As COVID-19 inoculations in the U.S. slowly push back the immediate threat of the coronavirus, experts say employers should be aware that some workers will be dealing with mental health issues brought on or exacerbated by the pandemic.
Exactly how severe the impact of COVID-19 and the accompanying isolation will be for America's workers remains an open question, but experts agreed that an uptick in pandemic-related mental health issues is likely in the coming months.
Tamar Rodney, an assistant professor at the Johns Hopkins School of Nursing and psychiatric nurse practitioner whose doctoral research focused on post-traumatic stress disorder, offered a grim prediction.
"I'm expecting it to get much worse, and I think it will be in the realm of nothing that we've seen before," she said. "Because, for the first time, we're having an event that's affecting everyone."
Here, experts offer five tips to help employees while staying on the right side of the law.
Tell Managers to Empathize
Allegra Lawrence-Hardy, co-founder of commercial litigation firm
Lawrence & Bundy LLC, said she's an optimist, but being alert to employees' mental health in the coming months is a smart move for employers.
"I'm not here to say it's going to be bad, but I do think it's going to be significant," she said, adding that many employers have already realized there's a "business incentive" to holistically support their employees through the crisis.
Johns Hopkins' Rodney noted that long-term effects of post-traumatic stress disorder are typically seen about three months after the initial exposure to a trauma, and the past 14 months have been a source of rolling waves of traumas for different people — some more than others, like frontline workers and those who lost a loved one.
Some hallmark symptoms of PTSD include sleep loss and nightmares, avoidance of certain situations in which a person feels unsafe, irritability and outbursts, and hyper-alertness, said Rodney, noting that one challenge is that these symptoms often aren't recognized as a manifestation of the disorder.
"We're going to have to train our leaders on how to be empathetic and act with humanity in spotting and responding to, with active listening, some of these newer issues which we haven't seen before," said Nonnie Shivers, an employment-side shareholder at
Ogletree Deakins Nash Smoak & Stewart PC.
Shivers said workplace leaders could be trained on what they might see or what the country is already seeing in people's mental health. Other mental health challenges — including anxiety, depression and substance use — are all up in the U.S., particularly in communities of color, researchers say.
Shivers also said managers should know what to do if someone is acting differently. Workplace leaders should be able to communicate with the affected employee without eliciting more medical information than they need, which could trigger liability under the
Americans with Disabilities Act, 
Shivers said.
Shivers also noted that employers are likely to see a wide range of pandemic-related mental health issues among their workforce. She urged a focus on manager trainings and preparation.
For example, supervisors should be instructed to avoid so-called "excited utterances," like exclaiming to an anxious employee, "What do you mean, you freaked out on your commute?" she said.
Don't Try to Diagnose
Employment attorneys cautioned against supervisors and managers drawing their own conclusions about an employee's mental health based on their behavior.
While employers can train their supervisors to recognize the symptoms of PTSD, leaders should also be careful not to imply that they think a worker has it, as any mention could later become the subject of a "perceived-as" disability claim under the ADA, experts warned.
"We are not medical doctors. We may like to think that we have knowledge, but we need to defer to true medical experts," Shivers said. "Our job is to know our employees and our workforce and our culture and be able to spot differences, divergences and aberrations."
She emphasized framing conversations about performance issues around
concrete expectations of the job.
Lawrence-Hardy agreed with the sentiment.
"We would be encouraging any leader, any manager to document the behavior," she said, adding a disclaimer that she wasn't offering legal advice. "A manager is only managing performance."
As part of the plan to address that behavior, she added, human resources could remind the employee about help available to them.
Review ADA Accommodation Process
Sometimes accommodations are necessary for workers dealing with a mental health issue, and such measures should be approached on a case-by-case basis, experts said. Now is a good time for employers to make sure they have their Americans with Disabilities Act ducks in a row, Shivers noted.
"It's a good chance, an opportunity for employers to reevaluate the state of affairs of their accommodation process and make sure that all paperwork and processes are clear and transparent and that leaders are familiar with those," she said.
What constitutes an "undue hardship" — which would allow a company to deny certain accommodations for an employee with a disability under the ADA if it would pose a strain on colleagues or finances — is largely untested in our current reality, Lawrence-Hardy said.
Things could get especially tricky if a high percentage of the workforce asks for mental health accommodations at the same time, she said.
"These are interesting questions … the case law does not yet provide an answer," she said. "The reality is, I don't know the employer that can have, for example, 40% of its workforce not at work and still do whatever it's in business to do."
Someone with PTSD symptoms could request a modified work schedule — for example, coming in later or doing some work from home — if they were having trouble sleeping or needed to attend therapy appointments, Lawrence-Hardy suggested.
Some work tasks could also be difficult for a customer-facing employee with PTSD-related irritability or outbursts, Lawrence-Hardy noted. In that case, they might be moved to a different position, she said. But if all the workers had to deal with customers and many were also experiencing difficulties, the shift would be more of a burden on the employer, she pointed out.
"So those are the sorts of questions we'll be having," Lawrence-Hardy said.
Remember the Therapeutic Power of Time Off
Shivers said that in her observations, front-line workers are ready for a vacation.
"Overall, what I would say is, I think that some folks are starting to wear thin," Shivers said, adding that she's particularly seen it in the e-commerce industry.
Employees who have been working in person all along need a break, not only to deal with the complications of the pandemic but also with the national reckonings around racial justice, she said, and this downtime is necessary.
"That much-needed time off, it's kind of that third component of mental and physical health … That pace they've been maintaining is wearing on some of our workforces," Shivers said.
She added that she's hopeful employers will act with "empathy and humanity" in recognizing what difficult times we are in and move forward with lessons from the year, such as allowing employees to stay home without repercussions when they're sick.
Health care workers in particular will need robust support in the coming months, Johns Hopkins' Rodney noted. As the dire threat of COVID-19 ebbs somewhat for the general public, she pointed out that health workers will need to remain vigilant for symptoms of the disease in their patients for the foreseeable future. They are likely to experience pandemic-related mental health issues at a higher rate than the general population.
"It's like when you have a funeral and everybody comes that one day to mourn, and then two weeks afterward nobody else is there," she said. "That's precisely what's going to happen to our mental health, for the mental health of health care workers, when it gets quiet again."
Take a Holistic Approach
Lawrence-Hardy said her clients, particularly those with heavily millennial workforces, have leaned in hard to employee assistance and wellness programs during the pandemic.
"One of the things I've seen, particularly interesting in terms of trends, is that millennial workers are really raising their hand," she said. "We have a generation in the workplace for whom there is less stigma around these issues."
Shivers said that while employee assistance programs can be a good source for tools, they tend to be underutilized, and employers shouldn't necessarily lean on them as a "silver bullet."
Shivers also pointed out that Americans' physical health may be suffering as a result of the pandemic year, and that employers should be prepared to support their workers in addressing that as well.
The
American Psychological Association's 2021 Stress in America survey found that nearly half of Americans had "delayed or canceled" some health care, while over half had squeezed in less physical activity than they wanted.
In the coming months, employers could see an uptick in employees using leave and calling out of work in order to get treatment and preventative care they've delayed, such as dentist's appointments, as well as evaluations of health problems that developed over the past year, Shivers said.
"We may see an uptick in people who are then needing to address a variety of health issues, and we need to be prepared for that on both ends," Shivers said.
--Editing by Haylee Pearl and Neil Cohen.
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