Behavioral Health Crisis in the Legal Community

The legal community is currently experiencing a behavioral health crisis. As Gina Rubel details in her Mid-Market Report article, the Hazelden Betty Ford Clinic and ABA Commission on Lawyer Assistance Programs surveyed nearly 13,000 lawyers across 19 states and from all regions of America in 2016. The results concluded that of those surveyed, 61 percent reported having anxiety in their careers, followed by depression (45 percent), social anxiety (16.1 percent), attention deficit hyperactivity disorder (12.5 percent), panic disorder (8.0 percent), and bipolar disorder (2.4 percent). Due to the crisis, many organizations have been started to provide peer assistance.

One organization, Lawyers Concerned for Lawyers of Pennsylvania works to educate lawyers about behavioral health issues and offer a confidential helpline for lawyers in need. Rubel also provides suggestions on how the legal community can support their peers.

To learn more about how to support behavioral health in the legal community, read “The Behavioral Health Crisis Among U.S. Lawyers: It’s Time to Take Action.”

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The Behavioral Health Crisis Among U.S. Lawyers: It’s Time to Take Action

As lawyers, we pledge that fiduciary duty to our clients, to act in their best interests, to proceed prudently, to solve their complex problems and to help them avoid future issues. But who’s taking care of the lawyers?

By Gina F. Rubel | March 21, 2018 | Originally published on The Mid Market Report

When a person seeks legal representation, the presumption is that their lawyers will take care of them, do what’s best for them, watch out for them. The client believes the lawyers to whom they’ve entrusted their business will dutifully turn over every rock, unlock every door and illuminate every shadow to procure a positive outcome.

This expectation by clients isn’t merely based on what they hope to experience. As lawyers, we pledge that fiduciary duty to our clients, to act in their best interests, to proceed prudently, to solve their complex problems and to help them avoid future issues.

But who’s taking care of the lawyers?

Behavioral Health Crisis Among Lawyers

The U.S. legal profession is in crisis. Multiple studies independently conducted by institutions of higher learning, medical researchers, nationally recognized drug and alcohol abuse treatment centers and the American Bar Association have found lawyers exhibit a range of mental illnesses and addictions at rates higher than many other professions and the general population. Those mental health concerns include drug abuse, alcohol abuse, depression, stress, panic, anxiety, social alienation, isolation, and even suicide. It is a massive problem that has led to many promising careers and even lives cut short.

The data is alarming. A February 2016 landmark report funded by the Hazelden Betty Ford Foundation, the nation’s largest nonprofit treatment provider, and the American Bar Association Commission on Lawyer Assistance Programs (CoLAP) documented the near-epidemic reality of lawyers and mental illness. Of nearly 13,000 lawyers surveyed across 19 states and from all regions of America, 61 percent reported having anxiety in their careers, followed by depression (45 percent), social anxiety (16.1 percent), attention deficit hyperactivity disorder (12.5 percent), panic disorder (8.0 percent), and bipolar disorder (2.4 percent).

The report, published in the Journal of Addiction Medicine, showed lawyers have depression and anxiety rates twice that of the general population, and substance abuse and addiction substantially higher than the general population.

The data on lawyers and alcohol abuse disorder is troubling. The Hazelden/ABA report found lawyers have a rate of problem drinking more than three times higher than the general population, and 1 in 3 practicing lawyers are problem drinkers, based on the volume and frequency of alcohol consumed. Another interesting aspect of the study indicated attorneys in the first 10 years of practice, not veteran lawyers perhaps worn down by the demands of the profession, experienced the highest rates of problematic alcohol use, at 29 percent.

Particularly worrisome is the report’s findings on lawyers and suicide. Nearly 12 percent reported having suicidal thoughts at some point during their career. Almost 3 percent reported self-injurious behavior, and just under 1 percent reported at least one prior suicide attempt.

A CNN review of 50 state bar associations found eight associations so concerned about suicides they took measures to address the deadly pattern. California, Florida, Iowa, Kentucky, Mississippi, Montana, North Carolina and South Carolina all added a mental health component to mandatory legal continuing education.

Lawyers are unmistakably in crisis: “As many as one in four suffers from psychological distress,” wrote Martin E.P. Seligman, Ph.D., the Fox Leadership Professor of Psychology at the University of Pennsylvania, the director of the Positive Psychology Network, and former president of the American Psychological Association, on the website lawyerswithdepression.com in November.

Causes of Behavioral Health Issues Among Attorneys

According to Dr. Seligman, the contributing factors to the high rate of mental illness among lawyers are wide ranging. Among them are heavy law school debt that frequently forces graduates into high-paying jobs at private mid-size and large firms, where intense deadlines, staggering billable-hour requirements, and grinding hours are routine. The conflict-driven nature of the profession also plays a role, as does traditional legal training, which conditions lawyers to be emotionally withdrawn, a trait that can help them professionally but hurt them personally. Additionally, lawyers are known to be high achievers, perfectionists, and workaholics, all of which can lead to high stress and depression rates.

These factors, often unavoidable given the demands of the job, have contributed to lawyers committing suicide at rates higher than the general population. The U.S. Government’s Centers for Disease Control and Prevention reports lawyers rank fourth when the proportion of suicides in that profession is compared to suicides in all other occupations in the study population (adjusted for age), immediately behind dentists, pharmacists and physicians.

The likely trigger? Depression, according to the American Psychological Association, which reports lawyers are 3.6 times more likely to suffer from the mental illness than non-lawyers.

A survey conducted by americanbar.org and published in Psychology Today in 2017 revealed, as did the Hazelden/ABA study, that mental illness and addiction issues associated with lawyers are not confined to veteran attorneys. Within six months of entering law school, future lawyers show signs of depression, anxiety, hostility and paranoia. Forty percent of law students suffer from depression after the first year of school, and that persists throughout school and career. One in nine reported suicidal thoughts at some point in their career, causing them to self-medicate with alcohol or drugs or gain access to addictive medications through the medical system.

The data is as disturbing as it is incontrovertible. Lawyers provide, assist and protect clients who need help at the most critical moments of the lives. But now many lawyers themselves are in desperate need of life-changing and, in some instances, life-saving help.

Time to Address Behavioral Health Issues in Law Firms

Attorney Patrick R. Krill, director of the Legal Professional Program at Hazelden, architect of the Hazelden/ABA project and lead author of the study, identified the findings as “a call to action.”

“This long-overdue study clearly validates the widely held but empirically under supported view that our profession faces truly significant challenges related to attorney well-being,” Krill said in the report published in the Journal of Addiction Medicine. “Any way you look at it, this data is very alarming, and paints the picture of an unsustainable professional culture that’s harming too many people. Attorney impairment poses risks to the struggling individuals themselves and to our communities, government, economy and society. The stakes are too high for inaction.”

So, how can the legal profession adequately care for its own? Which proven strategies can be taken by management committees, human resources, managing partners and colleagues to identify lawyers who may be reluctant to seek help on their own while at risk or in peril? What types of behavioral health support and wellness initiatives should be made available through law firms’ human resource departments and the legal community to provide the necessary tools for addressing the issue? And once identified, how should law firm leadership handle such a situation, not only in terms of confidentiality within the firm, but in their ethical responsibility to that lawyer’s and the firm’s clients?

Signs of Depression and Other Behavioral Health Issues

The initial step is identifying a potential problem. Behavioral health experts have categorized the signs of depression as follows: diminished interest or pleasure in most activities; significant weight loss or gain without effort, or loss of appetite; difficulty sleeping, or sleeping too much; fatigue; feelings of worthlessness or excessive or inappropriate guilt; diminished ability to think or concentrate, or indecisiveness; psychomotor agitation, or emotional restlessness; psychomotor delay, or the slowing down of thought, movement and speech; and recurrent thoughts of death or suicide, or a suicide plan or attempt.

Some symptoms, such as difficulty sleeping, may not be obvious. Others, such as weight gain or loss, psychomotor agitation and delay, and indecisiveness and lack of concentration are discernible.

The signs that may indicate a person may be suicidal are as apparent as they are frightening: unrelenting low mood, pessimism, hopelessness, desperation, anxiety, inner tension, withdrawal, sleep problems, increased alcohol or drug use, impulsiveness and taking unnecessary risks, and threatening suicide or expressing a strong wish to die.

Given the stigma often attached to mental illness or addiction, lawyers may be reluctant to seek help, even from colleagues, because, as problem solvers, they believe they could handle it on their own. A 2004 study completed at Cottonwood de Tucson, a behavioral health treatment center in Arizona, confirms that likelihood. Lawyers recovering at that facility indicated that was the main obstacle preventing them from accessing care.

Krill transitioned into addiction counseling in 2010 and now consults law firms. The Hazelden/ABA project he spearheaded showed only 3,419 lawyers, or about 25 percent, of those surveyed answered questions about drug use. Krill’s assumption? He believes they were afraid to answer, which is telling.

In an interview in The Wall Street Journal in 2017, Krill revealed that a reduction in billable hours by a lawyer in crisis, particularly at mid-sized and large law firms, was a major reason colleagues ultimately intervened in their behavioral health issue.

“Unfortunately, the help really begins to emerge when the performance falls off,” he said.

Another factor that may exacerbate a lawyer’s mental illness may involve the bar exam. According to americanbar.org, in some states bar exam applicants are required to disclose whether they’ve been treated for behavioral health issues. This disclosure may worsen the problem, as future lawyers may not seek treatment in order to avoid the question of whether they’ve been treated for mental illness, thereby raising questions as to whether they’re suitable to practice law. There are some states such as Pennsylvania that do not ask behavioral health diagnosis-related questions in their character and fitness questionnaires, only conduct-based questions.

Getting Attorneys Help to Face Behavioral Health Challenges

Initiating a dialogue with a lawyer regarding a perceived behavioral health issue, whether by a partner, colleague, family member or friend, is an important yet tenuous first step, and there are confidential resources available within the profession.

Lawyers Concerned for Lawyers of Pennsylvania (LCL), for example, is an independent, caring, nonprofit peer assistance program that offers confidential helpline services, volunteer support and education with a mission to save lives and restore the behavioral health and professional competence of those in the Commonwealth’s legal community. Headquartered in Camp Hill, Lawyers Concerned for Lawyers is led by executive director and attorney Laurie J. Besden, who, as a recovering prescription drug abuser, is an example of the effectiveness of intervention and treatment. The program advises talking to the lawyer in crisis about what may be troubling them, offer emotional support, encouragement and affection, point out the realities of the situation with kindness, don’t be judgmental, offer hope, and help guide them toward seeing a qualified behavioral health professional.

“These diseases are chronic, progressive and fatal,” said Besden. “There is an epidemic not just in the public, but in our profession. LCL has a whole network of lawyers and judges in Pennsylvania we see. The point is, it does happen to us.

“Someone can call here and say they want to remain anonymous and they can. They can just say, ‘I’m an attorney, or even make up a name and say they’re an attorney, and we can help them, and we help family members of lawyers and judges.” She said, “The bottom line is, people don’t reach out for any number of reasons, and they’re dying because of it.”

Lawyer Assistance Programs are available throughout the country and offer a variety of strategies to address behavioral health issues in the profession. The ABA’s CoLAP provides comprehensive state-by-state resources at www.americanbar.org/groups/lawyer_assistance.html.

Keep in mind that while contemplating whether or not to broach this subject with a lawyer in crisis may be difficult, it pales in comparison to the churning sea of turmoil in which the lawyer in question may be drowning.

When a lawyer finally decides to seek help for their behavioral health issue, there remains the delicate issue of confidentiality within the law firm. All matters must remain confidential while ethically and delicately balancing the clients’ best interests by transitioning work to other capable lawyers within the firm. Violation of such confidentiality would not only violate the individual’s privacy rights but will also inhibit other attorneys with similar issues from seeking help.

Confidentiality is key when assisting a lawyer in crisis. Many law firms do not have adequate or thoughtfully designed policies and procedures in place for dealing with attorney impairment issues, including meaningful protection and confidentiality. The prudent course of action to all firms, large and small, is to examine their protocols around these issues and update them to reflect a philosophy of early detection and intervention, support, confidentiality and workplace reintegration. This should be done with the guidance and input of behavioral health experts who understand addiction, depression, treatment and recovery. Too often, firms fail to address these issues proactively and find themselves cobbling together a crisis response strategy after an incident has emerged or is threatening to emerge.

When a lawyer in crisis decides to seek treatment from a professional for behavioral illness or addiction, the concern has ramifications far beyond the initial treatment and recovery. Reputations and careers can be impacted by the stigma society continues to associate with behavioral health issues. Law firms must be cognizant of that unfair reality and maintain the utmost discretion.

“When a lawyer recognizes the need for treatment and goes to the head of the law firm, confidentiality should be adhered to,” said attorney Samuel D. Miller III, a member of the board of directors of the Pennsylvania Bar Foundation and an advisor to Lawyers Concerned for Lawyers. “In that instance, the firm should allow them to go, and take care of his (case) files while he’s in what is usually a 30-day patient treatment center or if its determined he needs more time.”

Another concern that must be addressed regarding a lawyer in treatment is how a law firm should explain the attorney’s sudden absence to their client. Miller said the usual strategy is to not lie to the client, but avoid specificity to maintain confidentiality for the lawyer.

“It can center around the idea that their lawyer has been hospitalized for medical treatment,” Miller said. “And until the lawyer is able to return, the firm will have another qualified attorney working on their matters.”

The vast amounts of data and personal accounts show undeniably that lawyers in America are in a behavioral health and addiction crisis. Reassuring is the array of agencies available to assist them in recovery. The Hazelden/ABA survey concludes that greater education aimed at prevention is key, along with public awareness campaigns with the profession designed to overcome the pervasive stigma surrounding substance use disorders and behavioral health concerns.

Yes, there is a behavioral health and addiction crisis among lawyers in America. A colleague in the legal industry who has struggled with clinical depression may have said it best after our dear friend committed suicide last fall: “When someone has depression, you cannot love them back to health. You must get them professional help.”

The alternative can be catastrophic.

Gina F. Rubel is an attorney and law firm PR expert. The owner of Furia Rubel Communications, Gina and her agency support growing law firms with integrated legal marketing, public relations and crisis communications. Contact her at gina@furiarubel.com. On Twitter: @GinaRubel