**4. Recommendations**

The COVID-19 pandemic has taken a tremendous toll on the status of both individual and collective mental health. To better address our current reality, while also preparing for future crises, we must expand research, implement policies and interventions, and provide inclusive and accessible resources that include awareness and representation of marginalized groups. With the extreme negative mental health outcomes associated with the pandemic, employers will need to expand their focus on mental health and wellbeing beyond traditional employee assistance program referrals. Nelson (2020) prescribes fostering a workplace culture of health with strategies to address both short-term treatment and long-term sustainable well-being goals for employees [54].

#### *4.1. Destigmatizing Mental Health Conditions in the Workplace*

To address the mental health needs of employees, organizational members and leaders must work to destigmatize workplaces by focusing on eliminating the perception that utilizing mental health services through employers might be detrimental to job security. Stigma directed towards people with mental health conditions and substance use disorder can manifest as discrimination, shaming and prejudice [55]. These negative behaviors perpetuate barriers with profoundly harmful outcomes for those in crisis, typically preventing them from asking for help. A recent survey of nearly 1000 employees and more than 500 U.S. benefit program decision-makers during the pandemic found that 37% of employees avoided treatment for mental illness and 52% for substance use disorder because they were fearful of others becoming aware of their condition [55]. Toth and Dewa (2014) report that stigma associated with disclosure of mental disorders in the workplace severely limits employees from seeking assistance [56]. "Individuals who possess a stigmatizing attribute that is concealable often live in constant fear of being discovered, and significant stress results from seeking to keep the attribute hidden and making decisions about disclosure" [56] (p. 733). According to Nelson (2020), 68% of employees are afraid to ask for help and yet NAMI, the National Alliance on Mental Health reports that eight out of ten people experience mental health conditions [54]. Workplace culture is critical in terms of ensuring an environment that supports disclosure decisions by employees. Moreover, Toth and Dewa (2014) point out that organizational goals should not be focused on the act of disclosure itself; "rather, the organization should strive to create an environment in which employees feel safe to disclose should they wish to do so" [56] (p. 743).

The pandemic has catalyzed employee demand for workplace environments focused on mental health inclusivity. More than 90% of employees want their employers to provide personalized benefits that accommodate their unique individual needs, age and life circumstances [57]. With five generations currently represented in the workforce, meeting distinctive behavioral health needs is paramount. The greatest percentage of healthcare users in the workplace are the traditionalist generation or those born between 1925 to 1945 who make up 2% of the current workforce, while Baby Boomers born between 1946 to 1964 comprise only 25% of the workforce but are the second highest user of healthcare at 60% [57]. Over 53% of workers from Generation X, born from 1965 to 1980 and representing 33% of the workforce, are looking for all encompassing wellness programs [57]. Comprising 35% of the workforce, approximately 85% of Millennials or those born between 1981 to 1996 report that their healthcare insurance has contributed to their decision to remain with their existing employer, when services focused on both holistic physical and mental health were included [54,57]. Finally, 65% of Generation Z, or those born between 1997 and 2012 report that they pursue employment opportunities based on benefits, specifically companies with Employee Assistance Programs (EAPs) and benefits that include mental health [57]. Therefore, organizational culture that communicates well-being across all levels of the organization combined with whole-person healthcare strategies that are adaptable to employees' changing mental health needs will contribute to successful attraction, hiring and retention goals.

#### *4.2. Strategies for Addressing Discriminatory Behavior and Misperceptions*

Organizational leaders need to confront structural stigmas such as cultural norms and institutional practices that limit resources and negatively impact employee well-being. There are several strategies that can be implemented within the workplace to promote inclusion and to address misperceptions and discriminatory behavior towards people with mental health conditions.

*Integrate person-first language within all communications.* Ensure this inclusionary practice is incorporated into all workplace internal and external communications. Placing the emphasis on people rather a particular condition or diagnosis "frames the disease of substance use disorder as a negative characteristic of the individual and brings moral judgment. By utilizing person-first language, an individual is no longer defined by their

condition. The person is placed first with the condition being secondary, which helps to eliminate stereotypes and biases" [58] (pp. 3, 5). Furthermore, communicating the treatable nature of mental health conditions and substance use disorders through recovery programs helps to mitigate discrimination that propagates the shame that people with behavioral health needs often experience.

*Implement mental health literacy education programs.* Ensuring educational awareness programs are accessible to all employees helps to address stigma and concepts of moral failing that many associate with mental health conditions. For example, the Mental Health First Aid (MHFA) standardized training program, developed in Australia in 2001, has proven to be a globally effective program for improving "participants' knowledge, attitudes and behaviours related to mental ill-health" [59] (p. 467). This evidence-based approach to increasing confidence in one's ability to recognize the signs of mental health and substance use disorders empowers organization-wide support by employees for those in distress.

*Review workplace mental health policies and practices.* Creating an environment in which employees feel comfortable discussing mental health issues enables the development of policies that meet legal requirements while also incorporating aspects that truly fulfill employee needs.

#### *4.3. Creating a Psychologically Safe Environment*

The more generalized actions previously discussed can facilitate changes within the workplace to reduce stigma. However additional measures should be taken to implement destigmatizing strategies that acknowledge and address the needs of marginalized groups that have been more profoundly impacted.

*Promote a psychologically safe culture.* A workplace environment that includes a psychologically safe climate empowers employees to feel comfortable being themselves. Organizational culture represents a group identity constructed through a process of learning that evokes purpose within all organizational activities. The phenomenon of cultural DNA becomes integrated within organizations to the degree that beliefs become accepted assumptions which provide structural stability regardless of transitions in workforce membership [60]. Recognizing and addressing organizational disparities in the distribution of influence, authority and power that negatively affect marginalized groups is paramount to developing a psychologically safe culture. When a supportive and trusting organizational culture is the norm, employees "feel able to show and employ one's self without fear of negative consequences to self-image, status, or career" [61] (p. 708). Marginalized social identity groups such as women, people with mental or physical disabilities, racial and ethnic groups, immigrants, native and Indigenous communities, and LGBTQ+ people encounter exclusion and stigma. Therefore, it is even more critical that leaders "display behaviors that promote an employee's perceptions of belongingness while also experiencing that they are valued for their uniqueness" [62] (p. 11). Shore and Chung (2021) point out that for stigmatized social identities, inclusionary treatment that values uniqueness in concert with fostering belongingness creates a foundation for psychological safety [62]. Below are several recommended actions adapted from Schein and Schein (2017) and Shore and Chung (2021) that can be implemented to create workplace psychological safety [60,62].

*Acknowledge* limits of leadership knowledge, including past mistakes and establish accountability, ensuring that leaders clearly articulate these demanding inclusive practices within performance management at all levels of the organization. *Remove* literal and figurative barriers, systems and structures that promote exclusionary and discriminatory behaviors. Create or fix systems and structures, providing equal access to tools and opportunities, thereby recognizing that marginalized employees do not have the same advantages, opportunities, or experiences. *Promote* inclusive leadership practices by valuing the unique perspectives contributed by a diverse workforce. Diversity and inclusion are not interchangeable concepts. Where legislation and policy can specifically mandate diversity, inclusion is a voluntary action that must be taught, promoted, and integrated. *Ensure* that diversity, equity, and inclusion agendas include neurodiversity that also encompasses behavioral-health conditions, thereby creating a supportive workplace that removes barriers for people with mental health issues, whether disclosed or undisclosed. *Provide* resources, support groups, and diverse ways for employees to openly share ideas, experiences, and feedback. Organizations that promote a psychologically safe culture and integrate inclusivity practices as a desirable environment increase organizational capacity to adapt, especially in times of extreme crisis like that caused by the COVID-19 pandemic.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** Not applicable.

**Conflicts of Interest:** The author declares no conflict of interest.

#### **References**

