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How Untreated Mental Illnesses Can Damage Leaders’ Success And How Organizations Can Help

Kathy Caprino

Part of the Series “Supporting Today’s Workforce”

In almost two decades serving in corporate organizations, I experienced firsthand more than a few leaders and managers whom I now recognize were facing mental illness issues, substance abuse and disorders such as bipolar disorder, anxiety and depressive disorders and narcissistic and borderline personality disorders. At the time, I didn’t understand what I was dealing with but later, as I trained as a marriage and family therapist, studied these disorders, and began offering treatment to professionals in distress, I grew to understand what these executives were facing. And I also learned more about the havoc they can wreak on their organizations and employees and in their personal and professional relationships if treatment is not received.

What role does mental illness play in some leaders’ destructive behavior? And how often do they actually seek and obtain effective treatment? One key contributor to the challenges that leaders have in reaching out for help is that they find it difficult to accept they may be suffering from mental disorders or illness at all.

To learn more about this important topic, I recently caught up with Dr. Michael Groat, MSc, Ph.D. of the renowned Silver Hill Hospital in Connecticut. Dr. Groat specializes in treating executives suffering from these conditions. He shares the challenges and lack of resources available to effectively help executives with emerging behavioral health problems. And he explores how having an open discussion about mental illness at the executive level can lessen the stigma behind the condition and make treatment possible.

As Chief Clinical Officer of Silver Hill Hospital, Groat oversees the day-to-day clinical operation of Silver Hill psychiatrists, psychologists, nurses, social workers and admissions specialists. Established in 1931, Silver Hill Hospital treats adolescents and adults for disorders, complex conditions and co-occurring disorders including addiction, depression, bipolar disorder, eating disorders, personality disorders, schizophrenia and other conditions. Groat’s prior roles include President and Chief Executive Officer of CooperRiis and Director of the Division of Adult Services at the Menniger Clinic, where he led the Professionals in Crisis Inpatient Program.  

Here's what Dr. Groat shares:

Kathy Caprino: What are the specific barriers to treating an executive with mental illness that we need to be aware of?

Michael Groat: Many high-achieving and high-status executives face significant personal and organizational challenges to receiving treatment for substance use disorders or mental illness despite having access to more life opportunities, experiences and services than many who work for them. This is due, in part, to the dearth of well-researched programs for people at their level. 

Executives are also accustomed to being at the helm and in charge. They are the public face of the organization that employees look to for leadership. They’re often independent, self-determined, decisive, driven, resourceful, highly competitive, overconfident and calm in crisis, so acknowledging their vulnerability is difficult for them. Executives are considered experts, not individuals in need of help. 

Few possess the skills, knowledge, or fortitude to address evidence of impairment in the executive. Loyal staff, fearful of exposing the executive’s weaknesses as well as their careers, may cover up problems related to work deficits, unreliability, or inappropriate behavior. Those the executive reports to may similarly be flummoxed. As a result, no one addresses the issue, leaving the executive to operate in a vacuum without any support. Sadly, many executives reach a state of crisis before anyone recognizes and addresses their problems.

Overcoming these obstacles requires enormous courage for both the executive and the organization. Executives face real-world risks related to faltering performance such as derailed or stalled careers, tarnished reputations, reprisals and discrimination related to stigma surrounding mental health and substance use disorders. If an executive is used to being rewarded for taking charge, hearing that their performance is declining is intensely threatening. 

Caprino: What are the unique challenges people in leadership may face accessing mental health services?

Groat: Many executives prioritize the needs of others and organizational performance goals above their own. They believe they can overcome personal challenges, such as depressive episodes, suicidality, alcohol or drug craving, through sheer force of will and as a result, don’t seek help. 

In other cases, executives fear their illness will become public knowledge so they may not know where to turn for guidance. The executive leader and those surrounding them may not know how to differentiate among treatment options amid flashy marketing appeals. For example, they need to determine if the facility has professionals who understand the unique personality traits, organizational challenges and risks that these executives encounter. They also need the ability to leverage this understanding to provide outstanding care. 

Caprino: What are some characteristics of workplace cultures that facilitate or impede signs of mental illness?

Groat: When senior leaders and board members believe mental health is a key part of overall well-being, and reinforce that through management practice and policies, mental illness can get the attention it needs. A workplace that trains managers to recognize the possibility of impairment secondary to substance use or mental health challenges (e.g., absenteeism, withdrawal, performance difficulties, disruptive behavior), and respond appropriately, shows that it values its staff and will treat all with dignity and respect. Companies that offer insurance options for mental health and substance treatment, as well as Employee Assistance Programs, also serve as appropriate gateways to treatment. 

Companies that undermine mutual support, foster intense competitiveness and punish vulnerability (e.g., criticize employees for asking for a day to rest and to see a doctor for a mental health visit), will impede the development of a culture that supports mental health needs. 

Caprino: How does a colleague tell someone in a leadership role that for various reasons (performing poorly, frequently being absent or constantly berating employees) they need to get help? What should the protocol be?

Groat: This can be a daunting task. Thankfully, there are steps that can help. First, identify your primary concerns, write them down, review them, and if the situation is not urgent, let them sit. If you do need to address some concerns, rehearse what you will say before approaching that individual.  Speak only to what you can verify or have directly observed and do so without attacking the person’s character (e.g., “you are probably behind because you have gotten lazy”). If you know the person is late on projects, be specific about the project and make sure they understand what the consequences are not only for that person but, you and others. If the person is open to help, identify practical ways you can assist. If that individual’s behavior is particularly egregious, you may need to take disciplinary action.

Caprino: What strategies can board members and other high-level stakeholders use to address inappropriate behavior of executives in their charge? How should they evaluate an executive’s progress?

Groat: Similar to concerned colleagues, board members and other high-level stakeholders need to outline their concerns and carefully verify the nature of them. They may have to consult an expert in mental health or substance abuse to validate that a problem exists and establish expectations such as requiring the executive to be evaluated, take a leave or seek treatment as a condition for returning to their role. 

The executive might respond to a board member that they feel particularly open with, so consider who should initiate contact. This person should be well-informed, carefully prepared, and able to be clear and direct while conveying compassion and concern. 

Board members should present a united front as well. For the executive who may not yet accept that they have a substance use problem, for instance, turning to a board member they believe will “take their side” against others will undermine the effectiveness of both holding the executive accountable and providing them support in getting treatment. 

Caprino: What are the potential repercussions of not addressing evidence of toxic behavior, substance use or personality disorders among executives? What are the upsides?

Groat: When a board of directors or senior leaders fail to address toxic behavior, the message they send to staff is that such behavior is tolerated at best or condoned at worst. If the executive berates others, doesn’t complete tasks, or performs poorly, the staff may decide to “keep the peace” by covering for the boss and downplaying the toxic impact. Others may quit. Staff surrounding the executive risk faltering in their own work performance and may manifest signs of stress-related disorders such as anxiety or depressive episodes. Failing to address toxic behavior ultimately undermines all those involved. 

Caprino: What options are available for treating executives who have mental illness, and how do you determine which one is best?

Groat: Executives in need of treatment have to rely on experts who know the best treatments for addiction and psychiatric disorders. Thankfully, there are established standards for best practices and ones that can be applied to executives. These include outcomes, evidence-based practices, and experience in working with the complexities of executives’ lives and personalities.

The outcomes to examine include whether:

  • Individuals in treatment experience symptomatic improvement
  • Their quality of life has improved 
  • They’re able to return to meaningful work 
  • They have long-term success

A review of best practices also includes assessing whether the prospective care team uses treatments supported by rigorous research and the consensus of expert opinion. For example, the best treatment for an executive with a substance use disorder and pronounced narcissistic traits addresses substance use and personality factors simultaneously. This can involve engaging the executive’s skill in problem-solving around the substance use while providing admiration and encouragement that appeals to their ego. 

In the end, it’s vitally important that executives and leaders who are suffering, and the organizations that employ them, accept that substance use problems and mental health challenges affect even the most accomplished people. When they can get the quality treatment and restoration they need, we all win.

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To build your leadership strength, work with Kathy Caprino in her Career Breakthrough Programs and stay tuned for her new book The Most Powerful You.





