If you've ever wondered what leadership in Big Law thinks about the addiction and mental health problems in the legal profession, as well as what those leaders are—or are not—doing about the issues, you are not alone.

Despite the rapidly growing emphasis on lawyer well-being throughout the profession, the attitudes and actions of the largest and most influential law firms have mostly gone unmeasured with regard to this important subject.

Until now, that is.

Seeking to understand what these firms believe about the prevalence of substance abuse and mental health distress, the threats those problems pose to law firms, and the tools and resources being deployed to combat them, ALM Intelligence and I teamed up to survey Am Law 200 firms earlier this summer.

Confidential, online surveys (as well as several reminders to take the survey) were sent to managing partners, practice group leaders, general counsel, and benefits and HR directors at all 200 firms. The survey contained a series of questions on subjects ranging from stigma, to culture, to policies and education.

Here's a quick summary of what we found: The overwhelming majority of law firms report that alcohol abuse, depression and anxiety are occurring at their firms; half said the same about drug abuse. The stigma surrounding substance abuse, addiction and mental health problems is pervasive in Big Law. Firms are providing at least some training and resources around these issues, but they appear to be insufficient, underutilized, or both. In addition, firms worry most about addiction and mental health problems in the context of potential harm to clients, and see stress and workload as the No. 1 driver of the problems.

Suffice it to say for now, Big Law takes a mostly charitable view toward occasional alcohol abuse, but not so much when that abuse turns to addiction, or when it comes to mental health problems like depression and anxiety. In fact, occasional drug abuse has less stigma attached to it than suffering from depression and anxiety. More on that later.

Perceived Threats of Substance Abuse and Mental Problems to a Law Firm Setting

Aside from cultural norms that have long created tolerance for alcohol abuse in law firms, one reason why firms may take a dimmer view of addiction and mental health problems than occasional alcohol or drug abuse is that they don't perceive occasional alcohol or drug abuse as posing threats to clients or to their firms' reputation as significant—the two areas that our survey reveals worry firms most.

When asked to rank concerns related to substance abuse and mental health problems according to negative impact on the firm, Big Law views “threat or damage to clients” as having the most negative impact, followed by threat or damage to reputation, productivity and damage to work environment. It would follow then, that if occasional alcohol abuse is less stigmatized than addiction, depression or anxiety in a law firm setting, it is because it is seen as less likely to damage clients or the firm's reputation.

Another notable finding related to the risks that law firms see with substance abuse and mental health problems is the comparatively low level of concern about the threat to firm productivity. Excessive alcohol use costs the U.S. roughly a quarter-trillion dollars each year, with more than 70 percent of those costs attributed to lost productivity, while mental disorders top the list of the most burdensome and costly illnesses in the U.S. at more than $200 billion a year, well exceeding the cost burden of heart disease, stroke, cancer and obesity. More than one-third of the costs associated with mental disorders are directly related to lost productivity.

It is completely unreasonable to believe that law firms are somehow exempt from those national trends, despite the historic lack of emphasis they have placed on behavioral health as a key factor in profitability. While I can certainly understand—and agree with—firms perceiving the most negative impact of substance abuse and mental health problems as being a threat or damage to clients, I remain more convinced than ever that large law firms under-appreciate the profound economic inefficiencies that substance abuse and mental health problems introduce into their operations.

Given the continued predominance of the billable-hour structure in law firms, it is worth noting that the economic costs associated with struggling or impaired lawyers are more likely to manifest in quality of work rather than quantity, or in other ways less visible than simply missing a billable-hour target.

Next week's column will take a closer look at the issue of stigma, the following week will examine the causes of substance abuse and mental health problems in Big Law, and the fourth column will discuss the policies, resources and education that firms are making available to address those issues. I hope to see you back here then!

The ALM Intelligence Compass full survey on the mental health and substance abuse is available here for Compass subscribers. Not a subscriber? Click here.

Patrick Krill is the founder of Krill Strategies, a behavioral health consulting firm focused exclusively on the legal industry. Go to www.prkrill.com for more information.