Danielle M. Hall is the executive director for the Kansas Lawyers Assistance Program, where she oversees the daily operations of the program. In addition, she advises and provides resources to lawyers and law students in the areas of mental health, substance use-disorder, well-being and law practice management. She serves on a number of boards and committees, including serving as the vice president of policy for the Institute for Well-Being in Law and on the executive committee of the Kansas Task Force for Lawyer Well-Being.
Anna Levine is the director at the New Jersey Lawyers Assistance Program (NJLAP). She is passionate about her work assisting lawyers with a range of concerns, from day-to-day well-being, alcohol/substance use and mental health topics or questions, to law practice management. She enjoys collaborating with her colleagues throughout North America and the world and serves on the American Bar Association’s Commission on Lawyer Assistance Programs (ABA COLAP).
Roberta Tepper is the chief member services officer for the State Bar of Arizona. Roberta leads the Member Services Division team, which supports numerous programs and departments, including continuing legal education; lawyer assistance programs; diversity, equity and inclusion; legal specialization; mandatory CLE and compliance; the bar’s resource center, and more.
What are the signs that a lawyer (or judge or law student) is in distress and may need help?
Roberta Tepper (RT): It can be difficult to tell, sometimes. But typically we tell people to look for changes in the usual habits of a lawyer: things like missing deadlines when the lawyer has always been prompt; changes in mood – so a normally even-keeled lawyer becomes increasingly volatile, cranky or withdrawn; mistakes where there ought not to be – missing an obvious case law reference, something like that; difficulty remembering basic facts. In other words, something that makes you think “I wonder what’s up with them?” Also, a new pattern of absences on Monday can indicate a weekend of alcohol or substance abuse; defensiveness to a “how are you doing?” inquiry. And sometimes a lawyer may be really good at covering up their distress as it’s building – it may take a one-on-one conversation with a colleague, a manager, etc. to give us the first hint something is wrong. Of course, the most drastic calls for help – attempted suicide being one – are the ones we want to avoid because someone has intervened or seen the distress long before that. That’s the goal, anyway.
Anna Levine (AL): There are some widely recognized red flags, such as significant changes in mood, difficulty controlling emotions, persistent lack of motivation, being withdrawn, day-drinking, drinking to excess at work functions, the distinctive smells of alcohol or marijuana and visual clues of active drug use, such as traces of cocaine on someone’s nose or fresh track marks from intravenous drug use.
In many cases, particularly with high-functioning people long accustomed to masking their anguish, the signs will be subtle and even undetectable. Sure, there are many observable and even measurable symptoms of possible distress: tremors; racing heart; sweaty palms; sleep disturbances; behavioral changes; and others, but these can also be signs of medical conditions and it is important to leave formal diagnosis to clinicians.
Whether a certain behavior or action is a sign of distress will depend on that person’s norm. Perhaps the most obvious and least-discussed sign that someone might need help is if they ask for it. Institutions that successfully cultivate environments and systems that make disclosure safe and provide meaningful support can be critical factors in early detection and intervention.
Are there any mental health issues to which lawyers and judges are more susceptible than other professions?
Danielle Hall (DH): By now, we should all be aware of the published research which shows that those in the legal profession suffer from higher rates of anxiety, depression and substance use-disorders, but burnout is something that I also see a lot of at the assistance program. Couple the stressful nature of the job with the high demands, and then throw that into a system that is adversarial in nature with a culture that uplifts the overworked, and we have the perfect environment to breed burnout. In fact, we have a recent study from Massachusetts that showed more than three-fourths of Massachusetts lawyers are experiencing burnout, and almost half have thought about leaving their legal employer or the legal profession for that reason or because of stress.
AL: Research suggests that lawyers are more prone to alcohol use disorders, anxiety and depression than the general population and other professionals. The numbers vary depending on the study you cite and there is even research that rebuts this widely accepted conclusion. Lawyers may also have ADHD at higher rates than the general population. Other problems include burnout, vicarious trauma and plain old-fashioned stress. Many of our number also suffer from inadequate sleep, which can also impact well-being.
RT: Research tells us that lawyers are prone to anxiety and depression at a rate higher than other professionals; and the Krill study in 2016 gave empirical support to what people in the LAP world have known anecdotally for a long time – that lawyers are more prone to substance use disorder at a rate higher than most other professionals. Recent research, or a resurgence of research, on vicarious trauma (aka secondary trauma) reminds us that because lawyers, and judges for that matter, routinely see people at their worst, they eventually are impacted by the level of trauma they are witnessing and are sometimes drawn into.
Do you see any areas of law practice that are particularly prone to mental health issues, such as high stakes litigation for example?
AL: Litigation is an area of high stress and there may be a correlation between the amount of litigation in a person’s practice and their alcohol or drug consumption. Any lawyer with a high billable hour expectation is also at risk for high stress. Solo and small firm attorneys are often stressed due to inadequate administrative acumen, insufficient support and a shortage in mentors. Also at risk are attorneys who work with vulnerable people: children & families, refugees in search of asylum, clients with alcohol/substance use or other mental health conditions and victims of crimes. Imagine needing to look at crime scenes or autopsy photos daily, or regularly witnessing children being separated from their parents, or graphic child protective service reports depicting repeated patterns of abuse. While some take pride in their ability to withstand other people’s trauma, claiming imperviousness with a certain bravado, repeated exposure to this type of material can have cumulative impacts—many of them deleterious to one’s mental health.
RT: It’s hard to say; while there are some practice areas one might anticipate might have more impact on lawyers – family law being the one that comes most quickly to mind – sometimes it is the lawyer themselves, rather than the area of practice that make them prone to mental health issues. The pursuit of perfection, being harder on oneself than on everyone else – that self-critic that never takes a break, that can be harder on a lawyer than the subject matter they focus on.
When one thinks of addiction, alcohol and drugs typically come to mind; are there other addictions that are equally harmful?
AL: Behavioral addictions, also known as process addictions, do not involve drugs or alcohol, instead they involve compulsive behaviors or activities that are rewarding or pleasurable. Like drugs or alcohol, these behaviors activate the brain’s reward system and therefore could result in a similar type of dependence that we observe with substance use disorders. Essentially, it is not the nature of these activities that is “harmful;” the harm is associated with becoming all-consumed by these behaviors despite significant negative consequences. Common behavioral addictions involve gambling, the internet and shopping. Even fundamental human needs for food and sex could evolve into harmful addictions if a person becomes excessively preoccupied and compulsively seeks food or sex as ways to cope with distress. In terms of severity of potential harmful impacts, a gambling addiction can put an attorney (especially one who holds clients’ funds in trust) on the fast track to disbarment.
RT: Any addiction can be harmful; we’ve seen lawyers with gambling addictions who end up stealing from their client trust accounts; an addiction to pornography that is so distracting that it impacts a lawyer’s day-to-day routine; sex addiction that destroys a relationship. Food addiction can so negatively impact one’s health that it impacts a lawyer’s ability to practice.
What are the best tools for maintaining professional health?
DH: As lawyers, we tend to over-complicate things, but when it comes to maintaining our overall well-being, it doesn’t have to be so complicated. For instance, the research supports that the basics―sleep, nutrition and physical activity―are important to maintaining our professional health. Beyond the basics, I often tell lawyers that self-care is not a one size fits all sort of thing. You must find what works best for you. Meditation and yoga are great well-being practices, but simply making sure you are not eating lunch at your desk and that you are taking breaks throughout the day or shutting down your devices by a certain time are also helpful daily practices. I also think focusing on and building things like organization and time management skills can be a beneficial part of our well-being practices. If you better manage your time and work in an efficient and productive way, then meeting your work-life balance goals can become easier.
AL: Knowing, establishing and keeping one’s boundaries, balance practices that cultivate joy and interests and activities that take us out of the professional persona—learning to understand that being a lawyer is an occupation—not an identity. If being a lawyer is who we are instead of what we do, it is very difficult to strike a balance and know when to wind down, be it for the day or for good. We need to know how to turn off lawyer mode.
RT: It would be great if there were a simple answer to this – just do this one thing and you’ll be fine. The answer overall, I think, is balance – keeping work and personal life in perspective and in a balance that works for the individual. For each person that may be different – one person may need some physical activity or exercise; another may use other tools like mindfulness or meditation; others, a hobby that provides an opportunity to unwind and focus on something other than work. It can be a combination of all of those things, and for some, counseling or professional support may need to be added to that mix. The important thing to do is to make health – physical, mental and emotional health – a priority and not something you fit in when you have a break.
Have you seen an increase in the number of people using your programs?
DH: We are definitely seeing an increase in the number of people using the assistance program in my state. I think the increase is two-fold though. The obvious reason to point to is the impact that the pandemic has had on all of us and on mental health. I would also like to think, however, that the well-being movement has had an impact on this increase. As we talk about mental health and substance-use disorder more and work to reduce stigma, the more comfortable the legal community will be in coming to the LAP for assistance. I think we are already seeing this play out some. But, as we continue to educate the legal community about these issues and ensure that people know about the services the LAPs provide, we also need more financial support and resources. I am hopeful that, as we see this increased usage, we will also see more investment in our LAPs.
AL: Absolutely. In New Jersey, our utilization rates have doubled in the last year. There are still many who suffer in silence, and we dedicate significant time, effort and other resources towards reaching them.
Are there any taboos that may prevent someone seeking help from an assistance program?
DH: Stigma can play a large role in preventing someone from seeking services. Stigma can come from a lot of different places for an individual. For instance, one can be influenced by stigma within the profession, their family or culturally. That is why it is important that we focus on reducing the stigma within the profession and implement strategies so we are not further perpetuating the ideas that someone should be scared about confidentiality, the reactions of their colleagues or that seeking help is a sign of weakness. Providing education and having work-place policies, for instance, that encourage help seeking behaviors and support well-being can be helpful.
AL: I don’t know if “taboo” is the word I would use, but some obstacles include: a) fear of appearing weak; b) concern that revelations will lead to disclosure/bar discipline (usually unfounded, as in most jurisdictions [check your local rules]and definitely in NJ, by rule of court, consulting with the lawyers assistance program is confidential and exempt from reporting to bar discipline: See, e.g., NJ RPC 8.3(d)); c) identifying as someone who helps people and feeling an inability to reconcile that role with the idea of seeking help for oneself and, of course; d) not having enough time/the inability to take time away from work for oneself.
RT: Sure, lots. Despite the recent attitude shift generally, which acknowledges the need to be a healthy lawyer to be a competent lawyer, and the understanding that substance use or mental health disorders are not weaknesses, but treatable conditions, there is still a lot of shame attached to a lawyer admitting they need help. Lawyers, much like doctors, are supposed to be the fixers, right? So, for someone who should be able to, or is able to, “make it all better” for their clients to admit that they need help is a big step. Then, there’s more. For a program like ours, which is housed within a mandatory, integrated Bar, there is the fear that somehow the lawyer discipline folks will find out. In Arizona, our program is confidential by Supreme Court rule, but I start most of my calls with members answering their question about whether our conversation is confidential.
What is your advice for anyone feeling anxious, depressed or using substances to self-medicate?
RT: You are not alone. There are many people who have suffered in the way that you have, and there is hope and help out there. Our peer support volunteers include members who are in recovery and members who have not themselves experienced substance use or mental health disorders, but just want to help.
AL: You are not alone. Ask for help. Talk to someone. Research shows us that strong relationships and connection with other people, the opposite of isolation and suffering in silence, protect our mental health. I would also tell them that there is no problem in life that a drink or drug won’t make worse. I would try to reframe help-seeking not as a sign of weakness, but a first step on the path towards renewal and strength. Many who confront their struggles head-on often emerge from their darkness feeling like they are better lawyers now, as they have learned to put their humanity to work in new and exciting ways.
What can an individual do if they think a colleague needs help?
DH: Approaching a colleague can be scary, especially if you feel like you don’t know what to say or how you can help, but that is where your state LAP can be of assistance. Take a look at your state LAP rules and get to know them better. We have rules relating to confidentiality, and I tell lawyers in my state that when you call the LAP, you are not reporting your colleague, you are making a referral for services, and we can reach out to the person to see if we can provide help.
AL: First, you can call your lawyer assistance program for support and advice. A significant percentage of our inquiries are from callers concerned about another person, often a colleague or family member. Lawyer assistance program professionals are used to brainstorming in these situations and running through different approaches with the concerned person.
Second, be aware of your potential to create (or destroy) an environment where vulnerability is allowed. Refrain from gossip or seemingly harmless jokes. You never know who is listening and how your words (perhaps intended humorously) might impact them.
Third, when you are ready to ask the person if they are ok, make sure you have the time to listen to their answer and be fully present for them. It’s possible the person may blow you off with a brusque “I’m fine.” Accept that they may not be ready to share at the moment you ask them. If they sense your genuine care, they will have a greater chance of approaching you when they are ready to accept support. Everyone’s process is different. Your timing might be just right, and when you ask, your question may come as a huge relief and the person may really want to unburden themselves.
RT: Sometimes nothing, and that is a hard thing for lawyers who want to help. One of the hardest lessons I was taught by the long-time members of our member assistance (advisory) council is that no one can fix anyone else. You just have to be there when they are ready. But that having been said, if you know a colleague who needs help, it’s fine to ask them how they are doing – they may not realize that their distress is showing. They may not want to talk to you, but you can encourage them to find someone to talk to – whether through your state’s LAP program, or through their doctor or religious leader or through another therapeutic program. In our program, you can also call us and let us know that someone is struggling. We will reach out to them to let them know there is help available, contact them through one of our peer support volunteers (which may be less scary than getting a call from “the bar”) and let them know that people who care are worried about them. You just never know whether your effort is the one that tips the scale and starts a colleague on the road to well-being.