One of the things that I do in my role as a forensic psychiatrist is so-called Fitness for Duty evaluations. Basically, these are requested by Employee Assistance Programs (EAPs) at large companies of various kinds after an employee's performance has fallen off previously excellent work. The purpose of the evaluation is to determine whether a psychiatric issue (including substance abuse) has any role in the changes that have been observed.
While the immediate problem varies from case to case, I have found that they often come down to one common denominator...denial. Whether the issue is an alcohol problem, depression, anxiety, or some combination, in each case I have seen, the individual cannot see that anything significant is wrong despite indications from supervisors and co-workers that something is amiss. Part of the problem is that it is difficult to tell someone that it seems like they have a mental problem so the fact that a problem exists is often communicated in language that facilitates the denial.
The take home message is this: if people at work are trying to tell you that something is wrong, LISTEN. Suggestions that you need a vacation, or instructions to go home early or take the weekend off are more than just generous offers. They are an indication that something is wrong and that it is affecting your performance more than you think. It's worth paying attention to and seeking help yourself. Otherwise, you might end up in a psychiatrists office anyway, but in a less private way with career influencing consequences.
