Nearly one-fifth of US workers describe their mental health as fair or poor, and twice as many say their job has a negative impact on their mental health, according to Gallup. At the same time, more than 20% of US adults have some form of mental illness.

While many workplace mental-health strategies tackle those two issues as one, new research in the Academy of Management Annals argues that supporting workers’ mental health and supporting workers with mental illness are two distinct tasks, requiring two distinct approaches from employers.

“People often conflate those things, mental health and mental illness. That's really problematic, because workplaces need to do different things to address poor mental health than they do to address mental illness,” says co-author Emily Rosado-Solomon, an assistant professor of management at Babson College. “And when they're conflated, we don't really see a lot of opportunity for those sorts of nuanced discussions.”

For further insight, we spoke with Rosado-Solomon and Jaclyn Koopmann, another of the paper’s co-authors and an associate professor of management and entrepreneurship at Auburn University’s Harbert College of Business. Here is a transcript from our conversation, lightly edited for clarity:

What gets lost when workplaces conflate support for workers’ mental health with support for workers with mental illness?

Rosado-Solomon: It's a blurry boundary. When we talk about mental illness, we're really talking about a chronic disease. This is not temporary feelings of anxiety or depression. This is something that meets a clinical definition based on the DSM-5, which is the established book of diagnostic criteria in psychology. Mental health can be a really wide range of things—it overlaps with mental illness, but it's really not the same. Often what we see in workplace research is that it’s temporary feelings of depression or anxiety. Or burnout is something that we frequently see as part of poor mental health.

What is really important is that they're not opposite ends of the spectrum. A lot of times people say that you either have mental illness or you're in good mental health, and it's a singular spectrum. And it's really not. With physical health, you could have a specific condition—maybe you have arthritis, or in the case of mental health, maybe you have bipolar disorder—but you could be in otherwise good mental health, you could be able to thrive at work. Or you could be in generally poor mental health, just like you can be in generally poor physical health but not necessarily have a specific clinical condition. And so in our research paper, it comes out really clearly that people often conflate those things, mental health and mental illness. That's really problematic, because workplaces need to do different things to address poor mental health than they do to address mental illness. And when they're conflated, we don't really see a lot of opportunity for those sorts of nuanced discussions.

How would you characterize the different approaches organizations should take for each issue?

Rosado-Solomon: We reviewed everything we could find about mental health and mental illness and work, 556 papers. We found a couple things that were really important. One of them was that there is disproportionate evidence, like hundreds of studies, that suggest that there are things about the way work is fundamentally designed that contribute to employees’ poor mental health. Things like a lack of clarity about what your responsibilities really are, or a lack of flexibility, or a lack of feeling ownership over making decisions in your work. And so in order to really address poor mental health, especially the parts that organizations can control, those are the things that need to be changed. These are systemic things. We might need to redesign jobs. We might need to revisit the job description and make sure everybody understands what is expected of them, what they're responsible for.

And what's interesting about that is first of all, it is work that is contributing. But also if we were to address these things about work, we would be able to do it proactively. The sort of strategic redesign that we're talking about, we wouldn't wait till employees are feeling symptoms of anxiety and depression. We would say, ‘Okay, we know that there are hundreds of studies that say a lack of clarity about your job or being consistently overloaded or lack of flexibility, these things are bad.’ And so what comes out of our paper is this opportunity that organizations have to really get in front of this, to not wait until their employees are burned out or their employees are feeling anxiety or depression in order to proactively fix things.

What we see, though, both in terms of practice and also in terms of a lot of the experiments about how to fix this, are really reactive strategies. They're looking at, ‘Okay, Bob is feeling depressed. We could send him to counseling or we could do something to help him,’ without connecting the dots that maybe there's something about his job that could be changed more proactively.

For mental illness, because it's a chronic condition, organizations are likely not going to be able to solve it, but there are a lot of things that they could do to accommodate people with mental illness. Things like depression and anxiety are often episodic, so people with an anxiety disorder might be fine for months and then all of a sudden they have a panic attack. To support them is not necessarily a matter of clarifying their job description or redesigning their job. It's something like, can they leave the office or can they work from home for a few days without having to feel like they're forced to disclose to anybody why they're doing that? It's much more about accommodations, as opposed to a strategic redesign.

Embedded in that story is the fact that scholars, and I think laypeople too, really do conflate poor mental health and mental illness. And so we spend a lot of time disentangling those things. A lot of the research is about how work can be designed so it doesn't harm mental health. Mental illness is a clinical condition that requires different things. But when we get messy with the wording and we conflate it, what ends up happening is organizations hear, ‘Oh, depression is bad.’ And that promotes this ableist trope against people who have mental illness. We know from research and just from anecdotal examples that there are lots of people who have mental illness who are great at their jobs. But a lot of the messaging to try to get employers to redesign jobs is, ‘If your employees are going to be depressed, they're not going to be able to do their jobs as well, or productivity is going to suffer.’ A lot of times employers misunderstand that and say, ‘I should stay away from people with depression or anxiety,’ when in fact that's really not true. And there are many people who have mental illness and manage it incredibly well.

You mention in your paper that there’s been an uptick in recent years in workers’ willingness to disclose mental illness and mental-health problems. What’s behind that?

Koopmann: There's just been a general lessening of the social stigma more broadly, outside of organizations. There's a lot more discussion and visibility of influential role models who are very successful, who have disclosed, ‘Yes, I'm an Olympic athlete or I'm a CEO of a company, but I also have struggled for years with such and such mental illness.’ So I think there's a lot more visibility and reduction of stigma, and ability to see people who are successful and willing to be vulnerable and to admit, ‘This is another part of me, but I'm still successful at my job and I manage it well.’ And I think Covid escalated that as well, because it was something that was starting to affect everyone. Everybody could start to relate to some of the symptoms that might be experienced with a clinical condition, even if they were experiencing more of a temporary poor mental health state.

So all of that culminated in more willingness to disclose. Now, it doesn't mean that everybody is super comfortable fully disclosing all of their conditions in the workplace. But we've seen a move towards it feeling more acceptable and safe to be able to do so, because of the broader societal stigma shifting a little bit and the pandemic and everyone having that shared experience.

A lot of the guidance for managers in particular focuses on how to help their reports feel comfortable discussing mental health at work. But some recent reporting has highlighted the pitfalls of putting too much of that burden on managers to support workers’ mental health. How should organizations find the right balance?

Rosado-Solomon: Mind Share partners recently had this campaign that says, ‘Leaders go first.’ The idea is that leaders should be the ones who are talking about their mental-health challenges, and that will help rank and file employees feel more comfortable discussing their own challenges. I think in some cases that's fine and that's good. But it puts a lot of pressure on middle managers ,who are not completely immune from whatever other stigma might be going on and maybe did not sign up for that level of disclosure as part of their director-level job.

What our paper really hammers in on is, one, there's been some research that when people disclose, they won't always disclose all the way. So instead of saying, ‘I have major depressive disorder and it's really flaring up,’ they might say, ‘I'm having a really difficult time today.’ They're not calling it mental illness, but they're still reaching out for help. Any time an employee says, ‘Hey, I'm struggling, I need this thing,’ organizations need to be really mindful that the way that they respond to that sets the tone for both that employee's comfort disclosing in the future, and for other employees and how they're observing that.

But also, so much of what we find in terms of what exacerbates poor mental health and what might be useful for people with mental illness doesn't require disclosure. There is this really false assumption that a lot of organizations have, like, ‘I need to know about an employee's mental health or mental illness to be able to support them.’ You really don't. If you do the strategic proactive redesign and you're a little flexible, and you take your employee's word for it when they say, ‘Hey, I'm having a problem, I need to work from home today,’ then they feel supported. They feel like they could come to you with things and it's not necessary for them to put themselves out there. And so I don't know that a culture that promotes universal disclosure is actually the most realistic or the most beneficial goal. If we switch to thinking about this as what can we do proactively, and what can we do to be generally supportive, organizations would have employees that are a lot better off.

Koopmann: A lot of those proactive steps mean that employees don't have to think about disclosing and take on the burden of worrying about, ‘If I disclose this to this person, will they look at me differently in the future? Will my boss be supportive?’ Built-in flexibility in the job is going to lead to a built-in ability for those with chronic conditions to take flex time that they might need, without having to fully disclose what their medical condition is.

Even if you create a safe environment for an employee to disclose, I don't know that you would fully remove the vulnerability experienced by the employees in that situation. So it's not necessarily that we want to make it a climate where everybody can fully disclose all their conditions that they need help with, or might need help with in the future. It's not bad to have a safe culture for that, but we should be really thinking proactively about it and making it a setup where the organization is the responsible actor for making sure that employees are well taken care of. They might not need to disclose a mental-health challenge, for example, if the organization has taken proactive steps to mitigate the psychological hazard at work.

Rosado-Solomon: Disclosure research is good and important, and there's lots of really good research there, but the focus on mental illness research has disproportionately been about disclosure. We know that only about two-thirds of people tell somebody at work when they have a mental-health challenge. And so we're interested in, well, how do we support that other third of the people who aren't talking about it, but still need support?

I don't think disclosure should be the only focus. And I think we have seen a predominant focus on it thus far, at least in the scholarly work. And perhaps that is informed by misunderstanding or misconception for practitioners that you need to know if somebody has a mental illness in order to support them. What our research finds is you really don't. It might be putting them in an uncomfortable position to try to pressure a disclosure, because even if the organization is not stigmatizing, their manager is not stigmatizing, maybe Bob sitting three desks down is stigmatizing and the organization can't control that all the way. And so based on the hundreds of studies we've reviewed, my personal opinion is that there is an overemphasis on disclosure at the expense of looking at ways that we can support all employees with mental health challenges.

What are some examples of proactive steps that would eliminate that burden on the employee?

Koopmann: A big one is the job design or redesign—revisiting how your organization is going to have particular policies about being flexible with work schedules or building autonomy into positions, clarifying roles, who's responsible for eliminating any ambiguity in what someone is responsible for, removing excess demands that might be embedded within a certain role. Maybe there was a removal of a position in an org restructuring, and now one person is holding two jobs and it's a really excessive workload. Find a way to make that person be doing just one job again, and find a way to either spread the second job across people in a way that is reasonable or make sure that separate role is reintegrated into the organization. So it's a lot of making sure that jobs are giving some empowerment or control or autonomy to employees, giving them some flexibility, making sure their responsibilities are very clear to them, expectations of them are very clear. All of those things are proactive things that organizations can be doing.

Rosado-Solomon: One more thing to add on is culture. It’s not necessarily a culture where everybody discloses, but is there a culture of support and that lacks bullying? If you have a high-performing superstar who's bullying other people, move them, fire them, discipline them. Even if you are worried about what that'll do in the short term to your company's productivity, the impact on the culture is huge for mental health. And make sure that employees have the opportunity for social support. Are they allowed to take a couple minutes at the coffee machine and chitchat with their friends without the manager looking at them or yelling at them? So do they have that opportunity for social support and do you really have a no-tolerance policy for bad actors that might damage the climate?

What about for interventions specifically to support workers with mental illness?

Rosado-Solomon: There has been less on that, and it depends also on what kind of mental illness we're talking about. We've been talking in general about clinical depression or anxiety. Those require very different things than something like schizophrenia, or something perhaps more impairing that might require FMLA or intermittent FMLA, where they can take periods of time when they're really not able to work. But even then, there's one study that shows that if the manager reaches out every couple weeks to check in on the employee who's on leave, who's not in good mental health, that person is much more likely to come back. So it goes back to that support piece and feeling supported by the people in your organization. And then the other one is flexibility, so that, again, we're not forcing the employee to make that disclosure decision.

You write that “workplaces’ response to physical health could serve as a model for attention to mental health.” Can you elaborate?

Koopmann: There's been a lot of attention paid to ensuring physical safety and physical health at work. There was discussion of physical health and physical safety issues all the way back to the turn of the century, around 1900. In the early part of that century, there was a lot of work on something called ‘industrial fatigue.’ They looked at a lot of physical things, and they were aiming to make the most productive worker, but there was also discussions of mental exhaustion as well. But as the decades progressed, there was a lot more attention, especially with accidents in mining industries or other very hazardous industries, on, ‘How do we safeguard the physical bodies of our employees?’ Because that was obviously paramount at the time. And so we saw a lot of more consistent progress in protecting the physical bodies of employees.

We really haven't seen this sort of uptick in paying attention to the mental health of employees or employees with mental illness until maybe the 1980s, is when the research started to pick up. So our whole idea here was to just set up that we knew physical health was a problem, we took care of it, and it was a more of a linear trajectory in paying attention to it. The research just kept going on that topic. We had different laws that were passed that really protected and regulated physical safety. And now we want to say, ‘Why aren't we doing the same thing for mental health, and protecting employees from psychological hazard?’ We found ways to have people wear hard hats on the job, to wear protective eye gear, to wear protective clothing in certain hazardous environments.

And we know that we can take similar proactive steps with regard to mental health and mental illness and the job redesigning and social support being available. So we wanted to draw that parallel to say, ‘We've done this already. We did this for physical safety. We took a linear path and paid attention to that over the course of the 1900s and made great strides. Let's do the same thing for mental health.’

There was sporadic attention paid to mental health in different time periods. It started out kind of similar to physical health, where it was in especially hazardous types of jobs and occupations, like nursing or firefighters. Any type of public service is where we started to see much more attention and volume of research related to things like traumatic stress that might be experienced, either a primary experience or a secondary experience of it. There was also a lot of attention paid to the burnout that can be experienced by folks who work in medical care, nurses and physicians and other staff.

And now I think we're seeing a bigger shift to understanding that it's not just that traumatic work that has mental-health implications for our employees. That's where the research really started, but now it's spreading to other types of occupations. And there may be very occupation-specific hazards—there are different experiences in the workplace of those who work in the medical field or as a frontline responder, versus someone who works more in an office setting or administrative setting. But nonetheless, there are still psychological hazards to be understood and to be proactively addressed for each type of worker.

Your research also argues for the importance of tying support for workers with mental illness to diversity, equity, and inclusion efforts.

Rosado-Solomon: If you think of mental illness as part of the broader umbrella of neurodiversity—people who have different chronic mental illnesses have brains that are wired differently, and that is the definition of neurodiversity—then people who have mental illness are a category of diversity that we often don't talk about in mainstream corporate DEI efforts. So that's one way.

But then the other way is that people from different genders, from different racial backgrounds, experience mental illness differently. It manifests differently for them. They have different access to resources. For instance, in the Hispanic community, in the Asian American community, just nationwide, there's a dearth of culturally competent psychiatric care that understands the culturally specific factors at play in poor mental health. And so that idea of intersectionality is really important to understand— not just people with mental illness as a form of neurodiversity, but also the way that intertwines with gender diversity and racial diversity. And the acknowledgement from organizations that what works for maybe Caucasian women with anxiety or depressive disorder might not work for somebody from another gender or from another racial group.

So how might a workplace approach the creation of an intersectional mental-health strategy?

Rosado-Solomon: It goes back to what we've been saying, that the first step is really the proactive stuff. So let's get out of the way all this stuff we know is causing problems about work. And then it is the acknowledgement that everybody's experiences are different. Back to our discussion earlier of how to get people to disclose, it is much more stigmatized in some cultural backgrounds, for men in particular, to disclose a mental illness. We might just have to know that we're not going to get people from those backgrounds to disclose. And so how can we build in flexibility? How can we make sure that they have mental-health benefits that cover really high-quality mental-health care so that they could see a professional? Because managers are not in the position to help employees with mental illness. We are not suggesting that managers should become therapists or psychologists. In fact, really bad things happen when they try. But looking at it from an HR perspective, do they have the benefits or is it really just, ‘Well, here's five therapy sessions per year in a clinic that doesn't necessarily do any good for anyone’? That is where a lot of organizations have historically been focusing their efforts.

Koopmann: Are they fully aware that they have these benefits available to them? That's another thing that is forgotten about. Sometimes people just don't know they have access to those mental health benefits.

Are there any other ideas or practices you would want leaders and managers to take away from this research?

Koopmann: It's the same message that we said a few times already: Are your jobs designed optimally to protect employees’ mental health and to accommodate those with a diagnosed condition? Do they have the accommodations they need in their job? It's proactively making sure that jobs are at adequate levels of responsibility and workload, adequate levels of control and autonomy, clarity, having social support, removing any toxic employees, including higher-level managers that might be more abusive or rude in nature, somehow counseling them for that behavior, retraining them. Or if you can't change the behavior, maybe they shouldn't be leading people and influencing the work climate in that way.

Rosado-Solomon: To build on that, an important observation is that it's not the sort of interventions that look impressive in a shiny annual report. Things like building in autonomy and flexibility—I've taught HR for many years at the college level, and we don't teach those as mental-health related things. Those are basic strategic HR functions. But it really is those things that make a disproportionate difference for employees’ mental health.

I worked at a coffee shop when I was 16, and not that I had mental-health problems at the time, but at a coffee shop, we don't really think of an opportunity for a lot of autonomy and decision-making. But I had a really good boss, and he let me design the front windows and I got to make a new decoration for each season. And so even jobs where we don't think there's a lot of opportunity for building in autonomy or building in flexibility, if you think really creatively, there probably is. Even in traumatic jobs. There's a really cool research study about humanitarian aid workers, and they found that, yes, the carnage and devastation they saw were contributors, but poor supervisory support and bad culture were also things that impacted them. And so even the most unlikely jobs, do we have room for improvement there?

One big thing in the air right now is worker stress about artificial intelligence and the risk of their jobs being automated away. How might workplaces think about addressing that stress proactively?

Rosado-Solomon: We did not cover that in our paper, but in general, uncertainty is one of the most stressful emotions people can have. We know that uncertainty about anything or ambiguity is terrible for mental health. To the extent that organizations can reduce uncertainty and say, ‘Hey, this is where we might have AI, this is how it will change your job, this is what it looks like,’ really articulate a clear path forward to remove as much of the ambiguity and uncertainty as possible.

Koopmann: It's really proactive communication. That applies to really any organizational change. In general, reducing that uncertainty through proactive communication that is deep enough in information about how it might change the person's role going forward, how they might use the technology going forward, does a lot to help allay concerns over any new organizational change.