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  • Growing Concern
  • A Million Things
  • Tell Me If There’s a Problem
  • Question: What should Carlos do? The Experts Respond
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  • Which of the following terms describes the maximum reimbursement a third party payer will provide?
  • In which of the following location should the inside address appear in a business letter?

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Rami Niemi

As Carlos Guerrero walked to the whiteboard where the app development team had gathered for its daily stand-up, he noticed that Larry Berman was absent again. But this time he didn’t bother to ask anyone about it. He just carried on.

“Morning,” he said, staring at the dizzying assortment of sticky notes on the whiteboard. “Hit me with your updates.”

As the director of digital strategy for Meals Now, a rapidly growing subscription meal-delivery service, Carlos was cosponsoring a critical app redesign project, staffed by a team of seven plus a few external consultants. Larry, the head of technology, was his partner in this endeavor, but recently it hadn’t felt much like a partnership. In fact, Carlos had offered to run the stand-ups on an as-needed basis only—they really should’ve been Larry’s job.

Carlos tried to focus on what Irina, one of Larry’s developers, was telling him about the current agile sprint. With the redesign six months along and more than halfway done, these daily stand-ups were increasingly important if the team was to meet its aggressive deadlines.

“We’re just not sure whether Larry has signed the contract with the social login provider yet,” Irina said.

“OK, let’s check with him on that,” Carlos replied, realizing that he’d said the exact same thing the day before. “What time did he say he’d be in?” Irina exchanged a nervous glance with Mike, Larry’s number two, and they both shrugged. “I’ll give him a call,” Carlos said with a sigh.

He knew that Larry had had a rough year. His team’s application architect had left mere days before the redesign project began, and he’d struggled to find a replacement, in the meantime assuming many of that position’s responsibilities. On the personal front, rumor had it that he’d been separated from his wife for several months and was living in an apartment near the office. Though he was in the habit of working from home occasionally, his schedule had been very erratic in recent weeks. Some days he didn’t show up at work; others he arrived before everyone else, worked furiously at his desk without even getting up to eat, and stayed well into the evening if not through the night.

John A. Quelch teaches the note on which this story is based in his course Consumers, Corporations, and Public Health.

What drew you to this story?
The course encourages dialogue and understanding between public health and business students. With 18% of U.S. GDP now allocated to health care, leaders across all sectors need to be familiar with the health care system, including mental wellness.

How do students typically respond?
They often share personal experiences of trying to help colleagues suffering from mental illness. Many felt unprepared to do so and were unaware of the legal and ethical aspects of any intervention.

What do you hope they will learn from the discussion?
The goal is to encourage them to think about promoting mental wellness in the organizations they will influence during their careers. We hope to dispel some of the stigma around mental illness and to encourage students to look out for their own mental well-being along with that of colleagues.

As the meeting was breaking up, Carlos caught Irina’s attention. “Do you have a minute?” he asked. She nodded, and they walked to a small conference room.

“What’s going on with Larry?” he said.

Irina looked nervous. “Don’t worry,” he reassured her. “I’m just trying to make sure we’re on track with this project.”

“As you know, he hasn’t been in yet this week,” she confessed. “But it’s only Wednesday, and we’ve got things more or less under control. And honestly, it’s nice to have a bit of leeway to figure it out ourselves. Mike is doing amazing work. I’m sorry we don’t have Larry to buffer us from the rest of the company right now, but I’m sure he’ll be back soon. When he is here, he works twice as hard as the rest of us.”

Walking back to his office, Carlos dialed Larry’s cell phone. No answer. He could feel his chest tightening. Meals Now had a lot riding on this project. Cynthia Walker, the company’s brilliant, hard-charging CEO, had assured the board that the redesign would set their business apart from the competition in an increasingly crowded space, and the company had invested close to $500,000 on the project. “More or less under control” wasn’t really good enough. Where was Larry?

Growing Concern

Later that afternoon, Mike stopped by Carlos’s office and asked if he could shut the door. “I’d like to check in on timing,” he said.

“Things seem to be moving along,” Carlos said. “Right?”

“Yeah. But we might have to push the launch date back again.”

“We should try to avoid that,” Carlos replied curtly, and then added, more diplomatically, “You know we can’t afford any more delays. Cynthia’s breathing down my neck, and the board’s breathing down hers.”

“I know—we’re all feeling the pressure,” Mike said. “Speaking of, I wanted to talk to you about Larry. I’m concerned about him. A lot of what we used to shrug off as quirky is starting to seem a little scarier. I know he slept in the conference room at least two nights last week, and this week he hasn’t been in at all. I spoke to him yesterday, but today he’s not picking up.”

“Have you asked him what’s going on?”

“I’ve tried, but he didn’t really respond, and I don’t feel it’s my place to push. I don’t want to jump to conclusions, and I’m not a psychologist, of course, but I think he might be cracking a bit.”

Carlos nodded, remembering his own experience with anxiety. A few years back he’d seen a therapist and considered taking medication.

“I know you both report to Cynthia,” Mike continued, “but the last thing I want to do is go to her. I’m not at all comfortable speculating on his mental health with the CEO, and if I just emphasize the work issues, I’m scared she’ll get rid of him, which would obviously be terrible for him and for us. He still knows better than anyone how to work with vendors and contractors, and he keeps the rest of the organization off our backs so that we can get our work done. I’m not sure we can hit all the project targets without him.”

“But you don’t seem to have him now,” Carlos said.

“Half-time is better than nothing.”

“But who’s leading the team?”

“I guess I am,” Mike said, with a touch of weariness in his voice.

“Have you talked to Kara or Anaya?” Carlos asked, referring to the company’s small HR team.

“They’re both pretty new, and I worry they’d overreact and take it straight to Cynthia. And I’d never want Larry to hear that I’d been talking behind his back, much less reporting him to HR. I guess I’m saying I don’t know where to go.”

Carlos didn’t know either.

A Million Things

Carlos’s car was the last in the parking lot; he’d stayed late because he was meeting friends for dinner in town. As he put his laptop in the backseat, he saw Larry’s Volkswagen pull into a spot near the front of the building. “Larry,” he said, walking over as his colleague got out of the car.

“Hey, man,” Larry said, looking a little surprised to see him. His hair was mussed, his eyes were red, and his T-shirt was wrinkled and stained. “In a bit of a rush here.” He grabbed his computer bag, closed the car door, and started walking toward the entrance. When Carlos moved to follow him, he waved his hand dismissively. “Don’t come back in on my account. I’ll see you tomorrow.”

Carlos returned to his car but didn’t get in. It felt strange to leave Larry in what was certainly an empty building by now. He texted his friends: “Running late. Go ahead and order without me.”

Back inside, he could hear Larry talking loudly. Was he on the phone, or talking to himself? Carlos knocked on the open office door and peered in, but immediately wished he hadn’t. Larry looked up angrily. “What are you doing here?”

“I’m worried about you, Larry. It’s almost 8 o’clock and you’re just coming to work.”

“I know that—don’t you think I know that?” Larry’s voice rose. “I’ve been working all day at home, too. There are a million things to do. A million things. A million things. Why wouldn’t I be here at night? Why on earth wouldn’t I?”

Carlos forced himself to stay calm. “But you’ve been out three days this week, and quite a few days last week and the week before, and your team hasn’t been able to reach you. We’ve been waiting for you to move a few things along.”

Larry’s face softened some, but he still didn’t look healthy. “Sure, sure. Of course. Whatever you need. Send me an e-mail, and I’ll take care of it tonight.”

“Are you sure you’re all right? It’s not only about the project—it’s about you, too. If you need to talk about something, I’m here.”

Larry looked angry again. “Do me a favor and go home, Carlos. Everything’s fine. Just let me do my job my way.”

Mike was right, Carlos thought. This went beyond unusual behavior. Was Larry breaking under the stress of work? Was it mental illness? Could he be taking drugs?

Tell Me If There’s a Problem

The next morning Carlos’s inbox was full of e-mails from Larry. Some were reassuring: Yes, the contract with the login provider had been signed. Yes, he’d sent the beta to the user-experience people already. Yes, he’d reviewed the plan for social media integration several times, and it was fine. No, he hadn’t gotten approval from HR for the revised application architect position yet, but they had worked through the latest salary question, and he expected to have the approval by Friday. Other messages were troubling: Had they considered adding a more robust ingredient search feature? Could they double the amount of user testing? Should they alter the color scheme? Larry knew that Cynthia, the board, and the project team had already decided on all those issues. Well, the old Larry knew.

When Carlos went to his colleague’s office to talk about it, Larry wasn’t there. He was heading back into his own office when Cynthia stopped him.

“I was just coming to get an update,” she said. “Three board members have e-mailed me this week asking if we’re still on schedule. Are we? And where’s Larry?”

“Not sure,” Carlos said, willing his face not to turn red. “I know he was working late last night.” He pushed himself to be straight with her instead of sugarcoating things. “Mike told me yesterday that we might need to reset the launch again. The tech team is doing what it can, but we’ve had some unexpected hiccups, and the timeline is tight.”

“We can’t afford another delay, Carlos. The board will have my head. Tell me Larry can fix this.”

Carlos was silent.

“Is there something else you should be telling me? I know I’ve been traveling, but I haven’t seen Larry in weeks, and my assistant mentioned that he’d been acting strangely and his team seemed stressed. Is that true?”

Carlos hesitated and then said, “We’re all under a lot of pressure.”

“Listen, Carlos. I’m trusting you to tell me if there’s a problem and I need to bring in someone else to do this job. Because you know as well as I do that this needs to get done.”

“I’m on it, Cynthia,” he said.

As soon as she left, he closed his office door, picked up his cell phone, and dialed a number he hadn’t called in a while. “Could I leave a message for Dr. Thales, please?” He knew he wouldn’t get her immediately, but she called him back not 30 minutes later.

“Thanks for taking my call,” he said, happy to hear his former therapist’s voice. “This actually isn’t about me. I wanted to get your advice about a friend of mine.” He described what was happening with Larry.

“Obviously, I can’t make a diagnosis without meeting him,” she said, “but from what you’re saying, I think it might be manic behavior.”

“Like bipolar?”

“Possibly, yes. It’s more common than most people think—not as prevalent as depression or anxiety, but close to 4% of adults in the U.S. have it. Do you know if he’s seeing anyone?”

“No, I don’t.”

“Well, if that’s indeed the problem, it can often be managed with a therapist’s help and medication. Does he acknowledge there’s an issue? Have others noticed?”

“I’ve tried to talk to him about it, and his team has too, but he just ignores us. I could go to our boss or HR, but I don’t want to get him fired.”

“If he’s diagnosed with a mental health issue, he’ll be in a protected class.”

“I’m also a little worried about losing him,” Carlos continued. “I probably wouldn’t admit this to anyone but you, but he’s critical to this project. If he gets help and needs to take a leave of absence or something, we’re screwed. That sounds completely selfish, I know.”

“I can see how you’d feel that way. Those episodes seem to have kept him productive for a while. But now it’s different—at least different enough for you to call me. He might be unraveling.”

Yes, Carlos thought, “unraveling” seemed like the right word.

Question: What should Carlos do? The Experts Respond

Carlos needs to help Larry. Many people would ignore what’s happening and focus on the project. But if Larry showed up bleeding after an accident on the way to work, no one would ignore that. Someone would drive him to the hospital.

The equivalent in this case is finding time to sit down with Larry and privately express concern. Carlos might say, “I’m worried about you. Your behavior has been erratic, and it’s affecting your work and your team. I think you need to seek treatment.” He might mention his own counseling for anxiety (if he feels comfortable doing so) and ask if Larry has a doctor he trusts or someone else he could ask for help.

Situations like this are much more common than people think. In any given year, one in five Americans has a mental health issue. Depression alone accounts for 200 million missed workdays each year. Sadly, because of social stigma, a fear of repercussions at work, and the lack of quality, affordable, accessible care, only a third of the people who need help will get it.

If Larry is indeed having a manic episode, he may continue to resist Carlos’s offers of help because he enjoys the “up.” It doesn’t appear that anyone at Meals Now has expertise in mental health, so I’d suggest that Carlos go to the CEO, Cynthia. He might say, “Larry is struggling with something—I don’t know what, but we can’t ignore it. He needs to get treatment and take time off.” If she’s a good boss, she’ll insist—with discretion and compassion—that Larry take a leave of absence until he is again able to do his job. That probably wouldn’t derail the project: Larry has a strong team in place, and Mike can assume leadership of it temporarily.

People often think this topic is too private to be discussed at work.

I’ve been in Carlos’s shoes. When I suspected that a client was having a manic break—he was talking more loudly and quickly than usual and, alarmingly, making large and imprudent bond trades with his company’s investment portfolio—I approached him about it directly. Unfortunately, probably because he was enjoying the mania and the grandiose feelings, he didn’t realize he was ill, so I ultimately had to go to his manager, who told him to take time off. He returned to work a few weeks later and continued to be very good at his job.

Organizations need to do better at supporting and improving the mental health of employees and their families. At NAMI-NYC Metro we’ve collaborated with American Express, EY, Goldman Sachs, and Prudential Insurance as they’ve developed cutting-edge programs to increase awareness about these issues and encourage people to support their coworkers. If Meals Now had such a program, Carlos could seek advice from knowledgeable professionals, and Larry would have access to the resources he needs. Most important, he and others could talk as openly about their mental health as they would about, say, diabetes or hypertension. People often think this topic is too private to be discussed at work, but that just perpetuates the stigma. After all, if you can’t mention it, you can’t manage it.

Right now Carlos’s priority should be the project. Yes, Larry seems to be struggling with his mental health, but when faced with the high probability of an occurrence that will affect many people (the failure of the redesign) and the low probability of one that will severely affect an individual (a breakdown), you have to focus on the former.

That’s not to say that Carlos should ignore what’s going on with Larry. He just needs to accept that he’s shouldering the project leadership alone, with Larry as an erratic but still valuable contributor who merits special attention. Carlos should maintain brief, positive interactions with his colleague, face-to-face as often as possible, and watch for any slippage in his decision-making abilities. He can enlist Mike to do the same. This is not to spy on Larry but to give him the opportunity to confide in one of them if he so chooses.

Carlos and Mike should strive to support each other—working more closely on the redesign and also in deciding what to do about Larry. It’s stressful to deal with someone who has an unrecognized and untreated mental illness, and it’s hard to do it alone.

Carlos should maintain brief, positive interactions with Larry.

Of course, if Larry’s behavior deteriorates further and begins to affect morale and productivity on the project team, I do think Carlos needs to go to Meals Now’s HR managers and tell them what he’s observed. I know some people distrust HR, viewing it as a protective agent of the company rather than an ally of employees. But most HR departments have access to useful materials and resources. For example, many health insurance plans include confidential and free access (by phone or in person) to mental health counselors.

Carlos’s reluctance to go to Cynthia or HR is understandable, but given how much he already has on his plate, he shouldn’t feel bad about shifting some of the responsibility, and he should trust HR to do the right thing, including informing Cynthia about the problem. Hopefully, the CEO will realize the importance of having a healthy, high-functioning employee and respond appropriately, offering Larry as much time off and support as he needs. If she fires him just to meet a product revision deadline, knowing that he is probably suffering from an illness, Carlos will see what kind of company he is working for.

If Carlos takes these steps, it’s possible that Larry will feel betrayed, which could hurt their relationship in the short term. But that’s a price worth paying.

After my first company failed, in 2001, I was severely depressed. At the time, I didn’t reach out to colleagues. It didn’t occur to me to ask for help. The company I then worked for was tiny and didn’t have an HR group. I recovered on my own, eventually getting out of that hole by focusing on my next project. But in retrospect, I wish that someone had noticed I was struggling and invited me to have a conversation away from work or visited me when I was sick at home. I might have tried to push the person away at first, but I would have appreciated the effort in the long term.

HBR’s fictionalized case studies present problems faced by leaders in real companies and offer solutions from experts. This one is based on “Mental Health and the American Workplace,” by John A. Quelch and Carin-Isabel Knoop.

A version of this article appeared in the May 2016 issue (p.109–114) of Harvard Business Review.

Which of the following actions should a medical assistant take when performing an ear irrigation?

Which of the following links initiates the chain of infection?

Which of the following terms describes the maximum reimbursement a third party payer will provide?

In which of the following location should the inside address appear in a business letter?