Removing barriers to mental health to support employees

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question mark graphic made up of word such as who how what when Patients wanting mental health help often don’t know where to turn—and if they do, they often face long waits to see someone. (Photo: Shutterstock)

When COVID-19 first hit the U.S., the primary focus was on the physical impact of the disease. While physical health is undeniably important, it’s time to think about the effect on mental health.

In a Kaiser Family Foundation survey, 45% of adults said that their mental health has been negatively affected by the COVID-19 crisis. According to research by SHRM, 22 to 35% of workers have often experienced symptoms of depression as a result of the pandemic. Since the pandemic struck, employees’ work-related worries have increased, with 40% of respondents reporting feeling hopeless, burned out, or exhausted.

Related: Employee burnout affecting more than just productivity

The problem is clear: Mental health is a critical but often overlooked component of overall employee well-being. However, awareness is growing: Half of employers say they have offered some sort of mental health support since COVID-19 arrived. The trouble is that only 7% of workers have actually contacted a mental health professional.

Given how stress and poor mental health affect employee job performance, productivity and communication with coworkers, employers need to better support their workers in this regard. The problem is that not all organizations understand the barriers to care, and many do not evaluate the effectiveness of the care they offer to ensure that it’s supporting their workers’ well-being.

Barriers to care

Getting mental health care was a challenge long before the COVID-19 crisis.

Patients wanting care often don’t know where to turn—and if they do, they often face long waits to see someone. Why? On average, there are just 20 mental health care providers for every 100,000 people in the U.S. This shortage means that employees may struggle with mental health challenges far longer than needed, which further harms their mental health.

Even if providers are available, cash may not be. Too often, a copay proves a burden enough to deter patients from seeking care. And because insurance coverage may be limited — and some providers won’t accept insurance at all — cost becomes a real hurdle that some may be unable to overcome. Consider this: a counseling session in New York City costs, on average, $220, and a counseling session in Providence, RH costs $150 on average.

Then there’s the fear of being stigmatized, which occurs among various demographics for different reasons. For example, men who were raised to hide their feelings worry they’ll be seen as weak if they ask for help. Overcoming this barrier to care in this demographic is especially critical because men are far more at risk of suicide or accidental death from substance abuse.

People of color also face stigmas and other barriers to care, such as finding therapists who understand the specific problems they face. Compounding the problem: racism both causes and exacerbates stress and depression.

How your clients can support their workforce

Benefits brokers and employers have an important role to play in supporting workers, particularly during this difficult time. Here are a few options for mental health treatment and support.

Traditional therapy

Many therapists are offering care via video chat or phone, thanks to the CARES Act, passed in response to the pandemic, which expanded Medicare access to telehealth services, allowing patients to speak with their provider remotely, instead of risking exposure at the doctor’s office.

Employees who already have a therapist may have transitioned smoothly to virtual care with their current provider. However, this model doesn’t solve the problems of high costs and the difficulty of finding a provider.

Employee assistance programs

Employee Assistance Programs (EAPs) are ubiquitous among employers’ offerings. Offering a wide variety of services, from daycare finders to therapy to financial counseling, EAPs aim to address multiple challenges that affect employees’ mental well-being.

The problem with EAPs is that they are severely underutilized. Even though the services are free, employees often don’t know that they even have an EAP, and usage is reported to average well below 10%.

Why is usage so low? First of all, employees are presented with the EAP in a way that gives the impression the service is both “too much” — and not enough. With so many services on offer, employees face an overwhelming buffet of options, and so they tune out.

What employees want is to learn about the services that target the concerns specific to their own lives. Most EAPs cannot tailor information to an employee’s needs because they are not receiving detailed eligibility and enrollment information. This means they cannot send out targeted direct-to-employee communications. Instead, they rely on HR staff to shoulder the communications burden, and the messaging tends to be generic.

Second, barriers to getting sufficient care through an EAP are significant. Arbitrary caps on the number of sessions leave an employee thinking, “I doubt I can get what I need in three sessions, so what’s the point of starting?” An employee can’t know if they’ll need more than three visits. They think, “Why start with an EAP counselor if, after three visits, I’ll only end up having to seek further care somewhere else — and have to start from scratch with a new provider?”

Even if they don’t want to be in long-term therapy, caps give them a ready excuse not to call. And if they do call, they’ll likely find that nearly all EAPs require counseling sessions be in-person. While that’s especially difficult now, even in “normal” times, it’s burdensome.

While EAPs are well-intentioned and have potential, they often fall into the “check-the-box” category of benefits that runs in the background but offers little benefit.

Text-based apps

We have recently seen the emergence of text-based therapy apps and sites. These allow patients to chat with a therapist via text, and sometimes offer video sessions at an additional cost.

Text-based apps are convenient and can be particularly helpful for those who may be reluctant to get in-person care from a traditional therapist. However, they cannot provide the robust care offered by half-hour or hour-long in-person therapy sessions.

While employees can sometimes use their HSA/FSA to pay for these services, they are usually not covered by insurance. And using text-based apps is still expensive — typically costing more than $100 per month. Some of these services have partnered with health plans and EAPs — but then the issue of low EAP utilization remains.

Virtual mental health care

Virtual mental health care options provide employees with remote, talk-based counseling similar to traditional, in-office counseling. These services are provided as an employee benefit, connecting employees with a therapist who specializes in their unique needs and costs them little to nothing.

The virtual approach is becoming more common as a growing number of employers prioritize employee mental health. For example, Starbucks recently made headlines when they began offering 20 sessions of virtual mental health care to their employees earlier this year. This is a great start, but to ensure a good outcome, employers shouldn’t limit sessions.

In summary, as your clients and their employees face new and unanticipated challenges, the need for mental health care will only increase. Companies must make sure that their employees have access to the care they need so they can do their best in the workplace — and in life.

Teira Gunlock is the senior vice president of operations at First Stop Health, which provides telemedicine and Virtual Mental Health services as an employee benefit program from employers.


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