Tag Archives: mental health

The Opportunity for Employee Well-Being

Companies that want a fulfilled, resilient workforce are making well-being a comprehensive part of their culture. The line between professional and personal lives continues to blur, and companies can use this as an opportunity to differentiate by moving beyond the traditional benefits package.

Well-Being Trends

According to a recent study conducted by the National Business Group on Health, midsize and large employers are expected to spend an average of $3.6 million on well-being programs in 2019. Well-being is expanding and evolving, driven by trends that include:

  • A focus on financial wellness and the adverse impact that debt, low savings and a lack of planning can have on productivity, engagement and health
  • A realization that mental health requires increased attention after the prolonged silence, and in some cases stigmatization, that have made it difficult to connect needs with treatment

Financial Wellness

Financial wellness is one of the most popular well-being initiatives. According to Wellable’s 2019 Employee Wellness Trends Report, more than 68% of employers say they will be investing more into financial wellness. Employees are looking to employers to provide financial wellness tools that will increase their overall well-being.

The Wellable report also finds that over 70% of millennials say they’ve delayed major life decisions due to their student loan debt, indicating the value of student loan assistance programs. Globally, over the past two years, 27% of workers report suffering from stress, anxiety or depression due to their finances, which diminishes employee productivity, engagement and health. With education costs skyrocketing, this issue isn’t going away. Expect participation in financial wellness programs – that address debt management, budgeting and financial planning – to grow considerably in years to come.

See also: Why Financial Wellness Is Elusive    

Mental Well-Being and Mental Health

In recent years, the spotlight on mental health and mental well-being has intensified. According to a 2017 national survey by the APA, the workplace was the third-leading cause of stress (61%), after money (62%) and the future of the nation (63%). Supporting mental resilience by reducing stress needs to be a key focus for well-being in the workplace.

Mental well-being is all about prevention and skill-building. Most of us never learned how the brain works or about the importance of training our brain for ultimate vitality. Instead, we are conditioning our brains to be distracted and overstimulated. The good news is that the latest neuroscience research proves that we can train our brain to perform more optimally. While adoption within the employer population remains slow, brain training apps are increasingly commonplace.

Solutions like Total Brain apply the latest brain optimization research to help employees learn skills, but the responsibility rests on employers to offer these types of solutions for mental fitness and mental optimization training to help employees improve brain health. There are also hundreds of apps, websites and online courses designed to enhance mental well-being.

In addition to providing mental well-being training to your employees, it is critical to focus on mental health benefits and interventions. Millions of Americans need additional support and resources for the mental health disorders that continue to plague our society.

The good news is that, like other chronic diseases, mental health disorders are treatable, and employers have a unique opportunity to improve the mental health of the 157 million U.S. adults who spend more time working than doing any other activity apart from sleeping. The key is that employers must take a comprehensive approach, including:

  • Access to care: No matter how much we do to create a culture of mental well-being, employees have to be able to access and afford treatment. To prevent higher co-pays and out-of-pocket costs, employers need to ensure that employees aren’t forced to access out-of-network providers for mental health care.
  • Comprehensive coverage: Employers must view a high frequency of claims in behavioral health as favorable instead of trying to mitigate these visits like with ER or specialist visits. Weekly therapy can be a very effective treatment for many, and employers should not be concerned about the number of visits an employee has if the employee is seeing qualified specialists.

The Way Forward

If organizations want to thrive in the next decade, they need to invest in the well-being of their employees. There is an opportunity to innovate, set yourself apart with a commitment to the health of employees and create a culture that talented individuals want to be part of for many years to come.

See also: Employee Wellness Plans’ Code of Conduct  

Take time to evaluate your ecosystem – culture, leadership, management, benefits, employee resources, third-party solutions, workplace environment and communications – then devise a plan, execute and make refinements when data exposes gaps. The result will be a safer, higher-performing workplace driven by empowered individuals who are committed to the well-being of the company that employs them.

15 Keys to Mental Health Safety Net

Acknowledgment: Thank you, Dr. Jodi Frey and Jon Kinning, for assisting in the preparation of this article.

The employee assistance program (EAP) might be one of the best-kept secrets for many employers. Instead, EAPs should be resources widely publicized to help encourage managers, employees and often their family members so that support services for personal and workplace problems can mitigate risk and promote vibrant workers. Many employers simply “check the box” when signing up for the EAP benefit, figuring health insurance will cover the mental health needs of their employees; however, most employers really don’t know what the EAP services entail or the value the services can bring to a workplace.

With that said, not all EAPs are created equal. EAP services vary greatly, including some or all of the following::

  • biospsychosocial assessments, including substance use assessments
  • individual and family counseling
  • financial and legal coaching and referrals for counseling
  • referrals for additional services, with follow-up
  • psychoeducation through workshops, newsletters and other communication for personal and workplace concerns, including stress management, parenting, mental health literacy, relationships and organizational change and individual crisis prevention, crisis response and support
  • mediation and team development
  • leadership consultation, coaching and development
  • fitness for duty evaluations
  • suicide risk assessment, treatment and “postvention” (i.e. what to do after a suicide)
  • staff training on best practices on how to support someone in distress
  • and more

Sometimes, the services are cursory, such as a brief telephone assessment and referral by a contracted outside provider. Other EAPs provide robust and high-touch services like 24-hour support; on-line assessment and information; telephone and in-person assessment and counseling; on-demand crisis consultation; on-site workshops; mental wellness promotion; and much more. As with many things, you get what you pay for, so employers need to decide how much they are willing to invest in the mental wellbeing of their workers and conduct a cost-benefit analysis. However, EAPs, even more customized programs with onsite services, have been shown to be cost-effective to employers through the years.

Are EAPs Effective?

While the research on the effectiveness of EAPs is limited, studies have found that employees’ use of EAPs enhanced outcomes, especially in “presenteeism” (how healthy and productive employees are), life satisfaction, functioning and often absenteeism (Joseph, et al., 2017; Frey, Pompe, Sharar, Imboden, & Bloom 2018; Attridge et al., 2018; Richmond, et al., 2017). In one longitudinal, controlled study, EAP participants were more likely than non-EAP participants to see a reduction in anxiety and depression (Richmond, et al, 2016). Another matched control study found that users of EAP services often reduced their absenteeism more quickly than non-EAP users experiencing similar challenges (Nunes, 2018). In another longitudinal study (Nakao, et al, 2007), 86% of people who were suicidal when they engaged with their EAP were no longer suicidal at two years follow-up. Researchers have concluded that, while not all EAPs are created equal, they often provide accessible services that are effective at improving employee mental health and well-being.

See also: Impact on Mental Health in Work Comp  

Are EAPs Prepared to Support an Employer Facing an Employee Crisis With Suicide?

When it comes to the life-and-death issue of suicide, EAPs have the potential to provide evidence-based suicide prevention, intervention and postvention services to employers. The EAPs’ contribution to the comprehensive workplace suicide prevention strategy is essential, and many would benefit from annual state-of-the-art training in evidence-based methods of suicide risk formulation and treatment to help distressed employees get back on their feet. Social workers, who provide the majority of EAP clinical services in the U.S., often report having no formal training in suicide formulation, response and recovery (Feldman & Freedenthal, 2006; Jacobson et al., 2004), so annual continuing education on suicide intervention and suicide grief support is often helpful to providers. Once trustworthy and credentialed providers have been identified, they should be highlighted in the “suicide crisis” protocol, so that companies are not trying to do this leg work in the midst of a crisis.

If one of the main messages in suicide prevention is “seek help,” we need to make sure the providers are confident and competent with best practices approaches to alleviating suicidal despair and getting people back on track to a life worth living. Thus, dedicated employers will evaluate and even challenge their EAP providers to demonstrate continuing education in the areas of suicide prevention, intervention and postvention skills. In fact, some states are mandating that all mental health professionals, including licensed providers of EAP services, have some sort of continuing training in suicide risk formulation and recovery.

Do Employees Know About the Benefit of Their EAP?

In addition to making sure the providers have the needed skills, companies need to make sure that their employees know when and how to access the care. Recently, the American Heart Association and CEO Roundtable worked with experts in the behavioral health field to develop a white paper for employers, which includes seven specific actions employers can take to improve the mental health of their employees (Center for Workplace Health, American Heart Association, 2019). The report can be viewed online here. Dr. Jodi Frey, expert panelist for the report and internationally recognized expert in the EAP and broader behavioral health field recommends that “employers need carefully consider their workplace’s needs when selecting an EAP, and then should work with their EAP as a strategic partner to develop programs and communications that encourage utilization of the program and continued evaluation to improve services over time.” (Dr. Jodi Frey, personal communication, March 18, 2019).

Employers that are mindful of their workers’ well-being will continually promote well-vetted and employee-backed resources throughout the career of the workers. Leadership testimonials of the efficacy of the resources after the leaders have used them for their own mental health would bring credibility to the resources and model appropriate self-care to the employees. Bringing the resources on-site to the workers (and not waiting until the workers stumble upon the resources) is another way to break through the barriers to care. The Employee Assistance Society for North American (EASNA) developed a guide to help employers evaluate EAPs and determine appropriate vendors. The guide also can be used to help employers evaluate their current EAP and decide if needs are being met or if more attention to what services should be offered needs to be addressed. The guide can be downloaded free.

Are There Different Types of EAPs?

Much diversity exists in EAP structure and quality (Frey, et al, 2018). Some companies use internal EAPs, where providers are also employees of the company. This arrangement often provides the benefit of having an immediate resource that has clear knowledge of the company and industry culture. Evaluation of internal EAPs has found increased utilization, customization and supervisor referrals (Frey, et al, 2018); however, there are some drawbacks. Internal EAPs, because they are so closely connected to the company, run the risk of being perceived as having blurred lines of confidentiality and objectivity. By contrast, external EAPs are often more diverse and can respond 24/7 across a vast geography. Because of these benefits and consequences, many companies have moved to a hybrid model to get the best of both models.

Hybrid EAPs often have an internal employee to manage the EAP and to work with managers and employees on critical incident response, strategic planning and organizational change, and to provide onsite assessment and problem resolution. They can be an important ally for the employer to understand the potential for an EAP and to help evaluate whether EAP providers are effective in their response and offering high-quality services (Frey, 2017).

See also: What if They Say ‘Yes’ to Suicide Question?  

EAPs are most effective when they understand the industry and organizational culture, have business acumen and can adapt to changes in organizational structure (Frey, et al., 2017; Frey, et al., 2018). Thus, employers seeking to find a best fit for their employees will interview mental health providers about their knowledge of the unique stressors and strengths in the industry. Some industries (e.g., emergency responders and aviation) have gone so far as to credential mental health providers as being specialists in their industry to avoid a mismatch.

Case Study From the COO of a Construction Contractor

“We had an issue where our EAP was referring counselors outside of our healthcare providers, so, after the three free sessions, the participant learned they could only continue with the suggested provider at $150 a session; so the employees would drop out. My understanding is that counseling often takes around seven sessions to have a sustained impact, so, I put in a mandate with our HR team to renegotiate our EAP to ONLY refer in-network counselors, or they would pay for the continued care.

“We then incorporated our EAP into our safety program. When there is a serious accident, we deploy counselors and have our EAP involved for post-accident assistance to our employees. Accidents can bring up traumatic responses from our employees, and these experiences bring up memories from other accidents they may have been involved in or around. This cumulation of trauma can be highly distressing for them.

“In the early years, we had to work through the skepticism that the EAP would notify management of anyone that used the service. Since HIPAA came into play, we have less of this skepticism. The employees thought they would get fired or laid off first if they had issues.

“I’ve worked with our safety and wellness groups to actually pick up and call the EAP for someone in distress and get them on the phone. Once they lay the groundwork with the counselor, they hand the phone over and leave and let the employee get the help they need. This helps break down the stigma, and some people just don’t have the courage or have a mental block about picking up the phone for help. This has been VERY effective to get those in need the help they need.

“We promote our EAP in our weekly newsletter, and we also have business cards with the information, and we utilize hard-hat stickers that have all the information. This helps it be available when they need it.

“I’ve also encouraged our managers to use the system so they can promote it from their point of view. This also has helped remove the stigma around using the EAP. I also talk when in front of our employees about the program and educate them so they will use it. Our utilization rate is the highest in our EAP network, and I think this is the reason why.”

15 Questions Workplaces Should Ask to Strengthen the Mental Health Safety Net

Employers should remember they are the customers of their EAP, and they should do the due diligence to make sure they are getting the best benefit possible. Here are 15 questions employers should ask their EAP to get the best services possible:

  1. What services does your EAP cover? Are these services available 24/7?
  2. Who answers the calls of the EAP, and how are they trained and supervised? What professional and educational preparation and certifications do they have? Are they licensed?
  3. How are counselors selected and trained? Are certain licenses and other credentials required to be a part of the EAP provider network?
  4. What types of training have EAP providers received? Specifically, when was the last time they received training in suicide risk formulation and treatment?
  5. How is your EAP reporting utilization? How does your workplace’s utilization rate compare with others in your industry and what can be done by the EAP and by you as the employer to encourage more utilization?
  6. Do your employees know about your EAP services and how to access them?
  7. For those who have used the EAP, how satisfied were they with the services? Did the services help with the problem for which they were seeking support?
  8. When employees completed EAP services, did the EAP follow up (or attempt to follow up) with the employee to make sure all needs were met?
  9. How does your EAP interact with health plans? Are EAP providers also providers of outpatient mental health, and, if not, are they well-versed in the benefits of employees to make effective and seamless referrals?
  10. How is your EAP measuring outcomes? Can they also provide you with a return-on-investment (ROI) or other cost-benefit analysis?
  11. How is the EAP promoting upstream mental health efforts like prevention, resilience, positive psychology and work-life integration?
  12. Are there general mental health screening or other wellness tools the EAP can offer the workers to help them understand and monitor their mental wellness? Does the organization also assess its own culture of system-level mental wellness?
  13. Does the EAP have experience serving clients in our industry? If yes, what are some recommendations to improve how EAP services are promoted and offered at our workplace?
  14. Is the employer receiving regular reports (i.e., bi-annual, annual) from the EAP on utilization, presenting problems, satisfaction and other workplace outcomes?
  15. Does the EAP provide manager or HR training on how best to support an employee experiencing a mental health or suicide crisis? Are there additional staff training on skills needed to identify and assist employees in distress?

15 Top Apps for Mental Health

For many people, apps are a part of our everyday living – from Uber, to conference schedules, to how we find our restaurants. They can also be part of our resilience toolkit.

When we consider a comprehensive strategy to suicide prevention and mental health promotion, it’s helpful to segment approaches into “upstream” (preventing problems before they emerge through self-help), “midstream” (catching emerging problems early and linking people to least restrictive support) and “downstream” (helping people with more serious mental health challenges and suicidal thoughts) tactics.

Thus, for this article, I have organized some of the most popular, best-researched and most innovative apps into these three categories.

Upstream: Resilience Self-Help Apps

  • Positive Activity Jackpot

Developed by t2health, this app uses the phone’s GPS system to find nearby enjoyable distractions. It comes with a clinician’s guide:

  • Calm

Calm is designed for people new to meditation – starting with guided practices from three to 25 minutes in length and focused on a variety of topics from sleep to gratitude.

  • Breathe to Relax

Another t2health app, Breathe2Relax, offers portable stress management focused on diaphragmatic breathing skill-building that helps with anger management, mood stabilization and anxiety reduction.

  • MoodKit

Based in cognitive behavioral therapy, MoodKit helps people improve their mood by engaging them in over 200 mood-enhancement activities like thought checking and journaling.

  • Pacifica

Pacifica is designed to help people who live with anxiety through soothing meditation and other personalized self-help strategies. Check out the science behind this strategy.

See also: Impact on Mental Health in Work Comp  

Midstream: Early Detection and Peer Support/Life Coach Apps

  • Life Armor

Another t2health app, this brief assessment tool helps users manage emerging symptoms like depression, sleep deprivation and post-traumatic stress. Videos share personal stories from warriors and military family members.

  • DBT Diary Card and Skills Coach

Through this app, users can master the skills of dialectical behavior therapy (DBT), known for its effectiveness in regulating emotions and interpersonal relationships. Users remind themselves of skills they are trying to develop and track skill use.

  • TalkLife

Developed by folks at Harvard and MIT, TalkLife is a peer support platform that engages an online community when people just need someone who’s willing to listen. Posting can be done anonymously. Here is some research behind TalkLife.

  • Koko

Also developed by researchers at MIT, this app provides help for people in all states of distress from bullying and harassment, or even thoughts of suicide and self-harm. Koko provides evidence-based supportive interactions with users while referring users in crisis to international lifelines for immediate help.

  • Lantern

Lantern is a subscription service offering daily on-one-one coaching sessions and simple exercises combining cognitive behavioral therapy (CBT) and advice from real “professional coaches” trained in CBT. Recommended plans are personalized based on the user’s initial self-assessment.

See also: Top 10 Ways to Nurture Mental Health  

Downstream: On-Line Mental Health Services and Suicide Prevention Apps

  • Virtual Hope Box

The original non-app version of the Hope Box was developed as a tool to help therapists in clinical practice work with their suicidal clients so they can find reasons for living. Clients would find something like a shoe box and fill it with future goals, pictures of loved ones, bucket list experiences and the like. When clients felt their suicidal intensity increase, they would bring out the box to remind themselves of these things.

The Virtual Hope Box (VHB) does this and more. Still designed as something to augment treatment, the VHB helps people live through painful emotional experiences through distraction, inspiration, relaxation, coping, support and reasons for living.

  • BetterHelp

BetterHelp is a monthly subscription on-line counseling app that matches people with licensed mental health professionals and gives them unlimited access to these therapists.

  • My3App

My3app is a safety plan tool that helps people who are at high risk for suicide. It helps people develop a written list of coping strategies and sources of support. This app is based on content developed by B. Stanley & G. Brown (2008) and the Department of Veterans Affairs and is owned and maintained by Link2HealthSolutions, the administrator of the National Suicide Prevention Lifeline created in partnership with the California Mental Health Services Authority and was funded by the California Mental Health Services Act.

  • MyVAApps — Safety Plan for Veterans

Part of the MyVAApps suite of apps, the Safety Plan app helps users create or co-create with their therapist a safety plan that outlines specific steps to take when they face crises, including connecting to Veterans Crisis Line.

  • SAMHSA — Suicide Safe

This app is designed to help healthcare providers reduce patient suicide risk and is based on the SAFE-T Approach.

I am interested to hear about your experiences with these apps! What else have you used? What do you find to be most helpful in managing your resilience, mental health and emotional crises?

How to Help Veterans on Mental Health

Employers need to re-evaluate their relationship with the military and the profound disconnect that exists between the lip service of “Thank you for your service” and the tangible, material benefits we give to our armed forces and veterans. The reception and perception that veterans often receive by the civilian population is in need of a total overhaul.

A Veteran’s Perspective: The Frustrations of Being Valued by Civilian Workforce

Hearing gratitude for one’s service does make an impact and has been special to me personally, but I would have much more preferred the chance to show what I could do with my skills in the workplace. I remember when I first separated, I spent most of my days job searching and tailoring my resumes to fit each job description precisely. I had received a few calls back but nothing that led to an interview or job offer. After about three to four months of the same routine, I found myself questioning our decision to separate from the military. My experience helped me land a job, but I found it frustrating that my training in the Air Force was considered null at my new place of employment. Veterans with just four or five years of service are almost guaranteed to have some sort of management/supervisory role when they stay in the military, so starting out at entry level all over again in a civilian job is also somewhat difficult.

Some employers do not want to hire veterans for fear they might have PTSD or other performance-limiting conditions. This remarkable stigma exists and is actually a form of discrimination. The prejudice persists even though service members are expertly trained and capable of remarkable problem-solving, teamwork and leadership.

Part of the difficulty veterans face is that the civilian work culture is often far different than the one in which they thrived, and often the level of discipline and performance is below their expectations. Whether it’s the Marines, Navy, Army, Air Force or the Coast Guard, veterans count themselves as being part of something bigger than themselves. Assimilating to a new standard becomes all the more difficult when moving into a new field.

One veteran shared, “My co-worker showed up 20 minutes late with no consequence. If we were in the service, we would have beat his ass.” Veterans are accustomed to being pushed to excellence, to the boundaries of their abilities to serve an important calling. In the right motivating environment, veterans will bring this level of performance to the workplace. From the initial training and throughout their career, our service members are repeatedly tested to:

  • Work together as a team to complete a mission
  • Implement efficient procedures
  • Quickly overcome obstacles
  • Have one another’s back

These skills and many more and the mindset of service for the greater good can benefit an employer in countless ways.

Switching From One Battlefield to Another

When our warriors move out of military life, those who deployed are sometimes moving from one battlefield to another – that being the battlefield of the mind. For those who return with images and experiences of war, their minds may ruminate on these experiences as they try to process what they experienced. Post-traumatic stress is an understandable reaction to these extreme conditions, though civilians may not have knowledge or awareness of symptoms, and may unfortunately exercise bias against the veteran unknowingly.

For others, the battlefield of the mind comes from feeling isolated and misunderstood at home. One minute they are spending 24-7 in a tightly knit unit, the next minute they are surrounded by family and friends who now feel like strangers. Many don’t feel comfortable talking about their military experiences with civilians for fear of being judged.

While veterans were well-trained for one battlefield, the military does not adequately train them to battle the demons of depression, anxiety, addiction and trauma. From a mental health perspective, transition inoculation is critical to thwarting the potential negative outcomes of this life change.

See also: How to Help Veterans on Mental Health  

We provide the greatest military training to our armed services; they are the undisputed elite military fighting force in the world. But what kind of training do we provide for re-entry into to civilian life? The preparation and training they receive is in no way comparable to the pre-deployment preparation, especially in terms of mental health. .

A Veteran’s Perspective: Honoring the Warrior in Transition

The loss of identity is a big deal in transition, along with camaraderie and cohesion. We think about “Who I was, who I am now, who I am going to be.” We have all these warriors coming back, and we need to find ways to honor them because they are always going to be warriors.

The Transition Assistance Program does tremendously important work, and provides critical resources and access to post-service opportunities. However, many veterans have described the process as a one-size-fits-all, death-by-Powerpoint experience. They liken the process of moving out of service as something akin to being released from prison.

We can do better.

One veteran shared that when he received his benefits manual, it was hundreds of pages thick. He became so frustrated in trying to read through it that he literally burned it.

A Veteran’s Perspective: Help Us Translate Our Warrior Skills to the Workforce

What would be most helpful would be if organizations on the outside could assist veterans with translating the job skills and experience learned in the service to a language more consistent with that of the civilian workforce. One positive development is Google’s new “Jobs for Veterans” search capability where services members are able to enter their military job codes to identify civilian positions that matched their skills and abilities. This is a step in the right direction.

There are many pathways veterans can lead post-service; let’s create the means and conditions where their futures follow the pathway very best for them.

Often what is most helpful to veterans in transition is a peer who’s been there. Peers who’ve moved successfully in to new careers can help others behind them find their path. The continuing connection of these peers can offer troubleshooting and moral support when the job prospects are not forthcoming. Veterans can guide one another to employers who are veteran-friendly to help make sure the best and brightest job candidates are well taken care of.

A Veteran’s Perspective: Employee Support Group for Veterans

It would be so helpful to offer an employee veterans support group. Veterans isolate themselves because they feel others they work with do not understand their experience. Allowing veterans to meet at work will provide a safe environment for them to share current struggles in adapting as well as frustrations with communicating with their fellow civilian coworkers. Imagine being a new employee coming straight out of the military and being able to connect with other veterans at the workplace that have shared similar experiences in serving as well as the difficulties of moving into a new civilian job.

Preparing Employers for What to Expect

When veterans return home, some reintegrate quickly, putting their training and discipline toward becoming successful entrepreneurs or seamlessly moving to a parallel career path. Others need more help with converting their unique strengths into job opportunities best-suited for them. Often employers need coaching on what a veteran employee can do.

Here’s a brief narrative:

A good friend of mine, Charlie Shelby, a retired Army captain, shared his experience of trying to find post-service employment with a well-known technology company:
Talent rep: “So, Mr. Selby, what did you do while in the military?”
Charlie: “I worked in artillery.”
Talent rep: “What does one do when they work in artillery?”
Charlie: “Well, you blow stuff up.”
Talent rep: “Well, we here at [well-known technology company] don’t blow things up. Thank you for your service. Have a nice day.”
Charlie did not get the job.

Sadly, this experience is not uncommon. A colleague from a job-sourcing company shared that “recruiters see a veteran’s resume and say ‘Oh, you have experience using a firearm; your job opportunities are a security guard or a police officer.’”

This limited thinking needs to be turned on its head.

How are we going to sustain enrollment in the armed forces, if returning veterans are not treated properly? How are they going to justify encouraging their children to join if they themselves are not receiving the benefits, entitlements and compassion they deserve?

We grow accustomed and take for granted the benefits their continued sacrifice provides. All of us move through our day-to-day lives with relative ease and safety due to the efforts of armed service members. They protect our freedoms by facing threats to our safety abroad, and, yet, they face tremendous threats to their safety at home.

Work Is Good for Veterans

Meaningful work gives veterans a new mission to focus on. While the exact purpose may shift from protecting our country to something new, the discipline and teamwork needed to reach audacious goals is familiar. Veterans’ sense of duty to a larger cause can help them live through the challenges they may experience like post-traumatic stress or other mental health conditions.

Veterans need to be needed.

The structure of needing to get moving each day can also help veterans’ well-being. A routine in the day of exercising brain and body helps ward off emotional and physical pain. This ebb and flow of work and rest is the rhythm that humans are meant to exist within. Too much idleness is not good for the soul. When work challenges veterans in a good way, they experience “eustress” — the positive side of the stress continuum that helps us continue to grow and learn.

See also: New Approach to Mental Health 

Finally, working helps veterans establish a sense of community and can offer social support. Belonging is central to mental resilience. When veterans find workmates who help them evolve into their best selves, they thrive. A sense of camaraderie is formed that transcends the immediate task at hand. Building a new part of an identity post military service that extends the self into new self-descriptors beyond “former military” is a critical step in transition success. Together this enhanced self-concept combined with new, supportive tribe increases self-esteem and builds a safety net around veterans, so when times get tough, they have something to keep them standing strong.

What to Do if You Are Worried about a Veteran Employee

Treat them like any other employees. Don’t assume that because they served in the military they have PTSD, as many are not deployed and many do not see combat. Do assume that they come with a high level of resilience and self-reliance, so they may not readily disclose if they are experiencing hardship. You may need to ask, reassure, refer and follow up.

1. Ask: All employees should have regular mental health check-ups. Workplaces can participate in national screening days for depression, anxiety and alcohol abuse. If a supervisor or other employee is concerned they should ask directly, “Hey, you don’t seem like yourself lately. Are you okay?”

2. Reassure: Employers can create a culture of caring for all employees by reassuring them that “they have their back” if they ever are facing a mental health challenge.

3. Refer: Employers seeking to support veterans should be aware of both veteran and non-veteran mental health services, including:

  • Veteran Crisis Line — 24/7 crisis counseling for military, veterans and families.
  • Make the Connection — Make the Connection is a free resource with veterans, military families and clinicians who can connect veterans with care for fulfilling, healthy lives.
  • Real Warriors — The Real Warriors Campaign is a multimedia public education campaign designed to promote service members’ engagement with psychological health treatment. The campaign website offers access to 24/7 live chat, message boards and more.
  • Vets4Warriors 855-838-8255 is a 24/7 confidential peer support network for veteran and military communities.
  • Treatment Works for Vets — A new website that offers evidence-based treatment for sleep and mood issues that veterans often face.
  • Give an Hour — Give an Hour is dedicated to meeting the mental health needs of military personnel, veterans, their families and communities affected by the post-9/11 conflicts through counseling and public education.

Non-veteran mental health resources (like most employee assistance programs) are not usually familiar with military-specific stressers like moral injury, traumatic brain injury, military sexual trauma and parenting/relationships challenges during deployment. Employers might brief non-veteran-specific providers with information on these challenges to help ensure that veterans’ experiences are better understood.

4. Follow up: Once support has been offered, following up is advised. Sometimes referrals don’t work out. Sometimes it’s just nice to know that someone cares. You can say, “I am not sure what is happening for you right now. I just wanted to let you know that I hope I can be that person you feel like you can talk to when things get overwhelming. I know you’d do the same for me.”

While it can be challenging to look at issues of distress and despair among our veterans head-on, it is thrilling to consider a future world where our society recognizes and demonstrates our appreciation for their service in a meaningful and material way. A job and career tailored for veterans and their individual skills and abilities allows them every chance for a thriving post-military life.

This article was written by Sally Spencer-Thomas, David Maron and Jason Field.

Impact on Mental Health in Work Comp

According to the World Health Organization, mental health is described as: “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stress of life, can work productively and fruitfully and is able to make a contribution to his or her community.” But the World Health Organization’s definition applies only to part of the population.

At any given time, one in five American adults suffers with a mental health condition that affects their daily lives. Stress, anxiety and depression are among the most prevalent for injured workers. Left untreated, they can render a seemingly straightforward claim nearly unmanageable, resulting in poor outcomes and exorbitant costs.

Increasingly, many in our industry are recognizing the need to do all we can to address this critical issue. We must openly discuss and gain a deep understanding of a subject that, until now, has been taboo.

Four prominent workers’ compensation experts helped us advance the conversation on mental health in the workers’ compensation system during a recent webinar. They were:

  • Bryon Bass, Senior Vice President for Disability, Absence and Compliance at Sedgwick
  • Denise Zoe Algire, Director of Managed Care and Disability for Albertsons Companies
  • Maggie Alvarez-Miller, Director of Business and Product Development at Aptus Risk Solutions
  • Brian Downs, Vice President of Quality and Provider Relations at the Workers’ Compensation Trust

Why It Matters

Mental health conditions are the most expensive health challenges in the nation, behind cancer and heart disease. They are the leading cause of disabilities in high-income countries, accounting for one third of new disability claims in Western countries. These claims are growing 10% annually.

In addition to the direct costs to employers are indirect expenses, such as lost productivity, absenteeism and presenteeism. Combined with substance abuse, mental health disorders cost employers between $80 billion and $100 billion in these indirect costs.

In the workers’ compensation system, mental health conditions have a significant impact on claim duration. As we heard from our speakers, these workers typically have poor coping skills and rely on treating physicians to help them find the pain generator, leading to overuse of treatments and medications.

See also: Top 10 Ways to Nurture Mental Health 

More than 50% of injured workers experience clinically related depressive symptoms at some point, especially during the first month after the injury. In addition to the injured worker himself, family members are three times more likely to be hospitalized three months after the person’s injury. Many speculate that the distraction of a family member leads the injured worker to engage in unsafe behaviors.

Mental health problems can affect any employee at any time, and the reasons they develop are varied. Genetics, adverse childhood experiences and environmental stimuli may be the cause.

The stress of having an occupational injury can be a trigger for anxiety or depression. These issues can develop unexpectedly and typically result in a creeping catastrophic claim.

One of our speakers relayed the story of a claim that seemed on track for an easy resolution, only to go off the rails a year after the injury. The injured worker in this case was a counselor who had lost an eye after being stabbed with a pen by a client. Despite his physical recovery, the injured worker began to struggle emotionally when he finally realized that for the rest of his life he would be blind in one eye. Because his mental health concerns were raised one year after the injury, there were some questions about whether he might be trying to game the system.

Such stories are more commonplace than many realize. They point out the importance of staying in constant contact with the injured worker to detect risk factors for mental health challenges.

Challenges

Mental health conditions — also called biopsychosocial or behavioral health — often surprise the person himself. Depression can develop over time, and the person is not clued in until he finds himself struggling. As one speaker explained, the once clear and distinct lines of coping, confidence and perspective start to become blurred.

In a workers’ compensation claim, it can become the elephant in the room that nobody wants to touch, talk about or address. Organizations willing to look at and address these issues can see quicker recoveries. But there are several obstacles to be overcome.

Stigma is one of the biggest challenges. People who realize they have a problem are often hesitant to come forward, fearing negative reactions from their co-workers and others.

Depictions of people suffering from behavioral health issues in mass media are often negative, but are believed by the general public. Many people incorrectly think mental health conditions render a person incompetent and dangerous; that all such conditions are alike and severe; and that treatment causes more harm than good.

As we learned in the webinar, treatment does work, and many people with mental health conditions do recover and lead healthy, productive lives. Avoiding the use of negative words or actions can help erase the stigma.

Cultural differences also affect the ability to identify and address mental health challenges. The perception of pain varies among cultures, for example. In the Hispanic community, the culture mandates being stoic and often avoiding medications that could help.

Perceptions of medical providers or employers as authority figures can deter recovery. Family dynamics can play a role, as some cultures rely on all family members to participate when an injured worker is recovering. Claims professionals and nurses need training to understand the cultural issues that may be at play in a claim, so they do not miss the opportunity to help the injured worker.

Another hurdle to addressing psychosocial issues in the workers’ compensation system is the focus on compliance, regulations and legal management. We are concerned about timelines and documentation, sometimes to the extent that we don’t think about potential mental health challenges, even when there is clearly a non-medical problem.

Claims professionals are taught to get each claim to resolution as quickly and easily as possible. Medical providers — especially specialists — are accustomed to working from tests and images within their own worlds, not on feelings and emotional well-being. Mental health issues, when they are present, do not jump off the page. It takes understanding and processes, which have not been the norm in the industry.

Another challenge is that the number of behavioral health specialists in the country is low, especially in the workers’ compensation system. Projections suggest that the demand will exceed the supply of such providers in the next decade. Our speakers explained that, with time and commitment, organizations can persuade these specialists to become involved.

Jurisdictions vary in terms of how or whether they allow mental health-related claims to be covered by workers’ compensation. Some states allow for physical/mental claims, where the injury is said to cause a mental health condition — such as depression.

Less common are mental/physical claims, where a mental stimulus leads to an injury. An example is workplace stress related to a heart attack.

See also: New Approach to Mental Health  

“Mental/mental claims” mean a mental stimulus causes a mental injury. Even among states that allow for these claims, there is wide variation. The decision typically hinges on whether an “unusual and extraordinary” incident occurred that resulted in a mental disability. A number of states have or are considering coverage for post-traumatic stress among first responders. The issue is controversial, as some argue that the nature of the job is, itself, unusual and extraordinary and that these workers should not be given benefits. Others say extreme situations, such as a school shooting, are unusual enough to warrant coverage.

What Can Employers Do

Despite the challenges, there are actions employers and payers are successfully taking to identify and address psychosocial conditions.

For example, Albertsons has a pilot program to identify and intervene with injured workers at risk of mental health issues that is showing promise. The workers are told about a voluntary, confidential pain screening questionnaire. Those who score high (i.e., are more at risk for delayed recoveries) are asked to participate in a cognitive behavioral health coaching program.

A team approach is used, with the claims examiner, nurse, treating physician and treating psychologist involved. The focus is on recovery and skill acquisition. A letter and packet of information is given to the treating physician by a nurse who educates the physician about the program. The physician is then asked to refer the injured worker to the program, to reduce suspicion and demonstrate the physician’s support.

Training and educating claims professionals is a tactic some organizations are taking to better address psychosocial issues among injured workers. The Connecticut-based Workers’ Compensation Trust also holds educational sessions for its staff with nationally known experts as speakers. Articles and newsletters are sent to members to solicit their help in identifying at-risk injured workers.

Continuing communication injured workers is vital. Asking how they are doing, whether they have spoken to their employer, when they see themselves returning to work reveal underlying psychosocial issues. Nurse case managers can also be a great source of information and intervention with at-risk injured workers.

Changing the workplace culture is something many employers and other organizations can do. Our environments highly influence our mental health. With the increased stress to be more productive and do more with less, it is important for employers to make their workplaces as stress free as possible.

Providing the resources to allow employees to do their jobs and feel valued within the organization helps create a sense of control, empowerment and belonging. Helping workers balance their work loads and lives also creates a more supportive environment, as does providing a safe and appealing work space. And being willing to openly discuss and provide support for those with mental health conditions can ensure workers get the treatment they need as soon as possible.

As one speaker said, “By offering support from the employer, we can reduce the duration and severity of mental health issues and enhance recovery. Realize employees with good mental health will perform better.”

To listen to the full webinar on this topic, click here.