Lawyer Mental Health and Well-being

What does the data tell us about mental health and well-being in the legal profession, and what are some practical tips to improve lawyer happiness?

During the summer of 2015, Eilene Zimmerman noticed something was wrong with her ex-husband, Peter. His behavior had become erratic. His voicemails and text messages were barely comprehensible soliloquies as though his once-brilliant mind had given way to a fireworks show.

Eilene worried the stress of his job had finally gotten to him. Peter was a high-powered attorney at Goodrich & Rosati, a prominent law firm based in Silicon Valley. He had been working more than 60 hours a week for more than 20 years.

When Eilene didn't hear from him for three days, she drove to his house. She used her key to unlock the door and began walking through the house, calling his name.

She saw the bloodied tissues first—scattered across his bed like wounded doves. When she entered the bedroom, she found him lying on the floor just outside the bathroom. Beside him lay a half-filled syringe, a lighter, and a spoon.

"Of all the heartbreaking details of his story, the one that continues to haunt me is this: The history on his cellphone shows the last call he ever made was for work. Peter, vomiting, unable to sit up, slipping in and out of consciousness, had managed, somehow, to dial into a conference call."

In the months that followed his death, Eilene sorted through Peter's text messages and bank statements, which gradually painted a picture of an uncommonly bright and successful attorney who had died a drug addict on his bedroom floor.

What makes a happy lawyer?

The United States Declaration of Independence lists the pursuit of happiness as one of three unalienable rights our government was created to protect.

As John Locke, from whom Thomas Jefferson borrowed the famous phrase, put it:

"[T]he highest perfection of intellectual nature lies in a careful and constant pursuit of true and solid happiness; so the care of ourselves, that we mistake not imaginary for real happiness, is the necessary foundation of our liberty."

But defining happiness and understanding what makes us happy has puzzled poets, philosophers, and laypersons for centuries.

In the 1920s, a research trend took hold in the United States. Researchers began looking at happiness and the methods available to gain happiness. Much of this research was targeted toward specific groups, including Black women and Jewish people. A vast literature emerged, coupled with a cultural commitment to happiness that inspired things like the happy birthday song (composed in 1926), music piped into department stores, happy meals, the iconic yellow smiley face, and eventually laugh tracks.

But it wasn't until decades later that researchers became interested in what makes lawyers—a stereotypically dour bunch—happy.

Factors that contribute to lawyer happiness

Florida State University Professor Larry Krieger became interested in studying happiness among lawyers while working as a government litigator. A few years later, after switching careers and becoming a law school professor, he had the opportunity to work with University of Missouri psychology professor, Dr. Ken Sheldon. The two set out to answer the seemingly straightforward question: Does the achievement of traditional career success lead lawyers to happiness, and if not, what does?

In 2015, Larry and Ken completed their landmark psychological study. The study gathered data from thousands of lawyers and judges across four states.

To the surprise of attorneys and non-attorneys alike, Larry and Ken's study found that the external factors typically associated with legal success (class rank, earnings, partnership, prestige) do not contribute to lawyer happiness. Conversely, internal factors that are less likely to impress at a cocktail party (autonomy, integrity, strong relationships, purpose) contribute dramatically to lawyer happiness.

As you can see from the two graphics above, internal factors have the strongest correlation with happiness. For context, a correlation coefficient of .10 is thought to represent a weak or small association, a correlation coefficient of .30 is considered a moderate correlation, and a correlation coefficient of .50 or larger is thought to represent a strong or large correlation.

The factor most correlated with happiness (autonomy) encompasses more than just the freedom to make one's own choices. As Larry Krieger explains in The Best Lawyer You Can Be: A Guide to Physical, Mental, Emotional, and Spiritual Wellness:

"[Autonomy] includes the need to have coherence between our self and our behaviors in day-to-day life. This means that choices and actions express our ‘true self' and ‘true values.' You can see that in normal parlance, it means your integrity—the extent to which you say what you mean, do not misstate or bend reality, and otherwise express what is inside you in your words and actions. This is the most important predictor of whether or not a lawyer is happy and satisfied most of the time."

Other surprising conclusions from Larry and Ken's landmark study include the following:

• Happiness does not vary significantly with the number of hours worked in a week. One possible explanation for this is that lawyers who enjoy their work may, in turn, work more hours.
• Happiness decreases as firm size increases. The happiest lawyers are solo attorneys. Unsurprisingly, solo attorneys report more autonomy, whereas lawyers at large firms report a stronger focus on external factors (such as earnings and billable hours).
• Lawyers who are married with children are happier than lawyers who are single and childless.
• There is an "almost meaningless" correlation between lawyer well-being and graduating from a higher-tier law school, despite a modest correlation with higher income.

The pillars of happiness

The results of Larry Krieger and Dr. Ken Sheldon's study came as a surprise to most attorneys, but the findings were old hat to psychologists.

Psychologists who study happiness have long believed that certain pillars contribute to a happy life. The terminology used to describe these pillars varies slightly between psychologists, but all of the pillars represent what Larry Krieger refers to as internal rather than external factors.

What does the research tell us about happiness and well-being among lawyers?

If you're a lawyer or have been around lawyers, it probably won't come as a surprise to hear that lawyers are largely unhappy. However, they may not be quite as unhappy as previously thought.

Let's take a look at what the research tells us about lawyer happiness and well-being.

The 2015 American Bar Association-Hazelden Betty Ford Foundation study

The landmark study that alerted the world to the legal profession's mental health crisis was funded by the American Bar Association (ABA) and the Hazelden Betty Ford Foundation in 2015.

The study (hereinafter referred to as "the ABA study") looked at nearly 13,000 practicing attorneys and found that lawyers suffer much greater rates of depression, anxiety, and alcohol abuse than the general population.

Specifically, the ABA study found that:

• 36 percent of lawyers surveyed qualified as problem drinkers
• 28 percent of lawyers surveyed struggled with some level of depression
• 19 percent of lawyers surveyed struggled with anxiety
• 23 percent of lawyers surveyed struggled with stress

According to the ABA study, young lawyers in the first 10 years of practice and those working in private firms experienced the highest rates of problem drinking and depression, leading to obvious concerns about the future of the legal profession.

The ABA study also surveyed more than 3,300 law students and found that:

• 17 percent of law students surveyed experienced some level of depression
• 14 percent of law students surveyed experienced severe anxiety (23 percent experienced mild to moderate anxiety)
• 6 percent of law students surveyed reported suicidal thoughts
• 25 percent of law students surveyed were at risk for alcoholism

The 2021 National Health Interview Survey study

The National Health Interview Survey study (hereinafter, "the NHIS study") published in the Journal of Empirical Legal Studies in 2021 raised some concerns about the ABA study.

The NHIS study pointed out that the ABA study was based on weak empirical evidence—specifically, data collected from volunteer respondents as opposed to a random sample of lawyers.

"Because the volunteer survey respondents may not be representative of the general population of lawyers, it is inappropriate to rely on these data for estimating the prevalence of mental illness or excessive alcohol use for lawyers or comparing rates for lawyers with other populations who went un-surveyed. If lawyers struggling with mental illness are more likely to fill out the survey, for example, then the survey data will indicate a higher rate of mental illness than we find in a random survey of lawyers."

The NHIS study sought to remedy this perceived error by looking at a random sample of 1,000 lawyers using the "gold standard of public health data," the Center for Disease Control's National Health Interview Survey.

The NHIS study drew two notable conclusions based on the data:

1. The percentage of lawyers with moderate to severe mental health issues is in line with that of doctors, veterinarians, dentists, and other similarly-educated workers.
2. The percentage of lawyers with moderate to severe mental health issues is lower than that of people without a college degree.

Yale Law Professor Yair Listokin, who helped analyze the data collected in the 2021 study, cautioned that the results shouldn't be taken as evidence that attorneys don't struggle with well-being.

"It's not as though we should say, ‘OK, we don't have to worry about it," said Yair Listokin. "But in terms of, ‘Is there something uniquely wrong in the legal profession?' Maybe not."

Substance abuse in the legal profession

Perhaps the biggest surprise to come from the research into lawyer well-being is the prevalence of problematic alcohol use among legal practitioners.

The ABA study found that 20.6 percent of lawyers surveyed engaged in problematic drinking based on the Alcohol Use Disorder Identification Test (AUDIT).

The high stress associated with the occupation is one explanation for the high rate of problematic drinking among lawyers, but it's not a satisfactory explanation. An AUDIT-C subscale test, which focuses solely on the quantity and frequency of alcohol use, found that 36.4 percent of lawyers screened positive for problematic drinking, whereas only 15 percent of surgeons, an equally high-stress job, screened positive.

You might assume that lawyers begin drinking during law school, a notoriously stressful program, but 44 percent of lawyers in the ABA study stated that their problematic drinking habits began during their initial 15 years of practice.

Like the ABA study, the NHIS found that lawyers drink excessively at higher rates than the general population and at much higher rates than other highly-educated professionals.

The NHIS study further noted that problematic drinking among lawyers has grown considerably worse over the last decade, with today's rates more than 50 percent higher than the rates reported in the mid-2000s.

In addition to alcohol, lawyers struggle with other drugs. The ABA study found that within the previous year:

• 15.7 percent of lawyers surveyed had used sedatives
• 10.2 percent of lawyers surveyed had used marijuana
• 5.6 percent of lawyers surveyed had used opioid drugs
• 4.8 percent of lawyers surveyed had used stimulants

What's more, a large number of lawyers did not answer the questions about substance abuse, leading researchers to suspect that the numbers might be much higher.

Patrick Krill, one of the authors of the ABA study and a leading authority on addiction, mental health, and well-being in the legal profession, believes that a combination of factors—including professional demands, attorneys' personalities, and the profession turning a blind eye to problematic alcohol and drug use within its ranks—makes lawyers a risk for substance use-related disorders.

A 2022 study published in the Journal of Occupational and Environmental Medicine confirmed many of Patrick Krill's beliefs, concluding that burnout—characterized by overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment—is a statistically significant predictor of drug abuse.

According to the study, law professionals whose burnout scores fell in the highest tier have 4.71 times higher odds of having a problem with drug abuse than those whose burnout scores fell in the second tier.

Suicide in the legal profession

A 1990 study conducted by researchers at Johns Hopkins University found that lawyers were 3.6 times more likely to suffer from depression than nonlawyers. The Dave Nee Foundation, a think tank that studies lawyer depression, followed up the Johns Hopkins' study years later and found that the legal profession ranks 5th in incidence of suicide.

Other studies have sounded the alarm on the prevalence of suicide in the legal profession:

• The 2016 ABA study found that 11.4 percent of lawyers had suicidal thoughts in the previous year.
• A 2021 law.com survey found that 19 percent of respondents contemplated suicide at some point in their profession.
• The NHIS study found that lawyers were five times more likely than the general population to die by suicide.

"On the morning he killed himself, he said he got an email and had to go into work to put something together. I wanted to ask if I could go with him and just sit there, but instead, I simply offered to make him a sandwich for lunch. And without any hesitation, he said, ‘No baby, I'll be fine—I won't be long.'"

Well-being among female lawyers

The body of research on lawyer well-being suggests that female attorneys are more likely than male attorneys to experience stress, anxiety, and depression and are also more likely to engage in problematic drinking.

A 2020 study conducted by the California Lawyers Association and the D.C. Bar found that the proportion of male legal professionals with problematic drinking behaviors is fairly consistent with men in the general population, but women in the legal profession had much higher rates of problematic drinking (39.5 percent) than women in the general population (19 percent).

What's more, the California Lawyers Association study found that:

• 67 percent of female attorneys reported moderate or severe stress compared with 49 percent of male attorneys
• 23 percent of female attorneys reported moderate or severe anxiety compared with 15 percent of male attorneys
• 20 percent of female attorneys reported moderate or severe depression compared with 15 percent of male attorneys

Studies also indicate that a wide gender gap exists with respect to attorney attrition, with some reports estimating attrition rates for women to be 150 percent higher than for men.

For many women, the usual challenges associated with practicing the law are compounded by being the primary caregiver and facing pervasive sexism that exists within the profession.

"We're still in some ways practicing law in a very similar fashion as we did when it was mostly men practicing," said Jeena Cho, an attorney who works with law firms on well-being and mindfulness. "A lot of courthouses to this day still don't have a mother's room where you can go pump, and that's just a very simple example of how the job is not designed to be accommodating to women at all."

Practical recommendations for positive change

The research on lawyer well-being, while not extensive—as of 2022, researchers at the University of Utah have identified only nine peer-reviewed publications examining lawyer well-being, nevertheless paints a clear picture of a deeply troubled profession.

Everyone has an interest in lawyers being healthy and happy. Unhappy lawyers not only present challenges for themselves and their family members, but they injure their clients by failing to provide adequate representation, as unhappiness and depression are intimately associated with passivity and poor productivity at work.

With all of this in mind, let's take a look at some practical ways legal employers, lawyers, and law schools can improve lawyer well-being and help change the narrative going forward.

Recommendations for legal employers

Legal employers have a moral and financial incentive to ensure the well-being of their employees. The moral incentive should be obvious, so let's focus on the financial incentive.

A number of studies have shown that the costs associated with promoting wellness at work are significantly outweighed by the financial benefits.

According to a study published in Health Affairs, for every dollar a company spends on employee wellness programs, medical costs fall by $3.27 and increased costs attributed to employee absenteeism fall by $2.73.

Here are some other notable findings from the study:

• Workplace health programs reduce presenteeism—the measurable extent to which health symptoms, conditions, and diseases adversely affect the work productivity of individuals who choose to remain at work.
• Because employee health behaviors frequently influence family members, employees who work for companies that value wellness are less likely to miss time caring for ill family members.

On top of the aforementioned benefits, legal employers who prioritize well-being will be more likely to retain top-notch employees and recruit new attorneys. This is particularly true in the midst of the current work-life reimagining, where employees are quitting their jobs in search of positions that allow for a better quality of life.

So how can legal employers prioritize lawyer well-being?

First and foremost, legal employers need to commit to doing better. In 2018, the Commission on Lawyer Assistance Programs (CoLAP) launched a campaign to promote best practices for law firms to take care of their attorneys.

CoLAP encourages legal employers to sign a pledge, which includes a seven-point checklist for employers to improve their messaging to lawyers about the employer's interest in well-being.

As part of its campaign, CoLAP circulates an annual commitment form, which asks participants to describe any steps they took toward the objectives set out during the previous year and recommit to the pledge.

Similar to the CoLAP campaign, the Tristan Jepson Memorial Foundation identifies 13 factors for promoting psychological well-being in the legal profession and provides a survey and supporting documents to help employers assess and enhance these 13 factors.

Once a legal employer has committed to prioritizing well-being and has meaningfully communicated that priority to its employees, the legal employer can focus on improving lawyer autonomy, which we know from Larry Krieger and Dr. Ken Sheldon's study is the factor that most drives lawyer happiness.

There are a number of ways legal employers can improve lawyer autonomy. Perhaps the most significant way is to tackle the billable-hour problem.

The billable hour system, which forces lawyers to focus on hitting their hours rather than doing a good job, is the antithesis of autonomy. In recent years, more lawyers have spoken out about the many ills of the billable hour model.

Alternative fee models are becoming more popular across the globe. Fee models, such as value pricing, offer a number of benefits over the billable hour system, including a focus on profitability rather than revenue, a focus on effectiveness rather than efficiency, and the ability to provide clients with upfront pricing before any work is done.

Legal employers would also be wise to listen to their workers' wishes when it comes to when, where, and how they work.

"If the last two years have taught us anything," said Nick Lillios, CEO of Nowsta, a workforce management platform, "it's that flexibility is key in all aspects of life. More specifically, flexibility in the workforce is in high demand. We've transformed the way we've worked and it will only accelerate in the coming years. Not only are employers seeing the benefit of this way of work, but employees are more empowered to take a hold of their work-life balance."

A survey of nearly 2,000 ABA members found that 44 percent of lawyers that have practiced for 10 years or less would leave their job for another one that provides a greater opportunity to work remotely. Only 13 percent of lawyers practicing for 41 years or longer reported they would do so.

Flexibility, whether it takes the form of more remote hours or the autonomy to work some non-traditional hours, could go a long way in helping attract and retain female lawyers in particular.

Legal employers, perhaps because lawyers are trained to be risk averse, have a long-held reputation for being slow to innovate. But when it comes to improving lawyer well-being, law firms that refuse to implement practical and durable changes risk missing out on top-tier talent.

Legal employers can find more tips for improving the well-being of their employees in The Path to Lawyer Well-Being: Practical Recommendations for Positive Change, created by the National Task Force on Lawyer Well-Being.

Recommendations for lawyers

The research shows that happy lawyers have fewer symptoms of anxiety and depression, as well as better immune systems, cardiovascular health, and pulmonary functioning. What's more, happy lawyers have higher life and work satisfaction, and are less likely to engage in passive or poor work productivity.

Anne Brafford, an attorney who earned a Master's degree in Applied Positive Psychology, recommends that lawyers create a happiness plan as a way to bring more positivity into their lives. As part of that plan, Annie recommends trying to offset every negative experience with three to five positive experiences. The reason for this ratio is that, for evolutionary reasons, negative emotions are much stronger than positive ones, and therefore, you won't feel happy unless your positive emotions significantly outweigh your negative emotions.

To increase your positive experiences, consider some of the factors we know drive lawyer happiness:

• Loving and engaged relationships. A famous Harvard University study followed individuals from various economic and social backgrounds for more than 75 years (President John F. Kennedy was part of the original group). The study found that the number one predictor of happiness is having loving relationships with family and friends. The study also found that people with strong social support experience less cognitive deterioration as they age, and in fact, people's level of satisfaction with their relationships at age 50 was a better predictor of physical health than their cholesterol levels.
  
  Investing in relationships can be a challenge for busy attorneys, but it's well worth the effort. Two things to keep in mind: be sure to share positive experiences with friends and family members (don't just vent) and aim for in-person interactions (rather than texting or using social media).
• Meaningful work. We know that feeling a sense of purpose is one of the biggest contributors to happiness. Unfortunately, we're often stuck at jobs that don't give us meaning. For some attorneys, a job transition is worth considering. Reach out to the folks in your state bar association's career services department for help with a career switch. For other attorneys, taking on a "side hustle" or volunteering during the weekends might be the answer.
• A faith or life philosophy. It's not necessary to find a particular kind of faith to be happy. Rather, as Arthur Brooks explains: "The key is to find a structure through which you can ponder life's deeper questions and transcend a focus on your narrow self-interests to serve others."
• Activities that promote autonomy. We know that autonomy is the number one factor driving lawyer happiness. Attorneys would be wise to find ways to engage in activities that feel "authentic." To put it another way, take the time to do things that align with your interests and values.

There's no question that increasing your positive experiences takes work. We've created a series of worksheets to help you get the process started.

Recommendations for law schools

Before starting law school, law students are actually healthier than the general population, both physically and mentally. Andy Benjamin, a psychologist and lawyer who teaches law and psychology at the University of Washington, points out that they drink less than other young people, use fewer substances, have less depression, and are less hostile.

In addition, law students typically start school with their sense of self and their values intact. Unfortunately, research shows that the structure of law school begins to change all of that. Once law school begins, students experience a marked increase in depression, negative mood and physical symptoms, with corresponding decreases in positive affect and life satisfaction.

"The psychological factors seen to erode during law school are the very factors most important for the well-being of lawyers," explains Larry Krieger. "The factors most emphasized in law schools—grades, honors and potential career income—have nil to modest bearing on lawyer well-being."

Dr. Debra Austin writes and speaks about how neuroscience and psychology research can improve the well-being and performance of law students. She lists seven things law schools can do to improve the well-being of their students:

• Identify organizational practices that may contribute to well-being problems and assess changes that can be made
• Educate faculty on well-being issues in the legal profession
• Provide well-being curriculum for students
• Provide student resources on mental health and substance use disorders
• Create a peer mentoring program
• Discourage alcohol-centered social events
• Survey student well-being

Law school administrators who wish to learn more about how to improve lawyer well-being should review the law school and law student resources collected by the ABA.

Additionally, we’ve developed a series of worksheets to help law students boost their happiness. These can be distributed by law schools to their students.

It may seem like the term happy lawyer is an oxymoron right up there with jumbo shrimp, civil war, and Shakespeare's "O brawling love! O loving hate!" But it's absolutely possible to be a happy lawyer in the twenty-first century; it just takes some hard work. Fortunately, working hard is something lawyers already know how to do.