Law firm leadership has been increasingly engaged in improving the mental health of their lawyers and staff, launching programs and hiring professionals to help address the effects of work on the well-being of their people.

But answers to ALM's Mental Health and Substance Abuse Survey show that many doubt whether those in charge will ever sincerely address the causes of poor mental health in the profession.

The survey data was collected in late 2019, before the new coronavirus reared its head in the U.S. The pandemic has forced many law firms to quickly change their perspectives on issues that often come up in the mental health conversation, such as remote work flexibility, work-life balance and—perhaps most universally—isolation.

But the survey respondents, in discussing the roots of the struggles they have seen, pointed to the dynamics of the law firm business model that remain beneath the external factors that have quickly changed because of the pandemic.

Respondents to the survey blasted billable hours, clients, unrealistic deadlines and unused vacations as causes of the legal profession's mental health crisis. Yet many respondents also professed doubt that these realities, which are in part responsible for the historic profitability of modern law firms, will ever be changed.

"Law firms realize the problem mental health issues present, and are making progress towards tackling the consequences, but are completely failing to take preventative action to stop the issues arising in the first place," one survey respondent said. "Big Law firms will continue happily running associates into the ground, and then offering them therapy."

Among numerous multiple choice questions, the ALM survey asked respondents: "What do you think needs to change about the legal profession to improve the mental health and well-being of its members?"

Of the 3,800 total survey respondents, 1,882 responded to this open-ended question. While many pointed to specific aspects of law firm life that cause undue stress and contribute to poor mental health, they also expressed resignation to the current state of things, and little hope the business model will change enough to meaningfully improve lawyer mental health.

It's one thing, they said, to institute mental health policies and programming; it's an entirely different challenge to address issues and systems that contribute heavily to the bottom line.

"I do not have confidence that this problem will be addressed effectively without a fundamental change to the way firms operate. And I don't see that change being seriously, or sincerely, considered at the management level of my firm," another respondent said.

While some firms have begun pushing for alternative fee arrangements, these billing methods have not caught fire among most practices and attorneys. And the continuing consolidation and commoditization of law firms seems to be here to stay as well.

"Stop the emphasis on billable hours and working 24/7. Push back on clients by letting them know our firm values a work-life balance. Every lawyer can make a decent income without having some partners make millions per year based on stressing out everyone else," said one respondent.

The ALM survey, released last month, found that 31.2% of the more than 3,800 respondents feel they are depressed, 64% feel they have anxiety, 10.1% feel they have an alcohol problem and 2.8% feel they have a drug problem.

Billable Hours

Of the 1,882 written responses, 474 mentioned the billable hour—roughly quarter of responses. Some were succinct: "Billable hours are a nightmare and make life sheer misery." Others were more explanatory.

"The billable hour requirement needs to go. It is unreasonable to expect people to bill 2,000 hours a year if there is any chance of them developing and maintaining relationships and outside interests and taking care of their children. I love the law, but the billable hour is the sword dangling over your exposed neck at all times," another respondent said.

The billable hour, they say, turns eight-hour workdays into 12-hour marathons. And the criticism should come at no surprise: attorneys from all corners of the legal system have condemned the billable hour and yearly requirements as one of the most damaging influences on attorney mental health.

The metric was a common target in separate ALM surveys of partners and mid-level associates. Last year, Dentons partner Jana Cohen Barbe drew a direct line between suicide, depression and the billable hour, arguing that instituting wellness programs without addressing billing "fall[s] short, treating the symptoms but not the cause."

And even if an attorney excels and hits their billable hour, some feel like it isn't enough.

"I'm not sure how it could ever get away from the billable hour system, but it seems that is really driving a lot of the lack of health. I met my requirement last year but was told in my review that I 'left money on the table'—[in other words,] I should've billed more, which was frustrating," a respondent said.

Never Off

Most, if not all, of the respondents' most common criticisms are interconnected in one way or another. The billable hour tied into another common refrain: The inability to take vacations. No matter where or when an attorney takes their vacation, respondents said, the billable hour hangs over their head.

"A 2,000-plus-hour year presumes you're billing eight hours a day every day except for the calendar holidays and the weekends. If you don't meet that quota on a given day then you have to make it up elsewhere; so if I take a week off for vacation, that's 40 hours I have to cram into the year somewhere else," said one respondent.

Respondents said they felt their career was at risk anytime they turned off their phone or ignored their email inbox, even when on vacation. This "always on" mentality exacerbates stress, some said.

"I think firms need to stop requiring associates to be on 24/7 and stop punishing associates who try to carve out time for family," said a respondent. "We can be responsive to client demands without all ruining our personal relationships."

And many even said that they would even take a pay cut to work fewer hours and disconnect more:

"We need real sabbatical and flex-time opportunities—I would be so happy to do my job four days a week if I could realistically be considered for partner in 20% more years, but that's not a realistic option at all."

The Clients

Outside of the billable hour, clients were the second-most frequently targeted factor in mental health. Clients were mentioned in 392 responses, the vast majority of them unflattering. Most took issue with their expectations, condemning what they see as unreasonable deadlines and pressures—a criticism which also touched on the always-on mentality.

"We need to change the expectation regarding our response time to clients, both internal and external. We need to slow it down a little bit or take time to pause and think. Nobody should be on 24 hours per day," said a respondent.

It is not uncommon to hear from attorneys that clients are increasingly demanding services cheaper, better and faster. While firms have often turned to technology to help service an increasingly sophisticated client base, many attorneys are feeling the increased pressure—from weekend work dumps to near-impossible project deadlines.

"Transactional attorneys are constantly at the mercy of their clients and the business timelines," said another respondent. "Often, it seems the business timelines are arbitrary. The message the attorneys hear is, 'this deal needs to close in 10 days. Get it done.' Despite whatever else may be going on in our lives, all of that must be put on hold to get the job done. This often involves sacrificing meals, time to exercise and sleep."

And the blame does not stop at the client. Many hold their attorney managers and law firm leaders as responsible—partners who are too timid to push back on client demands, they say, no matter how unreasonable.

"As long as the client is large enough, and/or provides enough billable work, partners will frequently not push back on the demands for 'free work' from associates, nor will they push back on the unreasonable timelines demanded by the client," a respondent wrote. "The end result is extremely stressful: weekends and vacations are cancelled for work that cannot even be billed for."

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Minds Over Matters: An Examination of Mental Health in the Legal Profession