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I'm not taking questions on stage, but you can find me after the talk!

(or on Twitter/Slack)

@jmeickle

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Engineering problems are usually people problems

Competing goals and incentives
Communication and coordination
Setting expectations
Managing stress and mental health

@jmeickle

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Ops best practice: reduce mental health burden

Blameless postmortems
Empathy
Impostor syndrome
Hero/martyr culture
Burnout
#hugops

@jmeickle

It's already widely considered a best practice in ops to understand how it can hurt your mental health, and what that looks like. Not every team regards mental health that way but there's been so much interest and progress.

We should be proud of this. Most industries do not have honest conversations about these topics. We have an industry where our technological leaders are also cultural leaders, and are generally also trying to promote an open, honest, caring culture. That's a really awesome alignment!

Blameless postmortem: via Etsy

Impostor syndrome: you have women to thank for the term - two women psychologists coined it, and women promoted the concept within software engineering. "The term was coined in 1978 by clinical psychologists Pauline R. Clance and Suzanne A. Imes."

Hero culture - andrew clay shafer, 2009 at least. Jennifer Davis at DOD Boston 2014

John Sawers - "Your Emotional API" - DOD Boston 2017 https://www.youtube.com/watch?v=Mc5HJSsYB7A

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Mental health: the overall state of our system

General condition of well-being
Influenced by stress, coping strategies, etc.
Can have poor mental health without anything specific being wrong
Direct parallel to physical health

@jmeickle

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Mental health matters for everyone, but...

@jmeickle

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Mental health matters for everyone, but...

It's much harder with a mental disorder.

@jmeickle

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~25%

of people have a mental disorder at any one time

@jmeickle

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~50%

of people will have a mental disorder during their life

@jmeickle

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Mental illnesses

"Health conditions involving changes in thinking, emotion or behavior"

"Associated with distress and/or problems functioning in social, work or family activities"

Depression
Anxiety
Bipolar disorder
Schizophrenia
Eating disorders
And dozens more.

@jmeickle

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What ISN'T a mental illness?

Grief
Burnout
Political views
Having emotions
Being upset

@jmeickle

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Neurodevelopmental disorders

Neurodevelopmental disorders are disabilities associated primarily with the functioning of the neurological system and brain.

...can experience difficulties with language and speech, motor skills, behavior, memory, learning, or other neurological functions

Learning disorders
Autism
Attention deficit hyperactivity disorder
Traumatic brain injuries
Face blindness
Childhood lead exposure

@jmeickle

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Medical model vs. Neurodiversity

Medical model:

Disorders cause deficits
We should treat them

Neurodiversity:

Everyone's mind is different
Everyone is valuable regardless of how their mind works
Being different is something to be happy about!

"...neurological differences are to be recognized and respected as any other human variation..."

@jmeickle

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Mental disorders are a hidden diversity problem

A distinct group with horrible statistics on employment, happiness, etc.
One of the few legally protected groups where discrimination is not only accepted but encouraged in mainstream representation

@jmeickle

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Mental disorders aren't evenly distributed

Race, gender, and sexuality impact rates of diagnosis
They also impact what diagnoses you receive
Poverty impacts diagnosis, too

And they also impact access to treatment.

@jmeickle

But when I say coin flip, it's not a fair coin. We see different rates of diagnosis: the rate for queer people is two to three that of average. There's also a smaller magnitude difference by race.

https://www.nami.org/find-support/LGBTQ

We see different types of diagnosis: women are diagnosed with different mental disorders than men. Some diagnoses, like histrionic personality disorder for women vs. antisocial personality disorder for men, or depression for women vs. alcohol dependence for men, are on the order of 3-5x as many one gender than the other.

http://www.who.int/mental_health/media/en/242.pdf

Class and poverty makes a huge difference in access to treatment, and even what kind of treatment. Antipsychotics have a lot of side effects, particularly if you start them young. So, children in foster care have an excess rate of 2-4x other children. These are all very intersectional topics; black children are in foster care about 1.6x as often.

https://www.npr.org/sections/health-shots/2015/09/02/436350334/california-moves-to-stop-misuse-of-psychiatric-meds-in-foster-care

https://www.childwelfare.gov/pubPDFs/racial_disproportionality.pdf

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Mental health and mental disorders are orthogonal...

@jmeickle

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I’m occasionally sad or frustrated, but I don’t have any psychiatric diagnosis or symptoms.	These on-call shifts are killing me. I’m not getting enough sleep and I can’t concentrate.
I have a learning disorder, but it doesn’t come up much at work, so it’s not causing me stress.	My depression makes everything feel pointless, and lately I can’t even enjoy my friends.

Poor mental health

Good mental health

Has

Disorder

No

Disorder

@jmeickle

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...but mental disorders are strongly correlated with poor mental health

@jmeickle

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Mental disorders can harm mental health directly

Intrusive thoughts
Uncontrollable behaviors
Emotional dysregulation
Difficulties with sleep, memory, attention
Panic attacks, psychosis, and crisis

@jmeickle

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Mental disorder stigma can harm mental health

Trouble making or maintaining friends
Trouble maintaining employment
Trouble explaining resume gaps
Lack of professional credibility
Having to stay "closeted"
Lack of treatment

@jmeickle

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Treating mental disorders can harm mental health

Time lost to managing condition
Stress of dealing with insurance and appointments
Side effects of medication and therapy
Trauma from previous crises
Trauma from previous treatment

@jmeickle

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@jmeickle

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SREs already make reliable systems from unreliable components

Any "unreliability" from a mental disorder is much smaller in scale than the unreliability inherent in all humans

@jmeickle

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How do we care for engineers with mental disorders?

@jmeickle

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Engineers are...

Anxious
Depressed
Overworked
Stressed
Perfectionist
Isolated
Caffeine addicted
Misanthropic

@jmeickle

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Engineers are doing just fine (on average)

Anxious
Depressed
Overworked
Stressed
Perfectionist
Isolated
Caffeine addicted?
Misanthropic

The most stressful occupations are low responsibility, low prestige, low pay, and low control.

None of those apply to engineering as an industry.

@jmeickle

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There isn't a widespread mental health crisis among engineers.

@jmeickle

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There isn't a widespread mental health crisis among engineers.

There is a crisis in inclusivity for Americans with mental disorders, and engineers can fix our part of it.

@jmeickle

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Thoughts and prayers aren't scalable

Attention and awareness always come at the cost of something else
Personal experience doesn’t transfer well to others
Ending stigma doesn’t address tangible barriers

@jmeickle

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Caring a lot about people with mental disorders isn’t inclusive.

Evaluating your organization’s systems to remove exclusionary policies and unintentional discrimination is inclusive.

@jmeickle

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How do we care for engineers with mental disorders?

How can we make engineering workplaces more inclusive for people with mental disorders?

@jmeickle

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The Americans with Disabilities Act of 1990

Defines disability and accommodations
Tells employers how to handle accommodation requests
Thousands of pages of documentation

Advisory rulings
Court briefs
Handbooks for managers
Handbooks for HR
Handbooks for employees

This includes mental disorders!

Accommodations are a legal obligation, not just a moral one!

@jmeickle

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Sanity isn't a business requirement, so let's refactor and drop that dependency.

@jmeickle

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Let’s talk SDLC:

Software Developer Life Cycle

@jmeickle

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Software Developer Life Cycle

Application
Interviewing
Onboarding
Compensation
Benefits
Job duties
Working conditions
Training
Promotion

@jmeickle

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SDLC: Application

Clearly identify essential functions
Set expectations for hours worked and vacation schedule
Describe the specifics of insurance and other benefits
Use joblint on all postings

@jmeickle

Be up-front with people about what the job will require. People who can't do the job for mental health reasons will tend to filter themselves out.

Is on call essential?

Factors to consider in determining if a function is essential include:

• whether the reason the position exists is to perform that

function,

• the number of other employees available to perform the

function or among whom the performance of the function

can be distributed, and

• the degree of expertise or skill required to perform the

Function.

- We need on-call SREs, but do all SREs have to be on-call?

-- The original intent here is that someone needs to have on-call experience working with systems to support them effectively

-- If you're a 24 hour business, why do they need to do overnight shifts to get that experience?

-- Could they get that experience by just shadowing instead?

-- Is this really a requirement to be a reliability-focused engineer?

-- Or do we keep doing it because it's awkward for your team to discuss how much extra work being on call is, and how much you should be getting paid for pager duty?

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Antipattern: Cognitive and emotional requirements

full stack developers
with years of experience
systems thinking and a security mindset
and amazing communication skills
who can deal with lots of internal customers
in a way that demonstrates empathy
while having lots of team cohesion
even while everything is going wrong
and also it's 2 AM

If you're wondering why SREs are hard to recruit - it’s not just tech skills!

We need to draw boundaries between requirements for an SRE team vs. requirements for an individual SRE.

@jmeickle

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SDLC: Interviewing

Minimize whiteboarding or other "exams"
Avoid "puzzles" or artificially stressful situations
Determine interview questions and success criteria in advance, and consistently apply them
Avoid evaluations on “culture fit”, awkwardness of social interactions, etc.
Professional anti-bias training for hiring managers

@jmeickle

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SDLC: Onboarding

Provide mental health rights and resource documents
Maintain social aids: org/seat charts, lunch recs, in-jokes.
Conduct post-hiring interviews and actively ask about needs and accommodations
Avoid “exceptions” in accommodations by rewriting company policies to cover anyone in that situation

@jmeickle

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SDLC: Compensation

Base salaries on objective criteria, not negotiation
Don't base salaries on prior compensation
Set compensation expectations for yearly reviews and bonuses in advance
For large companies: create and publish reports on how mental disorders affect compensation

@jmeickle

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SDLC: Benefits

Provide comprehensive mental health coverage

Including trans inclusive coverage!

Switch from "unlimited vacation" to mandatory vacation
Document sick days for mental health
"Health benefits" should include mental health
Hire professionals to help navigate benefits with employees, rather than expecting “professional patients”

@jmeickle

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Antipattern: Expectation of getting better

There are many legitimate reasons to avoid any kind of treatment, including therapy

Expensive
Time-consuming
Limited efficacy
Side effects
Traumatic

@jmeickle

This ties in closely with the expectation that people with mental disorders will get "better". Take this cute embroidery! I'm totally in favor of someone buying this for their own house - but when we make it a meme to try and normalize this, we're also normalizing the tedious process of medication management as just what you do to "make your brain work". Even though that's a huge expense, and doesn't often succeed.

We also assume that someone even wants to get "better". They aren't as visible, but there's actually a "mad pride" movement - people who are in tune with their diagnoses, and personally value them, or see them as political statements, or a necessary form of diversity. For example, bipolar people often feel a strong relationship to their creativity or energy. Some of the least in favor of treating autism are autistic people themselves, who are proud and quite happy with how their minds work.

https://www.etsy.com/listing/491299267/storebought-neurotransmitters-cross?ref=shop_home_active_1

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SDLC: Job Duties

Make most meetings and presentations optional

Preferably stream/record them

Find alternatives to adversarial decision-making
Value and promote many forms of contribution
Don’t expect every SRE to perform every SRE team duty

@jmeickle

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SDLC: Working Conditions

Minimize unnecessary noise and distractions
Have private offices available
Have a formal flexible scheduling and remote work policy
Don’t require socializing on the company’s terms
Don't tolerate jokes about mental disorders

except from people who have them, because they're an important coping mechanism

@jmeickle

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SDLC: Training

Provide training material in multiple formats

Consider a site-wide subscription service

Establish a mentorship program
Provide mental health education for managers, or an alternate way to regularly check in

@jmeickle

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Antipattern: Have you tried yoga?

My aunt’s friend’s brother’s niece says that it was great for her depression
Dr. Phil had a great episode about it
I think I read about it in a book, can’t remember the name though. But it was really good! You should totally read it.
Actually, I did a detox cleanse once, and I felt sooo much better after
I feel great after I exercise
I bet you’d feel happier with a sun lamp!

@jmeickle

We don't have scripts about how to deal with mental disorders, or generally even serious physical sickness. So what do people do? They give advice. It might be less career impactful, but can still hurt others when unwanted suggestions accumulate. This is very similar to the concept of a microaggression: like an avalanche that builds up, yet no single flake of snow causes it.

One of the problems here is that rejecting advice is seen as incredibly rude, so you sort of just have to deal with people who know WAY less about this than you giving you advice you already tried three years ago. For the rest of your life, maybe. How long would you last in engineering if every time you mentioned an outage, someone said "Have you tried MongoDB? It sounds pretty cool."

Again, like paternalism: this leads to people just not talking because it's too painful to not be understood. This *is* part of the stigma! And I don’t want you personally feeling bad about contributing to it - the problem is that our whole society is set up to do this.

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SDLC: Promotion

Don't require increasing responsibility over time
Have multiple promotion tracks for different skillsets
Examine whether the criteria for advancement have implicit ability requirements

Coordinating or managing people
Presenting at conferences or traveling
Long hours or on-call shifts

Don’t “protect” people from career-enhancing work

@jmeickle

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Antipattern: Paternalism

Don’t try to protect people from themselves
At best, it’s humiliating
At worst, it can reduce someone’s capabilities

@jmeickle

A common way we let people with mental disorders down is through paternalism. This is when we act like we know what's best for people. Spoilers: unless you asked them, you do not.

Maybe this means avoiding or firewalling career-enhancing moves

-- Mentions that they're anxious -> you offer to do the investor demo for them -> you get the credit for what they built...

-- Mumbles and avoids eye contact during meetings -> you assign them solo projects because they "seem happier" -> their projects are all smaller and less impressive...

-- Takes time off after a psychotic break -> you assign them "easy" work to ramp back up -> they feel pushed out...

Or maybe it means "protecting” people from their own suicide jokes - their coping strategy - encouraging them to clam up because they don't want you treating them like a psychiatric patient.

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Pattern: Consent Culture

People should decide what happens to them
Find out their goals and constraints
Make offers, not impositions
Avoid coercion

"Don't assume when you can ask!"� ...and if it's not safe to ask, how can you change that?

“Do you want suggestions or do you want sympathy?”

@jmeickle

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A final note on crisis

Provide training to managers on mental health crisis
Regularly provide phone and digital help lines
Ask about emergency mental health contacts in advance
Weigh all of your options before coercing someone into leave or treatment
Don't call the police unless you are comfortable with the consequences, up to and including death.

@jmeickle

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Always keep consent and autonomy in mind, even when it's not convenient.

@jmeickle

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If we all become inclusive, we all benefit!

Remote workers
People experiencing grief
New parents
Disabled employees
Junior employees
Women in engineering
Hiring managers
You!

@jmeickle

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Next steps

Get your boss to watch this talk. (Apply recursively.)
Have them get your HR department to watch this talk.
Buy them copies of OSMI’s books: https://osmihelp.org
Let's build inclusive systems together!

@jmeickle

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Now a book chapter!

Chapter 29 - "Beyond Burnout"

Available via Safari (online)

Print on Demand (O'Reilly, Amazon)

@jmeickle

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Organizations to follow

Open Sourcing Mental Illness: https://osmihelp.org
mhprompt: http://mhprompt.org
burnout.io: http://burnout.io/en/latest/furtherReading.html
Trans Lifeline: https://www.translifeline.org
NAMI: https://www.nami.org
National Institutes of Mental Health: https://www.nimh.nih.gov/health/topics/index.shtml

@jmeickle

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April is Autism Awareness Month!

TBD about Autism Speaks

@jmeickle

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Thank you!

(Find me later for questions!)

@jmeickle