This article was written by Alan Manevitz, M.D.; Meredith Rimalower, J.D., M.A.; Colin Jamron, LMHC; Darin Wizenberg; David Evan Markus; Reid Murtaugh; Julia Clayton; and Joseph Milowic III in connection with their work on the Lawyers Depression Project, a nonprofit directed to addressing mental health and well-being in the legal professional, which provides an online peer support network for legal professionals at www.lawyersdepressionproject.org.
The average delay between onset of mental health symptoms and treatment is 11 years.
Mental health promotion and prevention work hand-in-hand to bolster mental wellness. Given the current global pandemic that has caused significant disruption in our daily lives, we are writing to encourage legal professionals to make mental health check-ins a routine part of their lives and practice—starting now.
Mental Health Is a Critical Issue, Including for Legal Professionals
Mental health has become a significant topic of discussion and study for legal professionals as of late, and for good reason. Mental health has a critical impact on the general population—in 2018 alone, 47.6 million adults in the United States experienced symptoms that met criteria for a diagnosable mental illness. This equates to 19.1 percent of the population, or one in five adults. Further, depression is the leading cause of disability worldwide.
The 2016 ABA–Hazelden Betty Ford Foundation study of attorneys (see “Studies on Well-Being in the Profession”) underscored mental health concerns in the legal profession. Of the attorneys surveyed, 28 percent reported experiencing symptoms of depression, 19 percent reported symptoms of anxiety, and 23 percent experienced symptoms of stress. These findings suggest that legal professionals may experience mental health issues at a rate higher than other adults in the United States. This, along with several recent deaths of legal professionals by suicide, have sparked a long-overdue conversation about mental wellness in the legal community.
Mental Health Has Multipronged Determinants
There is a tremendous amount of empirically established pain and struggle that goes on behind closed doors in the legal community. Why are so many lawyers struggling? Research into biological, psychological, and social science suggests that mental health issues arise from a culmination of different factors.
Risk factors tend to increase the likelihood of symptoms that impact mental wellness. These factors fall into several categories:
- Biophysical (poor nutrition, lack of sleep, a family history of mental health issues, and chronic medical conditions)
- Psychological (stressful life situations, traumatic life experiences, low self-esteem, and a negative life view)
- Social (few healthy relationships, company culture promoting unhealthy work behaviors, a recent loss, bullying, poor communication and social skills, discrimination, and lack of access to support services)
Some of these risk factors (specifically, social isolation, lack of sleep, stressful life situations, and bullying) are prevalent within the legal industry, which may explain the high rates of mental illness symptoms within the community.
Protective factors, on the other hand, can help mitigate risk factors and promote mental wellness. Protective factors fall into the same categories as risk factors:
- Biophysical (healthy diet, exercise, and sleep)
- Psychological (emotional self-regulation, coping and problem-solving skills, a sense of self-sufficiency, optimism, and positive self-regard)
- Social (ability to make friends and get along well with others, good peer relationships, community participation, and access to support services)
Mental Health Promotion and Preventive Actions
Mental health promotion and prevention work in tandem to bolster mental wellness. The concept of mental health promotion considers mental health to be a resource on its own and a basic human value essential to social and economic development. Mental health promotion also aims to remove social, environmental, and economic barriers to positive mental health.
Getting help when help is needed is a critical preventive intervention.
Preventive interventions are a type of mental health promotion that focuses on reducing risk factors and enhancing protective factors. Effective promotion and prevention can reduce the risk of mental disorders.
A number of interventions can help promote mental wellness by increasing protective factors. Getting the right amount of sleep, eating a healthy diet, and exercising can assist in promoting protective biophysical factors. In addition, making meaningful connections with others, learning a new skill or hobby, focusing on meditation or mindfulness, setting realistic goals, breaking up monotonous routines, and purposeful service aligned with our values can help enhance psychological and social protective factors.
Mental health promotion also includes getting help when help is needed. From a preventive standpoint, this contains two elements: first, understanding what it might look like to need help, and second, having access to resources to get help. Mental health check-ins, or the assessment of mental and emotional health, by or with access to mental health professionals, can help with both elements. It’s for these reasons that we would like to encourage legal professionals to make mental health check-ins a routine part of their lives and practice.
Mental Health Check-Ins
Getting help when help is needed is a critical preventive intervention. According to the National Alliance on Mental Illness, the average delay between onset of mental health symptoms and treatment is 11 years. Waiting to get help not only results in increased suffering, it can also have a significant impact on a treatment trajectory. The nature of certain mental health symptoms may make it more and more challenging to seek help as more time passes and the severity increases. We also recognize the social, cultural, and organizational barriers within the legal industry that can make it challenging to navigate the time and resources needed for mental health support. While these systemic issues need to be addressed on a larger scale, we feel that the concept of a mental health check-in may be an empowering way for individuals to have agency over their mental health concerns. Thus, we feel that mental health check-ins should be normalized and encouraged, particularly in the legal community, and especially given the current global pandemic. A mental health check-in can look like the following:
Mental health check-ups with a mental health care professional. Check-ups, as the Centers for Disease Control and Prevention, have already been normalized for physical health and are extremely beneficial in catching issues before they become problems, or catching problems early. It is logical to fold mental wellness in to preventive care. In fact, the U.S. Preventive Services Task Force has recommended depression screenings in primary care settings for both children and adults. It is always an option to check in with a mental health professional. Another resource we can use are our primary care providers, who can also provide helpful referrals and access to resources.
We feel that mental health check-ins are a vital way to promote mental wellness, especially during this difficult time.
Self-check-ins. It is quite easy in this demanding and stressful industry to go on auto-pilot. If we can learn to be aware of how we are feeling, we can start using resources before things escalate too far. This type of awareness provides an extremely helpful foundation for any therapeutic work. The American Psychiatric Association has provided the following starting point for a brief mental health check-up, available here.
Check-ins during transition periods. While the legal profession is generally demanding and stressful, there are certain transition periods may be even more challenging, and it may help to proactively check in with a mental health professional during these times. Relevant transition periods may include entering law school, preparing to take the bar exam, starting a new job, transitioning out of a job, being elevated (or not being elevated) to partner, taking a leave of absence, and experiencing major life events outside of work. Further, the current situation concerning COVID-19 has had a significant impact on many of our lives. Fear, uncertainty, and anxiety may feel particularly strong at this moment, which may be compounded by the social isolation that many of us are experiencing. There are many mental health professionals available and willing to help during this trying time.
A few final caveats. Mental health is incredibly personal and can fluctuate very rapidly, so it can be difficult to get an accurate overall picture in any given moment. For example, a check-in after a bad night’s sleep and sitting in traffic for an hour may look very different from a check-in after exercise or having a fun experience with friends. Further, there is a subjective element to mental health, and it is important to respect each individual’s autonomy. Thus, nothing in this article is meant to suggest that something is “wrong” or therapy is “needed.” Rather, we aim to provide tools that legal professionals can use to evaluate whether an issue is impacting their ability to live their life.
That being said, we feel that mental health check-ins are a vital way to promote mental wellness, especially during this difficult time. This proactive approach to mental health can help catch problematic symptoms early on and ensure that legal professionals have access to help when they want it.
*This article does not constitute medical, therapeutic, or legal advice. Further, it reflects the personal views of those who participated in its preparation and does not represent the official views or positions of their associated employers.
Alan Manevitz, M.D., is a practicing clinical psychiatrist and attending at the New York Presbyterian Hospital-Cornell Medicine and Lenox Hill Hospital- Northwell. Alan is the founder and president of the National Mental Health Project, which educates the public about mental health issues.
Meredith Siller Rimalower, J.D., M.A., is a former big law attorney who changed careers and is now providing therapy to attorneys and other professionals facing workplace stress. Meredith is a Registered Associate MFT in Los Angeles working under supervision by a licensed clinician at the Relational Center and in private practice (www.meredithrimalower.com; AMFT #115668).
Colin Jamron has a master’s degree in mental health counseling from New York University and is a licensed psychotherapist in the state of New York. Colin is the president of Jamron Counseling, a private practice centered in Brooklyn that seeks to provide accessible and effective care with a focus on improving mental health practices and overall wellness.