October 2019 will mark Espyr’s 30th anniversary. Over those 30 years, we’ve witnessed significant changes in attitudes toward mental health, both by society at large and in the workplace.
We’ve evolved as well, changing from EAP Consultants, a company focused primarily on comprehensive Employee Assistance Programs, to Espyr, a leading provider of behavioral health solutions designed to maximize human and organizational potential.
Compared to our founding 30 years ago, people today are much more aware of the importance of mental health and more open to discussing personal mental health issues. Also, employers are increasingly including mental health benefits as part of their company’s wellness offerings.
Despite all the progress in mental health awareness and understanding however, the stigma of mental health persists. Some studies indicate mental health stigma is even worse now than in the past. Meanwhile, many employers, while they talk about the importance of employee mental health, have not taken the appropriate actions necessary to put mental health on equal footing with physical health.
To illustrate the point, let’s recap the state of mental health and, particularly, mental health in the workplace.
Awareness and Attitudes Toward Mental Health Have Changed
In many ways, people today have a better awareness and understanding of mental health and mental health disorders.
• According to a 2015 article in the Huffington Post, as recently as 1996, more than 50% of the US believed that depression was a sign of personal or emotional weakness. While this specific question has not been tracked over time, recent polls have asked whether seeking treatment for mental health issues is a sign of weakness. Less than 20% of respondents said treatment indicates weakness.
• Another study in 2016 compared news stories concerning mental illness from 1995 to 2004, and from 2005 to 2014. Stories in which stigma or discrimination were mentioned as problems increased from 23% (1995-2004) to 28% (2005-2014).
• In a 1996 study, 54% of the US public attributed major depression to neurobiological causes; in 2006, this increased to 67%1. Similarly, the percentage of people endorsing the benefits of treatment by a physician for people with major depression went up from 78% (in 1996) to 91% (in 2006) 1.
• In another study of U.S. adults, only about 25% agreed that people are caring and sympathetic to people with mental illness 2.
Yet, Mental Health Stigma Still Exists
Just over 25% of US adults – one in four – will suffer from a mental disorder in any given year, including anxiety, depression, impulse control disorder and substance abuse3.
Yet, only about 20% of adults with a diagnosable mental disorder4 or with a self-reported mental health condition5 saw a mental health provider in the previous year. One of the major barriers to seeking help? The embarrassment associated with accessing mental health services.
In an article in May 2019, SHRM (The Society for Human Resource Management) noted a telling indicator of mental health stigma from a 2019 study done by Unum and the Disability Management Employer Coalition. In this study, 70% of employees who missed work due to mental health issues did not inform their manager that this was the reason. In the same study, 61% felt that there’s a social stigma in the workplace toward colleagues with mental health issues.
In fact, according to several studies, mental health stigma may be actually increasing.
In 2010, Pescosolido and colleagues assessed the stigma around mental illness by comparing findings from a 2006 survey with a similar 1996 survey. They reported an increase in stigma during the 11-year period, adding, “Our most striking finding is that stigma among the American public appears to be surprisingly fixed, even in the face of anticipated advances in public knowledge.”
Previously, the same researchers had compared the public perception of mental illness in 1996 with findings from a similar survey in 1950. They reported that, despite an increased understanding of the causes of mental illness by 1996, stigma had increased. This finding was also reflected in the 1999 Surgeon General’s report on mental health: “Stigma, in some ways, intensified over the past 40 years, even though understanding improved.”
Mental Health in the Workplace
In the battle to combat mental health issues, the workplace is ground zero. Workplace wellness programs can identify at-risk employees and connect them to the appropriate treatment. These programs also have the means to help employees manage stress. In addition, by addressing mental health issues in the workplace, employers can reduce health care costs for their businesses and employees.
The stakes are high. Depression alone costs the US economy an estimated $210 billion per year, and a little under half of the cost is related to lost productivity in the workplace, according to Darcy Gruttadaro, director of the Center for Workplace Mental Health at the American Psychiatric Association Foundation.
According to the CDC, mental health issues impact the workplace in multiple ways:
Poor mental health and stress can negatively affect employees in terms of
• Job performance and productivity
• Engagement with one’s work
• Communication with coworkers
• Physical capability and daily functioning
Mental illnesses such as depression are associated with higher rates of disability and unemployment.
• Depression interferes with a person’s ability to complete physical job tasks about 20% of the time, and reduces cognitive performance about 35% of the time6.
• Only 57% of employees who report moderate depression, and 40% of those who report severe depression, receive treatment7.
Mental Health and Physical Health are Connected
Complicating things further, mental health issues often occur along with physical health issues, a phenomenon called comorbidity. 29% of adults with a medical disorder have at least one mental health disorder. And 68% of adults with a mental health disorder have at least one physical health disorder.
Comorbidity makes medical diagnosis and treatment more complicated and more expensive. The costs for treating people with comorbid mental health disorders and physical conditions are two to three times higher than for those without co-occurring illnesses. According to a study published in the Journal of Clinical Psychiatry, more than 60% of the $210 billion annual cost of depression is actually going to treat medical conditions that often accompany mental health issues, such as diabetes and heart disease. In fact, it’s estimated that by combining medical and behavioral health care services, the United States could save $37.6 billion to $67.8 billion a year8.
What Leading Businesses are Doing
Unilever, American Express and Prudential are some of the many companies who are stepping up their efforts to improve employee well-being. These businesses have established comprehensive programs specifically designed to support employee mental health. Unilever also provides regular employee workshops on sleep, mindfulness and exercise, all of which have been linked to good mental health and psychological well-being.
General Electric has even taken steps to ensure employees know that the company views no difference between an employee seeking help for opioid addiction or an employee seeking help for cancer. Diana Han, chief medical officer at General Electric, noted that employees engaging in mental health programs are returning to work at a faster rate than unengaged workers. “Days away from work has really been a big win for employees and our business,” she said.
Kaiser Permanente has developed a Mental Health, Wellness and Resiliency Strategy to support company-wide awareness of mental health issues, and to create a stigma-free environment.
Deloitte announced its first Chief Well-Being Officer, Jen Fisher, in 2015. Ms. Fisher launched Deloitte’s Mental Health at Work campaign, which provides mental health training, information and educational opportunities. Deloitte’s employee resource initiatives promote well-being, provide content on how to mitigate stress and practice resilience in the workplace.
Johnson & Johnson has created many internal employee resource groups and programs around mental health. The J&J Mental Health Diplomats – headed by Craig Kramer, J&J’s first Mental Health Ambassador – has recruited over 1,000 employees in 32 countries, and trained more than 350 employees in Mental Health First Aid. The company extends mental health services to employees’ family members, too, ensuring positive well-being beyond the workplace.
Lendlease conducted a global health assessment of its employees in 2013 and found that 16% were at high risk of developing depression. In response, Lendlease introduced Well-Being Leave, an initiative that allowed employees to take one day off every quarter to attend to their health and well-being needs. In its global headquarters, the company also established The Wellness Hub, a place for preventative care, resources and activities focused on employee well-being.
Is It Enough?
Despite these notable examples, there is still work to be done. Just over half of employees surveyed in one recent study stated they either had no mental health programs offered through the workplace or didn’t know if any such programs were offered.
Furthermore, to be effective in maintaining employee mental health, businesses need to train managers to recognize the symptoms and warning signs of mental health conditions. By at least one measurement, employers are falling short in this regard. According to findings released in May 2019, only 25% of managers in the US have been trained in referring employees to mental health resources.
What Should Businesses Be Doing?
Most mental health experts will agree that there are three primary areas where employers should focus their mental health actions:
• Raising overall awareness of the importance of mental health and ending the attached stigma
• Changing the culture
• Improving access to mental health care
In an earlier Espyr blog (Removing the Stigma of Mental Health), we described a number of steps businesses should be taking to increase awareness, remove mental health stigma and increase access to care.
1. Your EAP is the most powerful weapon in your arsenal to combat mental health stigma and increase employee access to help. While this is certainly the case if you have a comprehensive EAP, it may not be true with a “free” or low-cost EAP that came bundled or embedded in a disability insurance product. These “EAP with purchase” products generally provide an EAP in name only; their business model only works if employee engagement is minimized, so they will be unlikely to serve any meaningful role in creating employee engagement.
2. Education and visibility are critically important. Your EAP should be very willing and adept in helping to build awareness and educate your employees. Initiatives we’ve seen work include:
• Hosting lunch-and-learns and guest speakers on behavioral health topics in the workplace
• Offering a monthly topical webinar to educate employees and normalize behavioral health issues
• Providing educational newsletters
• Providing special presentations to educate managers and supervisors about key mental health issues: mental health first aid, suicide prevention, PTSD awareness and substance abuse (including the opioid epidemic)
3. Promote awareness of the EAP and easy access to behavioral health treatment services at company benefit fairs.
4. Create a culture of acceptance, and make sure that it starts at the top. “Having full C-suite level support is important because you need to create a culture of safety,” says Don Mordecai, national leader for mental health and wellness at Kaiser Permanente. “Just going up to people saying, ‘This is okay’ is not going to make them feel safe in our stigmatized society. Workplace culture needs to be open to talking about mental health.” For example, when speaking to employees about medical benefits, include behavioral benefits and issues in the conversation, thereby normalizing behavioral health. Also, incorporate language in company policies to prevent stereotyping and eliminate improper labeling or bullying of employees with behavioral health challenges.
5. Develop a peer support program to train employees to assist distressed co-workers and encourage them to access provided professional behavioral health services.
Helping employees feel comfortable talking about mental health and developing a culture of support is a good start. But these steps are only worthwhile if employees have adequate access to care. Some suggestions we provided in our blog, Removing the Stigma of Mental Health, included:
1. Provide access to an interactive screening program, allowing employees to anonymously take a screening test for stress, depression and anxiety. Then, if they wish, enable them to speak with a behavioral health professional to understand their screening results and, if needed, connect them to the appropriate form of assistance – a therapist, psychiatrist, treatment program or self-help or support group. Espyr offers just such a behavioral health solution, called REALYZE™. REALYZE includes a screening program, as well as a review of the results with a professional, licensed mental health coach. Employees are then connected with the appropriate intervention resources, which could be the employer’s existing health plan. Espyr’s mental health coaches oversee the entire process to ensure more positive outcomes.
2. Larger companies should consider placing behavioral health clinicians on-site at workplaces to assess, refer and provide short-term counseling. A 2015 survey by the The National Association of Worksite Health Centers claims that 45% of all employers offer some sort of on-site health clinic. Adding a behavioral health clinician to these clinics is a natural wellness extension and further helps normalize the concept of mental health.
3. As behavioral health professionals, let your EAP partner help you draft policies that permit employees to leave work to keep behavioral health or EAP appointments. Structure benefits and policies knowing that many areas are underserved in terms of psychiatrists, so alternatives to psychiatry may be needed.
Espyr is Leading the Way
At Espyr, we’ve recognized the changes in mental health awareness, attitudes and our client’s needs over the past 30 years. In addition to providing one of the most comprehensive EAPs that employers can find anywhere, we’ve enhanced our product portfolio with new groundbreaking behavioral health solutions to help employers address the well-being needs of their employees.
• Products like Spotlight and REALYZE work to proactively target at-risk employees and deliver greater engagement, productivity and retention, while reducing healthcare expense.
• Our newest offering, Fit To Pass, provides coaching support and a customized plan to help professional drivers overcome barriers and challenges to achieving better health, especially when it comes to passing their DOT re-certification exams. This program is just as effective for law enforcement or any other occupations that require physical exams as a condition of employment.
To learn more about how Espyr can help your employees and your organization achieve their full potential, please call us at 888-570-3479.
1. (Pescosolido et al., 2010)
2. (Kobau, DiIorio, Chapman, & Delvecchio, 2010).
3. (Kessler, Chiu, Demler, & Walters, 2005)
4. (Wang et al., 2005)
5. (Hennessy et al., 2012)
6. Lerner D, Henke RM. What does research tell us about depression, job performance, and work productivity? J Occup Environ Med. 2008;50(4):401–410.
7. Dewa CS, Thompson AH, Jacobs P. The association of treatment of depressive episodes and work productivity. Can J Psychiatry. 2011; 56(12):743–750.
8. Melek SP, Norris DT, Paulus J, Matthews K, Weaver A, Davenport S. Potential Economic Impact of Integrated Medical-Behavioral Healthcare: Updated Projections for 2017. Milliman Research Report. Seattle, WA: Milliman, Inc.; 2018.