Most organisations see only two options: do nothing, or start a formal process. A structured conversation is a third. It is planned in advance, held outside the disciplinary route, with treatment arranged beforehand so a yes can be acted on the same day. It is not a fitness for duty assessment and it is not legal advice.
Someone senior is not themselves, and has not been for a while.
Performance has slipped in a way that is noticeable but difficult to write down. People have started covering. And nobody wants to be the one who says it out loud, because of what saying it out loud might start.
I am Chris Howard, and I get called into this situation more often than people would guess. Almost always later than would have helped.
Why it goes unaddressed for so long
Because the only two options most organisations can see are doing nothing and starting a formal process.
Doing nothing is uncomfortable but costs nothing today.
A formal process feels enormous, final, and hard to stop once it has begun. So the situation continues, colleagues absorb more, and by the time HR is formally involved the options have usually narrowed to the one nobody wanted.
There is a cost to that delay that rarely gets counted: the colleagues doing the covering, the decisions being made by someone who is not at their best, and the person themselves getting further from the point where this would have been straightforward.
The third option most organisations can’t see
A structured conversation sits between those two.
It is not a disciplinary meeting. It is not a performance review. It is a planned, prepared conversation designed to end with the person accepting help, with that help already arranged. The Executive Interventions page describes how this is handled when the person is senior and visibility is a real cost.
The practical difference is that the formal process asks what the organisation is entitled to do. This asks what will actually work.
Those two questions have different answers more often than people expect.
What a structured conversation looks like at work
It is planned in advance, usually over days rather than hours.
The people in the room are chosen deliberately, and it is not always the family. Sometimes it is colleagues. Sometimes it is one trusted person and nobody else.
Everyone knows what they are going to say before the day. Nobody improvises.
Treatment is arranged in advance, so that if the answer is yes there is somewhere to go that afternoon rather than a suspension and a fortnight of waiting. A yes with nowhere to go usually becomes a no within days.
And there is a plan for a refusal, because refusal is common and survivable if the organisation has thought about it beforehand.
Discretion is the first question, and it should be
For someone with a board seat, a professional licence, a public profile, or a business that depends on their judgement being trusted, exposure is a real cost.
I do not try to talk anyone out of that concern. It is legitimate, and treating it as vanity is one of the faster ways to lose the room.
So it gets planned for, like everything else. Who genuinely needs to be involved. Where the conversation happens, and when. What is said to anyone who asks. Which treatment options sit outside the immediate professional circle.
What I will not do is promise total invisibility, because nobody can hold that promise. I will tell you honestly what can be contained and what cannot, which is more useful than reassurance.
Separating the two questions
Organisations get into trouble when they try to answer two questions at once.
The first is what the organisation is required or entitled to do. That is a question for your own employment counsel, and it depends on your jurisdiction, your policies and the role. It is not a question for me.
The second is what will actually help this person accept care. That one is mine, and it has different answers.
The trouble usually starts when a health situation gets handled as a conduct situation, because conduct is the process the organisation already has. The For Employers page sets out how I usually work alongside HR without converting the health question into the conduct one.
Where the family fits
Sometimes the family does not know. Sometimes they know better than anyone at work and have been managing it quietly for years.
Working out who should be involved, and in what order, is part of the planning rather than something to decide on the day. The family intervention approach is a different starting point from the workplace one, and sometimes both are needed.
I have seen well meaning employers bring a family in at the wrong moment and lose the person entirely. I have also seen situations resolve quickly because somebody thought to ask whether a spouse should be in the room.
There is no rule. There is a judgement, and it is worth making it deliberately.
What this isn’t
It is not a fitness for duty evaluation.
It is not a clinical assessment, because I am not a clinician and I do not diagnose anybody.
It is not legal advice, and it does not replace your own counsel.
And it is not a guarantee. Nobody can promise you that a person will say yes, and I would be careful of anyone who does.
If the situation is an emergency
If there is immediate danger to life, call 911 and say clearly that this is a mental health crisis. The Crisis Interventions page describes what happens when the situation moves faster than a planned conversation can.
For an emergency that is not immediately life-threatening, the 988 Suicide and Crisis Lifeline is confidential, available at any hour, and carries no cost to the caller.
Los Angeles County residents can reach the Department of Mental Health ACCESS line on 800-854-7771, which can dispatch a mobile crisis team.
Frequently asked questions
Can an employer require someone to get treatment?
That is a legal question for your own counsel and the answer depends on jurisdiction, policy and role. I can tell you what a structured conversation can practically achieve, not what you are entitled to require.
Does the family have to be involved?
Not always. Sometimes the most effective room is colleagues rather than relatives. That gets decided during planning.
What if they refuse?
Refusal is common and rarely final. What matters most afterwards is whether the organisation stays consistent, which is worth agreeing before the conversation rather than after.
Is this confidential?
Conversations with me are confidential. What happens inside your organisation is governed by your own policies, and that distinction is worth being clear about with everyone involved.
Should we involve HR?
Usually yes at some point, but the sequencing matters. Bringing HR in first often converts this into the formal process you were trying to avoid.
Will this show up anywhere?
That depends entirely on how it is arranged and what your own policies require. It is the right question to ask early rather than late.
Do you work with companies outside Los Angeles?
Yes. I travel where that is the right approach and coordinate remotely where it is not.
If this is the situation you’re in
Whether you are an employer weighing this up or a family member watching the professional side unravel, it is worth a conversation before anything formal begins. Options narrow quickly once a process starts.