There has been much publicity in Florida this spring as The Florida Bar has focused on the health and wellness of its members. It all seemed to start in early 2018 when then-Bar President Michael Higer highlighted the subject in the Florida Bar Journal. That issue had various related articles including Mental Health and Wellness: Destigmatizing the Discussion and Promoting Solutions; What do the Statistics About Lawyer Alcohol Use and Mental Health Problems Really Mean?, The Surprising Master Key to Happiness and Satisfaction According to the Lawyer Research, and more. Perhaps those efforts were spurred by a "landmark report on attorney well-being" that was published in August 2017.
That 2017 report was mentioned recently in a report by the Virginia State Bar. The Virginia authors find significant merit in that report of the National Task Force on Lawyer Well-Being, a group assembled by the American Bar Association (a voluntary group to which some lawyers belong). While praising the effort of the Task Force, the Virginia report concludes that "little has been done to 'drill down' to the reason that lawyers experience wellness problems at a disproportionate rate." That is, accepting that there are wellness issues as identified, why are there such issues?
The report leads with a discussion of a national survey of 13,000 attorneys. And it demonstrates we have problems with drinking, depression, anxiety, and stress. The effects of these mental health problems included suicide, social alienation, work addiction, sleep deprivation, job dissatisfaction, a diversity crisis, and even negative public perception. Significantly, the ABA study found that younger lawyers in the first ten years of practice and those working in private law firms experience the highest rates of problem drinking and depression.
The Virginia report identified both physical and non-physical risks that are of interest. The "physical included sedentary nature of work," "long and unusual hours," "sleep deprivation," "working indoors," and the "aging of lawyers." The non-physical factors included: "adversarial nature of the work," "individual work," "professional demands," "vicarious trauma and managing other people's problems," "the duty of confidentiality," "educational debt," "business management and the practice of law," and the "need to display confidence and conceal vulnerability."
Physical Factors:
"Physical included sedentary nature of work"
The report says there is "a risk of dying similar to the risks of dying posed by obesity and smoking" associated with a lack of activity. This is not only a lawyer problem, as it also notes "86% of American workers sit all day at work." But, there is evidence that this one can be reasonably simple to combat. In fact, "low-intensity, non-exercise activities" are seen as effective. The report recommends: "parking at a distance from a building, using stairs instead of elevators, setting reminders on a phone or watch to stand up and move, working at a standing desk, taking multiple stretch breaks, and walking at lunch" as efforts worthy of consideration.
"Long and unusual hours"
It notes "working long and unusual hours is a fact of life." This may "yield predictable consequences, including exhaustion, stress, and mental burnout." The report notes that our affinity for remaining connected and leveraging technology is part of both the "long and unusual." The report recommends various methods to combat this including delegation and organization. But also suggests avoiding the lure of multi-tasking and procrastinating to reduce the stress. Finally, it says "schedule time to relax and recharge." Lawyers are inherently (it seems) resistant to such scheduling.
"Sleep deprivation"
Surveys suggest that lawyers are the "most sleep-deprived professionals." A recent study on the effects of sleep loss found even minimal interruption is problematic. Admittedly, this is a stressor, but also itself "a major health issue," that may impact "mental and physical health." The impacts are listed in detail but include impaired driving, food cravings, obesity, diabetes, and high blood pressure. The authors recommend a variety of tools, including exercising regularly, putting "thoughts on paper and out of the mind," and even mid-day napping. The report suggests that recognition of the importance of sleep by organization leadership may encourage good habits by associates and employees.
"Working indoors"
The report says that this tendency leads to "limited exposure to sunlight," "disruptions of circadian rhythm," and "vitamin D deficiencies," and can thereby contribute to issues with sleeping. There are also attendant risks of depression, air quality, and even vision issues. This is also not an issue limited to lawyers, it notes that "90% of all people spend close to 22 hours inside each day." The authors suggest more time outdoors, "two hours of daylight per day," and advocate that firms and other employers should "adopt policies promoting time outdoors, such as permitting 'walking meetings.'”
"Aging of lawyers."
This one is certainly not about lawyers only, and the authors acknowledge that. The authors contend that with age comes "the potential for mental or physical impairment." These may include physical challenges due to degenerative disease, or mental issues related to memory, attention, concentration, or emotion. The report recommends annual medical examinations, and if necessary with specialists in psychology or psychiatry. Employers should encourage all lawyers to "watch out for each other," and to be conscious of "red flags that suggest a colleague’s cognitive abilities" may be suffering.
In a nutshell, it seems a great deal could be accomplished in regards to all of these physical factors by each of us taking a couple of breaks daily and spending time walking around outside with others while we all engage in conversation?
Non-Physical Factors:
"Adversarial nature of the work,"
The authors conclude that legal work "is necessarily conflict-ridden, and conflict breeds stress." This may be frustrated by the fact that lawyers involved may be high-stress ("type - A") to begin with. The very nature of the work means "conflict is an unfortunate reality for many lawyers." The process leads to "anger, guilt, and fear," and the chronicity of it can produce physical effects. The authors suggest training and education on "civility-centered" topics and engagement in "organizations devoted to professionalism and civility, such as the American Inns of Court." Firms should "create comradeship and combat the feeling of isolation engendered by the chronic aggression of law practice."
"Individual work,"
The report suggests that attorneys are lonely, concluding the practice is "the loneliest kind of work." There is a danger of feeling isolated as well as challenged by an "often-competitive culture." Loneliness is seen as driving "diminished physical activity," "depression," "disrupted sleep," a variety of physical changes that could affect health. How detrimental is loneliness? The Authors conclude "loneliness has the same effect as smoking fifteen cigarettes a day on our overall health." The report suggests lawyers should "say 'yes' to as many social gatherings as" possible. A concerted effort should be made to "maintain healthy relationships with family and friends." And, employers should be aware of the "risk and symptoms," and create "positive social support in the workplace."
"Professional demands"
The report notes a tendency for lawyers to be "pulled in too many directions to manage," noting "clients, colleagues, and the courts." There is no mention of the concurrent commitments to family, friends, and other social outlets (see above, re loneliness). The authors note that clients are often in stressful situations, thus they hire a lawyer. They may be disappointed, demanding, or even angry. And that may lead to "bar complaints, unfavorable online reviews, and malpractice claims, adding to the lawyer’s overall stress." The authors suggest establishing expectations at the outset of relationships (clients are mentioned, but this might as well apply to others). Furthermore, they recommend focusing on communication, time management, and having a "trusted mentor or colleague" to speak to about such issues.
"Vicarious trauma and managing other people's problems"
The report says this one is complicated by the primacy of other's problems, and the way lawyers "shoulder" them. These aggravate other issues already mentioned such as "increased stress, depression, anxiety, sleep disturbance," and more. The pressures can lead to “emotional fatigue” and “compassion fatigue,” as the lawyer's emotions and energy are invested in the troubles of others. The effects may include avoidance of some kinds of work, "risk-taking behavior, insomnia, feeling helpless," and withdrawal (social isolation, see above). The report suggests that lawyers acknowledge and recognize the potential, and commit to "not feel guilty about taking breaks during the work day," whether that is "a workout, lunch with a friend or even a massage or quick trip to the mall." The emphasis for such breaks should be something "that will occupy the mind and provide a break from worrying about a client’s situation."
"The duty of confidentiality"
This leads to feelings of isolation according to the authors. That may be particularly challenging when facing a novel issue, situation, or circumstance. When there are issues "attorneys cannot unravel," there is frustration and stress. When an attorney must maintain confidentiality of "disturbing facts," that may prove particularly challenging. The authors suggest that this may be more prevalent in the "solo practitioner" who lacks an attorney confidant with whom to consult or share. The report suggests that therefore "lawyers should strive to develop strong working relationships with the other attorneys in their firm or organization." "Collaborative environments," where attorneys are "companions rather than rivals" is a suggested remedy. That is not of assistance to the "solo" attorney. The report recommends that such attorneys might reach out to their state bar, through an ethics hotline, for support and advice on dealing with challenges of confidentiality.
"Educational debt"
The report sees debt as "relatively new" and "potentially soul-crushing." It notes that law school "tuition increases have vastly exceeded the normal rate of inflation." In this regard, the educational process may have similarities to the medical inflation situation featured in The Conundrum of Medical Inflation. The report advocates for planning before undertaking debt of this magnitude. However, it contends "many law students make the life-altering decision to take out large amounts of student loans with little to no thought as to the repercussions." In short, people are borrowing money, obtaining education, and then facing a lifetime of repayment. And that, the authors contend, is causing these lawyers to stress. The report advocates better research and informed decisions, delayed law school entry until some capital is saved, and more thorough thought about return on investment. They contend that "simply beginning — and continuing — this conversation is a good start."
"Business management and the practice of law"
Lawyers learn a variety of skills in law school. Business management, in my experience, is not one of them that is stressed. Thus, the graduates are trained to practice law, but not to manage their bank account, staff, assets, liability, and more. The report notes that "many new lawyers are forced to start their own practices to make ends meet"; that the employment market is not sufficient for the volume of graduates being produced. The authors conclude that the lack of business training and knowledge therefore "certainly contributes to stress and anxiety." The report recommends having resources for "preparing law students for the business side of being a lawyer." The authors advocate for "Practicing lawyers (to) consider taking business classes through local colleges." There is also the suggestion that small firms or solo attorneys should network with others to confront these business challenges.
"Need to display confidence and conceal vulnerability"
The report concludes on this point that the practice of law "can be, at times, ruthlessly competitive." The education process discourages any showing of vulnerability, which includes "seeking help." The authors see this as an outgrowth of "the inherently competitive nature of law school," and processes that "pit students against one another without regard to their individual merit" as they will be in "the practice of law." This is magnified perhaps by the public perceptions of attorneys, and their role in our country, which "incentivizes lawyers to exude confidence." The recommendation on this point is to essentially destigmatize those who seek mental health assistance. The authors advocate that employers should similarly "indicate acceptance, and even encouragement, of help-seeking behaviors" such as obtaining mental health treatment. Furthermore, "more social interactions and team building" might "increase firm profitability in the long run."
The verdict, having considered all of this, is perhaps not clear. Some may argue about particular conclusions of the report regarding risks or solutions. Some may see particular aspects as avoidable or not, addressable, or not. Some may even raise the potential for some proposed solutions to create unintended detrimental consequences. Some will note that the report repeatedly acknowledges that various issues are not "only lawyer issues." But everyone should remember that they are perhaps nonetheless issues for lawyers. That they are faced by a variety of professions should perhaps not in itself diminish the potential effect or importance.
Perhaps everyone could agree, despite the potential differences of opinion regarding various details, that the key point of the whole report is best summarized in the particular suggestion regarding debt that "simply beginning - and continuing - this conversation is a good start." While the report makes that contention as to debt specifically, perhaps the fact that there is this conversation, from the Florida Bar Journal articles devoted to the topic or from this Virginia report, that we are perhaps beginning to be introspective, analytical, and self-critical is truly "a good start?" As for me, having been up most of the night writing this, I am going to go try that "sleep" thing with which they seem so enamored. Each of you should perhaps go have a conversation about these topics with a co-worker or friend as you take a nice break and walk outdoors? After all, what can that hurt?
