A deep dive on mental health at work

Of all the pandemic’s impacts on employer-sponsored health plans, none are as widespread as declining mental health, according to survey results from the Business Group on Health.

The nonprofit’s annual survey of large employers found that 77% were seeing increased mental health issues, such as depression, anxiety and substance abuse disorder, while an additional 16% said they anticipated mental health impacts in the future.

That share represents “a stark jump” from BGH’s 2022 survey, in which 44% of employers said they were seeing mental health impacts, President and CEO Ellen Kelsay said during a press call Tuesday. “Certainly, a key finding here is the dire need for mental health services and supporting employees as they’re navigating their myriad needs.”

Mental health concerns outpaced other impacts measured by the survey, including healthcare labor shortages, worsening population health and increased chronic condition management needs. BGH’s survey data include responses from 152 large employers whose health plans cover more than 19 million people.

The survey tracked several focus areas for mental health for 2023 and 2024, with 80% of respondents stating that access to mental healthcare was their top such focus this year. Employers said they were also focusing on burnout, quality of care, and addressing cultural awareness of mental health over the next two years, among other areas.

Aside from increasing access to mental health resources, particularly online resources such as apps and webinars, BGH found that employers are looking to improve care provider networks for mental health needs.

A majority of respondents said they would work with their health plans and other vendors to expand mental health networks in 2024, and nearly half, 44%, said they would offer mental health-specific navigation programs.

One challenge employers have encountered in improving mental health access has to do with provider directories. “It’s probably fact or fiction, or somewhere in between, [but] we often hear that the directories are very antiquated and not kept up to date,” Kelsay said. “Having accuracy in those directories is critically important.”

These challenges overlap with concerns about diversity and inclusion, Kelsay said. Black workers in particular face greater barriers to mental health support in the U.S., according to a July survey by The Hartford and the National Alliance on Mental Illness. Access to diverse providers is one such barrier, sources previously told HR Dive.

Slightly fewer than half of BGH respondents said they were already expanding provider networks to include more diverse healthcare and mental health professionals. Employee resource groups also figure prominently in health equity strategies, with 79% of employers reporting that they had worked with ERGs to promote benefits and target well-being initiatives to specific groups.

On two other oft-discussed aspects of mental health — cost and culture — employers have converged on at least one approach in 2023, BGH found. Seventy-five percent of employers offered no- or low-cost virtual counseling or telehealth for mental health treatment in 2022, a share that increased to 77% this year. More than one-third currently cover out-of-network treatment for mental health and substance use disorder services, which is “another reflection of the shortage of providers that employees are facing,” Brenna Shebel, VP at BGH said Tuesday.

Cultural improvement strategies included managerial training to recognize mental health issues and direct employees to appropriate services, adopted by 74% of respondents. By 2024, 52% said they planned to implement similar training for employees.

Meanwhile, BGH found that the share of employers running “anti-stigma” campaigns for mental health is projected to decline within the next year. “This is one area where we don’t necessarily think it’s a bad thing,” Shebel said. “It’s really reflective of the progress that employers have made in addressing stigma of mental health within the workplace.”

LAS VEGAS — The classroom-style space at SHRM23 ran out of seats. For a repeat session titled “I Need a Mental Health Day! Handling ADA Accommodation Requests for Stress, Anxiety, and Mental Health,” the demand for the session was perhaps equal parts encouraging and troubling.

Per the National Association of Mental Illness, about one in five people have a mental illness. About 5%, according to NAMI data, experience "serious mental illness."

"Are you surprised?" Anne-Marie Welch and Mario R. Bordogna, attorneys for Clark Hill PLC, asked during the session. The "no" was resounding.

And when employees disclose a mental illness,"are they telling you it's serious?" the speakers asked.

It was seemingly offered as a rhetorical device — to encourage thought and push the presentation along in an interactive manner. But many attendees present for the session vigorously nodded or answered “yes.”

Mental health is increasingly in the public conversation due to COVID-19; financial hardship; and social and political unrest, the speakers reminded the audience. But disputes around accommodations also are a notable, often publicized area of employment law.

The speakers focused mainly on Americans with Disabilities Act compliance and what HR needs to determine reasonable accommodations — and also, where HR incurs risk by rejecting accommodation requests because of undue hardship to the business. But apart from a compliance refresher, the conference speakers encouraged HR pros in attendance to approach mental health challenges with tact.

Specifically, they urged attendees to leave stereotypes at the door. Just because someone has a disability doesn’t mean they’re unable to do their job functions, the speakers said. In turn, casually and cavalierly saying that co-workers have attention-deficit disorder or obsessive-compulsive disorder — or that they’re “bipolar” — can also be discriminatory.

“Disability” as defined by the ADA deals not just with physical and mental health impairments, but also those that substantially limit workers’ abilities to think. Disability as a concept includes a record of having a disability or being “regarded as” having a disability, the lawyers said. Along with having an accommodation request form easily available, Welch and Bordogna also encouraged HR leads to have an “interactive process” in place — an informal back-and-forth between employer and employee with the goal of arriving at a reasonable accommodation.

For further inclusion guidance — and, naturally, to help keep workplace policies ADA compliant, too — the speakers suggested HR pros brush up on EEOC guidance on psychiatric disorders, as well as depression and mood disorders. They also recommended the Occupational Information Network as a resource for defining essential functions and other best practices.

Managers affect employees’ mental health more than doctors or therapists, respondents to a poll by UKG’s Workplace Institute said — and they reportedly have the same impact as a spouse or partner. 

The survey also found that work stress doesn’t stay at work. Employees said it negatively affects their home life, well-being and relationships. Workers recognize the strain and say they’d be willing to make sacrifices, with 4 in 5 valuing good mental health over a high-paying job and two-thirds saying they’d take a pay cut for a job that better values their mental health.

Leadership isn’t immune, either; 40% of C-suite respondents said they’d likely quit within the year due to work-related stress, with younger leaders saying they were the least enthusiastic about work. 

The common saying that workers don’t leave a job, they leave a manager, may be borne out in the UKG data. Previous surveys have backed up the finding. But bad managers are more than just an annoyance, UKG data showed — they have a serious impact on workers’ wellness. 

What makes a bad manager? Previous survey respondents and experts have cited micromanagement, unfairness, poor listening, disorganization, an impersonal approach, not soliciting feedback and withholding opportunity as behaviors and traits exhibited by poor managers. 

On the flip side, effective managers check in with their direct reports’ emotional state, are nurturing and ready to help, keep track of their direct reports’ goals and offer constructive feedback, experts said.

These skills aren’t always natural to those in management positions, whose previous roles may have required different strengths. To help managers more effectively do their jobs — and turn down the dial on direct reports’ frustration — researchers have repeatedly emphasized the importance of training. Specifically, managers can excel when given the tools to coach, researchers have said.

While addressing co-worker relationships may be key to improving employees’ mental health, employers also can look at different methods to ease worker stress, including changing work arrangements to allow for more flexibility and investing in well-being benefits that encourage stress-management activities like exercise.

Addressing mental health continues to be a challenge at work. According to report from the Conference Board, about a third of U.S. workers say their self-reported level of mental health was lower than six months earlier. Despite this, according to an additional study from Amwell, 85% of workers don’t use the mental health benefits they are provided.

Deskless workers face significant hurdles in accessing their mental health benefits, even though they have the same challenges — and then some — as their desked co-workers. The nature of their work and sometimes schedules mean that it might be hard for them to find a regular time to set up appointments with a mental health professional, and for managers to see signs that a worker might be in need of help.

“Even though employers have increased mental health benefits, a lot of front-line workers don’t know about them or don’t how to access them,” said Sandra Moran, chief marketing officer at Workforce Software.

Here’s what HR can do.

Connect deskless workers with benefits already provided

The challenge isn’t so much that deskless workers don’t receive mental health benefits. It’s that they may face pain points in accessing them.

“Even though the employer offers a wellness benefit, a front-line worker’s ability to get in a predictable schedule is a major barrier,” said Moran. In a recent study, Workforce Software found that 55% of employees have weekly changes in their schedules.

Finding a therapist who is taking new patients and accepts a worker’s insurance is also becoming more difficult. Fewer than half of people with a mental illness were able to access timely care in the U.S. in 2021, according to the Substance Abuse and Mental Health Services Administration.

If a worker’s hours change every week it can be near impossible for them to schedule an appointment when they find the right practitioner, said Moran.

Deskless workers may also be harder for managers to keep in the know about benefits offered or spot when someone might be in need of help, said Deb Muller, CEO and founder of HR Acuity. “Whether in a retail environment or climbing poles, you as a leader are not watching them every second,” she said. “The signs of mental health [issues] might not be as easy to recognize.”

Help bridge the gap

One way to help these workers access benefits is to stop putting up barriers to scheduling appointments, said Moran. That means offering more predictable schedules, so that workers can set up therapy sessions and keep them.

Knowing your workforce can help employers create schedules that suit worker needs. For example, said Moran, if a significant portion of a company’s deskless workers are women, who typically carry a heavier burden for child care, then offering things like three-day-a-week mini shifts can ease some of those outside stressors and allow workers to schedule for themselves — and benefit other people who have caretaking duties as well.

Managers of deskless workers, especially those who are deskless themselves, should also be trained to spot signs that a worker may need mental health services, said Muller. “Give managers the tools they need to check in, and understand how to check in,” she said. Managers can also be trained to “open a dialogue about their well-being that might be uncomfortable, but we are training those managers to have those conversations.”

Companies can also use anonymous surveys to get feedback on mental health initiatives, she added, which can help employers understand barriers workers face in accessing care without those workers feeling they may face negative consequences for speaking up.

Employers can set up text-based services for workers to submit feedback, or place QR codes in places like the bathroom or break room, which would lead workers to links providing them more information on services, or to submit feedback, Muller said.

While the pandemic has taken a major toll in people’s lives, it did teach employers that they can make major changes, quickly, to help workers as much as possible, which should be applied to addressing the mental health needs of deskless workers now. “If the pandemic taught us anything, it’s that we can make those changes,” Muller said. “Things can be turned on their heads and we can make drastic changes and it can work.”

Black workers in the U.S. face greater barriers to mental health support, a finding which highlights a need for companywide education, according to a report from The Hartford and the National Alliance on Mental Illness.

Researchers found that Black workers were more likely to rate their mental health as “fair/poor” compared to their White, Hispanic/Latino, and Asian American/Pacific Islander peers. Black workers were less likely to say their employer had empathetic leadership and an open, inclusive environment that encourages discussions about mental health.

Among other barriers, Black workers were more likely to say they encounter difficulty discussing mental health at work due to their race, ethnicity, cultural background or gender identity. Black workers were also more likely to report exclusion, hostility and discrimination at work that affected their mental health.

To address those barriers, The Hartford and NAMI recommended employers have senior leaders lead initiatives that normalize talking about mental health. Employers also can provide companywide mental health education and create employee resource groups to serve as safe, accepting spaces.

“All Americans deserve safe, supportive and mentally healthy work environments,” said Christopher Swift, The Hartford’s chair and CEO, in a statement. “It is vital that companies continue to break down stigma and prioritize diversity, equity and inclusion.”

Employee training programs focused on basic ways to address common mental health concerns in the workplace can reduce workers’ stigmatic beliefs and absenteeism, according to a study published in BMC Public Health.

Among a group of staff at the Driver and Vehicle Licensing Agency (DVLA) in the United Kingdom, this type of program led to a 22% drop in recorded sick days. Since the program is aimed at common mental health problems and isn’t specialized to a particular workforce, it could be used across various organizations and industries worldwide, researchers said.

“Mental health problems are often hidden and therefore get worse over time without effective intervention,” Nicola Gray, the lead researcher from Swansea University’s School of Psychology, said in a statement.

“Prevail [the program] teaches people evidence-based psychological techniques for the treatment and management of these conditions,” she said. “It also aims to reduce stigma by providing evidence that these problems are common and can happen to anyone.”

Managers often lack the tools to address employees’ mental health needs, particularly in recent years as burnout and stress increase, according to a recent WTW report. Training programs that focus on mental health sensitivity could help leaders identify staff who may be struggling and use tools to collaborate on solutions.

Gray and her colleagues placed a priority on improving common conditions, including depression, anxiety, and distress caused by bereavement, divorce, debt, housing problems and friendship issues.

In the study, DVLA staff and managers were split into two groups — one that took part in the training sessions and one that didn’t. The group that participated in the training program learned psychological techniques and coping mechanisms to handle these common conditions, as well as basic mental health literacy.

After the study, the group that received the training had fewer sick days and had reduced mental health stigma. However, the group that didn’t participate in the training had an increase in sick days.

Instead of identifying staff who may need help with mental health concerns, the Prevail program was created to provide training to all employees so they can help themselves and colleagues, friends or family. 

DVLA Head of HR Helen Davies said in a statement about the study that development of and investment in the Prevail program has been worthwhile.

“Many staff have commented on how Prevail has helped them overcome their mental health difficulties, and even helped them to help other people by teaching them the techniques they have learned.”

The call for mental health training — as well as mental health benefits — will likely grow stronger in coming years, especially among younger workers. In a survey of recent college graduates, nearly all said employers should offer mental and emotional health benefits, and more than a third said they’re prioritizing companies that do so during their job search.

Workers have been saying they want mental health benefits, but still aren’t using them.

In a Amwell report, 85% of survey-takers said they do not use their mental health benefits. Why is this the case?

Respondents cited confusion as the reason why they hadn’t accessed mental health care — both confusion regarding how to access mental health benefits, along with what their employer-sponsored packages included. 

Survey-takers also cited a lack of telehealth options as a factor; Amwell charted a decline in in-person therapy use. About half of respondents say they prefer digital programs when caring for their mental health, and 67% said they’d be willing to use wellbeing benefits if they were digitally accessible.

The gap in care is due to an increasingly busy personal and professional life, theorized Amwell’s chief behavioral health officer, Ken Cahill. Relatedly, in health care provider OneMedical’s “State of Workplace Health” report this year, 45% of respondents said packed schedules were the reason they hadn’t accessed mental health help.

That busyness is compounded with “challenges around access, waiting lists, costs of care and inflexibility of scheduling,” Amwell’s Cahill said in a statement, suggesting that hybrid care (health care inclusive of digital options) is a solution to filling the mental health care gap.

The point of no-return

Since March 2020, worker mental health has become an increasingly hot topic for HR. Likewise, amid the Great Resignation, retention strategies including beefed-up benefits packages also became the workplace gold standard.

Data suggested that 80% of workers would feel more supported if their company invested in wellness. While respondents in the Opinium survey took physical health benefits, like sponsored gym memberships, into consideration, 56% of respondents said they were interested in monthly wellness stipends. 

About half said they were interested in employer-sponsored mindfulness sessions, and about a third said they would do yoga. 

Some mental health offerings are intangible

While researchers note that cost and education regarding total rewards are veritable barriers in worker access, research also suggests corporate leadership can stand to make some more noise about mental health offerings. 

Last summer, a report by benefits provider Unum suggested 70% of workers think their bosses can do more to end stigma around mental health in the workplace. 

In a case study by KPMG, a senior leader illustrated to HR Dive how training on psychological safety, a reassessment of manager workloads and encouraging more frequent one-on-one check-ins are all ways to address mental health holistically — on top of benefits offerings.

Undgraduates preparing to end the workforce say their college experience was shaped by COVID-19 — and their mental health is a little worse for wear.

In a recent survey conducted by a higher education wellness provider, these newcomers said that while they’re hopeful for the future, the pandemic worsened their mental health. And that has negatively affected their workforce readiness, they said.

Nearly all respondents said employers should offer mental and emotional health benefits, according to the results, and more than a third said they’re prioritizing companies that do so during their job search.

The students’ request echoes what some in the workforce say, too: Employees have expressed a desire for wellness benefits in several recent surveys, with some voicing a particular interest in mental well-being. 

But even when employers offer such benefits, uptake remains low. A majority of workers surveyed by OneMedical at the end of 2022 said they use employer-provided health benefits to access routine medical care; only 19% said they had accessed mental healthcare. Workers attributed the lack of uptake to cost, embarrassment and busy schedules.

Among other efforts, improved employer communication may help workers take advantage of benefits offerings, sources say; year-round communication about access — in a variety of formats — may help employees make use of employers’ full employee value propositions.

Today’s workers are being pushed to work harder than ever before, and they’re slowly being squeezed by the increased pressure. 

That increased strain has manifested itself as a global mental health crisis in the workplace — a situation exacerbated by the COVID-19 pandemic and its aftermath. Rising rates of worker burnout, dissatisfaction and disengagement threaten employee performance and corporate bottom lines. Employee turnover remains near record highs, and historically low unemployment rates have made it harder than ever for companies to hire and retain talented employees. 

There’s no doubt that work burnout is real. In 2019, the World Health Organization classified work burnout as an occupational phenomenon resulting from unsuccessfully managed workplace stress. Burnout, according to the WHO, can manifest itself in three ways: as feeling exhausted or drained of energy; as viewing one’s job negatively or cynically in an attempt to distance oneself from work; or being less effective. A new book, “The Burnout Challenge,” reports that an overload of work, a lack of control, low pay and numerous other factors can create mismatches between workers and their jobs that lead to burnout. Burnout, in other words, is a condition that organizations must address.  

The challenge hasn’t gotten any easier over the past several years. The pandemic, the global racial reckoning that occurred after the death of George Floyd, economic turbulence, fierce political polarization, a continuing skills shortage and new expectations of workplace flexibility and agility have increased the stress and strain on everyone.

In the four years since WHO’s codification of burnout, people are bringing this added pressure with them to work. More than 40% of companies say they have made significantly more accommodations since the pandemic began to help their employees manage anxiety, depression and other mental health conditions. But more than 40% of human resources professionals say their companies don’t do enough to support the mental health of their employees. Indeed, levels of workplace burnout are higher now than they were during the pandemic — especially among workers, younger workers and workers whose companies have been slow to adopt new technology.

To help their employees survive and thrive in today’s post-pandemic workplace, companies need to proactively help them decompress. It’s about understanding that the need to decompress is as important as eating, sleeping and exercising. It’s about helping employees understand what’s important in their lives and to reconnect with the world outside of work. 

Companies have multiple tools at their disposal to address burnout and mental health challenges in the workplace. But there’s one overarching principle that captures the most important thing businesses can do: leading with listening. 

Everyday progress — for workers, companies and people — requires everyday feedback. That level of feedback requires everyday engagement — and that starts with listening.  

Listening involves gathering information through one-on-one conversations, regular workplace interactions or at scale via technology. Leading is acting on the information collected. It’s leveraging data to inform decision-making. Good leaders listen first — and listen often — and take action second. That’s because good leaders know the solutions to these immense workplace challenges aren’t coming from the top. They’re emerging from the bottom. 

The good news is new, innovative technology is making it possible for leaders to listen in ways they never could before. In our own work at SHRM, we’ve launched both an accelerator and an investment fund to support mission-driven start-ups that aim to solve the most pressing workplace challenges. One of these companies, Mainstay, is taking lessons learned from nearly a decade of success in higher education — using AI-based text messaging to help colleges listen to their students at scale — to enable companies to listen to the needs and challenges of their workforce.

That work has led to some surprising findings. Companies are using the platform to text their employees and learn within minutes what’s on their minds and what problems they’re wrestling with — maybe it’s the commute or a lack of access to wellness benefits — or why they didn’t complete their required IT security training. So often, business leaders who listen learn that it’s the little things that make the difference in the ability of employees to navigate the world of work. Those little things can have an outsized impact on people’s success on the job. But understanding them is the first step to fixing them, and those small fixes can in turn have disproportionately positive results.

By listening to what employees have to say, leaders can respond to minor concerns before they become major issues that lead to job dissatisfaction, burnout and departure. 

Today more than ever, being a good leader at work starts with listening to employees. When employees ask for help to manage their stress and to decompress, it’s critically important that their leaders must listen first — then act. Doing so is a necessary first step toward building a workplace that works for everyone.

While a majority of workers access their healthcare benefits, mental health resources often go untapped, research suggests. OneMedical’s 2023 State of Workplace Health report collected responses from 800 HR and benefits leaders and 800 full-time employees. 

Most respondents reported using the benefits package for “routine” care — more than preventive care, and more than care related to COVID-19, chronic conditions or mental health. For context, 61% of survey-takers accessed routine care, compared to 19% of workers who said they accessed mental health care. 

When asked why they avoided using their mental well-being benefits, 22% cited costs, 25% said they were embarrassed and 45% pointed to packed schedules.

Per the data, some workers may be falling through the cracks. Since the pandemic’s onset, mental health in the U.S. has been on a recorded decline. As HR Dive previously reported, pandemic-related stress and anxiety reigned throughout 2021. Notably, from the pandemic’s onset to February 2022, Google searches for “how to ask for a mental health day” jumped by 1,000%. 

In summer 2022, HR professionals largely told the Society for Human Resource Management they were prioritizing mental health benefits going forward.

To be fair, about 1 in 4 respondents to OneMedical’s March survey said their mental health has improved over the last year. But almost half of respondents said their mental health stayed the same throughout 2022 and 32% said their mental health worsened. 

Most HR lead respondents expressed a belief that their staff’s mental well-being had improved in 2022. “This indicates that leaders may not appreciate the extent to which their team members may be struggling with their health,” researchers noted.