Damian Sendler, M.D. – Employers are increasingly concerned about the mental health and well-being of their employees, especially in the wake of the COVID-19 pandemic. Despite the fact that the virus has been around for over a year, many employees are still afraid of contracting the disease or spreading it to others, whether they are family members, coworkers, friends, or complete strangers. 1,2 There are additional pandemic-related stressors that have further affected employees’ mental health, including high ambiguity and uncertainty, social isolation due to physical distance measures, changes in both work and domestic duties, and concerns about financial and job security. 3 Recently, during the COVID-19 pandemic, workers were more likely to report mental health symptoms such as increased guilt (24%), insomnia (38%), agitation (50%) and sadness (53%), as well as emotional exhaustion and fatigue (54 percent ). 4
Damian Jacob Sendler: Mental illness has a devastating effect on the economy. As an example, the US economy lost $210.5 billion (2010 USD) as a result of depression, with about half of that amount paid for by employers. 5 Depression is often accompanied by other long-term conditions, which increases the financial burden on employers and healthcare providers. Comorbid conditions like cardiovascular disease and diabetes account for about 60 percent of the cost of depression. 6 It has also been found that the working-age population has higher rates of anxiety, substance abuse, and mental health issues than any other group in the population. 7 Work is a major source of stress for adults in the United States, and job-related stress has been linked to poor mental health8. Many of these workplace stressors are linked to an increased risk for a variety of mental health issues, such as depression and anxiety. 9
Dr. Sendler: Absenteeism and presenteeism, two common manifestations of poor mental health, have significant indirect costs in addition to the direct ones associated with treatment (ie, performance decrements while continuing to work). Absenteeism and tardiness cost an estimated $1.7 trillion a year in direct and indirect costs in 2010, and these figures are expected to rise to $1.8 trillion a year by 2030, according to the World Health Organization. 10 When it comes to promoting good mental health, employers are looking for guidance on action steps that are evidence-based, cost-effective, and broad in scope.
But employers often find it difficult to assess their employees’ mental health needs because mental health conditions are still stigmatized. A culture of silence and discrimination prevents employees from speaking up for themselves or asking for assistance. Employee assistance programs (EAPs) offer mental health services that are often underutilized, despite their widespread availability. Employees with mental health conditions are reluctant to seek help because they are afraid of being discriminated against by coworkers and superiors, social exclusion, and being perceived as incompetent. This can have a negative impact on employee performance, interpersonal relationships, and workplace well-being. 11
In 2016, the Johns Hopkins Bloomberg School of Public Health (JHSPH) hosted a public health summit titled: Mental Health in the Workplace. The current state of workplace mental health practices was discussed by professionals from a variety of fields. An open call to action to improve workplace mental health was made at the summit’s conclusion, and a list of recommendations for further research and actions by employers was provided. 12 Recommendations made by the consortium included: 1) developing a quantitative scorecard for measuring mental health in the work environment, 2) transforming workplace cultures to value mental well-being, 3) increasing the accessibility of workplace mental health information, and finally, 4) setting up an award to recognize exemplary programs and to encourage employer participation in mental health initiatives
JHSPH and The Luv U Project have partnered to create the Carolyn C. Mattingly Award for Mental Health in the Workplace (Mattingly Award), which focuses on developing evidence-based criteria for this award.
1 A corporate social responsibility award that recognizes outstanding efforts to improve mental health in the workplace could boost the reputation and brand of companies that are already doing this and inspire others to do the same.
It’s easy to overlook the importance of organizational culture because most companies with established organizational structures already have recurring behavioral patterns in the form of distinct power relationships and political structures that are deeply ingrained in their workplace environment.
18 These behavioral patterns will then have an impact on other organizational variables and workplace behaviors. Workplace values and norms, physical and social environment, and “unconscious assumptions that make up the culture of an organization” are all possible variables. 18 As a result, establishing a strong mental health culture can have a significant impact on the awareness, utilization, and impact of mental health programming efforts. A company’s culture is made up of a variety of elements, including the actions and attitudes of its leaders and managers, as well as any guiding documents or official policies. When taken as a whole, these represent the company’s core values and can help or hinder the mental health of employees.
In addition to having a supportive corporate culture, employers must offer comprehensive coverage for mental health services as part of their health insurance plans. People who need mental health treatment are often discouraged from seeking it because of the difficulty in finding a provider in their area and the high out-of-pocket costs. 20 Access to numerous mental health professionals, a wide range of mental health benefits covered, lower or no cost-sharing for treatment, and the elimination of unreasonable service limits, such as the number of outpatient sessions covered, lifetime spending caps or restrictive prescription medication rules, are all part of the solution. These components are also included in the solution.
The MHPAEA mandates that companies provide employees with equal access to both physical and mental health services.
21 As a result of the Affordable Care Act’s expansion of the MHPAEA’s mandates, mental health and substance use disorder services were included as one of ten “essential health benefits,” and many insurance plans were required to cover preventive services like mental health screenings. 22 Despite paying 12 percent more than Medicare for services provided by other physician specialties, private insurance companies pay 13 percent to 14 percent less than Medicare for mental health coverage, according to a Congressional Budget Office report, highlighting the growing gap between inadequate mental health coverage and higher cost-sharing payments. 23 One way to ensure that employees can afford needed mental health treatment is to address this cost barrier. Organizational outcomes are positively correlated with workers’ access to high-quality mental health services. For example, depression treatment has been shown to reduce absenteeism and presenteeism by 40% to 60%.
Employee assistance programs (EAPs) frequently offer mental health counseling and support services for employees who are dealing with personal or work-related stressors. The effectiveness of an EAP program can vary widely depending on a number of factors, including the provider, the scope of services offered, the program’s use, the organization’s culture, and the level of care provided. 25 An original program to address alcohol abuse in the workplace has expanded to include a wide range of services, including clinical assessments and brief counseling as well as referral to community resources that provide counseling services, including those focusing on financial wellness. 26
By partnering with insurance carriers and offering mobile applications and telemedicine, EAPs have evolved from their original models to ensure that the services they provide are more widely disseminated and accessible.
As a result, EAPs have been able to play a more prominent and important role in the management of behavioral health risks.
Damian Sendler
Companies that place a high value on employee well-being have employee assistance programs (EAPs) that provide access to counseling, substance abuse treatment, and referrals to local providers who accept the company’s insurance. The low use of EAPs by businesses is one of the main issues they still face. 28 Although a majority of civilian workers in organizations with 100 or more employees have access to an EAP29 and despite substantial evidence indicating that EAPs increase the well-being of employees who actively use the services,30 utilization averages just 2% for basic EAPs bundled with other benefits, and 8% for more comprehensive full-service EAPs. 31 Employee assistance programs (EAP) with a proven track record of success are more likely to be utilized, which in turn increases the likelihood that those in need will be able to get the help they need. The use of EAP services alone will not suffice to determine whether or not a company’s mental health needs are being met; a multi-method assessment is required to place EAP usage within the context of a healthy or unhealthy company culture.
Anxiety and depression in the workplace have been linked to high levels of workplace stress, and long-term exposure to this type of stress can harm one’s mental health as well as their physical health.
32 In a study examining EAP impact on clinical outcomes, employees who used EAP services performed better clinically than those who did not use EAP services. 33 EAP professionals are trained to identify and address the root causes of employee mental health issues in order to meet the needs of a wide range of workforce populations. 33
Employers may also provide other types of stress management programs in addition to EAPs, with the goal of lowering blood pressure and cholesterol while also helping employees cope with stress and anxiety.
34 It is possible to categorize them as follows: cognitive behavioral therapy (CBT), relaxation/meditation/mindfulness techniques (RMT), system restructuring (RSR), multimodal interventions, or alternative interventions. 35
Organizational factors that cause stress are being examined more closely by employers in order to develop programs to alleviate these stressors, which have a direct impact on health and well-being outcomes.
Damian Jacob Markiewicz Sendler: There are many factors that contribute to work-related stress, including heavy workloads, lack of control and autonomy, work-life conflicts, increased technological demands, and unpredictable schedules. As part of the 36 strategies for preventing and reducing stress, supervisors can improve communication and management support while also ensuring that workloads are in line with employees’ abilities and resources.
For a work environment to be healthy and safe for employees’ mental well-being, it is essential to prevent and address issues such as physical and verbal abuse, sexual harassment, and other forms of discrimination. It is possible to develop chronic health conditions as a result of psychological and physiological stress caused by workplace discrimination and harassment. 38 Inequality in the workplace, such as unequal treatment or limited opportunities, can be exacerbated by a workplace that is racially or gender imbalanced. 39 For both employees and organizations, toxic work behaviors can cause long-term distress from negative emotions that result in increased staff turnover as well as a decrease in job satisfaction and attrition. 40
It is possible to reduce or eliminate these harmful practices through policies and training. Workers with mental health conditions can benefit from workplace orientation programs that include training on the normative behaviors associated with bullying, harassment, and discrimination, as well as information about their right to confidentially report these issues to human resources personnel.
Damian Jacob Sendler
Ergonomic office design concepts must be considered in order to prevent injuries. Office location, layout, and workspace can have a significant impact on the well-being of employees, both physically and emotionally. 43 Employees’ physical, mental, and cardiovascular health can be improved by ensuring that their work environments and work tasks are as closely aligned as possible. Lower back pain and tendonitis from physically demanding jobs are common work-related musculoskeletal injuries that can lead to long-term health problems and disability. Promoting health-conscious attitudes, coworker support, reducing repetitive work, and better work postures are all examples of protective ergonomic factors.
Individuals’ mental health can only be improved if their workplace has a supportive culture. Changes in the “physical surroundings and social, economic, or organizational systems” are necessary to achieve this goal of promoting and improving mental health in the workplace. 45
Opportunities for social connections and self-care can be found in a supportive work environment. Creating an inclusive and connected workplace is a social process that requires organizational responsiveness in order to achieve mutual understanding and make accommodations for people with mental health conditions. 42 Employee well-being, reduced fatigue, and lower rates of burnout are all linked to workplaces that provide opportunities for stress recovery and mental recharge, such as quiet rooms to rest in and breaks from work like vacation days, work-free weekends, and “real” lunch breaks. 46 In order to foster a positive work environment, it is important to alter the physical and social surroundings. 47
Damien Sendler: Employees’ nutrition and fitness needs can be met in a holistic work environment, for example, by providing healthy food options in cafeterias and providing nutrition education. While not every workplace has the resources to provide on-site fitness facilities, employers can lower the barriers to physical activity by offering employees discounts on fitness club memberships or hosting activity challenges. 7 Participants in workplace wellness programs showed lower stress levels, improved social satisfaction, higher energy levels, and improved self-efficacy and quality of life after the program was completed, according to a study that examined employee health using the validated SF-36 mental health scale.
Employees’ perceptions of mental health in the workplace can be influenced significantly by leadership’s openness and consistency in providing it. It is impossible to implement workplace mental health policies without the full support of the company’s leadership at all levels. Employees’ perceptions of the company’s commitment to health promotion are shaped by the emphasis that leaders place on improving mental health in the workplace. 49 Making mental health an integral part of corporate leadership is an important step in reducing the stigma around mental health issues. As a result of leadership training, employees are able to learn more about mental health benefits, resources, and the importance of emotional well-being from their managers. To close the gap between employee mental health needs and the resources available to address those needs, training leaders in adapting their management style to the needs of employees is essential. Rather than relying on employees to openly discuss their mental health issues, leaders can take the lead by modeling desired behaviors and providing support services to address workplace stressors and psychological impediments to individual and team well-being.
Establishing positive organizational climates can be done with positive leadership practices. Workers who have mental health issues can benefit from workplace leaders taking on the role of wellness champions. This will not only increase awareness of mental health issues and encourage people to seek help, but it will also increase the likelihood of successful treatment delivery. 50
Management at all levels can demonstrate supportive supervision by encouraging employees to identify and address the sources of stress and conflict in their personal and professional lives.
36 This has been shown to have a positive effect on employee job satisfaction, physical health, and productivity in the workplace.
Measurement of employee mental health and well-being outcomes is essential to establishing the impact of organizational mental health efforts. EAP awareness, utilization and satisfaction with available resources and a decrease in stigma related to mental health are all indicators of success. There are currently no standardized metrics for determining what constitutes “success” in a mental health program at work. Employee engagement and satisfaction with their work environment, supervisors and colleagues, participation in health-promoting programs and services, as well as an improvement in psychological well-being indicators can be used as indicators of a healthy company culture’s success. It is critical for employers to clearly define their overall goals and objectives for such programs in advance, and to continually monitor the key metrics linked to those goals and objectives throughout the program’s life cycle. To be eligible for the Mattingly Award, a workplace mental health program must meet the following criteria: structure, process, and outcomes.
Programs aimed at reducing workplace stigma aim to improve mental health knowledge, attitudes, and behaviors regarding mental illness There is still widespread workplace discrimination against people with mental illnesses, as evidenced by a recent study that found that nearly half of the general population (47%) was unwilling to work or socialize with people who had been diagnosed with depression. 51 Fear of social exclusion, lack of opportunities for advancement, and over-inferring of mistakes to illness are some of the reasons why people avoid disclosing their mental health status. 52
Healthy workplace cultures are those that encourage, humanize, and prioritize the well-being of their employees. However, negative outcomes may reflect unhealthy work cultures that include high levels of stress, unmanaged risk factors, unpleasant or dangerous working conditions, and in more extreme cases, discrimination and harassment as well as dysfunctional power dynamics that can lead to hostile work environments or violence. Simple assessment tools and surveys can be used to determine the overall well-being of employees and the effectiveness of workplace interventions in order to evaluate these outcomes. Psychosocial, organizational, and environmental categories of assessment tools exist. PHQ-9 and GAD-7 surveys are examples of psychosocial tools, while the CDC Worksite Health ScoreCard, 53 the Hero Scorecard, 54 and the Workplace Health Achievement Index55 are examples of organizational tools. An environmental assessment focuses on identifying and addressing health and safety hazards in the workplace, and this may include making sure that workspaces are ergonomically designed to prevent injury, eliminating exposure to chemical or biological toxins, providing personal protective equipment like N95 face masks and protective clothing, and implementing adequate security measures to reduce the risk of violence in the workplace.
New approaches to workplace mental health have emerged due to the widespread use of technology and the increased interconnectedness that characterizes today’s world. Technology-based approaches can be found in some initiatives, while others are based on theory and focus on making resources more accessible.
Another interesting side effect of telehealth is the rise of tele-mental health innovations. Apps aimed at training mindfulness, improving cognitive performance, and reducing work-related stress are becoming increasingly popular among businesses. 56 Anxiety and depression symptoms can be effectively treated with the help of e-health interventions that are targeted, individualized, and less likely to be biased. Growing evidence suggests that mobile platforms can improve healthcare delivery. 56 EAP underuse has resulted in a lack of attention to employees’ mental health needs, and many employers believe that these new technologies will help employees track and monitor their own mental health and locate relevant resources while protecting their privacy. 50
In light of the increasing focus on behavioral health offerings by more employers,57 there is a growing need for innovative solutions that help increase awareness and access to care resources. Employers can offer behavioral health services at the workplace by partnering with providers to develop tailored mental health plans that meet each organization’s unique preventive and care solutions as healthcare mobility solutions become more cost-effective and integrated into primary care.