Neurodiversity is a natural part of human variation. It was first described in the context of understanding autism and, soon after, ADHD, dyslexia, and other related differences with the goal of reframing neurodivergent experience as that of diversity rather than a deficit.
Mental health struggles are not the same as neurodiversity. Not all neurodivergent individuals will experience mental health problems, and neurodivergent nervous systems can be described as a different operating system rather than a broken neurotypical nervous system.
Under the right conditions, neurodivergent individuals thrive. However, most public spaces (e.g., crowded transportation systems, shopping malls and open offices) and societal practices have not been designed to include neurodivergent individuals.
Currently, there is a significant link between neurodiversity and mental health struggles. In some cases, this correlation might be traced to biological predispositions, but research shows that often it is due to the stress of living in a world not designed for neurodivergent individuals, resulting in psychological strain and trauma. Stressors, including discrimination, internalized stigma, and the pressure of masking, or camouflaging, significantly impact mental health. Many neurodivergent people also experience sensory trauma as a result of living in a world designed for less sensitive sensory systems.
The Stress and Stigma of Mental Health Struggles
At the same time, mental health struggles are widespread. In 2022, about 20% of adults in the US experienced a mental health condition. The working lives of all people, neurodivergent or neurotypical, can be impacted by mental health crises. Worldwide, depression and anxiety disorders are among the leading causes of disability. In some cases, mental health struggles become fatal.
From the business perspective, investing in mental health care can play an essential role in lowering absenteeism and presenteeism at work (working while sick, resulting in suboptimal performance). From the human caring perspective, timely mental health aid can alleviate and prevent much suffering.
Unfortunately, the majority of full-time employees experiencing common mental illness do not receive treatment, or delay seeking treatment – which exacerbates the problem and increases the risk of long-term disability.
Help-seeking is hindered by several workplace barriers, including a lack of recognition of mental health conditions, stigmatizing attitudes, and discrimination.
Lack of awareness and recognition is a major problem. In a study of 60,556 Australian workers, 31 % did not recognize that they had a mental health problem and therefore did not seek any help. The lack of recognition of our own mental health struggles limits the usefulness of Employee Assistance Programs (EAP) for addressing mental health – regardless of the quality and confidentiality of these programs.
The work of supporting mental health at work is made even more difficult by widespread prejudice and discrimination. People with depression experienced significant discrimination in the workplace, according to a recent study across 35 countries. Managers are more critical of an employee’s performance if they are experiencing burnout or depression than if they are experiencing a physical illness. A lack of manager support doubles the likelihood of long-term sickness absences caused by mental illnesses.
The double whammy of mental health struggles is the strain and stress of the condition in itself, combined with the stress of stigma, shame, and social rejection. The struggle might be even more dramatic when the stigma and stress of mental illness is combined with the stigma and stress of being neurodivergent in a neurotypical world.
Individual distress and work productivity losses can be significantly reduced by improving workers’ recognition of their need for help, addressing others’ attitudes, and eliminating structural barriers to help, support, and inclusion.
Mental Health First Aid (MHFA) approach
One promising approach to reducing both the stress and the stigma of psychological struggles is Mental Health First Aid (MHFA) training. This model was developed in Australia to address public understanding of mental health and adopted in many other countries, including Denmark, Sweden and Canada. MHFA follows a physical first aid model. People outside of the mental health profession (such as coworkers and managers) are trained to provide initial support to people who are experiencing a mental health crisis or developing a mental health issue, until professional help is available.
MHFA follows a five-component action plan (ALGEE):
- Approach, assess and assist with any crisis – assess the risk of suicide or harm and look for signs of trauma and high anxiety.
- Listen to the person non-judgmentally.
- Give the person reassurance, support and information.
- Encourage the person to seek appropriate professional help.
- Encourage the person to seek self-help and other support strategies.
Unlike other emergency action plans, the tasks of the ALGEE action plan do not have to be done in sequence. It is possible to assess the risks, give reassurance and listen without judgment at the same time. In many cases encountered in the workplace, non-judgmental listening is all that the person needs.
MHFA was originally developed as an intervention for the general public, but it is increasingly used as a workplace intervention, with substantial research support and specific guidelines and training for providing MHFA in a workplace setting, with additional recommendations for first aiders who are also managers.
A typical MHFA training, however, does not cover neurodiversity, so individuals who have received it may not recognize that common mental health conditions such as depression and anxiety may affect autistic people or those with ADHD in a different way.
Hence, the standard MHFA training may need to be supplemented by training that is focused more specifically on neurodiversity. For example, the training developed by Bury and colleagues is focused on mental health in the context of autism. Although it does not include other neurodivergent conditions, it might be a helpful starting point. In addition, there are many other systems and approaches to reducing mental health stigma in the workplace, such as training for managers developed in Germany that effectively improved knowledge and reduced managers’ stigma toward depression.
While there is no “perfect” mental health first aid system for neurodivergent individuals, incorporating the attention to mental health into the workplace culture can significantly contribute to reducing the mental health stigma. Another, more systemic way of creating workplaces that support mental health and wellbeing, including in neurodivergent populations, is developing trauma-informed organizations.
The models of trauma-informed organizations and trauma-informed leadership were originally developed in helping professions and first-response organizations. However, the key principles are applicable across industries and can help create systems that improve stress management in the workplace. The key principles of the trauma-informed approach are safety, transparency, peer support, collaboration, empowerment, and understanding of diversity factors. These principles can be applied across a variety of workplaces, and expanded to include an understanding of neurodiversity.
1) Safety. In the context of most workplaces, this means safety from psychological violence, such as bullying. Harming others through incivility, gaslighting, hate speech or other forms of psychological violence is not acceptable. While these behaviors are enacted by individuals, organizations must develop systemsof justice that prevent and quickly address these behaviors. For example, while some people might be sexist, research shows that they can control their bias and abstain from sexist jokes in environments that oppose sexism.
However, discouraging psychological violence does not mean suppressing how we feel. In fact, emotional inclusion is necessary for our wellbeing. Emotional expression is an important part of who we are – and that means feeling safe sharing sadness, anxiety, or grief without the fear of being shamed or deemed “unprofessional.” This is particularly important for neurodivergent employees who may experience emotion more intensely.
On the organizational level, ensuring civility and freedom from psychological violence does not require suppressing employee voice and self-expression. The constructive organizational climate, characterized by both civility and voice, is most conducive to collaboration and safety.
2) Trustworthiness & transparency. The sense of the unknown is sometimes unavoidable when the economy is uncertain. But intentional secrecy in our interpersonal interactions and organizational processes is a major stressor. Transparency is a non-negotiable characteristic of inclusive organizations that welcome neurodiversity and support employee mental health.
3) Peer support. Consistently with MHFA approach, this aspect of creating trauma-informed organizations is based on the idea that having understanding peers who listen without judgment can help prevent a minor mental health challenge from turning into an all-consuming and debilitating problem. More broadly, positive peer interactions and workplace friendships are foundational to employee satisfaction and well-being.
4) Collaboration & mutuality. Competitive and cutthroat organizational climates contribute to employee stress. Collaborative cultural norms and training employees in tension reduction can help create non-violent and productive environments.
5) Empowerment & choice. Agency and control are our core needs, and participation is one of the principles of an inclusive workplace. Empowering employees to make choices about their work supports productivity, and for neurodivergent employees, it can make a difference between outstanding productivity and unrealized potential.
6) Diversity Awareness. I have expanded this important point beyond the original “cultural, historical & gender issues,” to include neurodiversity, disability, and mental health differences. Historical and lived injustices and discrimination create an exaggerated stress response. So do certain health and mental health conditions. Understanding neurodiversity as both biological differences in brain wiring and as shared cultural experience enriches the understanding of issues that should be considered in creating trauma-informed organizations. That shared cultural experience includes unique cultural symbolism as well as dealing with stigma, discrimination, and with hostile and traumatizing sensory environments.
Supporting Mental Health Helps All
The interplay between neurodiversity and mental health is complex. However, sources agree that the impact of the environment – including coworker attitudes and organizational practices – plays a major role in whether neurodivergent individuals experience mental health struggles.
There are many approaches to supporting mental health at work; these can complement each other, as well as help organizations move toward increasingly more comprehensive approaches to inclusion. Improving the psychological literacy of coworkers and managers via mental health first aid or similar programs can make a difference by helping reduce the mental health stigma and providing support that is likely to help reduce stress. It can also lay the foundation for a broader transformation, such as adopting trauma-informed organizational practices, and even more comprehensive approaches to inclusion, such as creating intersectionally informed inclusive talent operations systems.
Importantly, all approaches to promoting psychological well-being can help both neurodivergent and neurotypical employees. In a broader sense, organizations that focus on preventing mental health dangers associated with toxic environments and build systems that support the well-being of the most sensitive to toxic environments employees, including neurodivergent and those more vulnerable to mental health issues – canaries in the coal mine – will create workplaces where all thrive.