The World of EAP

EAP in Italy Beginning to Overcome Challenges

By John Maynard, PhD, CEAP

Italy boasts stunning mountains and alpine lakes, gorgeous coastlines, and world famous art, fashion, and cuisine. Along with its near neighbor, Greece, Italy is acknowledged as the birthplace of western culture.

What a treat, then, to learn that 2017’s Employee Assistance European Forum (EAEF) conference would be held in Milan. Milan is Italy’s second-largest city, and besides being renowned for fashion and design, it is Italy’s main financial, industrial, and business center – a most appropriate place for a gathering of EA professionals from around Europe and the world. 

The EAEF conference in June had a record 100 attendees from 25 countries and showcased the continued growth and maturation of EAP across Europe. I was fascinated to learn about the unique features of EAP in each country, and at the same time, the many interconnections among EA professionals throughout Europe, including Italy.

Economic Ups and Downs
Italy’s diverse, but somewhat vulnerable, industrial economy has experienced significant volatility over the last 40 years. In general, the Italian economy enjoyed strong growth from the 1950s until the 1990s, and Italy became one of the original Euro zone countries. However, by the late 1990s, the economy began slowing, with economic growth lagging behind Europe’s average in most years. By 2005, Italy had the worst economic statistics of all Euro zone countries. With its already shaky economy, Italy was particularly vulnerable and hard hit by the global recession in 2007-2008.  

A number of structural features within the Italian economy helped create and perpetuate its economic struggles, and also contributed to a relatively slow start to the EA field. Geographically, Italy’s industrial economy is clustered mainly in the north, while southern Italy is less economically developed and suffers higher unemployment. A large “underground” economy, estimated as high as 17% of Italy’s GDP, means the government struggles to collect enough tax revenue to finance its needs. A history of government corruption and high government spending aggravates already difficult conditions. Recently, the migration crisis in the central Mediterranean region has added to economic stresses.

Health and Mental Health Care
Since 1978, health care in Italy has been delivered through a national health service funded by taxes and providing universal coverage to all citizens and residents. Routine waiting times are often up to several months in large public facilities and a few weeks in smaller private facilities, although more urgent cases can be seen more quickly. A “free market” option with much shorter wait times is available for patients who opt to pay completely out-of-pocket.

Mental health care in Italy was assigned in 1978 to regional public Mental Health Departments, which are charged with the management and planning of community-based medical and social activities related to prevention, treatment, and rehabilitation in their defined areas. Unfortunately, while the 1978 law that created the Mental Health Departments set out general principles and guidelines (such as using multi-disciplinary teams to provide effective continuity of care), it did not provide funding or specific standards for service provision and staffing.  Only after a new national plan for mental health, which included funding and standards, was launched in 1994 did the comprehensive network of mental health services in each district really become effective (Piccinelli et al., 2002). 

For the private sector, the difficult economy, along with the availability of comprehensive public mental health services, meant that Italian companies had very little interest in anything like EAPs. Some US-based multinational companies did expand their EAP services into their Italian locations but services, including client intakes, were still based outside the country.  Not until the early 2000s did these multinationals begin to arrange for more local intake services.

New Laws and the Great Recession Stimulate EAP Interest
In 2004-2005, both the European Union and the Italian government began holding workplaces more accountable for prevention of psychosocial risks, including stress and interpersonal conflicts.  When the recession took hold a few years later, stress levels soared, and the private sector began searching for solutions. Thus, the convergence of several forces in the early 2000s – new Italian and EU labor regulations, a serious recession, and continued maturation of EAPs in nearby European countries – finally resulted in the emergence of the EA field, at least in northern Italy.

Nevertheless, progress remains slow.  Even today, companies rarely implement ongoing full-service EAPs, tending instead to seek more time-limited services in response to specific situations.  For example, they may contract for EAP response services after a critical incident, specific training topics, or focused consultations about interpersonal communication issues or company reorganizations. According to Italian EA professionals, it remains difficult to communicate to company decision-makers that EAPs can be an investment in improving productivity and reducing costs, as opposed to being an employee benefit only. When EAPs are offered, they are often under-promoted, resulting in low utilization and further compounding the difficulty of communicating their potential full value.

Challenges and Opportunities
For a generation, the Italian economy has struggled. This has made companies cautious about risking resources to offer benefits like EAP, which they may see as overlapping with services already available through the health system.  At the same time, Italians traditionally have relied on their families, rather than outsiders, for emotional support in times of difficulty, so the demand for workplace-based services has been low. 

Ironically, the same economic difficulties that have produced caution by employers, are beginning to break down barriers to individuals asking for outside professional help. As individuals have had to move to other cities or regions to find jobs, family is less available, and attitudes toward professional assistance are becoming more positive.  

For example, a recent survey of Italian adults (Munizza et al., 2013) found that 98% were aware of depression, and 62% had experienced it, either directly or indirectly.  Virtually all (99%) thought that the best way to recover from depression was to seek help from outside professionals, especially psychologists.  This important social shift, only now coming into focus, should increase demand for EAP services and improve utilization rates within existing programs.

As in so many countries, the future for EAP in Italy is bright. The challenge will be to continue to educate the business community about the possibilities of EAP and to continue to grow the professionalism of those who sell and deliver EA services.

Let’s Continue the Discussion
I would like to thank the following individuals for taking the time to answer my questions as I was preparing this column: Laura Sinatra of EAPItalia World; Laurence Duretz and Diego Scarselli of Psya Italia; and Miguel Cristobal and Carla Boyer of Healthy Work. Let’s continue the discussion of EAP in Italy and other countries! You’re welcome to contact me directly anytime or to post your feedback, questions, or suggestions on EAPA’s LinkedIn group.  

Dr. John Maynard served as CEO of EAPA from 2004 through 2015. Prior to that, he was President of SPIRE Health Consultants, Inc., a global consulting firm specializing in EA strategic planning, program design, and quality improvement. In both roles, he had the opportunity to observe, meet, and exchange ideas with EA professionals in countries around the world. He currently accepts speaking and consulting projects where he can make a positive difference. He can be reached at 


Munizza, C., Argentero, P., Coppo, A., Tibaldi, G., Di Giannantonio, M., Picci, R. & Rucci, P. (2013). Public beliefs and attitudes towards depression in Italy: A national survey. PLoS One, 8(5): e63806. Published online 2013 May 20.

Piccinelli, M., Politi, P. & Barale, F. (2002). Focus on psychiatry in Italy. The British Journal of Psychiatry, 181(6), 538-544.