In recent years, mental health has been in the spotlight around the world. In addition to new challenges brought forth by the pandemic, a confluence of other factors drew attention to an issue that has, until now, remained under the radar.
The prevalence of civil unrest, mass shootings, a growing opioid crisis, and a shortage of mental health practitioners all played a part in shining the light on emotional wellbeing.
Today, people receive mental health care from many sources, and many begin in the workplace. Manager referrals to an employee assistance program are highly effective, in part because mental health and substance use are so firmly linked to work performance. It has been widely accepted that an employee struggling with behavioral health issues will hang on tightly to a job until the bitter end. Because of the motivation to hang on to one’s livelihood, the workplace becomes a critical steward of behavioral healthcare.
An Employee’s Mental Health Affects Their Work, and Vice Versa
Employee Assistance Programs (EAPs) have been the primary means for organizations to offer mental health care, besides health insurance. According to data on corporate EAP adoption, 97% of larger employers have an Employee Assistance Program and 50% of Americans get their mental health care from work.
Originally started to address addiction issues, EAPs quickly pivoted to be able to address all types of wellbeing issues. The result is that most top-tier EAPs achieve 30-50% impact when they offer a variety of options, and their services are easy to access. This is especially true when they are encouraged to promote these services in the workplace.
How an EAP Provides Mental Health Support
Employee Assistance Programs typically offer a variety of services geared to helping with social determinants of health such as legal issues, financial hardship, childcare resources, and eldercare challenges.
EAPs are provided by external vendors with a high value placed on timely and confidential services. Practically speaking, the assistance can come in the form of tele-support (a number an employee can call when they need to talk), an online or in-app chat function, or support in seeing a counselor or therapist.
Many EAPs and employers are adding additional mental wellbeing resources to their slate of benefits including pastoral care, peer support, and cognitive behavioral apps. All of these are geared toward helping with the shortage of licensed mental health providers while providing options for traditional therapy.
Manager Education on Employee Wellness is Critical
In some ways, the workplace sets a good stage for monitoring and managing emotional difficulties. For one, a good manager is paid to be aware of how their direct reports are doing. Even with many employees working from home, managers depend on others to deliver work that is done well and on time.
A key job of managers is to recognize changes in job performance and address them before the employee reaches a point of burnout or long-term harm. Changes in work performance might include missing deadlines, making errors and omissions, or having personal conflicts with others. At the same time, managers may also notice when someone is struggling with personal problems or starting to look depressed.
Mangers' responsibilities don't disappear when staff are on the way out, either: minimizing layoff anxiety if and when these difficult situations arise is also key.
EAPs typically train managers to identify employee issues quickly before they worsen. Early markers that a manager might take note of in order to stay alert to emerging issues include:
- Knowledge of multiple life challenges or other stressors
- Signs of depression or anxiety, or the early stages of burnout
- Signs of absenteeism
- Indications of presenteeism
- Repeated conflicts with others
- Change in affect or mood
- Known exposure to trauma
Early Intervention is Key
An important goal in workplace mental health is to encourage early intervention. The best kind of call to an EAP is one that happens well before a crisis.
To accomplish this, an EAP must be widely promoted and supported throughout the work environment. This requires a true partnership between the EAP and the organization. Of course, employees may be guarded about their personal issues, and a manager may become aware of their challenges long after it has taken a toll.
The role of a manager is also to notice undisclosed barriers in an employee's engagement and work performance.
The Markers of a Struggling Employee
When poor job performance occurs right at the beginning of a new job, it is assumed that it is the result of a poor hire or a poor skill match with the job. But when problems develop well into employment, it is most often found to be a result of personal problems.
Indicators that an employee is going through a difficult period and/or mental health struggles may include.
- Signs of being overwhelmed or exhausted, such as being agitated, absent-minded, or easy to tears.
- A loss of interest in their work.
- Negativity towards new initiatives, or in general.
- Changes in their work performance.
- Distancing themselves from others.
- Regular unexplained absenteeism
These behaviors are sometimes easier for managers to see than for an employee to recognize in themselves. So it makes sense that a manager might nudge the employee to make use of an EAP before they thought of it. The critical and deciding factor here is the accessibility of the assistance they need to get back on track.
When signs of dwindling work performance start to be visible, a good manager will notice and act.
Managerial Steps to Assist a Struggling Employee
- Preparing for intervention: The first step might include a call to the EAP to prepare for the conversation with the employee.
- Speaking to the employee: Usually, a “heart-to-heart” talk with an employee to give and get feedback would start off as, “I’ve noticed that you seem distracted lately and I wondered what’s going on?”
- Intervention and referral: Depending on the outcome of the conversation, a referral to the EAP might take place, along with a plan to talk again after a specific period. The referral should never be forceful. A suggestion, such as, “Are you aware that we have an Employee Assistance Program and that the services are strictly confidential” might be all someone needs to reach out for help.
- Checking in: Follow-up is critical, even when managers find these conversations difficult or unpleasant.
Many new telehealth networks have emerged to make counseling services accessible. However, technology alone cannot solve mental health problems. There is no replacement for human oversight and even strong assistance programs are known for a concierge approach.
A good EAP helps employees figure out what kind of help they need. Telehealth networks typically offer therapy and not all employees need therapy. If they bypass the EAP and go directly to a telehealth network, they may never know about all the other services offered by the EAP such as child care search, legal and financial services, and parent coaching. Counseling doesn't solve some of these more practical problems.
EAPs Combat Presenteeism
The recent Littler Annual Employer Survey found that 65% of respondents (consisting of 515 in-house lawyers, senior executives, and HR professionals across the U.S.) received an increase in requests for disability accommodations and leaves of absence related to mental health conditions/issues since the start of 2022. Although this indicates employees are taking their mental health more seriously, it’s probably not a reflection of the true need for intervention.
A lot of workers don’t take the time they need to deal with mental challenges because of financial reasons, or because they simply don’t feel comfortable asking for the time off. If there is a stigma within the company about mental health, an employee might be reluctant to ask for help. This is particularly true if the stigma seems prevalent among management.
Presenteeism, when employees come to work instead of taking time off to address physical and mental health issues, is much more difficult to observe than absenteeism. Yet, presenteeism is often more costly to organizations than absenteeism because it tends to go unnoticed for a longer time.
An Explanation of Presenteeism
Presenteeism occurs when someone is on the job, but not fully functioning. This can be the result of distractions such as personal problems, pain, illness, substance use, anxiety, or depression. Most workers will continue to go to work, even when they have mental health concerns or their physical health isn’t up to par. Presenteeism often gets worse when there are economic pressures— as there are for many people post-pandemic.
Signs of presenteeism can include:
- Making more mistakes than usual
- Issues with performance or quality of work
- A sense of disinterest or apathy toward work-related issues
- Disappearances during the workday
- Missed meetings or avoiding cameras on virtual calls.
- Working when ill
- Appearing fatigued or disheveled
Presenteeism can also be the result of multiple problems converging, or when an employee becomes distracted by multiple demands at the same time. An elder care issue is a good example of this:
When an elder goes into crisis, it often lasts for months while new services are put into place. It may involve getting emotional support, arranging a full-time or part-time caregiver, getting services lined up like Meals on Wheels, and/or finding an assisted living solution. Whatever the issue, these are normal problems that require heavily consequential decision-making on the employee’s part. That can put extraordinary stress on any employee and may cause presenteeism.
Addressing Presenteeism with an EAP
Research on presenteeism is some of the best in the EAP industry. For the past 12 years, data from multiple EAPs involving 35,693 employees has shown that presenteeism improves after using an EAP.
Originally developed by Chestnut Global Partners, the Workplace Outcome Suite has been widely adopted by EAPs across the country. The study found that over half of the people who use an EAP for counseling become more engaged at work after counseling and show fewer signs of presenteeism.
EAPs help with personal problems and indirectly improve productivity at work by 50%. An older review by the National Behavioral Consortium found that, in a large study of 100,000 EAP cases, 86% reported clinical improvements from the help they received. Of course, results vary, depending on the quality of the EAP.
The Reasons Why Employees Contact an EAP
Naturally, the drivers that lead to employees’ overwhelm or poor mental health are varied and can be one thing, or multiple aspects of their lives. According to the experts in the field of EAP research, and subsequent reports, the predominant reasons why employees make use of an EAP are as follows:
- 30% have a mental health or emotional issue such as depression or anxiety disorders.
- 29% want help with their personal life and stress management
- 19% need assistance with a relationship issue (marriage, family, or personal)
- 19% are experiencing difficulties with work and workplace stress
- 3% need help with substance use
Once an employee has contacted an EAP provider, assistance can be provided in a number of ways, for example:
- Debriefing and stabilizing for traumatic injuries
- Assessment and referral for addiction
- Assistance with caregiver issues
- Referral for parent coaching
- Financial and legal support
- Referrals to CBT (Cognitive Behavioral Therapy) apps
- Referral for peer support
The need for personal counseling may not help solve the problem if multiple problems are converging. For example, new research used neuro-linguistic programming (NLP) and electronic health record (EHR) data to demonstrate the link to underlying legal issues and other social determinants in people who died by suicide. EAPs have unique, evidence-based expertise in assessing complicated situations and helping employees know where to start.
5 Ways Employers Can Support Mental Health
1. Invest in an Employee Assistance Program
Make sure you have a top-tier EAP in place and that you are promoting it well within your organization. Look in depth at your EAP services and make sure that the services are easily accessible, and that personal follow-up takes place.
Try out the services yourself to see how accessible and thorough they are.
2. Provide Mental Health Benefits
Since employees rely on their employers for mental health care, make sure that your medical plans are top-notch.
Look at coverage to be sure there aren’t disincentives for improving one’s wellbeing. For example, are there long wait times for mental health care within your insurance carrier? Are people accessing inpatient substance use treatment because outpatient resources aren’t available? Are there pharmacy disincentives that might create a barrier to taking mental health medication?
3. Consider the User Experience
Evaluate the journey that an employee might undertake to get help for a mental health issue.
Try out all your benefits to evaluate barriers. Some plans tout giant provider networks but have few available resources in reality. Others overuse AI to set up appointments and leave users frustrated.
4. Make Sure There is Follow-Up Support
Whatever services you are using, make sure there is 100% follow-up after a mental health inquiry.
Without a personal follow-up call to the individual, one might never know whether a good connection to mental health services was made. Make suicide prevention a priority for everyone.
5. Promote a Positive Attitude Toward Mental Health Assistance
Even with the progress of the last two years, there is still a stigma about mental health. Make sure that the workplace environment and culture support good mental health care and are working on removing the stigma.
Creating a Mental-Health-Friendly Workplace
There is so much on the line in workplace mental health. Most people strive for a management role because they want to mentor others and be role models. However, today there is no more important issue than helping people who are burdened by emotional or substance use issues. In the long run, managers may experience more job satisfaction from the times they help their employees through personal problems than from their other professional achievements.
Start at the Top
Like many organizational issues, a top-down approach to mental health is needed to address and avoid stigmatization. However, in order to support employees fully, a good relationship with mental health and a healthy focus on work-life balance must come from the top.
Meet with senior leadership to look for “champions” of good mental health and workplace wellness. Who on the leadership team is willing to tell a story about a time when a personal crisis de-railed them to the point of causing work problems? How many are willing to speak out (on video or in person) to illustrate how important mental health awareness can be?
Acknowledge and showcase managers who are role models and identify other managers who might need training or coaching to do this. There also might be some “champions” of recovery who would be willing to speak out and go more public.
Focus in Inclusivity
Ensure that senior leaders are handling all the current diversity issues well. Nothing will undermine a leader’s respect more than a demonstration of insensitivity to issues related to race, gender, sexual identity/orientation, and employee health. If a leader is turning people off at the get-go, this needs to be addressed first.
Make Mental Health a Company-Wide Priority
Only with leaders and managers on board is it time to offer training to the troops.
The EAP will recommend trainers and consultants to offer programs such as mental health first aid, diversity and equity awareness, and EAP awareness. These programs should link back to the EAP and help to take the stigma out of getting help.
Get Out of Your Own Way
When it comes to mental health, many people (including leaders) have unconscious biases and nervousness about open discussions. Whether we want them to or not, these things can sabotage efforts you make in creating a healthy workplace where addressing mental health challenges is celebrated.
Here are just a few examples of things that leaders do that unintentionally damage employee mental health.
- Personal distance and disinterest: Failing to get to know someone means you can’t notice when their demeanor or attitude changes.
- Assumptions: Assuming you know/understand what is going on in an employee's life without asking the person for verification.
- Inappropriate speech: Making insensitive remarks or jokes about mental health or diversity issues. Throwing around terms like “manic,” “mental,” or “OCD” when referring to employee traits or tendencies is also wildly inappropriate.
- Deprioritization: Failing to teach managers and employees to be allies and initiate conversations with each other about mental health.
- Lack of EAP promotion: Failure to teach others how to use the EAP and connect employees with other resources.
- Stigmatizing mental health: For example, referring to mental illness or substance use disorder as “character flaws”, “choices”, or “excuses” as opposed to medical issues.
- Shaming mental health problems: For example, implying that there is some “willpower” involved or that emotional problems are “hard-wired” or that someone can just “snap out of it” implies that they are in the wrong for having this issue.
- Trivializing mental health problems: Saying things like “It could be worse,” “I know how you feel,“ or “Focus on things for which you are grateful” is also unhelpful and it implies that the employee’s mental health is “an easy fix”.
- Falseness: Hiding one’s own personal problems to try and look perfect.
- Missing the markers: Failure to inquire about whether an employee is thinking about self-harm in response to warning signs
The Way Forward to Employee Assistance
According to survey data, 61% of employers are planning to make changes in their mental health benefits in the coming year. In addition, 24% of employers plan to increase their EAP benefits over the next 3 years.
Overall, much more emphasis will be placed on early identification of workplace mental health problems. Additional focus will be placed on improving the quality and impact of EAP by promoting the existing services more thoroughly. Ancillary services will be added to their core offerings.
Other changes involve a top-down approach to normalizing mental health and offering specific mental health training for managers. Your organization would be well-advised to follow suit and offer employees the support they need.
