by Patrick Krill
from PDQ
May/June 2023

As we near the halfway point of 2023, I have both good news and bad news related to mental health and well-being in the legal profession. The good news is that over the last 8 years, meaningful efforts to prioritize mental health have been underway and gaining traction in the legal profession. Large numbers of dedicated individuals have now joined a growing well-being movement and are committed to fostering overdue cultural change.

The bad news is that the goal line can still feel elusively far away, frequently obscured by inertia, maladaptive attitudes, entrenched business models, and extrinsic motivations. And now, in 2023, you can add economic headwinds and budget cuts to the list of impediments threatening to mute and even unwind some of the gains we have made. There are also those in the legal profession who resist the idea that the mental health problems of lawyers should be worthy of sustained focus, let alone the revamping of work behaviors and organizational cultures. Although those individuals are increasingly in the minority, they are often in positions to exert outsized influence on the dynamics of many work environments.

In this article I will first summarize and discuss some of the more important takeaways from three peer-reviewed studies on lawyer mental health that I have co-authored with colleagues from the University of Minnesota Medical School over the last 24 months. This research is highly instructive and provides actionable insight into the mental health landscape in law. I will then offer 10 concrete suggestions — based upon my experience working with over one hundred legal employers, including 60% of the AmLaw 100 — for effectively advancing well-being as a strategic priority for a more sustainable profession. My hope and expectations are that this information will be both interesting and useful, and better prepare you for affecting change within your sphere of professional influence. Thank you for reading.

Lessons and Takeaways from the Data, Part 1:

Widespread Struggles, Notable Gender Disparities, An Employer’s Role in Curbing Problem Drinking

In May of 2021, a new study of lawyer mental health, substance use, and attrition that I co-authored was published online in the peer-reviewed scientific journal PLOS-ONE. If you and others in your organization have not yet read the paper —  entitled Stress, Drink, Leave: Gender-Specific Risk Factors for Mental Health Problems and Attrition Among Practicing Attorneys — I would strongly suggest that it is worth your time. This is especially true for employers who are still seeking to achieve a thoughtful and successful return-to-office paradigm for the post-COVID era. I will address just a handful of our many useful findings here.

The study, part of a wide-ranging research project with the California Lawyers Association and D.C. Bar, revealed alarming levels of mental health problems and hazardous drinking among practicing lawyers, findings which may not have come as a surprise to anyone who has been tracking the profession’s great mental health awakening in recent years. Even if we are not surprised, however, we should avoid resignation towards and acceptance of widespread problems whose effects ripple well outside of law. Clients, family members, society — they all lose when lawyers are unwell.

Our data, drawn from a large, random, bi-coastal sample of practicing lawyers, are demonstrative of an ongoing well-being crisis in law, one that was clearly worsened by the attendant stressors of COVID-19. While many of the articles that reported our findings focused on the prevalence of the problems, the more instructive takeaways were the risk factors we identified for stress, hazardous drinking, and attrition. Also of significant note, the clear and meaningful gender disparities associated with each of those problems. (Side note: following the publication of the study, the California Lawyers Association convened a working group to generate a report outlining specific recommendations to address the findings of the research. That report was published earlier this year and is full of valuable advice and information that would also be well worth your time.)

For women, who according to our study were experiencing higher levels of stress, depression, anxiety, and hazardous drinking than men, work-family conflict was the factor most predictive of thoughts about leaving the profession due specifically to mental health, burnout, or stress. (It is worth noting that work-family conflict was a significant stressor for men as well, albeit less so than for women.)

For charting a path forward, the implications of these findings may be obvious. As we state in our study, “a career in law should not be antagonistic to the full expression of a lawyer’s humanity, including their ability to undertake and navigate familial obligations should they so desire. Strategies and interventions aimed at alleviating work-family conflict would be wise pursuits for legal employers hoping to reduce unwanted turnover and increase the likelihood that their lawyers will be able to thrive across all dimensions of their lives.” If work-family conflict can be alleviated, even partially, by retaining more flexible policies around remote working post-pandemic, employers should be willing to explore those options with commitment and creativity.

To be clear, and as all my law firm clients have heard me say on numerous occasions, work-from-home can be the proverbial double-edged sword, and therefore must be approached very thoughtfully if it is going to be a successful endeavor for the legal employer as a business enterprise and its lawyers and staff as healthy human beings. There are real and tangible risks and downsides to working from home on a protracted basis, and legal employers have an obligation to account for and seek to reduce those risks.

Specifically, those downsides include that many lawyers are unwell, struggling with mental health and burnout, and often engaging in unhealthy self-medication in the form of excessive substance use. In a hybrid work environment, when people are not always observed on a regular basis, these problems can be much more difficult to detect. Mental health and substance use problems are also more likely to grow and flourish if someone is regularly isolated or only required to be around others a couple of days per week. Loneliness and isolation are well-known risk factors for mental health problems and addiction.

These facts present a clear risk management problem that cannot be ignored, and they can also undermine an employer’s best efforts to make mental health assistance available to people in need. Work-from-home enthusiasts and proponents would be well-served to not discount these risks and downsides, but rather to identify and propose effective mitigation strategies that are workable within the context of their organization. I believe that solutions to these challenges are only as scarce as the creativity deployed in the search for them.

Another opportunity for improving mental health that our data revealed pertains to a legal employer’s ability to influence the likelihood of hazardous drinking among their lawyers. Our study demonstrated that workplace attitudes and permissiveness towards alcohol significantly influence the likelihood of problematic drinking among lawyers, a finding which clearly underscores the need for employers to be more conscious of the cultures and environments they are cultivating. Social and peer influences and pressure are well understood risk factors for problematic substance use regardless of the setting. In the legal profession, this is the first empirical evidence of how pronounced this connection can be.

As a profession, we have made at least some minor progress in this arena thanks in large part to the ABA Well-Being Pledge. Launched in 2018, more than 200 legal employers are now signatories. As the person who originally created the Pledge, I have long understood that the work environments of lawyers played a meaningful role in their substance use. As such, the second plank of the Pledge calls for employers to deemphasize the expectation of alcohol use. Not to ban alcohol entirely or adopt overly draconian measures to discourage its use, but rather to actively seek to reduce the expectation that all forms of socializing, networking, and business development involve drinking.

Now that we have data demonstrating the link between workplace permissiveness towards alcohol and the likelihood of hazardous drinking, it is my hope that more employers will either sign the Pledge or approach their obligations under it with greater intentionality. Having now returned to the office in varying capacities, we find ourselves thrust into professional networking and socializing situations once more, making the ability of employers to influence drinking behaviors critical for them to understand. This is particularly true due to the increase in hazardous drinking that occurred during the pandemic.

Our data revealed that 35% of women and 29% of men reported that their drinking increased during the pandemic. Perhaps the more alarming fact, however, is that the nature of that increased use appears to be problematic for many. Men who reported an increase in drinking due to COVID were almost four times more likely to engage in risky drinking. Women who reported an increase in drinking due to COVID were seven times more likely to drink riskily. As we note in the study, these inauspicious findings may signal the early manifestation of what will ultimately prove to be a long-term problem for some lawyers. It is reasonable to conclude that many who were drinking more were doing so because of heightened anxiety and stress associated with the pandemic, and research has shown that drinking to cope with negative affect and anxiety can greatly increase the risk of persistent alcohol dependence. Educational interventions and the provision of structured advice about drinking behaviors have been widely shown to reduce problematic drinking in a variety of populations, and legal employers would be well-served to make those types of resources available to their teams at this pivotal time.

Lessons and Takeaways from the Data Part 2:

The Role Our Values Play in Our Well-Being

As a next step in the profession’s well-being journey, it is time to begin exploring the root causes of the problems we face with greater intentionality and sincerity, and to aim for a more candid understanding of our dilemma before the status quo once again regains the upper hand for which it is always vying. Fortunately, another study that my colleagues and I published last June moves us toward that goal with highly instructive and actionable findings.

Titled People, Professionals, and Profit Centers: The Connection between Lawyer Well-Being and Employer Values, our research explored the relationship between what lawyers think their employer values most about them, and those lawyers’ mental and physical health and risk of attrition. In short, our findings revealed a striking health hierarchy among lawyers that appears linked to their employers’ values, such that lawyers with the best mental and physical health — and lowest risk of attrition — work in environments that make them feel most valued for their skill, talent, professionalism, or inherent worth as a human being. Basically, the types of things that we would all like to feel valued for.

On the other hand, lawyers who felt most valued for their billable hours, productivity, responsiveness, and other financial contributions were in a distant second place in terms of their overall health and well-being, and they were — by a large margin — significantly more likely to report that their time in the legal profession had been detrimental to their mental health, caused their use of alcohol or drugs to increase, and that they were contemplating leaving the legal profession due to mental health, burnout, or stress. Apparently being in a primarily transactional relationship with your employer, wherein you may feel like a fungible billing unit, does not correlate with the best health outcomes or retention rates.

In third place, and with the most worrisome levels of poor health and highest risk of attrition, were lawyers who didn’t feel that their employer valued them for anything or who didn’t get enough feedback to know what they were most valued for. The only good news about this group was that it was relatively small—10% of lawyers—compared to 27% who were in the financial value group and 62% who were in the group that felt most valued for important professional attributes.

Some other important takeaways from the study include that lawyers working in larger firms were more likely to be part of the financial worth group (and consequently report worse health) and lawyers who identified as nonwhite were more likely to indicate that their employer did not value them or did not provide feedback.

Furthermore, the overall health of lawyers falls below that of the general population, irrespective of which of our three categories lawyers fell into regarding what their employer values most about them. This is notable because lawyers tend to fall higher on the socioeconomic scale, and it is typically people of lower socioeconomic status who are more likely to have worse self-reported health, lower life expectancy, and suffer from more chronic conditions when compared with those of higher socioeconomic status.

So, what does all this mean, big picture? To start, let’s highlight the good news: 62% of lawyers report feeling most valued for their talent, skill, and humanity, a number higher than I and many others thought it might be. Unfortunately, that still leaves us with nearly 40% of lawyers who are having a different — and notably worse — experience.

Paradoxically, it is those legal employers who value productivity and financial contributions above professional skill and human worth who are likely experiencing both lower levels of productivity and higher healthcare costs since numerous studies demonstrate that less healthy employees are less productive.

This is certainly not to say that profits are somehow bad or morally suspect, but simply that we may be sacrificing something vitally important — our health — in pursuit of them. And that is something we should be more honest about, first with ourselves and then with our colleagues, employees, and recruits. Full disclosure, informed consent, assumption of the risk: all concepts that lawyers should be comfortable with.

Furthermore, I am not suggesting that a pursuit of profits is some sort of scarlet letter whose bearers must be banished from the profession forthwith if we want to save our mental health. I like making money too. Maybe that shouldn’t be our overarching, primary, or exclusive concern, however. And maybe having it be slightly less of a priority should be directly reflected in our behaviors.

Interestingly, our research suggests that legal employers may be able to have their cake and eat it here too, in a sense. By reorienting themselves to focus more on talent, skill, and professionalism, more so than productivity, revenue generation, and responsiveness, employers may be able to both mitigate unwanted turnover and lower numerous costs, including but not limited to healthcare. Improving the lives of their people while strengthening their financial performance would, I hope, sound like a good deal to any employer.

We’ve all been through the ringer the last three years, the type of ordeal that generally prompts some introspection in its wake. It would seem fitting then to use this opportunity to ask ourselves who we truly want to be, both as individuals and as a collective.

Do we really want to value productivity and responsiveness over skill, professionalism, or intellectual contribution? If so, that’s fine, but let’s at least admit that an over-caffeinated person performing any array of mind-numbing tasks can also be highly productive, and animals are routinely trained to be incredibly responsive. These are not exactly high bars to clear, and not worth assuming mounds of student debt and numerous bad habits just to do so.

If you reflect on your own professional journey and the things that have made you feel good about yourself along the way, my guess is that those things are not predominated by the volume of your output, the speed with which you responded to emails, or the days and nights you spent wondering what your employer thought of you or whether they thought of you at all.

Instead, chances are that on the days you feel positive about yourself professionally — the days when you say your career was a good choice — you are doing challenging work that may also be either meaningful or enjoyable, maybe both. You are probably also feeling effective and competent at what you do, connected to your colleagues and clients, and autonomous in your life. These are core psychological needs that are essential to our well-being, but that can all be directly undermined by the demands and values of our workplace. As our research makes clear, it is time to elevate the role of our values in the well-being discussion. Are we valuing the right things in ourselves, our colleagues, and our work? If so, are we adequately communicating those values? The sooner and more easily we can answer in the affirmative, the sooner and more clearly our collective well-being will have improved.

Lessons and Takeaways from the Data, Part 3:

Suicidal Tendencies Explained

The third recent study that is important to understand for anyone seeking to promote greater mental health in the legal profession deals with a heavy but critically important topic — suicidal ideation. Suicidal ideation, defined as thoughts, ideas, or ruminations about ending one’s own life, is the first step to suicide and is predictive of suicide attempts. In addition to supporting the findings of several prior studies showing that lawyers were at least twice as likely as the general working population to experience suicidal ideation, our study was the first to go further and examine why that is the case.

On a very practical and near-term basis, it is important for legal employers to understand this research on suicidality and to ensure that their mental health trainings and protocols are updated to reflect a prioritization of the predictors of suicidal thoughts that we identified. Specifically, loneliness, being overcommitted to work, and having a prior mental health problem were all associated with meaningful increases in a lawyer’s likelihood of experiencing suicidal thoughts, as was being male.

As such, efforts and interventions targeting these factors will be an important part of any effective suicide mitigation strategies for the legal profession. Efforts to address loneliness in particular will undoubtedly be complicated by remote and hybrid working models that now predominate the legal field, especially as recent reports from the field suggest that many lawyers are reluctant to return to the office. Given the high rates of alcohol misuse among lawyers and the strong connection between workplace permissiveness towards alcohol and the risk of hazardous drinking, efforts to combat loneliness and isolation should avoid reliance on alcohol-based events as a primary means of increasing socialization and connection.

Above all, however, stress was the primary predictor of suicidal thoughts that we identified. In fact, lawyers with high levels of perceived stress were a remarkable 22 times more likely to experience suicidal thoughts than those with low stress. While stress has been linked to suicidality in many other populations as well, the stress-suicidality circuit in lawyers appears especially, and perhaps uniquely, well-formed.

When I first wrote about the problem of lawyer suicide nine years ago, it was in the wake of a spate of recent suicides in the legal profession that had garnered national attention. At the time, the only data we had on the subject were generally prevalence data (i.e., how often lawyers died by suicide). For many of us who were seeking to raise awareness and mitigate the problem, we had to rely on a combination of our professional experience and educated assumptions based on known suicide risk factors in the general population.

With this new research, however, we can better understand the mechanisms of distress that for some may tip the scales in favor of death. We can also all, whether lawyers or not, begin to question when and under what circumstances the stress we invite into our lives, including through our work, is truly worth it.

For lawyers especially, this may be a pressing question. A recent analysis by The Washington Post found that law is the most stressful profession, based on an examination of 11 years of data from the U.S. Bureau of Labor Statistics. Across the profession, several recent studies have shown that lawyers are struggling with mental health, drinking too much, and burning out at alarming rates. A new study of completed lawyer suicides that examined data from the National Violent Death Reporting System found that lawyers' suicides were 91% more apt than other suicides to have job problems as a contributing factor.

A mentor of mine—also a lawyer—used to joke that the common denominator in all his failed relationships was him. At a certain point, we ignore obvious patterns at our own peril, but find growth and solutions upon acknowledging the true origins of our problems. For law, a profession that is perhaps more vital now than at any time in our nation’s history, being honest about the sources of our problems is essential. It is essential for the health of lawyers themselves, and for a society that is depending on them to help safeguard liberties and freedoms in a rapidly changing and often precarious world.

Work is an essential part of our lives, one that can provide a sense of dignity, purpose, and enrichment. Yet, when it comes to the stress generated by our jobs, the potential for harm can be just as great and often greater than the harm caused by other behaviors or lifestyle choices. Our efforts to mitigate that risk should have a commensurate level of seriousness. We should also acknowledge that we can do better, much better. And considering the heightened mental health struggles of the generation that will soon be part of the workforce in law and elsewhere, it is imperative that we do.

Ten Practical Suggestions for Advancing Mental Health and Well-Being as an Organizational Priority

The following suggestions reflect a synthesis of my research, my daily work experience helping legal employers navigate the realm of mental health and well-being, and common sense. This is of course a non-exhaustive list, but I consider these suggestions to be best practices for organizations seeking to promote and enhance mental health and well-being among their lawyers and staff.

1. Leverage the GC’s Office. Especially in the context of a law firm, the General Counsel has an important role to play in advancing the goal of improved mental health and well-being. Too often, however, I observe the General Counsel’s office being siloed off from an organization’s well-being efforts, or only involved when it comes to educational programs linking substance abuse to impairment and rules of professional conduct. In truth, most GC’s have a deeply useful perspective (and sometimes budget dollars to contribute as well) that can be leveraged to develop a more robust and well-rounded well-being program. Involve them, ask for their perspective, and invite their participation and support. Your wellbeing program will improve as a result.
   
   
2. Deliver programming and resources through multiple formats. The firms that have had the most success in building a well-being program that their lawyers and staff appreciate and take seriously are firms that recognize—as an organizing principle—that a one-size-fits-all approach is bound for mediocrity. Making programming and resources available to people through multiple formats (live, on-demand, app-based, video, podcast, print, etc.) is a reliable way to ensure that your resources are well-utilized and that there is something for everyone, available when they need it, on their schedule, and suitable for their preferred learning style.
   
   
3. Seek partners, not vendors. Law firms and other legal employers often view their outside experts, content providers, and other professionals as ‘vendors.’ While perhaps being technically true from a contractual standpoint, approaching the relationship through that lens is a mistake that will meaningfully handicap the true potential of your well-being program. Conversely, when employers seek out and build relationships with partners who understand them, know their key staff members, and invest in a mutually beneficial relationship, better results and more effective solutions are bound to follow. You’ll also enjoy the work more and probably develop some valuable friendships as well.
   
   
4. Build relationships with colleagues and peers at other firms and organizations. A fair critique of the legal profession — especially Biglaw — is the propensity for lemming-like behavior. When firms obsess over or take their cues exclusively from what competitors are doing, creative solutions and original ideas can suffer mightily as a result. At the same time, it is worth knowing if peers at other firms have had good experiences with programs or resources they have deployed, or if they have developed an effective formula for driving engagement with and utilization of mental health benefits. Take time to get to know your peers and colleagues doing similar work at their organization. Never follow their lead blindly of course or assume their formula for success will necessarily translate wholesale to your organization, but also understand that you may not have to reinvent the wheel each time.
   
   
5. Prioritize quality over convenience. Employee Assistance Programs (EAP’s), online mental health platforms, and other content providers are increasingly seeking to offer everything (or mostly everything) you need for your well-being program under one roof. While turnkey solutions may seem appealing from an efficiency and perhaps even a cost-perspective, they likely will not lead to the best possible outcomes. From a practical perspective, the odds that all the best resources, tools, or experts would be housed within the same platform or company are effectively zero. Though it will undoubtedly be more time-intensive on your part, taking time to thoughtfully diversify the resources and services you make available will greatly increase the likelihood of providing the best solutions, and quality ultimately trumps convenience.
   
   
6. Partner with clients, law schools. To truly achieve cultural change around mental health and well-being in the legal profession, we need all stakeholders involved and rowing in the same — or at least a similar — direction. Creating opportunities for law firms, their in-house legal department clients, law schools and others to collaborate on events and programming is a great way to foster a spirit of cooperation and common purpose around mental health. Some of the most effective programs I have conducted in recent years have involved my law firm clients making the events open to others, including their clients. Not only does this lead to more robust attendance, it more importantly helps create a common touchpoint and to normalize a shared language around mental health while also breaking down stigma. It is a winning formula all around.
   
   
7. Utilize existing events and training opportunities to incorporate a focus on mental health and well-being. Scheduling regular, standalone events in support of mental health and well-being is obviously of great importance. But that doesn't mean your efforts should be limited to those offerings. A great way to anchor well-being as a core fundamental of your organization’s ethos is to begin incorporating it into your existing training and collaboration opportunities, such as onboarding and orientation, firm or partner retreats, new partner training, etc. Eventually your lawyers and staff will begin to anticipate and expect well-being offerings as part of these otherwise scheduled events, and that will be a major step in the right direction for your culture.
   
   
8. Bring the internal and external together. Utilizing external subject matter experts, speakers, and resources to promote mental health and well-being at your organization is a fully necessary but sometimes insufficient method of affecting change and facilitating progress. While it will not be possible or appropriate under all circumstances, identifying opportunities to incorporate the stories, perspectives, and advice of individuals from within the organization will be a winning strategy for amplifying and underscoring the importance of mental health and well-being. This is especially true when a more senior or well-respected individual shares their own struggles or experiences.
   
   
9. Identify synergy with DEI efforts. DEI and well-being are both important priorities for the legal profession, and each deserve their own budgets, resources and, where appropriate, staff. Attempting to artificially shoehorn these topics together for the sake of convenience, cost, or efficiency is a mistake, and will ultimately undermine the full efficacy of efforts in both realms. At the same time, there are absolutely areas where these priorities converge, overlap, and complement each other. Looking for ways to create or harness appropriate synergy between the two domains can lead to better results across both. Like the point I made about leveraging the General Counsel, organizations lose out on valuable perspectives and holistic understandings when stakeholders and priorities are overly and unnecessarily siloed off from each other.
   
   
10. Make it a family affair. I often find myself speaking to lawyers who view their own mental health and well-being as fine, but they are nonetheless stressed, worried or preoccupied about the health and well-being of their children, spouse, partner, or other family member. To the extent possible and practicable, extending the reach of your mental health and well-being resources and supports to family members can be a highly effective, albeit indirect, way of supporting the health of your organization’s lawyers and staff. While there may be practical limitations to what can be offered to family members, it is important to at least demonstrate your organization's recognition that people have priorities and concerns outside of work that also warrant attention and support.

Patrick Krill is a lawyer, licensed and board-certified addiction counselor, and researcher who has initiated and helped lead many of the legal profession’s more notable efforts to improve mental health over the last decade. Widely regarded as a leading authority on the mental health and well-being of lawyers, he is the founder of Krill Strategies, a behavioral health consulting firm exclusively for the legal profession. In that role, he serves as a trusted advisor to large legal employers, including roughly half of AmLaw 100 firms, numerous regional and boutique law firms, and several corporate legal departments and public sector agencies. He can be reached at [email protected]