How CPAs and employers can support mental health

The pandemic has exacerbated struggles with anxiety and depression that require colleagues and management to respond with empathy and care.
By Mark J. Cowan, CPA, J.D., and Matt Niece, Ph.D.

How CPAs and employers can support mental health
Image by johnwoodcock

Many CPAs live with common mental health disorders such as anxiety and depression. Some seek treatment and effectively manage their conditions. Others, embedded in a society that continues to stigmatize mental illness and a workplace culture that may not address mental health, suffer in silence. Left untreated, anxiety and depression can become debilitating. Mild or moderate cases can lead to reduced quality of life and productivity. Severe cases can result in disability or suicide. CPAs cannot live up to their full potential as people and professionals when burdened by untreated mental health disorders. For the CPA profession to thrive, its members must confront mental health issues.

Currently, we all face the uncertainty of a deadly pandemic, economic upheaval, a divided political landscape, and racial unrest. CPAs have also been under increased strain helping clients navigate the business and tax landscape amid COVID-19. These stressors can exacerbate the symptoms of those who suffer from anxiety and depression.

Addressing mental health in the profession does not mean that accountants need to become mental health counselors. Nor do CPAs need to revamp the way they do business. CPAs must serve the demanding world around them, including employers and clients. And that means deadlines, workload compression, and long hours. We are not suggesting that accounting offices become Zen meditation rooms. Instead, we recommend adjustments that can have a profound impact without preventing CPAs from succeeding in their jobs. First, CPAs must talk more about mental health issues and foster a culture in which it is acceptable to be vulnerable and ask for help (see "Depression and the CPA," JofA, Feb. 2020). Second, CPAs must get more comfortable reaching out to colleagues or others who seem to be struggling, and having one-on-one conversations about mental health. This would help de-stigmatize mental illness within the profession and allow more CPAs to live up to their full potential.

SOME PERSPECTIVE

While there are a variety of mental illnesses, we focus on two of the most common: anxiety and depression.

Anxiety, per the American Psychiatric Association, affects almost 30% of adults at some point in their lives. Just being alive means you have some level of anxiety, which is necessary to prepare for and react to life's challenges. Anxiety becomes a mental disorder when it involves persistent, excessive worry and interferes with normal functioning. Someone with anxiety might experience difficulty concentrating, sleeping problems, rapid heartbeat, excessive sweating, or trembling. Those with anxiety are also susceptible to abrupt panic attacks, which can feel like heart attacks. Depression, per the American Psychiatric Association, "is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. ... Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person's ability to function at work and at home."

Depression is more persistent (lasting in general more than two weeks) and more debilitating than the occasional "blues" we all experience. Someone with depression might experience low mood, changes in appetite (increased or decreased), changes in sleep (too little or too much), loss of energy, slowness in physical activity, difficulty concentrating, feelings of guilt or worthlessness, or a lack of interest in things that typically would bring joy and meaning. In the most severe cases, the depressed person may have thoughts of suicide that can range from ideation to planning to, tragically, completion.

Depression and anxiety can overlap and share some features. First, they are more severe than the stress of everyday challenges. Bad days, sadness, grief, shame, nervousness, and heartbreak are normal and healthy parts of the human condition. One cannot appreciate life's joys without experiencing the sorrows. While some of these negative feelings never go away, they do subside with time. Likewise, CPAs must deal with long hours, deadlines, complex problems, stress, and demanding clients or employers. These are normal parts of a CPA's chosen profession. Accountants would hardly be doing their jobs if they didn't experience some stress and dejection.

Second, depression and anxiety are medical conditions, not character flaws or weaknesses. Having these conditions says nothing about a person's work ethic, intelligence, or ability to be a good accountant. Yet anxiety and depression carry an irrational stigma. Society should, but often does not, view these conditions like any other medical ailment.

Third, those in the grip of anxiety or depression cannot simply snap out of it. They lack the ability to shed the unwanted feelings. Some well-meaning friends may tell an anxious person to "calm down" or a depressed person to "cheer up." Such advice may only make the sufferer feel worse. CPAs, because they are expected to independently solve challenging problems on the job, are conditioned to believe that with hard work they can overcome anything on their own, including anxiety and depression. But CPAs are more likely to thrive in an environment where it is acceptable to discuss mental health issues with others and seek help.

Fourth, the causes of anxiety and depression can vary and, without professional help, be misconstrued. Someone may be predisposed to anxiety or depression because of a complex mix of heredity, brain chemistry, childhood experiences, past trauma, or other factors. But symptoms may not manifest unless triggered by stimuli — like personal losses or stressful work situations. Because the existence or sources of the predisposition are often unknown and the stimuli are usually apparent, many conclude the stimuli alone are to blame for the anxiety or depression. Those who try to cure themselves without professional help may erroneously think the solution is to remove the stimuli. A CPA with anxiety, for example, might attribute the problem to stressful work projects (the stimuli) and leave the profession. If the CPA fails to seek professional help in addressing the underlying causes (the predisposition), however, the anxiety may return as soon as a new stimulus arrives. The CPA may have been better served keeping the job and going through therapy to address the underlying condition — better positioning the CPA to manage any future stimuli.

Fifth, a person with anxiety or depression will struggle to reach his or her full potential. Per psychologist Abraham Maslow's well-known hierarchy of needs, our psychological needs must be met before we can realize our full potential.

Finally, and critically, depression and anxiety are treatable. Medications and talk therapy can help alleviate the suffering. A CPA who gets professional help will often get better. Many CPAs would benefit from connecting with a counselor regularly, the same way they might with a dentist, except that they would see a counselor more frequently. Unfortunately, too many wait until issues have become debilitating before seeking professional help.

WHY MENTAL HEALTH SHOULD MATTER

Anxiety and depression, although they are medical issues, are relevant to the profession because the CPA workplace is both a venue where mental health issues can be identified and one that will suffer if mental health issues remain unaddressed. It is also the home of ample stimuli that can trigger or exacerbate anxiety or depression. CPAs are in a position to notice and intervene if a co-worker is in distress. Aside from their families, CPAs spend more time with their colleagues than anyone else. A CPA can notice changes in a colleague's behavior or performance that might not be noticed by others (see the sidebar "Identifying Colleagues in Distress" at the end of this article). Perhaps that CPA is the only one who notices.

CPAs should watch for mental health issues in the workplace because it is the right thing to do. If altruism isn't a sufficient reason, consider the business case. It is difficult to retain talent, and turnover is costly. By discussing mental health, firms might help reduce turnover. As noted earlier, many employees with anxiety or depression incorrectly blame their conditions solely on stimuli — like workplace stress — rather than the more elusive underlying causes of their predispositions. If struggling employees feel more comfortable seeking professional help, they are much more likely to discover the best way to manage their anxiety or depression. And that might allow them to stay in the profession and enhance their performance.

At recruiting events, many firms proclaim that their staff view themselves as a family. If these expressions are not mere platitudes, it should be easy for such firms to start talking about mental health. The accounting students graduating within the next few years have been tested by the pandemic and other disruptions. Many of them still succeed in part because they study on campuses where mental health issues are frequently discussed and addressed. These students, the future of the profession, will expect the same openness in the workplace. Firms that ignore this generational shift and fail to meet these expectations could find themselves at a disadvantage.

REMOVING BARRIERS

Those struggling with anxiety or depression are often reluctant to confide in others because they may not realize that something is seriously wrong or don't quite know how to articulate what they are going through. They may attribute their low mood or anxiety to the stresses of life that everyone is supposed to bear. Perhaps they fear the stigma and the potential impact on their careers of revealing they are struggling. Or, unfortunately, they may have confided in someone in the past, only to not be taken seriously or to be told to "just get over it." Likewise, a CPA concerned about a colleague may be reluctant to discuss his or her concerns with the individual. The reluctance could stem from the perception that mental health is a taboo subject at work, concern about invading someone's privacy, or uncertainty about what to say.

To remove these barriers, management must set the tone. A firm does not need to fundamentally change; it needs only to build mental health awareness into its culture and seek to be a place of "psychological safety" — where staff can express their true selves without fear of negative consequences. Creating or improving psychological safety could be as simple as explicitly normalizing the stress inherent in the profession and highlighting resources, like employee assistance plans, during onboarding. The firm could then have ongoing discussions of mental health issues at staff meetings. Firm leaders, perhaps supported by mental health experts, could encourage staff to watch for signs of distress in themselves and in colleagues. By openly discussing such issues, firms can signal that no one should feel bad about seeking help when they need it. Firms can also show their commitment to psychological safety by allowing employees, when possible, to have some flexibility to schedule counseling sessions. Making these small changes would help reduce the stigma of depression and anxiety, let people who suffer know they are not alone, encourage CPAs with anxiety or depression to seek professional help, and empower others to watch for colleagues in distress.

THE IMPORTANCE OF VULNERABILITY

Once discussion of mental health issues becomes routine and embedded in a firm's culture, it will be easier for concerned staff to reach out to distressed colleagues and have critical one-on-one conversations. A CPA who is concerned about a colleague may feel uncertain about how to approach the conversation. After all, CPAs are not mental health professionals. For some guidance, see the sidebars "Best Practices for Talking to Colleagues in Distress" and "When a Colleague Appears Suicidal."

For these conversations to succeed, CPAs must allow themselves to be vulnerable. Vulnerability does not always come naturally, but it is the best path to the genuine connections that are necessary to discuss these difficult subjects. Many CPAs may view vulnerability as unprofessional and a weakness. In truth, one can be vulnerable and professional at the same time. Many CPAs are used to having difficult conversations with colleagues and clients on sensitive, sometimes life-altering business, financial, family, or personal matters. CPAs can use the empathy and comfort with discussing difficult issues developed in those contexts when discussing mental health issues. Having difficult conversations takes grit, which, fortunately, CPAs have in abundance.

Talking more with colleagues about mental health may seem like a small step, but it can have tremendous impact. Just one expression of concern can save a colleague from falling into deeper despair. It can save a career; it may even save a life. And, over time, reaching out will have not only helped that one person but also countless others, as each intervention causes the stigma of mental illness to fade. Supporting mental health will help all CPAs — and the profession — live up to their full potential.


Identifying colleagues in distress

 

  • Pay attention to baselines and patterns — and deviations from them. For example:
    • A talkative colleague suddenly is quiet most of the time.
    • A quiet colleague gets even quieter.
    • A diligent worker starts turning in things late.
    • Someone who is meticulous in appearance now appears disheveled.
  • Make an extra effort to check in with staff during times when there is less opportunity for consistent interaction. For example:
    • During busy times, when everyone is distracted.
    • In practices where auditors are rotated among engagement teams and are working at client sites.
    • During a pandemic, when there is more stress and less personal interaction.
  • Be especially vigilant when more stimuli are present. While stressors are hard on everyone, they take a particular toll on those predisposed to anxiety or depression. Keep an eye out for staff who are, for example:
    • Working through a tough tax season or year end.
    • Studying for the CPA Exam.
    • Going through career transitions, such as:
      • A new staff member adjusting to working full time rather than being in school.
      • A tax preparer promoted to senior and getting used to reviewing others' work.
      • A staff member who recently switched offices or service lines.
      • A newly promoted partner adjusting to the demands of managing and growing the firm's business.
  •  

    Source: Mark Cowan, CPA.


    Best practices for talking to colleagues in distress

    Do:

    • Meet with the person privately in a quiet environment.
    • Be respectful.
    • Briefly share the observations that have caused your concern.
    • Focus on specific, observable behaviors (e.g., "I've noticed that lately you've been ...")
    • Speak in a calm, nonjudgmental manner.
    • Give the person the opportunity, if they feel comfortable, to discuss his or her feelings with you.
    • Listen carefully, not to respond but to understand. Don't agree or disagree with what they say.
    • If possible, normalize the person's situation. Let them know they are not alone. Sharing your own story or experience with challenges can help others feel safe to do the same.
    • Ask if the individual is seeing a professional to help with the problem. If not, and if appropriate, encourage the individual to make an appointment with his or her primary care physician or a professional counselor to discuss what they are going through.

    Don't:

    • Get involved with the situation more than you are comfortable; you are already adding a lot of value by reaching out and expressing concern.
    • Minimize the individual's feelings or fears.
    • Say things like "Everything will be better tomorrow."
    • Take responsibility for the individual's emotional state.
    • Try to solve the person's problems or offer quick fix solutions or advice.
    • Ignore signs of suicidal tendencies (see the sidebar "When a Colleague Appears Suicidal," below).

    (Adapted from Boise State University's Reaching Out Handbook.)


    When a colleague appears suicidal

    If your colleague has the following symptoms, you need to address the issue of suicide:

    • Withdrawal from colleagues.
    • Expression of extreme hopelessness.
    • Sudden mood or behavioral changes.
    • Giving possessions away.
    • Making comments like "Life isn't worth the trouble," "I won't be a problem much longer," or "Nothing matters; it's no use."

    In addressing the suicidal individual:

    • Be confident and caring.
    • Don't make jokes; this is no time to use humor to reduce the tension.
    • Don't use euphemisms like "Are you thinking of hurting yourself?" or "Are you thinking of doing something rash?"
    • Ask the question bluntly: "Are you thinking of killing yourself?"
      • Asking the question will not put the idea of killing themselves in the person's mind, and it will not make it more likely the individual will commit suicide.
      • It may even make it less likely that the person will consider suicide — because someone cared enough to ask the question.
    • If the person admits to suicidal thoughts or plans:
      • Call your local suicide prevention hotline, which is there not only for those who are suicidal but also for those who are concerned about someone who may be contemplating suicide.
      • Try to get the person to a qualified mental health professional immediately.

    (Adapted from Boise State University's Reaching Out Handbook.)


    AICPA RESOURCES

    Articles

    "How to Nurture Your Accounting Staff During the Pandemic," CPA Insider, March 8, 2021

    "Returning to Work: Prioritizing Mental Health," JofA, Sept. 11, 2020

    "Depression and the CPA," JofA, Feb. 2020

    Other resources

    Hotline

    National Suicide Prevention Lifeline, 800-273-8255

    Not-for-profit

    Suicide Awareness Voices of Education, SAVE.org

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