A senior executive at CIBC, she called her boss and said she needed time off.
"He said: 'Take all the time you need,' and I'll never forget that," Ms. Beaurivage recalled.
She ended up taking three months off work, getting educated about mental illness and caring for Jonathan. "It was overwhelming. Every ounce of me was invested in my son. There was no way I could work," she said.
But when she did go back to the office, it was cathartic and also a positive message to Jonathan that life was returning to normal. "Three months off was a good investment for my employer," Ms. Beaurivage said. "I'm a damn loyal employee now because I experienced the human side of CIBC."
Mr. Wilkerson says that, unfortunately, too many employers are short-sighted.
"We have a knowledge economy, where the heavy lifting is being done by the brain," he said. "We can't treat mental illness as a secondary or tertiary issue any more. Dealing with this issue in the workplace is essential to our economy and our quality of life."
By the numbers
1 Rank of depression among
the leading causes of disability
in the world
8% Percentage of workers taking
medication in Canada to treat
depression and other mental-health conditions
20.6% Percentage of workers who suffer a bout of mental illness, most in the prime of their working lives
40% Percentage of short- and long-term disability claims that involve a mental-health problem
60% Percentage drop in family income when a breadwinner is diagnosed with mental illness
500,000 Number of workers off sick each day in Canada with mental-health problems
$8.5-billion Amount that employers and
insurers spend each year on
long-term disability claims
related to mental illness
$9.3-billion Annual cost of short-term leave for mental-health problems
$51-billion Amount that mental illness costs the Canadian economy each year
Sources: World Health Organization, Centre for Addiction and Mental Health, Canadian Public Health Agency, Great-West Life Centre for Mental Health in the Workplace, Statistics Canada
PUTTING ITS STAMP
ON MENTAL HEALTH
"Going postal" is one of the most evocative phrases of modern life, conjuring up the disturbing image of an employee going berserk in the workplace.
The idiom, which arose from a series of bloody incidents at the U.S. Postal Service, makes Moya Greene cringe. "An unfortunate label," said the president and CEO of Canada Post Corporation.
It is also an expression she hopes to turn on its head. "Going postal, for me, should mean being a leader on the issue of mental health," Ms. Greene said.
Canada Post, a company with annual revenues of $7.5-billion and the country's sixth-largest employer, has decided to make mental health its issue of choice. It has created the Canada Post Foundation for Mental Health and, in the fall, will issue a stamp to draw attention to the cause.
Just as important, Ms. Greene says, Canada Post is trying to be a model employer. It is training managers to spot mental-health problems early and deal with them openly.
The corporation also plans to leverage its vast resources - people, infrastructure and visibility in communities - to promote awareness and combat stigma.
"I want to get to the point where we can speak of mental illness like we do diabetes," Ms. Greene said.
The CEO is leading by example, using her frequent public appearances to boost the cause. Last year, she was honoured as a "champion of mental health" by the Canadian Alliance on Mental Illness and Mental Health.
Ms. Greene says Canada Post, while large - 72,000 employees - is typical of many corporations in feeling the impact of mental illness. For example:
38 per cent of disability claims are related to mental health;
35 per cent of absenteeism is due to mental-health problems;
35 per cent of company drug-plan spending is for antidepressants.
Ms. Greene said Canada Post intends "to be an employer that takes the issue out of the closed office." André Picard
THE SERIES
Friday, June 20
The lonely madness of Alice G, by Erin Anderssen
Saturday, June 21
A life of anxiety,
by Carolyn Abraham
Staying alive in Miramichi,
by Erin Anderssen
Surviving schizophrenia,
by Erin Anderssen
Never give up: An interview with David Goldbloom,
by Carolyn Abraham
Today
Depressed and employed:
The workplace challenge,
by André Picard
Tomorrow
Trapped in a Victoria hospital room, by André Picard
Wednesday, June 25
Addiction as mental illness,
by Carolyn Abraham
and Tonia Cowan
Thursday, June 26
Sentenced to insanity in an
Alberta prison, by Dawn Walton
Friday, June 27
Scotland's good example,
by Elizabeth Renzetti
Saturday, June 28
What needs to be done:
The solutions, by André Picard
A made-in-Canada miracle,
by Carolyn Abraham
Essay: Fighting the stigma,
by Senator Michael Kirby
André Picard