Mental health at Work - 2013 ANZAM PELT PROJECT
‘John' (Stage One)
John G is a customer service officer who has been working in the university campus branch of a major Australian bank. His main duties are performing teller transactions and account advice, and he specialises in providing advice and assistance to international students who want to establish banking arrangements in Australia or handle international banking transactions. John is highly respected and valued by his colleagues and he has always been thought of as a skilled professional who is gregarious, outgoing, enthusiastic and passionate. However, over the past few weeks his general demeanour and behaviour have changed. He is often late for work and when he arrives he looks exhausted and increasingly dishevelled. He used to handle customer enquiries and teller transactions calmly and politely and was known to relish particularly challenging enquiries that tested his knowledge but now he struggles to handle even routine enquiries. He seems to be finding it more difficult to concentrate and make quick decisions and he has recently taken to "checking-in" more often with Claire, the Branch Manager, about how he should deal with situations that arise in providing advice to clients, in contrast to his normally self-assured approach to his work. His colleagues have noticed that he is less co-operative and helpful than usual and one team member has reported that he has exhibited inappropriate anger and frustration toward them. Claire has listened to a few of his interactions with customers and it appears that he has difficulty remembering facts and making decisions, and he shows little interest in trying to find the best solution for customers. He has failed to capitalize on many easy opportunities to up-sell on products and services.
Last week, John was involved in an incident involving two other tellers. The shift started in the usual manner with a briefing from the Branch Manager about some of the bank's new products, then John opened his teller window and processed some straightforward transactions for customers. Mid-morning, a student came into the branch to enquire about transferring funds from Malaysia to pay her tuition fees. Chris, the teller next to John, began advising the student about their options and identified two ways that the transfer could be handled. Chris asked John's advice as to which option would be best for the student to use, something Chris had done many times in the past. On this day, however, John seemed quite distracted and lost and seemed to find it difficult to follow the conversation. John finally offered a recommendation but Simon, the teller working on Chris's other side, said he thought that was no longer an option because the bank had changed some of its product terms. John snapped "Oh well, just do the other one then!" and turned away to deal with his next customer, leaving Chris and Simon feeling awkward and uncomfortable.
Concerned that John was behaving so atypically, Claire set up meeting with John to discuss his situation, and determine what was going on. When Claire first approached John and asked if he is ok, he has said he is just tired because he hasn't been sleeping well. He seemed defensive and when Claire asked him about the incident he responded as follows:
"I can't believe that just happened. I can't believe Simon just undermined me in front of a customer that way. I know perfectly well how to handle this kind of issue, I do it almost every day. I have never been treated so disrespectfully. He may know the new product information but he knows nothing about international banking!"
After reflecting on John's comments, Claire asked how he has been feeling more generally John reported that he no longer seems to enjoy things the way he used to and he feels a sense of sadness just about every day; so much so that it is a huge effort to even get out of bed some mornings. He used to enjoy tending to his garden in the afternoons and at weekends, but couldn't be bothered going outside much anymore. John has stopped going to the gym, and no longer attends his regular Community Environment Care group meetings. John says that he just doesn't have the energy to do these things anymore.
When Claire asked whether John has spoken to anyone else about how he has been feeling John reported that he has talked about things with his wife Julie, who is trying to be supportive, but also seems frustrated with John. Julie has repeatedly commented that John doesn't seem himself and is always "out of sorts". Julie thinks that a lot of what is going on is due to John not getting enough sleep - he often finds himself waking up in the early hours of the morning and is then unable to fall back asleep. John says that Julie has been encouraging him to take a break from work and for them to go away on holiday. John says although he thinks Julie's suggestion is a good idea, he doesn't want to overburden his colleagues at work by taking time off, and he doesn't really feel up to travelling anywhere for a holiday.
‘John' (Stage Two)
Three days after the incident involving John, Simon and Chris, John requested a meeting with Claire, the Branch Manager. In the meeting, John explained that he has been feeling down and defeated most of the time. He is very tired and irritable as he now has difficulty sleeping, which is making his mood even worse. He finds it a battle to get through the day, because even simple and straightforward tasks are feeling as though they require major effort. He has tried to maintain his usual cheery demeanour but feels exhausted by the effort it takes to be sociable even in everyday conversations. He admits this has sometimes caused him to snap at colleagues because he just hasn't got the energy to make small talk. He has tried to ‘buck up' but admits that changing so much as a person has left him feeling like he has lost control over his life and helpless to fix things.
John disclosed that he has consulted his GP to try and get some help with his situation. His GP has diagnosed depression and referred him to a psychologist who has now confirmed that diagnosis. His GP and her psychologist are now treating him with a combination of drug therapies and counselling. His GP has prescribed a combination of antidepressant medication and benzodiazepines (also known as sedatives) to help John deal with his feelings of helplessness. John has found that the antidepressant medications did help his mood but have also caused him to have headaches and nausea. The benzodiazepine has been prescribed to help to reduce John's feelings of tension and provide a ‘circuit breaker' for John's sleeplessness, but John's doctor has told him he would only be taking them for a few weeks as they have a high risk of dependency. Because drowsiness is a common side effect for this type of medication, John is taking a low dose in the mornings and a higher dose at night to help with his sleep. Nevertheless he is finding the new medications are making him feel ‘groggy' and causing problems with his focus and concentration, particularly during the morning. John is also undergoing Cognitive Behavioural Therapy with his psychologist, which is a form of therapy focused on helping people change their thought patterns and the way they react to common difficulties. John is now attending two counselling sessions a week and says he has found this therapy has already been useful in helping him identify when his depression becomes more acute and how this affects his thinking.
John and Claire began discussing ways in which the bank could accommodate John's situation. His main duties are performing teller transactions and account advice, and he specialises in providing advice and assistance to international students who want to establish banking arrangements in Australia or handle international banking transactions. John thinks that a respite from dealing with customers would make it easier for him to manage when he is feeling especially low. However, he also has responsibilities for overseeing the international banking side of the branch's activities, which is highly specialised work that could not easily be re-allocated. The bank is currently handling two particularly complicated situations which are both being handled by John. The first deal establishes relationships with a number of new banking partners in several overseas countries, which has required that John spent a lot of time on research into the banking regulations which apply in each country and protracted consultations with lawyers to develop a contract which meets the needs of all parties and all regulatory systems. The other situation is a case of potential fraud by one of the bank's international banking partners. The original allegations were raised over a year ago and John's expertise is critical as he investigated the original allegations and has been has been involved in all subsequent issues. The case is crucial to the bank's future as it affects relationships with a number of key banks in other countries, and John is certain that the other partners are watching closely to see how the bank handles the situation. He is concerned that if the bank does not handle the investigations well, the other partners may also try to defraud the bank.
Claire quickly realised that John's situation could not be managed as simply as offering John a period of extended leave to adjusts to his condition and his medication. John is keen to continue counselling but concerned that due to a change in his counsellor's schedule the counsellor can only provide appointments during working hours from now on. His working hours and duties could be changed but will require a re-allocation of duties amongst the customer service staff. This could be challenging to explain to the other staff as John does not want anyone else in the bank to know he has depression. John wants to continue working on both the deals he is currently handling but admits he is becoming increasingly anxious about his ability to do so. He is concerned that the difficulties he is experiencing with sleeplessness, poor concentration and ‘fuzzy thinking' might cause him to make mistakes when handling the deals, which could be very costly to the bank and to John's professional reputation. He has also mentioned several times that it is critically important that he keep handling these cases because they are so important to the bank. From John's responses Claire has gathered that John is particularly anxious about this because if his depression worsens and he cannot perform his usual duties he will leave the company ‘high and dry', but he is also concerned that if he cannot handle these deals effectively he will be dismissed for poor performance.
Case 1:‘John' (Stage Three)
Following John's disclosure that he had depression, John and Claire negotiated the following changes to his work arrangements. Claire agreed to John taking more regular breaks during the day, starting and finishing later to allow him to sleep longer in the mornings and a half-day of sick leave once a week to attend a counselling appointment. To provide some relief from the demands of dealing with customers, Claire arranged for John to be released from normal teller duties so he would only be dealing with customers when specific issues arose about international banking transactions. To help John manage the workload of the two situations he was handling, Claire has negotiated some admin support for John and arranged a weekly meeting in which she and John confer about the work he is doing. To protect John's privacy about his depression, Claire told the rest of the tellers that John was being redeployed for a special project related to international banking.
After a few weeks, John still seems to be struggling with the new tasks Claire has given him. A couple of mistakes he has made have caused concern at the bank's headquarters, and Claire has been asked for an explanation. In addition, the other tellers have started to complain that their customer queues are constantly long and it is difficult to get time for a break. Two tellers have also complained that John's position on the ‘special project' was not advertised internally and hence they were not given an opportunity to apply. John seems even more isolated from his team members. Claire has noticed that he has become more comfortable discussing his situation with her, and in asking for advice and support. She has started to feel a bit conflicted about her role in helping John. She wants to be available to provide support for John but has become concerned about maintaining a professional boundary in her relationship with him. On several occasions he has instigated conversations with Claire about his situation, in which he has discussed his treatment and how he is feeling about his situation. These conversations have included calls to her mobile during the early evening, which is impacting upon her home life. She is also finding that dealing with John's situation and the complaints from other team members has been personally demanding, causing her to feel very stressed at times and concerned about whether she is providing the right support for John.
‘John' Giving Voice to Values
Another week passes and John is still experiencing difficulties, though the work-place accommodations are making a difference for him. He is no longer quite so anxious about his future and has told Claire that this is largely because she has been so re-assuring and accommodating. Claire's support and the medication he is taking have provided some mental space for practicing CBT and mindfulness, which is helping to relieve John's distress. He is still not performing like he used to and is not dealing directly with customers. In addition, on a few more occasions John has rung Claire at home in the evening, which she finds intrusive. She is also still fielding complaints from other team members, which is especially demanding because of John's wish to keep the nature of his illness confidential.
Finally things come to a head when Claire returns from a meeting to a message from her manager, Charles Wilson, asking her to ring him about John. Charles explains that he has had a phone call from the Bank's State HR manager, Mandy Johnson, who has received complaints about unfair treatment of staff in her area. Mandy, and now Charles, wants to know why John is being treated so leniently when his performance is clearly sub-standard and why, given this, he is not being dealt with under the Bank's poor performance process. Mandy has called a meeting between Claire, Charles and herself to resolve the issue urgently. Moreover, Charles says that Mandy's parting words were "John needs to be ‘managed out' of the Bank and Claire needs to get her act together!"
Claire believes that managing John out would be the wrong thing to do both commercially and ethically. John has been an excellent worker for most of the time he has been employed at the bank and has a skill set that is hard to reproduce. He also does appear to be getting better and Claire believes he will improve further if given more time. Moreover, John is not performing well because he is ill, not because he is incompetent or lazy. In Claire's view he deserves respect, care and loyalty from the Bank, not dismissal. However, Claire knows she has a battle in front of her to convince Charles and Mandy. If only John would let her tell her managers about his illness, or better yet also allow her to explain John's problem to his colleagues.
Claire decides to try to convince John to let her tell her managers about his illness. And she also decides to speak with him about giving his colleagues just a little more information so that they also understand what is going on. However she feels that in doing so she must not force her views on John; she needs to convince him that being open to her managers and colleagues will help the Bank support him more effectively. Finally she thinks it is important to explain to John that she would prefer him not to ring her in the evenings.
You are to take on the role of Claire in this meeting with John. Given this in preparing for your discussion with John ask:
1. What is at stake or at risk for the key parties, including John and Claire?
2. What are the main arguments that John might raise against Claire's advice? What reasons and rationalisations might he raise to justify keeping his illness confidential?
3. What are Claire's most reasonable and persuasive responses to John's reasons and rationalisations?
4. How should she broach the topic with John and how should she conduct the meeting and what should she say to him?
After this meeting there are two possible scenarios, both require Claire to meet with Charles to discuss John.
Scenario A.
At the meeting John sees the sense of Claire's argument and agrees to let her tell her managers about his depression. Whilst a little taken back about not ringing her afterhours he seems OK with this as well. However, he still doesn't want her to say anything to his colleagues.
Claire sets up an appointment to tell Charles about John illness and argue that he be patient in regards to John's performance and not commence a formal performance management process. She is nervous as she isn't sure how Charles will respond. She decides she will have to prepare her case well and voice her values in a convincing manner.
You are to take on the role of Claire in this meeting with Charles. Given this, in preparing for your discussion with Charles ask:
1. What is at stake or at risk for the key parties?
2. What are the main arguments that Charles might raise against Claire's arguments? What reasons and rationalisations might he raise to justify manage John out?
3. What are Claire's most reasonable and persuasive responses to Charles reasons and rationalisations?
4. What should she say to Charles?
Scenario B.
Claire meets with John to present her suggestions but unfortunately John does not react well. He insists that his illness is his business, and no one but her is to know about it. He argues that the Bank and his colleagues should just accept that he is having a bad couple of months and that his years of loyal service warrants their patience. He also is clearly upset by her request to not ring her in the evenings. He leaves their meeting quite upset, and Claire fears she has made matters worse.
Nevertheless, even though she is not going to be able to tell her managers about John's problems, she decides that in the meeting with Charles she will seek to convince him that she has the matter under control and that he should be patient with her and with John.
You are to take on the role of Claire in this meeting with Charles. Given this, in preparing for your discussion with Charles ask:
1. What is at stake or at risk for the key parties?
2. What are the main arguments that Charles might raise against Claire's arguments? What reasons and rationalisations might they raise to justify manage John out?
3. What are Claire's most reasonable and persuasive responses to Charles reasons and rationalisations?
4. What should she say to Charles?