Mental Health


Stress, Drink, Leave: Warnings and Opportunities Around Lawyer Mental Health in 2021 and Beyond

By Patrick R. Krill

With summer now behind us and many legal professionals in the process of returning to an office either full or part time, this is a pivotal moment that warrants pausing and thoughtfully checking in with our mental health and personal well-being. It would be an understatement to say we’ve been through a lot over the last year and a half, with many of our minds and bodies enduring stresses that won’t soon fade. In the legal profession specifically, data published earlier this year clearly demonstrates that reality. In mid-May, 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 seeking to build a 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 we conducted in collaboration with the California Lawyers Association and D.C. Bar, revealed alarming levels of mental health problems and hazardous drinking among practicing attorneys, 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 attorneys, are demonstrative of an ongoing well-being crisis among lawyers, one that was clearly worsened by the attendant stressors of COVID-19. While many of the articles that initially reported our findings focused on the prevalence of the problems, the more instructive data lie in 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. For women, who according to our study are 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. Thoughts, by the way, which one in four women is having. Not to put too fine a point on it, but those numbers will not exactly help the profession achieve its longstanding gender diversity goals. Not now, not ever. (It is worth noting that work-family conflict was a significant stressor for men as well, albeit less so than for women.) For purposes of charting a path forward around return to work, 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 attorneys 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. As our research makes clear, depression and anxiety are rampant, and more than one-third of lawyers are engaging in high-risk hazardous drinking, including while working from home. In a remote environment, when people are not able to be 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 holed up at home alone. 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 attorneys. Our study found that workplace attitudes and permissiveness towards alcohol significantly influence the likelihood of problematic drinking among attorneys. In fact, workplace permissiveness towards alcohol use was more predictive of risky drinking than both age and high levels of work overcommitment, 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 conceptualized the Pledge framework, 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. As we return to work and find ourselves thrust into professional networking and socializing situations once more, their ability to influence drinking behaviors will be critical for employers to understand. This is particularly true due to the increase in hazardous drinking that occurred during the pandemic.

Make no mistake, the workforce that legal employers sent home in early 2020 is not the same workforce they are in the process of welcoming back to the office. This is true in multiple ways, some very tangible and some more philosophical. On the tangible side, a meaningful number of lawyers will emerge from the COVID-era experience with a notably less healthy relationship with substances. Our data revealed that 35% of women and 29% of men reported that their drinking has 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 during the pandemic were almost four times more likely to engage in risky drinking. Women who reported an increase in drinking during the pandemic 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. Overall, my prediction is that the employers who are most successful at navigating a return to work and the post-COVID era will be those who fully acknowledge that the composite mental health profile of their workforce has changed. Additionally, they must be willing and prepared to offer supports and accommodations that are reflective of that change. Employers who fail to acknowledge or understand the altered behavioral health landscape now present before them will be caught flat-footed. They will likely experience higher levels of workplace mental health crises, problematic behavior, and attrition, all coupled with lower levels of job satisfaction and thriving among their workforces. As the world emerges from the COVID-era, legal employers are confronted with both warnings and opportunities around lawyer mental health. How they respond could shape their organization’s trajectory for years to come.

For individuals seeking to reduce their alcohol consumption, eliminate unhealthy behaviors, or just generally strive for greater physical and mental well-being, I would recommend getting started sooner rather than later, but that does not necessarily mean making dramatic changes overnight. Often, slow but steady and consistent change leads to better results. One of the most-widely accepted and well-studied models for explaining how people accomplish change in their personal lives is called the Transtheoretical Model of Change, or TTM for short. It operates on the assumption that people do not change behaviors quickly and decisively (such as through a New Year’s resolution), but instead that behavior change, especially habitual behavior, occurs through a cyclical process. According to this model, behavior change occurs incrementally, with the individual moving from either being apathetic, unaware of the problem, or unwilling to make a change (known as the precontemplation stage), to a point where they are considering a change (contemplation), to deciding and preparing to make a change. Meaningful, committed action is then taken, with ongoing attempts to maintain the new behavior occurring over time. Relapses and returns to old behaviors are common and considered part of the process of achieving lasting change. Wherever we might find ourselves in the change process, having support is key. Whether it is your own established support network, an employer-sponsored resource like an Employee Assistance Program, or the confidential and helpful services of the California Lawyer Assistance Program, allowing others to be part of your journey to improved health and well-being is the best way to improve your odds of reaching your goals.

Patrick Krill is an attorney, licensed and board-certified alcohol and drug counselor, author, researcher, and advocate who has spearheaded numerous groundbreaking efforts to improve mental health in the legal profession. Recognized globally as a leading authority in the field, 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 law firms and corporate legal departments throughout North America and Europe, working to help them protect and improve the health and well-being of their attorneys and staff. Patrick's highly specialized background and unique breadth of knowledge related to behavioral health and well-being in the legal profession make him a widely sought-after expert and trusted resource for solving one of the legal profession's most challenging problems. His clients include many of the largest and most prominent and legal employers in the world.

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