Past, Present, and Future of Workplace Mental Health: How Employers Are Responding

As the COVID-19 pandemic continues to exacerbate mental health issues and rates of substance abuse, employers have been tasked with managing a public health crisis that has exponentially grown in recent years for both adults and adolescents.

According to a Kaiser Family Foundation poll, about 4 in 10 US adults have reported symptoms of anxiety and depression during the pandemic—a rise from 1 in 10 adults who reported these symptoms in 2019. With depression already representing the leading cause of disability worldwide, its rise in incidence has significant implications for affected individuals and for employers, who serve as the predominant provider of health care coverage in the United States.

Identifying the Employer’s Role in Addressing Mental Health

In an email exchange with The American Journal of Managed Care^® (AJMC^®), Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions (National Alliance), noted that employers have recognized that the impact of mental health and well-being is not limited to the health and productivity of their workforce, but also to managing their overall health care costs.

“While purchasers have continued to address issues around stigma, it’s become increasingly clear that there is inadequate access to high quality mental health services, either through networks or the providers that their employees are seeing such as their primary care doctor,” said Thompson.

The single most important strategy that employers believe can mitigate these issues is the integration of behavioral health into primary care. This would allow them to meet employee needs as to when and where they want to receive this care, while at the same time mitigating the impact of the shortage of behavioral health services to serve more people.

In fact, findings of the National Alliance’s Fall 2021 Pulse of the Purchaser Survey indicate that 92% of the 142 polled private and public employers nationwide identified mental health and substance use access and quality as a leading area of focus for health care strategies in the next 1 to 2 years.

With the Delta variant having influenced many of the actions being considered by employers in this poll, the emergence of the more infectious Omicron variant, now the dominant strain of COVID-19 in the United States, may lead to the implementation of necessary preventive public health measures that contribute to feelings of loneliness/isolation and subsequent adverse mental health outcomes.

In managing these concerns, Neil Goldfarb, president and CEO of Greater Philadelphia Business Coalition on Health (GPBCH), agreed with Thompson in an email exchange with AJMC^® on the importance of integrating behavioral health into primary care and emphasized the role of the primary care physician (PCP).

“PCPs can play a central role in identifying mental health concerns, treating less serious concerns, and referring patients to behavioral health services that cannot be handled in the primary care setting,” said Goldfarb.

During the GPBCH 2021 Mental Health Summit this month, Goldfarb said that a major theme expressed by employers was the need to improve access to mental health services, in which participants identified several potential solutions:

• Expanding employee assistance program visibility and services
• Providing access to virtual mental health services
• Promoting apps for stress reduction and mindfulness, cognitive behavioral therapy, and other support services

“CVS Health showcased an innovative program where social workers were deployed in the CVS Health Hubs (Minute Clinics) to address mental health needs, such as bringing mental health services into the community where they can be easily accessed,” he added.

However, one of the key challenges noted by Goldfarb remains how to ensure care integration for the range of mental health alternatives proposed and determining how and when to pay for these types of services.

“Employers should be talking with their carriers about how PCPs are reimbursed for coordination, counseling, and integration services, all of which take time,” he said. “I'd also encourage employers to ask how plans are measuring access and quality, and how they make those data available through their transparency initiatives.”

Beyond access concerns, Ray Fabius, MD, consulting medical director at GPBCH and a member of the National Alliance Physician Advisory Committee, said in an email exchange with AJMC^® that employers must create a culture of health, safety, and well-being to promote uptake of these services.

By also requiring sensitivity and support training for leadership and management entities of employer organizations, Fabius said that these strategies should focus on eliminating stigma and educating around the need for continuous self-assessment.

“Employers should require vendor partners to track waiting times and require vendor partners to alert them when access is an issue. Corrective action plans need to be implemented to assure rapid access for urgent concerns,” he mentioned. “Fortunately, with the advent of telehealth services and the use of a broad array of providers, acute episodes should be able to receive some form of care quickly.”

Guiding Strategies to Prioritize Workplace Mental Health

In prioritizing behavioral health, Fabius said that employers should look to design their strategies from a population health perspective that not only ensures resources for those who are struggling or suicidal, but also addresses risk and maintains good mental health in those already reporting positive outcomes.

“Employers must consider resiliency training, diversity training, a focus on health equity, programs to support financial fitness, mental health first aid certification, cultivated provider networks perhaps with providers on-site, depression, anxiety, attentional issues, alcohol, and substance abuse, and potentially function disorder management programs and workplace violence and suicide prevention,” he said.

This also warrants understanding where an employer is in their journey to achieving accessible, quality behavioral health services, mentioned Goldfarb. He said one of the key messages for employers cited at the GPBCH Mental Health Summit was to know what the data say about the prevalence and economic impact of mental health issues in their region and what opportunities are available for improving access and coordination.

To bring some of these priorities to fruition, National Alliance’s The Path Forward for Mental Health and Substance Use, a collective initiative of the employer/purchaser community, is taking a collaborative approach that defines key priorities for stakeholders, such as health plans and providers, to improve access and quality of mental health services.

As Thompson noted in the email exchange, the broad consensus within the employer community participating in the initiative is the need to bring together stakeholders to deal with root cause issues that inhibit broader engagement of behavioral health professionals in the system.

“The Path Forward leverages the purchasing power of employers and engages other stakeholders to instigate and facilitate system-based changes to benefit employees and their families. Plan sponsors deal with a variety of complex issues, but no issue is more pressing or of concern to employers today than improving access and quality of mental health services,” said Thompson.

“Lack of timely, affordable access to mental health services cost us far more than the actual treatment of mental health will ever cost. We must work together to ensure that employees and their families experience parity in practice in diagnosis, treatment and the quality of outcomes,” he added. “The Path Forward is a practical, pragmatic, and collaborative course of action to achieve measurable improvements over time.“