Mental health is in the forefront as an impact of the coronavirus pandemic. A new article in The Atlantic discusses widespread increases of anxiety, depression and substance abuse since the onset of COVID-19. A Kaiser Family Foundation survey found that this public health crisis has hurt the mental health of 56% of adults. The manifestations of post-traumatic stress – from spontaneous conflicts in retail stores to healthcare workers taking their own lives – have become common on the daily news.
Now, more than ever, the mental health of employees in the workplace is an immediate concern for employers. The impacts on productivity, quality control and business continuity are there alongside the health and safety of all workers. Financial insecurity and lost jobs raise concerns over workplace violence. For many workers, their home has become their new workplace, and adverse impacts of domestic and child abuse are emerging with disturbing frequency.
A variety of mental illness factors cost American employers more than half a trillion dollars annually. Investment in improving employee mental health and alleviating some of the stresses causing anxiety and depression yield valuable human and economic returns. Employers can take concrete actions to help their employees get the assistance they need.
Remove the Stigma of Mental Illness — Although it has been almost 25 years since passage of the Mental Health Parity Act, which considers mental illness on the same basis as any other illness, the stigma of mental health hangs on. Mental illness is too often viewed as a weakness, those who suffer from it characterized as “disturbed,” or worse, and the troubles it causes as “all being in your head.” The truth is that mental illness is real illness and requires treatment in the same way that cancer, diabetes or pneumonia does. By communicating supportively and offering real help for employees’ mental health, employers can break down the stigma and encourage early treatment before mental health issues become a crisis.
Communication That Educates — Employers that deal with workplace mental health realistically are doing more than just eliminating negative attitudes about mental illness. They are educating employees on how mental health affects their work, teaching them valuable skills for managing stress and resolving the kind of issues that lead to depression, anxiety or burnout. Resources for educating the workforce in stress reduction, conflict management and personal resiliency are among the training available through Keenan SafeSchools/Keenan SafeColleges/Keenan SafePersonnel platforms.
Supervisors Who Are On Board — Your supervisory and management team are the front line who work directly with the most employees. Just as important as general employee education on mental health, educating supervisors about mental health and supporting their employees helps mitigate the impact of mental illness in the workplace. An empathetic relationship between supervisors and their employees is a key success factor in addressing potential mental health issues early and encouraging the use of available mental health resources.
Professional Assistance Through Employee Benefits — Mental health benefits are vital to employees getting the treatment they need for mental health conditions. As one of the Essential Health Benefits provided under the Affordable Care Act (ACA), employer-sponsored health plans generally provide the range of treatments to address workplace mental health. In addition, an Employee Assistance Program (EAP) is effective for intervention for many immediate issues and response to major crises. These benefits make a real difference in people getting help without creating a financial burden or forgoing treatment altogether.
Employers bear a significant amount of the impacts of mental health. Confronting the challenges of workplace mental health compassionately and realistically, employers can also go a long way to reduce those impacts. While improving the vitality and safety of their facilities, they are also enriching the lives of their employees.
As the U.S. experiences a sudden rise in remote work self-isolation and health-related anxiety, there has been a general sense of unease for many people and exacerbated existing mental health issues for many more. Following a surge in anxiety caused by the COVID-19 outbreak, managing and supporting mental health at work has never been more crucial as research by Pews Research Center shows 73% of Americans reported feeling anxious at least a few days a week.
How Businesses Can Support Employee Mental Health Right Now
With some team members working remotely and others off ill, quarantined or self-isolating, it is more important than ever for businesses to retain talent, reduce presenteeism and maintain morale.
Break the Culture of Silence:There is still a stigma around mental illness that makes employees more likely to suffer in silence than share information with their managers or bosses. Around 82% of employees with a diagnosed mental health condition do not confide in management, and 40% of employees have given a false reason when taking time off for mental health.
Now is an ideal time for leaders within businesses to talk more openly about mental health and create a culture that encourages conversations around these issues. Taking a mental health day or asking for support should never affect an employee’s reputation or how the employee is perceived.
Keep Socializing With Your Teams:Remote working has its perks, but a lot of people are feeling isolated right now. Office banter is missed most about work since lockdown, with a recent study by Vodafone showing that 41% say they miss the daily jokes.
Environmental psychologist and wellbeing trainer Lee Chambers says dealing with a lack of social connections during the outbreak is a massive challenge for a lot of people: “In these turbulent times, social connection is vital to our wellbeing. Without the ability to go out and socialize in the way we usually would, we have to be more creative and have more intention in our connection with others during this lockdown scenario. In some ways, the enforcement of rules around movement have caused us to slow down. This actually gives us the chance to connect on a deeper level.”
Lead By Example: With many employees working remotely, managers need to be more conscious of the challenges that different households are facing. Encouraging flexibility, self-care and regular check-ins is key to reducing presenteeism and stress and ensuring that employees facing any issues can be identified and supported. Encourage transparent conversations and put action plans in place for team members who need help.
Introduce Team Activity and Training Sessions:With employees using tools like Zoom to connect with the office remotely, now is a great time for businesses to encourage morning catch-ups, remote Friday drinks, yoga sessions or even company training sessions. Encourage team members to take a class they’ve always wanted to try, or to attend industry-related webinars. This is a great way to support employees looking to upskill themselves and stay busy.
More work needs to be done to ensure businesses take care of their most valuable assets – their employees. Encourage employees to self-advocate and seek early intervention before their mental health requires more stringent measures, like having to take stress leave or resign.
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.
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 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.
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.
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.
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
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.
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).
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:
What services does your EAP cover? Are these services available 24/7?
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?
How are counselors selected and trained? Are certain licenses and other credentials required to be a part of the EAP provider network?
What types of training have EAP providers received? Specifically, when was the last time they received training in suicide risk formulation and treatment?
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?
Do your employees know about your EAP services and how to access them?
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?
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?
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?
How is your EAP measuring outcomes? Can they also provide you with a return-on-investment (ROI) or other cost-benefit analysis?
How is the EAP promoting upstream mental health efforts like prevention, resilience, positive psychology and work-life integration?
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?
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?
Is the employer receiving regular reports (i.e., bi-annual, annual) from the EAP on utilization, presenting problems, satisfaction and other workplace outcomes?
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?
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 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.
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.
Midstream: Early Detection and Peer Support/Life Coach Apps
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.
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.
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 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.
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 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 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?