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Monthly Archives: August 2011


It should come as no surprise that when the term human capital first appeared in the annals of economic theory some 60 years ago it was a fungible resource similar to the machinery of what was, at that time, a manufacturing based economy. (1) This characterization literally changed at the speed of light with the United States response to the Soviet’s launching of Sputnik in 1957 and the advent of  what is now commonly called the World Wide Web(2) As a direct result of this development, there has been a continual servicization of the US economy ever since with 77% of US GDP in 2010 being derived from the service sector. (3) In this same 60 year time span, the US labor market had to transition from one based almost entirely on its brawn to one that is now based almost entirely on its brains. The implications of this transition we are only now beginning to collectively witness. For instance, it is the cognitive evolution of our nations economy that resolves the seemingly paradoxical coexistence of Depression level unemployment with the critical low mass in attraction and retention of talent and successorship in Corporate America(4) When viewed from this cognitive” perspective it also should come as no surprise that absencedisability and unrealized productivity related to issues of employee mental health cost employers more than four times the cost of current employer-based medical treatment. (5) Leadership, both public and private, continues to fixate on spiraling health care costs while perilously neglecting the value of the most important asset in our national portfolio; our Human Capital.

Mental illness is the single largest contributor to disability on the globe accounting for 33% of the total and the single largest cause of impaired work performance in the United States. (6) While 70 to 90% of people with a mental illness improve appreciably with treatment only 1 in 3 workers with mental illness are ever even diagnosed much less effectively treated. (7) What is more is that always preceding a person’s first or repeated episode of a full-blown mental illness, there is a sub-threshold form of the illness where functional impairment is the only harbinger of the malady that is to follow. (8) Organizations that effectively watch and appraise their employees work performance and align this with their Balanced Scorecard are in a unique position to leverage these performance metrics in a way that will have an order of magnitude impact on both the health of their workforce and their bottom lines.

Organizational Health in the 21st Century:

Work Performance; a New Vital Sign for a New Economy

Providers of a cognitively complex service with a global reach need only experience an episode of jet lag to understand how functioning at anything less than their optimal mental state can negatively impact their work performance, much less should they experience a full-blown mental illness. One in four members of the American workforce is impaired by a treatable mental illness; arguably, those employees providing the most cognitively complex services will be most susceptible to performance impairment. While Cognitive Behavioral Therapy (CBT), psychotropic medication or both is effective in 70 to 90% of people with mental illness, only one in three workers with mental illness actually seeks the attention that they need and only one in ten actually receives adequate treatment. (8) In addition to the burden of human suffering, there is the unrealized value of the most critical asset in an Enterprises portfolio, its human capital.

If we are to fix this problem, we first must understand why we are failing to recognize mental illness. The perceived stigma of being diagnosed with a mental illness continues to play a significant role in the under-recognition of mental illness. However, the fact that persons with non-diagnosed mental illness, on a per capita basis, utilize significantly more non-psychiatric healthcare services including non-psychiatric hospitalizations, Emergency Department visits as well as visits to Primary Care Physician that the general population points to the main culprit, and that is the  failure to recognize mental illness.

Two factors contribute to the invisibility of  mental illness.  First is lack of recognition on the part of patients that their flailing work performance may be due to a mental health condition, and thus they don’t seek the care of a professional for diagnosis and treatment.  The second is the medical school and post-graduate training physicians receive, which focuses on diagnosing and treating illnesses that are three-dimensional; that have a color, a texture or a mass that can be pointed at with a finger. In contrast, mental illness is invisible to every clinical tool that the modern healthcare provider has at their disposal.  Two clinical vignettes can best demonstrate this contrast:

–      In the first post season playoff game on the opening pitch all 50,000 fans in the stadium hear the loud popping noise that comes from the pitcher’s mound and witness him fall to the ground grabbing his right shoulder in utter agony. Neither the team’s trainer nor a single spectator need to see him throw a second pitch to diagnose the fact that something terrible has happened to the shoulder of their beloved star’s pitching arm.

–      Another pitcher has a 10 year career ERA of 1.8 until this season, in which his ERA has fallen to 4.1.  Needless to say his team did not reach the post-season. Neither his trainer nor a single fan in the stadium ever considered that this once high achieving superstar had recently begun to have depressive episodes due to an undiagnosed mental condition known as Attention Deficit Disorder. In spite of the fact that his performance on the mound is meticulously and accurately measured, none of these metrics gave any sign that his decline in performance was a direct manifestation of his underlying mental illness.  Failing to receive treatment widely recognized as highly effective in restoring function and performance, this pitcher was sent back to the Minor Leagues and was never seen in the Majors again.

In the case of the first pitcher the definitive diagnostic tool for recognizing a torn rotator cuff is the MRI.  But what most organizations, including baseball teams and companies of all types don’t realize is there is an equivalent to the MRI for detecting a range of mental health conditions.  Inherent in the Human Resource organization’s rigorous employee processes and performance tracking resides the essential information to assure that a workforce’s health is maintained at an optimal level, and to detect instances where a treatable mental health condition is  likely present.

The Human Resources professional of the 21st century, wittingly or not, is at the front line in this nation’s battle to break with its myopic cost oriented health care system and lead us to one that is value based  with a return on investment; and who better qualified for this position than an person who actually has the term human capital in mind with every action she executes. Like a principle of an elementary school, she spends 90% of her professional life with 10% of the human capital whose professional lives are within her charge; but this is not where the similarity ends. The 21st century Enterprise comes equipped with performance metrics or, highly advanced versions of report cards that, when executed well, hold invaluable information germane to the future continual success of the employee, manager or executive to whom it is applied.

End Post

Please stay tuned for the following posts coming soon:

  • Performance-Health: The missing link in the evolution of Employee and Organizational Wellness
  • What the quality of an Employee’s performance saying about the quality of their health and why it is important to know?
  • Anticipating the unintended consequences of Performance as a Vital Sign
Thank you for sharing your comments and insights!
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