By now, most of us are familiar with the mental health risks associated with the practice of law. A 2016 ABA study found 20.6% of lawyers had unhealthy relationships with alcohol, 28% reported symptoms of depression, 19% showed signs of anxiety, and 23% had harmful levels of stress.
North Carolina has a long history of attending to the health of legal professionals. For 30 years, the North Carolina Bar Association and other groups within the state have been national leaders in measuring attorney well-being and promoting practices and policies to enhance the psychological welfare within the profession. A 2017 study of North Carolina lawyers shows some signs for hope, as well as areas in need of greater attention.
Leader in Attorney Well-Being
With decreasing levels of attorney satisfaction nationally, and many reporting “lost dreams and idealism,” the NCBA formed its Quality of Life Task Force in July 1989, to assess and address the health of North Carolina lawyers. Among other actions, the Task Force conducted a survey to evaluate the health of the profession. The Task Force designed and mailed questionnaires to 11,810 North Carolina attorneys, and received 2,570 responses (1991 survey).
Among other findings, the 1991 survey revealed that 81% of respondents were at least “mostly satisfied” with the quality of their lives. While generally positive, this figure was lower than it was for other professions and for North Carolinians in general. More troubling however, was that 24% of North Carolina lawyers reported having signs of depression at least three times a month, and more than 25% expressed feelings of anxiety.
The N.C. State Bar and NCBA responded with the creation of various supports for lawyers, including BarCARES and FRIENDS (one of the precursors to the Lawyer Assistance Program), and by adding mental health and professionalism components to the continuing education curriculum.
In 2002, the Chief Justice’s Commission on Professionalism checked in on the health of North Carolina lawyers again. A modified survey was mailed to a subset of the bar, receiving responses from 597 lawyers and 22 judges. While the Commission’s 2005 report uncovered new issues, such as certain declines in professionalism, general health, and concerns raised by women in the profession, the committee concluded that the overall picture of attorney health in North Carolina was improving. A greater percentage of respondents indicated that they were satisfied with their lives, and those reporting signs of depression declined to 18%.
The Current Study
These earlier North Carolina studies have informed and guided the mental health programs and offerings for lawyers across the country. This work has made life better for thousands of attorneys and has resulted in our being better able to serve our clients and our community. Despite their age, these earlier reports continue to be cited today. article continues after advertisement
Roughly 13 years after the 2002 study, the NCBA’s Lawyer Effectiveness and Quality of Life Committee (LEQOL) began work to update the findings about attorney well-being. On a much more modest budget, the LEQOL began an extensive review of the 2002 survey design and considered updates to reflect advances in data informatics.
After its evaluation, the LEQOL concluded that there was value in maintaining fidelity to the 2002 survey so that results could be more easily compared. In June 2017, LEQOL sent electronic surveys to all North Carolina attorneys, and received 2422 responses.
2017 Preliminary Results
The decision to stay faithful to the earlier survey structure proved valuable. Without even considering the 1991 study, the results from the 2002 and 2017 surveys yielded over 637,000 data response points that could be compared. This figure also does not include the massive amount of information that could be gleaned from the hundreds of pages of thoughtful, revealing written responses provided in the current study.
An initial, summary review of the data, has focused on just a few areas across a three specific demographics: the age of respondents; reported gender and practice size. Even this brief snapshot of the data offers insights, identifies issues for closer analysis, and provides areas for preliminary action. Among other findings, the current survey revealed:
Satisfaction with Life and Work: Approximately 80% of respondents in 2017 indicated they were “Delighted, Pleased or Mostly Satisfied” with “life as a whole”. This figure is roughly the same at it was under both the 1991 and 2002 surveys. It is significant however, that in 2017 many more lawyers (17%) reported that they were “delighted” with their lives (the most positive ranking in our study), than those who used the three lowest evaluations combined (7% reporting life as “mostly dissatisfied”, “unhappily” or “terrible”). Both this highest rating, as well as the combined lowest assessment, rose since 2002, when 14% percent of lawyers reported being delighted with life and 4% were dissatisfied. article continues after advertisement
In addition to a sense of satisfaction with life, in 2017 26% of attorneys, over one-quarter of the respondents, reported they were “very satisfied” with the practice of law. Only 3% of lawyers indicated they were “very dissatisfied” with the practice. These figures remained the same from the 2002 survey.
While it is promising that more lawyers are happier with their lives, it appears there is a widening “satisfaction gap” in the profession. Of particular concern, is that greater numbers of women (from 4% to 7%), lawyers under 50 (from 4% to 7%) and lawyers in large practices (5% to 9%) are reporting that they are dissatisfied with life.
Depression: Depression is particularly devastating, because it destroys perspective, undermines relationships, and interferes with our ability to do the things that counteract its ill effects. While 2017 saw a slight increase in lawyers who reported “feeling depressed or very unhappy” (from 8% to 10%), the current evaluation does not compare attorneys with the general population. Most studies show increases in the disease in the broader culture, suggesting that the rates of depression among North Carolina lawyers have remained relatively flat. In addition, in both 2002 and 2017, 63% of lawyers reported that they rarely or never feel depressed. article continues after advertisement
Not all areas of the bar maintained this steady state, however. There were dramatic increases in depression and unhappiness for women under 50 in large firms, where rates went from 14% to 23%.
Alcohol Usage: More North Carolina lawyers expressed an “uncontrollable urge” to drink alcohol in 2017 than had in 2002 (10% compared to 6%). They also reported they were drinking more often. Among those surveyed, 27% drank at least one drink, 5 or more days a week. This figure is up from 22% in 2002, and was seen across all demographics, except lawyers over 50.
While this raises concerns, the average number of drinks consumed declined over the same period. In 2002, 6% of lawyers were drinking at least 4 drinks on the days they drank. By 2017, that number had dropped to 3%. This is still a matter worth paying attention to. For a woman to consume 4 or more drinks on a single occasion, or a man to drink 5 or more, is considered binge drinking by the Centers for Disease Control. Eight or more drinks per week for a woman, or 15 or more for a man, is considered “heavy drinking”.
Support Services: While the data around lawyer satisfaction, depression and alcohol usage in North Carolina is mixed, increasing numbers of lawyers have sought help, either through bar supported services such as BarCARES and LAP (11% in 2017 vs. 4% in 2002), or through other counseling and support groups (40% vs. 30%). There were significant increases in the use of prescription medication to cope with depression or anxiety (16% compared to 9%). In addition, the lawyers surveyed reported that they have more people with whom they can share their most private feelings (from 2.7 to 4.1) and dramatically more people who will be happy for them, “simply because of who they are” (from 6.6 to 12.9).article continues after advertisement
Conclusions and Next Steps
The 2017 survey revealed some positive trends, as well as areas requiring increased vigilance. Overall, the levels of depression among lawyers appear to have remained generally unchanged. Further, more lawyers give life the most favorable appraisal possible, about a quarter are highly satisfied with the practice of law, and increasing numbers have rich social supports.
But the fact that a subset of lawyers are flourishing provides little comfort or solace to those who are struggling or for whom life is flat. This initial review of the 2017 survey data also highlighted real concerns for the profession: a widening “satisfaction gap”, increasing levels of depression among women attorneys, and decreases in life satisfaction for women, lawyers under 50, and attorneys in large practices. Further, the hundreds of pages of written responses collected provide a complex and subtle human narrative that can get lost when only comparing the numbers from a psychometric rating scale. It is a chronicle filled with joys and deep concerns about life as a lawyer.
Over the coming months, the successor committee to the LEQOL, the Professional Vitality Committee (PVC) will look at some of the specific risks to our well-being, such as the effects of technology, high stress and low decision latitude, the 24/7 demands, and financial pressures (law school debt, price pressures, billing requirements). It will consider strategies to both address these risks, as well as promote increased vitality in and out of work. The absence of illness is not the same as health or flourishing. Positive and negative affect are not disparate ends of a single continuum. They are independent, separately measurable, and suggest different things about our lives.
Some strategies will draw from the research about what causes people to thrive in general: exercise, connections with others, cultivating gratitude, recrafting our jobs to engage our strengths, building resilience. We also hope to find practices that are especially helpful for lawyers, such as discovering what may be different for the 26% of the bar who are “highly satisfied” with the practice of law, and for the growing number of attorneys who give life their highest appraisal.
Through my involvement with the 2017 survey, I have been privileged to work with so many people who are committed to improving the health and well-being of our profession, of individual attorneys, and in the delivery of legal services to our community. It would be impossible to acknowledge every one of them here. Scores of lawyers on the LEQOL and related groups volunteered hundreds of hours.
The late Allan Head, NCBA leadership and Board of Governors, and the North Carolina Bar Foundation made this study a priority and supported the work. Attorney Darren Allen, who was so instrumental in analyzing the 2002 results, lent his expertise for the current evaluation. Chandra Storrusten with Visible Value and Ryan Suydam of Client Savvy helped us navigate and narrow the tens of thousands of data points and alert us to trends to consider.
Of course, there was the assistance of the late Leary Davis, who led much of the work on the 1991 and 2002 studies, and provided invaluable guidance on the 2017 survey. And finally, we are extremely grateful to the 2,422 North Carolina attorneys and judges who generously carved time out of their days, to offer us their responses and insights on this important and extensive study.
©2020 John A. Doyle, Jr.
John “Sean” Doyle is general counsel of MCNC, taught psychology at N.C. State University and for the past 15 years, has worked specifically with lawyers on matters of well-being. A member of the Board of Directors of BarCARES, His book “Mud and Dreams” is a series of essays on the science and poetry of living, and is about falling deeper in love with life.
This article first appeared in the February 2020 issue of the NC Lawyer, pp 24-25. https://www.ncbar.org/media/1002931/ncl-february-2020.pdf