Why We Will Not Improve Mental Health at Work as Long as We Treat Organizations Like Emergency Room Patients
Too often, we treat our organizations like ER patients: rushed into triage, patched up, and sent back out without anyone asking what is the root causes of why they came into the ER in the first place. When symptoms spike, we stabilize just enough to keep things running. There is no time for history, no curiosity about root causes.
Like doctors treating “Jane Doe” cases in medicine, leaders seem to work without baselines — no prior records, no understanding of what healthy even looks like for this system. About how workers might have felt when they joined this organization 30 years ago versus today, for example — presenting with much higher rates of mental health diagnoses. However, burnout, disengagement, and conflict are not the disease — they are the fever.
Mental health at work is in crisis. Leaders see rising burnout, disengagement, turnover, and conflict — and scramble to respond and find a path forward while looking in the rearview mirror.
Of course, some organizational issues can be acute — a PR crisis, a mass resignation, or a high-profile failure. But many more are chronic — an exhausted workforce, eroded trust, or an unspoken trauma from past layoffs or scandals.
But in what feels to be the heat of the moment, leaders often cannot tell the difference. The pressure to act is high. The available tools are templated. Just like in the ER, leaders move fast and, in part, put root causes on the back burner to treat visible symptoms: they launch new programs, roll out buzzword-driven initiatives, or call in consultants.
But speed and expediency can come at the expense of accuracy and efficacy. Without understanding what is really going on — what past experiences, cultural dynamics, or structural stressors are shaping today’s behaviors — we risk applying the wrong intervention to the wrong problem.
Misapplied buzzwords — Resilience! DEI! Empathy! — become like overprescribed antibiotics: ineffective when used without proper diagnosis, and even harmful when ended too soon. The result? The symptoms return stronger, and the organization grows more resistant to help or change. The patient gets worse and might have gotten better if we had done nothing and just listened and waited.
The interventions tend to be blunt — standardized checklists applied to complex realities. We treat the acute issues in the hallway, rushing from one fix to the next, instead of pausing to ask:
- What is really going on inside this system?
- And what is our role in this moment — doctor, nurse, patient, administrator, perhaps even family member in the waiting room?
- What do we actually know about these symptoms? Are they new? Are they evolving?
- And how do they relate to the broader environment in which this organization exists?
We would never treat a hospital patient without checking their vitals, asking questions, or reviewing history. Yet that is exactly how we often treat organizations reporting markers of performance stress. What if we approached mental health at work like whole-person medicine — rooted in curiosity, continuity, and care? What if we slowed down enough to ask not just “What’s broken?” but “What is this system trying to tell us?”
To truly improve mental health at work, Daven Morrison and I consider what would happen if managers, leaders — and to some extent all those who profess who want to help support employee well-being — stop reacting like ER doctors and start thinking like long-term caregivers: treating the organization as a living system with a unique history, structure, and its own set of needs. This piece adds to our prior work on occupational medicine, which we consider to be a very fertile ground for a different kind of managerial playbook. How does our lens change when the organization is our primary care patient?
How Context Shapes Diagnosis
The diagnosis does not just depend on the symptoms — it also depends on the setting. In the ER, outcomes shift based on time of day, staff fatigue, external events, and available resources. In organizations, it is no different. A downturn, a regulatory investigation, or a media scandal change the work of the day on a dime. And sometimes cause permanent, catastrophic harm: “a mortal wound” if mismanaged. Social, economic, and political issues also affect employee moods, nerves, and tolerance for risk and change.
In addition, some environments are particularly challenging, such as finance (focused on returns), startups (quixotically pursuing opportunities regardless of resources currently controlled), or professional service firms (built around tournament systems pitting people against each other). These all reward competition over reflection. Yet within the challenges comes an appreciation for the human being — the professional service firm that doesn’t appreciate the value of relationships inside the firm and with clients will not last long.
Culture also shapes what gets noticed — and what gets ignored. In some organizations, symptoms are suppressed, and those who speak up are punished, making it dangerous to name what hurts. In others, a kind of organizational hypochondria or nombrilism takes hold: constant self-monitoring blinds them to larger shifts in the world around them. Like certain academic institutions, they obsess over internal dynamics and miss the tectonic changes happening just beyond their walls.
And some companies, to push our analogy further, do over-medicate — more training, more surveys, more slogans — and others power through the pain, making “sleeping faster” into a badge of honor. This is akin to assuming that everyone in the room is fine just because no one has hit the panic button. Waiting for a crisis to address trust, inclusion, or purpose is like waiting for a heart attack to start exercising.
Healthy organizations require constant care, preventive medicine, and prophylactic care, not just heroic triage.
A Better Approach to Organizational Care
We rush to treat because we think we know the answers or they worked before. Without asking important questions: What does healthy even look like for this system? What are the vitals we would be assessing if our teams or organizations were individuals? What is really making us sick?
Below are a few ways to get at these answers and tools for reflection.
Mapping the Genetics of Organizational Health
Before we can care for an organization and the well-being of its component human parts, we have to understand what it really is — not just what it produces. What happens if we consider it like every living system, whose genetic code — its mission, structure, and values — is shaped by the conditions in which it was formed and its exposure since? Getting clear on organizational DNA might make us faster and more precise in our interventions.
Think of every organization as having a genotype — its founding DNA, its mission, structure, core values, and the conditions it was born into. But just like people, organizations do not live from blueprints alone. Over time, that DNA expresses itself through a phenotype — how a company behaves under pressure, how it treats people, how it makes decisions.
But even a strong genotype can be disrupted. Organizations, like living systems, experience mutations — sudden shifts that alter how they function. A merger, a mass layoff, a new CEO, or a radical policy change can destabilize even the healthiest culture. What once worked may no longer fit the new environment. Resilience can turn brittle. Pride can become resistance.
Finally, there are possible immune responses: resistance, resilience, recovery — or inflammation, dysfunction, and attrition. They develop weak spots over time. Because organizations, like living systems, do not break without warning — they break where they were already compromised.
Reading the Emotional Memory of Organizations
Those reactions are shaped not only by the environment but also by the stories the organization tells itself, often related to past betrayals, abandoned values, unhealed wounds — and those stories shape how the organization seems to force people to respond.
Organizations, like cities, are layered and dynamic. They are physical and symbolic — built and torn down by human hands, shaped by time, memory, and external forces. They store not just products and processes, but emotions, patterns, and unspoken histories.
Just like individuals, organizations carry emotional memory. And they can be misaligned with the new challenges that present themselves to companies.
“We always pull through and never show weakness.”
“We work harder than the rest.”
“We are laid back and don't need rules.”
These narratives can be a source of strength — but they can also cause people to feel stress (“Am I tough enough?” and “How can things be fair if there are no rules?), suppress emotion, silence dissent, and mask distress.
The worst part is that, like trees, organizations actually often wear their scars in plain sight, but everyone is too busy rushing by to notice their patterns — or be reminded of prior mistakes. And to an experienced observer, they show their stress from the environment in clear, highly visible signs: “leaves desiccate,” “dead branches,” “rot,” insects and parasites take hold.
In much the same way, mental health at work does not degrade in isolation. It breaks down inside systems that are already under strain. When we ignore the warning signs in the organism — disconnection, chronic pressure, cultural fatigue — we also ignore the early signs of distress in the people within it. Most employees burn out where there is already emotional friction, confusion, or neglect. Without knowing what emotional “health” looks like for a team or organization, we misread the signals — and the scripts behind them.
And, of course, like a winter cold, mental illness enters the organization as well from external causes independent of the workplace. The worker who is also a parent and sick from a daycare “bug” didn’t get sick from the organization. The organization is part of its environment.
Watching for Mental Models that Distort Triage
We all carry mental models of what an organization is. These frames shape what we notice, what we measure, and what we believe needs “fixing.”
In Images of Organization (1997), organizational theorist Gareth Morgan introduced eight core metaphors: machine, organism, brain, culture, political system, psychic prison, flux and transformation, and instrument of domination. Some leaders see their organizations as precise machines — Taylorist systems to be optimized. Others see bureaucracies, political arenas, or social clubs. Still others embrace the idea of the organization as a living organism — complex, adaptive, and always in flux.
These mental models shape how we lead, what we measure, and where we focus. Each one highlights something — and obscures something else. They determine what we prioritize — and what we miss. A machine-oriented leader might tighten controls during a crisis. A politically minded leader might call a town hall. Each metaphor defines not only the system — but also what it means to “fix” it.
If we see an organization as a machine, we look for output. Success means efficiency: smooth processes, predictable outcomes, and minimal error. Leaders are expected to optimize performance, eliminate waste, and keep the system running on time and on spec. The relationship is transactional. The human is a resource.
If we see it as a bureaucracy, we emphasize consistency, accountability, and risk reduction. Success is predictability: well-documented procedures, clear rules, and careful execution. Leaders are valued for maintaining order. People become roles, and structure trumps story.
If we see it as a political system, we focus on influence. Success means alignment and persuasion — securing buy-in from the right coalitions. Leaders are credited with brokering deals, managing conflict, and navigating competing interests. Here, interpersonal dynamics become the battleground, stories reign supreme over data, and emotional intelligence is often a survival skill.
But if we see the organization as an organism, we look for stress signals, healing, and adaptive capacity. Success is resilience — the ability to self-correct and grow under changing conditions.
Each metaphor changes what we notice — and what we ignore.
Learning What “Healthy” Looks and Feels Like
Recognizing our metaphors and management instincts is only the beginning. If we want to catch problems early, we need to know what our version of “normal” or “health” looks like.
Without knowing a patient’s normal blood pressure, glucose levels, emotional affect, or allergies, doctors risk mistaking a crisis for the status quo — or missing real danger entirely.
Just as doctors track vitals over time to spot deviations from a patient’s norm, leaders must learn to notice subtle shifts in energy, behavior, and engagement — long before something breaks. This requires more than data. It requires observation, pattern recognition, and emotional fluency.
Yet in most organizations, we operate without those baselines. We track productivity, but not emotional well-being. We measure revenue, but not trust. Most companies have engagement scores, but those are snapshots — not stories. Emotional baselines are built through consistent attention: noticing patterns, asking better questions, and tracking how people change over time.
Most organizations onboard employees to make sure that they fit into the organization and have what they need to work — the basics of logistics and connections. But in the process, companies miss a chance to get a baseline read on new employees. We do not ask what people carry in, what stress looks like for them, or how they prefer to work. Then we’re surprised when they struggle or disengage. But how can we detect change when we never knew what “normal” looked like? And perhaps, actually, our management is doing its best under very challenging intake situations. No amount of great management will overcome fundamental emotional and stress management mismatches, for example.
Just as doctors take a baseline during a first appointment, managers can ask questions early — not just about skills and logistics, but about needs, preferences, and emotional signals. Even a lightweight intake can help reveal:
- How someone prefers to receive feedback
- What does stress look like for them?
- What support helps them feel motivated?
- What life experiences do they carry into the role?
When we understand someone’s working rhythm, stress patterns, and recovery needs, we can support them better over time — not just react when something goes wrong. If companies automate such surveys and repeat them after 6 or 12 months, they will not only get a baseline but also track the impact of management or conditions on the “patient” early and be able to engage in a version of organizational preventive medicine.
Encouraging Managers to Understand Their Treatment Defaults
The assumptions we make about what’s “broken” in our organization often reflect deeper assumptions not just about models but also people in distress. And just like doctors, managers develop default styles of care — many of them unconscious.
In our book Compassionate Management of Mental Health in the Modern Workplace, we describe four common managerial archetypes that emerge under pressure: the protective but smothering Kangaroo, the conflict-averse Ostrich, the cynical but sharp Hyena, and the calculating, self-protective Snake.
Each of these styles carries a story about what people need — and what leaders are responsible for. The Kangaroo shields too much and burns out. The Ostrich avoids discomfort and allows distress to grow silently. The Hyena mocks vulnerability, using dark humor or deflection as armor. And the Snake watches closely but acts politically, only if it serves it.
Each of these archetypes also reflects one of Morgan’s models of the organization. The Kangaroo treats it like an organism — seeing the team as something fragile to nurture. The Ostrich aligns with a bureaucratic model, relying on structure and avoidance to maintain order. The Hyena sees the workplace as a psychic prison or even a machine, where weakness is dangerous and efficiency rules. And the Snake thrives in a political system — sensitive to power, responsive only in self-interest.
Organizations might be over-indexing on some of these managerial types, but we can all have space for reflection. How a manager responds to distress often mirrors how a doctor treats a patient. Some might overprescribe to fix everything at once, offering programs, policies, and promises like antibiotics for every cough. Avoiders pretend nothing is wrong. Blamers assume distress is self-inflicted — “They’re just not resilient” — while Performers mask discomfort with slogans and surface efforts. The Diagnostician sees the problem clearly but cannot — or will not — connect with it emotionally. What kind of “medicine” or style do you reach for when someone on your team is hurting?
Training Managers to Read Symptoms, Not Just Test Results
Most interventions come too late. We respond after the resignation, the scandal, the mental health leave. But healthy systems are built on attentive listening long before a breaking point.
Managers do not need to become medics, but they can become more observant. They can ask questions not just during performance reviews, but at inflection points: after leave, after promotion, after a public mistake. Questions like:
- What’s different about you now?
- What do you need to succeed — today, not two years ago?
- What are you carrying that we cannot see?
Re-baselining is not indulgence. It is preventive care.
Without training, managers might misread what they see, mistake overwork for passion, and silence alignment. And by the time someone collapses — quits, lashes out, disengages completely — we treat the event, not the pattern that led to it. Burnout is not the problem — it is the mind’s and body’s way of telling us there is a problem. A fever is a signal, not the disease itself. When people burn out, disconnect, or become cynical, the system is already inflamed.
That is why early signs matter. Not all underperformance is laziness. Not all withdrawal is defiance. Some people overfunction out of fear. Others go quiet out of shame. Good leaders ask: What changed? What is this behavior protecting or expressing? They do not just look at the output — they look for the root.
In Every Story, There is Strength
We often say mental health is personal. But at work, it is never just individual. Our emotional health is shaped by the systems we move through — the histories we inherit, the pressure we normalize, the behaviors we repeat without question, preparing winning formulas that once worked but now get us in trouble.
Organizations are not machines we can optimize or crisis patients we can stabilize and discharge. They are living systems. They remember what they have been through. They pass those memories on as habits, policies, and unspoken rules. And if we want people to thrive inside them, we need to treat organizations with the same care we extend to the humans within them.
Mental health at work cannot improve unless we start listening differently. Not just for signs of personal struggle but for signals from the system. What hurts here? What has healed? What still lingers? What past business traumas or successes impair objective judgment today? Because in every disengaged team, in every burned-out employee, in every failing strategy, in every silence — there is a story.
And in every story, there is strength.
If we are willing to listen — to each other, to our internal stories, and to those of our managers, leaders, and organizations — we might get better together.
We welcome feedback and comments. Thanks to David Ehrenthal for his precious inputs!
