Making mental health a top priority is growing trend for employers, employees

Roughly two years of a pandemic have forced mental health needs front and center for many employers.

Faced with new or different challenges, many employees are more aware of their own mental health needs, and as they spoke up, employers, too, have developed a stronger awareness of the importance of addressing those needs, said Patty Starr, president and CEO of Health Action Council (HAC), a nonprofit coalition representing midsize to large employers that aims to enhance human and economic health.

Finding a better way to support employee mental health has been top of mind for many employers, including HAC members, prompting the council to make this one of the key topics of this year's IN-VALUE-ABLE Conference Series & Expo. The conference included virtual events in late January and early February, with two more planned for Feb. 24 and March 10.

The percentage of U.S. employees who reported symptoms of depression or anxiety during the pandemic has increased fourfold, according to the Integrated Benefits Institute.

"I think it was already an epidemic before, but that's really come to the surface now that mental health is a huge epidemic, and that people really aren't getting the care that they need for it," said Juliette McClendon, a speaker at the conference and director of medical affairs at Big Health, a Boston-based digital therapeutics company focused on sleep and mental health.

McClendon said she has "absolutely" seen changes in the way employers operate and approach mental health support in the past two years through the pandemic and following the racial justice movement in the wake of the murder of George Floyd.

"I think both of those events really brought very different topics of conversation to the surface and really reorganized many employers' priorities," she said. "Of course there were a lot of employers for whom mental health was a priority prior to the pandemic, but I think we've seen a lot more employers put mental health at the top of their list of priorities."

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Mental health has traditionally been thought of as a benefit strategy, but it really needs to be viewed through a workforce strategy lens, said Jennifer Hunter, founder of Emvitals, a mental health technology company.

"Employers are the largest purchasers of behavioral healthcare in the world," Hunter said. "If we're going to improve the standard of mental healthcare in terms of access, and if we're ever going to get into a conversation not just about access but about quality, it's employers who are going to really push that movement to the forefront."

Employers are making significant investments in employee assistance programs and benefits like outpatient mental healthcare, she said, but they lack good data around the value that they're getting for that investment — a gap that Emvitals aims to help fill.

Emvitals, founded in 2019, created a proactive outreach tool that invites users to check in on what it calls their emotional health vital signs through a root cause assessment of mental health symptoms. It asks about things such as stressful life events (not just the type, but the cumulative number), social determinants and protective factors (like sleep and social support) in order to be able to route individuals to the right level of care, Hunter said. The company serves more than 40 employers, supporting employees across the country.

Connecting users to care can offer great value to employers, Hunter said, noting that depression is one of the top reasons people go on short-term disability.

She points to research from the Integrated Benefits Institute, which indicates that depression afflicts one in eight employees and is one of the costliest conditions for employers' disability insurance policies, at $17 per employee, per year, compared with hypertension, diabetes and obesity, all of which are between $1 and $2 per employee, per year. Yet, the institute points out, fewer than one in 10 people are recommended for depression screenings.

There's substantial opportunity for cost savings in employers' mental healthcare benefits, and many are beginning to take note of that, Hunter said. And beyond cost, there are concerns of presenteeism, absenteeism and productivity.

"Depression is the No. 1 disabler of work performance," Hunter said. "There is no health condition that disables a person's ability to do their job more. It's one month of lost productivity a year for a depressed employee, or five hours a week of lost productivity."

Its "absolutely crucial" for employers to provide multiple options for mental healthcare to their employees, to meet their different needs, and from an equity point of view, McClendon said.

"In order to be able to actually get to a point where we have equality of mental health, we need to start from a place of equity, meaning we give people what they need when they need it," she said. "We sort of meet them where they're at, rather than just offering one-size-fits-all to everyone."

This means a range of different options, she said, including traditional mental health services, face-to-face and virtual care options, employee assistance programs and digital support services.

McClendon said it's important to get information and solutions to the different populations within a company in a way that makes sense to those employees. Outreach needs to be targeted and intentional, so they are more likely to engage or at least try to understand their options, she said. For example, to provide information from a trusted source focused on specific needs, Big Health has created videos of mental health professionals from different racial and ethnic minority communities to talk about access barriers these different communities face, and unique impacts to their mental health.

With no one-size-fits-all solution, Starr said it's important for employers to dig into their data to understand which populations may be needing additional services, where they're located and whether they're largely within the dependent or employee population. With that understanding, they can investigate services with the support of their insurance company or third-party administrator.

"I would check with my consultant and broker to say what are some of the best practices in this space, and then I would go to some of the trend studies and go, 'OK, what are some other employer trends I'm seeing in this space?'" she said. "From there, I would start to investigate clinically proven and supported solutions based on the audience and geography of where I need the additional support."

McClendon also stressed the importance of evidence-based solutions, especially given the explosion of telehealth and other virtual care options. Employers may not always know how to vet the myriad digital mental health tools available right now, she said. It's important to look for a culturally inclusive and responsive solution with clinical evidence and great outcomes.

"Digital therapeutics are starting to really move into healthcare," she said. "All of these different stakeholders are trying to figure out exactly how to make decisions and understand these digital resources."

Employers are also trying to figure out how to navigate the new world of more hybrid and remote work while keeping mental health in mind, said Bobby Kaleal, owner of Health 360 and a performance coach there. He supports individuals' mental, physical, nutritional and emotional health, and works with companies to offer workplace wellness solutions that address mental health.

"We're seeing employers recognize that the state of their employees is different than before and that certain things need to be addressed differently than before," he said.

Whatever solutions employers settle on, the recognition of mental healthcare's importance is growing among employers, Hunter said. There's a rapidly growing recognition that mental health care isn't an aside to health, but central to it.

"Whether you're a payer or you're a healthcare system or you're an employer, understanding that emotional health is core to health, I think we've seen just a rapid, rapid understanding of that — and demand," she said. "Employers, as purchasers, are demanding that be at the core of their healthcare investments. So in that sense, the pandemic has really accelerated something that has been much needed for a very long time."

This story first appeared in our sister publication, Crain's Cleveland Business.