The Health Parity and Addiction Equity Act of 2008 requires that health insurers provide the same coverage for mental health treatment as they do physical health care.
While a variety of factors, including a shortage of mental health professionals in some parts of the U.S., have made the goals of the federal law easier said than done, there is at least one other avenue for many Americans to seek mental health treatment: employee assistance programs.
Employee assistance programs are free for workers, paid for by employers and often staffed by counselors who are either contractors or company employees themselves. Counselors often have at least a master’s degree in a relevant field, such as psychology, and may also be certified by the International Employee Assistance Professionals Association.
These programs may offer trained professionals to talk with employees about immediate mental health or substance use challenges, or they may provide a more holistic approach, including providing referrals to outside mental health professionals and helping workers through the process of securing longer-term care.
From struggles with child care to concerns about the health of family members and friends, stress related to the COVID-19 pandemic has only increased the need for mental health care. Nearly 8 in 10 U.S. employees now experience work-related stress, with burnout at “all-time highs across professions,” according to an online survey of 1,501 workers the American Psychological Association conducted in July and August 2021.
The economic costs of depression alone are at least $210 billion per year, in the form of medical costs and lost productivity, according to a widely cited 2015 study in the Journal of Clinical Psychiatry.
Still, one-third of people who thought they may have needed mental health help during the pandemic did not seek it, according to a Kaiser Family Foundation survey of 1,862 U.S. adults conducted by phone in March 2021.
Employee assistance programs are most commonly offered by medium-to-large companies. Roughly half of U.S. workers have access to employee assistance programs, according to the federal Bureau of Labor Statistics. For every $1 companies put into workplace mental health programs, they get $4 back in increased productivity and better health outcomes, according to the World Health Organization.
Employee assistance programs are related to but distinct from employee wellness programs, which encourage physical health through efforts such as smoking cessation, weight loss and nutrition education programs.
Employer-sponsored mental and physical health programs date as far back as the 1940s, when employer-sponsored efforts focused on addressing alcoholism among employees. They expanded over subsequent decades to address a range of mental health challenges that can affect work performance.
Here, we summarize five recent studies on employee assistance programs.
- The first study explores what the future of these programs might look like — more virtual, more on demand — post-pandemic.
- Two studies recount how employee assistance programs at two large health systems responded to the immediate shockwaves of the pandemic. In sum, having employee assistance infrastructure for mental health in place before the crisis unfolded was critical in helping frontline health workers manage the stress of caring for patients and losing colleagues to COVID.
- And two of the studies, published pre-pandemic, explore the overall effectiveness of these programs. Both find improvements in presenteeism, which refers to how “present” and productive an employee is during work hours after they receive counseling through an employee assistance program.
Finally, it’s worth noting that mental health treatment through employee assistance programs is unevenly available. Some 78% of union employees have access to these programs, compared with 52% of nonunion employees, according to the Bureau of Labor Statistics. And while 75% of people among the highest quarter of wage earners have access, 33% of those among the lowest quarter of wage earners have access to employee assistance programs, the federal data show.
Usage rates, however, remain low, despite 1-in-5 adults in the U.S. experiencing mental illness. Employees on average use assistance programs at a rate of 10% or less, according to the Society for Human Resource Management, a trade group. The Bureau of Labor Statistics used to ask about the number of hours employees used assistance programs in its Survey of Employer-Provided Training, but that survey was discontinued in 1995.
EAP 2.0: Reimagining the Role of the Employee Assistance Program in the New Workplace
Alan Langlieb, Marin Langlieb and Willa Xiong. International Review of Psychiatry, January 2022.
What the authors studied: How employee assistance programs are currently structured and how they may need to adapt, in light of the COVID-19 pandemic, to new ways that employees seek mental health care, such as through telemedicine.
What they found: Employee assistance programs usually are designed to incorporate the life cycle of employee mental health care from assessment to referral to mental health professionals to ongoing case management. Still, some programs focus on short-term problem solving while others may offer more comprehensive mental health services, such as counseling with licensed professionals. The authors note that technology like on-demand video conferencing makes 24-hour counseling a possibility, which could encourage employees to take advantage of mental health services when they need them. Employees are more likely to seek employer-provided counseling if executives promote a workplace culture that encourages good mental health.
In their words: “The [employee assistance program] of the future might be as close as reaching for one’s smartphone or iPad. In light of past terrorist activities and the recent pandemic, [employee assistance programs] will also need to develop strategies for providing increased counseling and social support to large numbers of individuals at a moment’s notice.”
The COVID Chronicles: An Employee Assistance Program’s Observations and Responses to the Pandemic
Daniel Hughes and Acanthus Fairley. Journal of Workplace Behavioral Health, December 2020.
What the authors studied: How an employee assistance program at a major academic health system responded to sudden strains on the system and a spike in employee stress brought on by the COVID-19 pandemic. The health system, Mount Sinai in New York City, comprises eight hospitals and employs 42,000 people. As the pandemic began to unfold, the employee assistance program core staff consisted of a director, four counselors, three graduate students of social work and an administrative assistant.
What they found: The health system mobilized an executive-level task force to organize support to staff, some on the frontlines and others working remotely. Morale fell when a popular young nurse who tested positive for COVID died on March 24, 2020. An employee assistance counselor and the health system’s chaplain began working with the nurse’s colleagues to help them cope with the loss. Employee assistance program staff continued this method of reaching out to work groups when one of their members died.
The employee assistance program also deployed a “cluster-ball” approach with proactive outreach to clusters of employees likely to be experiencing stress, such as those working in emergency rooms, along with follow-up to specific employees asking if they had concerns about colleagues, in order to “snowball” support to staff in need. A hotline was also set up to direct employees to mental health and other services. One counselor with military experience engaged emergency medical technicians by sending them self-care messages and techniques via text.
In their words: “Employees should be offered a range of self-help options from spiritual care to exercise. Psychotherapy should be available, especially for those with preexisting psychological risk factors. Communication concerning available services should be straight forward and easily digestible. Some employees will need assistance to navigate complex systems of care. Employee assistance programs are well positioned to provide this service.”
Employee Assistance Program Response and Evolution in Light of COVID-19 Pandemic
Gregory Couser, Jody Nation and Mark Hyde. Journal of Workplace Behavioral Health, October 2020.
What the authors studied: Why staff turned to an employee assistance program serving 39,000 employees at the Mayo Clinic in Rochester, Minnesota, during the pandemic. At the outset of the pandemic, the program employed five on-site counselors with referrals for child, legal and other services provided by an outside vendor.
What they found: Stress over contracting COVID and running out of personal protective equipment were top of mind among many employees early on. Initial use of employee assistance services was low, consistent with other research finding that during stressful periods employees may be reluctant to show vulnerability. The authors also suggest that employees newly working from home may not have been aware of mental health services offered by telephone.
Take-up of services increased as statewide stay-at-home orders eased in June 2020. That month, the authors surveyed employee assistance counselors to learn why staff were using their services. Before the pandemic, employees sought help for various reasons, including relationship and work problems. During the pandemic, employees sought help primarily for mental health issues such as anxiety and depression.
In their words: “[Employee assistance programs] should be prepared for [a] potential influx of mental health and relationship concerns as the pandemic wanes. In uncertain times, [employee assistance programs] especially have an opportunity to show value to their respective organizations through the capturing of data regarding ability to rapidly respond and evolve to meet their organization’s needs.”
Demonstrating Value: Measuring Outcome & Mitigating Risk: FOH EAP Study Utilizing the Workplace Outcome Suite
Jeffrey Mintzer, Veronica Morrow, Melissa Back Tamburo, David Sharar and Patricia Herlihy. International Journal of Health & Productivity, December 2018.
What the authors studied: 2016 and 2017 data on outcomes from employees who used the Federal Occupational Health assistance program, which serves more than 900,000 federal workers and fields 8,100 monthly requests, on average. In all, 4,800 employees completed a five-item scored questionnaire before receiving services, and filled out the same questionnaire three months later. The questionnaire, called the Workplace Outcome Suite, is a standard survey used to evaluate employee assistance programs. Survey takers self-report levels of absenteeism, presenteeism (when an employee is present but not fully productive), work engagement (measuring how passionate the employee is about their job), life satisfaction and workplace distress.
What they found: The employee assistance program was most effective in reducing absenteeism, defined as missing work due to a personal problem. In 2016 and 2017, scores for absenteeism fell nearly 70%. Presenteeism improved by more than 20% each year, with life satisfaction also improving nearly or more than 20% each survey year. Workplace distress improved by roughly 10% each year, and work engagement improved by less than 3% each year.
In their words: “All five items were found to be statistically significant which indicates that they demonstrate a positive response to [employee assistance program] counseling.”
EAP Works: Global Results from 24,363 Counseling Cases with Pre-Post Data on the Workplace Outcome Suite
Mark Attridge, David Sharar, Gregory DeLapp and Barbara Veder. International Journal of Health & Productivity, December 2018.
What the authors studied: Results from an international survey of 24,363 people who sought help through employee assistance counseling, with more than three-quarters of survey takers based in the U.S. and most of the remainder from China. The employees completed the five-part Workplace Outcome Suite before counseling and then three months later. Four in 10 worked in health care, roughly one quarter worked in manufacturing and government each, and the remainder worked in the technology sector.
What they found: Half of people struggled with presenteeism before counseling, a rate that dropped to one quarter after counseling. Absenteeism also fell by about half after counseling — from missing 7.4 hours per month, on average, to 3.9 hours. Workplace engagement and distress improved slightly. The rate of employees reporting significant issues with life satisfaction fell from 38% before to 17% after counseling.
In their words: “When [employee assistance program] counseling is provided with adherence to basic quality standards the results are usually positive. There is considerable evidence from reviews of studies conducted in North America and in Europe that brief counseling provided by [employee assistance programs] typically reduces stress, improves symptoms of behavioral health problems and restores higher work functioning.”
The Journalist’s Resource is part of the Mental Health Parity Collaborative, a group of news organizations that are covering challenges and solutions to accessing mental health care in the U.S. The collaborators on this project include The Carter Center, The Center for Public Integrity, and newsrooms in Arizona, California, Georgia, Illinois, Pennsylvania and Texas.