Journal of Employee Assistance Vol. 48 no. 2 - 2nd Quarter 2018

Feature Article
Integrating Mental Health into the Workplace

By Julie Marshall, PhD, CEAP; and Anna Meiners, MA


One in six U.S. adults lives with a mental illness (National Institute of Mental Health). As a result, employers need a strategy that proactively integrates mental health into their overall wellness plans. EAPs are uniquely positioned to partner with employers in this endeavor because of the services they provide and the relationship they have with the employer.

Simple interventions, which are typically already part of basic EAP services, can be implemented to normalize, educate, and increase awareness of mental health issues. This involves changing the dialogue to present mental health in relatable language and offering interventions for life experiences such as divorce, grief, or stress.

For example, people are more willing to engage in the workplace on topics of managing change, resilience, self-care, and positive relationships than “coping with loss” or “depression”. EAP interventions such as on-site trainings (i.e. stress management or conflict resolution), introduction of promotional campaigns (i.e. sleep hygiene or resiliency), and supervisor support, further reduce stigma associated with a mental health issue.  

Beginnings
In 2016, Cascade Centers decided to help our client companies proactively assist individuals who needed assistance but who were not engaging with the EAP or other mental health treatment. It was recognized that in most health promotion programs, a first step to individual healthy behavior is a risk appraisal. The barrier Cascade faced was that the tool needed was not available. 

Typically, assessing mental health has required taking multiple, time-consuming assessments.  Not only is this cumbersome for the individual it does not provide employers a way to assess the aggregate mental health needs of their population. In response to this need Cascade developed the WholeLife Directions program and the WholeLife Scale™.  

Assessment and Intervention
The WholeLife Directions program is comprised of four phases. Each phase focuses on a specific topic and has a three-month duration. The entire program lasts one year, with each year building on previous outcomes and experiences. 

Phase 1: Decrease Stigma and Assess Needs of the Population 
The introduction of the program focuses on decreasing stigma, increasing awareness of mental health issues, and assessment. The key components of this phase include: 

* Consultation with the employer to decide how they can include mental health into their overall wellness approach. It is helpful to explore ways the employer currently encourages people to stay healthy, what may have worked for them in the past, and their goals for participation. 

* Engagement with leaders, who are encouraged to communicate their commitment and support for employees with mental health issues. Cascade provides customized messages that leadership can use to acknowledge the relationship between physical health and emotional well-being, encourage help-seeking behavior, and communicate EAP benefits.  

* A focused anti-stigma campaign, “Mental Health Isn’t a Choice”, is delivered. This campaign uses humor to educate employees on ways we’ve historically treated mental illness differently than physical health issues. For example, if someone breaks their arm they get immediate medical attention. However, if someone is depressed they may be told to “cheer up” or “snap out of it”.    

* Administration of the WholeLife Scale™ (WLS), an easily accessible, reliable, and valid behavioral health risk assessment. The WLS is a complete mental health appraisal that measures nine mental health domains: Anger, Stress, Depression, Anxiety, Relationship, Post-Traumatic Stress, Sleep, Substance Abuse, and Work Engagement. 

Cascade developed a 47-item assessment, which has been validated to measure each of the nine domains and asks users to answer the questions based on the last 30 days. Examples of questions include: “I thought I should cut down on my drinking or drug use”; “Stressful issues (family illness, financial setbacks, accidents) occurred in my life”; or “I woke up too early, or had trouble staying asleep”. The assessment takes 5-8 minutes to complete, is delivered through a user-friendly online HIPAA compliant platform, and is accessible online or through a mobile app. 

* A robust intervention following the assessment. Upon completion of the assessment, users are given an individual summary of their results. This provides a score for each mental health domain, an explanation of the score, and direction to recommended next steps. The next steps are determined based on the individual score and risk stratification (high, medium, and low). Those with high distress are directed to contact the EAP for intervention and counseling. Those with medium and low scores are guided to specific programs in Phase 2 of the WholeLife Directions campaign.   

* Aggregate data is used to understand the key mental health issues impacting the workforce. Once the employee population has taken the WLS, data is compiled into an executive summary. This provides a snapshot for each domain, which identifies the most prevalent mental issues within the employee population. The role of the EAP is then to provide consultation and guidance for the remaining three phases (or nine months) of the campaign. Targeted interventions for specific mental health domains are outlined based on the aggregate data.

The next three phases of the WholeLife Directions Program have an overall theme, in addition to highlighting one of the identified domains (listed previously as Anger, Stress, etc.).

Phase 2: Self Care 
This phase encourages individuals to utilize the EAPs recommended in their WLS summary report. The employer is also provided with tools that encourage self-care and domain-specific resources. 

* Web-based Cognitive Behavioral Therapy (CBT) programs are available to the individual user for each goal or domain identified in their WLS summary report. Each CBT program is broken into 5-10-minute sessions, which contain engaging, short, and accessible content. Tools include skill building, mindfulness techniques, and direction to EAP resources. 

* Resilience is targeted as an intervention during this phase. Webinars, interactive programs, and promotional materials are offered to the employer. Employees are encouraged to develop a personal resilience map and are offered interactive exercises through a module called “Resilience Journey”. 

* Resources are provided to employers based on areas of highest needs within the population. For example, if a significant percentage of the WLS scores indicated high distress in the depression domain, information would be shared about apps, podcasts, and treatment resources for depression. 

Phase 3: Care for Others
The next phase of the WholeLife Directions campaign focuses on caring for others, more specifically skill building for supervisors who are working directly with employees experiencing mental health issues.

* Supervisor support is crucial in supporting the needs of employees. Supervisors are sometimes the first in the organization to be aware of employee mental health issues. It is important that they receive training to recognize mental health issues in employees, and connect people with resources and response strategies in times of employee crisis. 

* Continued focus on stigma reduction is important. Employers are provided with a menu of promotional flyers to share, reducing myths associated with mental health treatment. The goal is to communicate treatment effectiveness, minimize shame, and reduce fears around help-seeking behavior. Domain-specific materials are also available, again focusing on areas of high distress within the overall population. 

* Users monitor their progress within the web-based CBT programs initiated in Phase 2. Individuals are encouraged to complete the programs through push notifications or emails. This is a proactive approach that enables the EAP to reach out to individuals who might not otherwise seek EAP services. 

Phase 4: Maintaining Healthy Changes 
The fourth and final phase encourages continued healthy behavior change, ways for dealing with setbacks, and ideas for helping the employer in the future. 

* Employees are encouraged to maintain improvement. They are invited to attend a webinar about stages of change and how to cope with barriers that may arise. For example, people using new skills to manage depression may experience a setback due to life changes, unexpected financial stress, or health issues. The goal is to offer EAP resources when barriers to sustained change occur.  

* Organizational support is provided to maintain momentum around the topic of holistic health. The EAP provides consultation and a menu of promotional flyers focused on continuous self-assessment and engagement with web-based CBT programs. 

* Population-specific needs continue to be addressed. Meaningful reporting on employee engagement allows for adjustment or continued focus of domain-specific interventions. For example, if users are not accessing anxiety self-use programs on an individual level, yet an organizational (e.g. aggregate) report shows that anxiety is high within the employee population, we may implement renewed attention and additional promotional materials focused on anxiety.

The WholeLife Directions program is designed to be easy to implement and take a minimal investment of time from employers. Employers are encouraged to use the program over multiple years to track progress through a year-to-year comparison.  

Designing a Program
Whether EAPs implement a program like the WholeLife Directions or design one of their own, there are specific elements to analyze for successful implementation:   

* Company environment and culture. What are the business’s needs? What are the employee demographics? What are successful communication channels used by the employer? Collecting this information will help prioritize specific areas. For example, does most of the employee population have access during their work day to a computer? If so, electronic communication will fit nicely within their structure. If not, using other communication channels such as print media (posters, flyers, etc.), staff meetings, and on-site training will be important avenues to consider.  
 
* Overall wellness strategy. Have you reviewed your claims data, absenteeism/presenteeism rates, and current wellness program utilization and outcomes? Is there an issue in your population you are concerned about? What barriers to access exist? What current wellness vendors are you working with? How can the EAP partner, supplement or replace what you’re currently using? Helping employers understand their preferences, needs, and goals allows for a holistic approach. Mental health should be prioritized as part of an overall wellness plan. An assessment such as the WLS will provide the employer with thorough baseline data that can identify issues for employer intervention and help inform coordination with wellness and other vendors.  

* Organizational support and engagement with leadership is key. Is there a personal or organizational connection to this topic? Who can serve as a champion to encourage participation, communicate benefits, and reinforce efforts towards positive change? Leadership buy-in is essential to help decrease stigma and increase engagement in EA programs. Ask a leader in the company if they are willing to lend their endorsement or share why the topic of mental health is important to them. Maybe it is a brief description of their own journey, how they have supported a friend or family member who has struggled with mental health issues, or simply what motivates them to live a holistic healthy life. 

* Provide incentives. What will motivate your client’s employees? In addition to traditional financial incentives, consider intangibles like celebrations, employee recognition, or extra paid time off. The goal is to reach as many employees as possible and incentives help give that extra push to encourage participation. Cascade has found that providing even small incentives to participants significantly increased utilization of the WLS.

* Emphasize confidentiality. A big concern with EAP participation in mental health treatment involves concerns about privacy. As a result, communicating the steps that are in place to protect personal health information is crucial. This can include distributing FAQ documents, and educating employees interested in serving as mental health advocates within the employee population.

Summary
Employee Assistance Programs are in a unique position to help employers integrate mental health into workplace wellness programs and safety initiatives. EAP services go beyond crisis, and low utilization does not have to be the norm. Partnering with employers to increase awareness of mental health issues, normalize help-seeking behavior, and reduce stigma is a crucial step in improving employee quality of life. 

The research is clear that mental health issues are costly to employers. It is important that organizations recognize that with the involvement of the EAP, support and intervention is available to reduce these costs. Customized programming, consultation, and organizational support are essential elements. Providing reports to demonstrate value is also key. This includes not only traditional utilization reports, but also measures on outcomes (such as the Workplace Outcome Suite, which we use), engagement with population-specific programming, and year-to-year comparisons. 

When it comes to employee health, the need to address wellness holistically has never been so important. Mental health issues are highly prevalent, with most people experiencing symptoms for years before they receive an accurate diagnosis and many never receiving treatment (Kohn, Saxena, Levav, & Saraceno, 2004). Utilizing new EAP tools for assessment and intervention can shift this paradigm. Prevention and early intervention is now possible. 

Julie Marshall, Ph.D., CEAP, oversees the administrative operations of Cascade and guides new product development in the area of behavioral health. In addition, she provides consultation to organizations in the areas of crisis management, behavioral health wellness, and organizational development. For more information, contact Julie at jmarshall@cascadecenters.com.

Anna Meiners, MA, is currently the Director of Account Services at Cascade.  Her experience in the mental health field includes provision of direct clinical services, wellness program development and consultation in all areas of Employee Assistance Services. Anna is an experienced presenter on the topic of mental health integration into the workplace. 

References

Any mental illness (AMI) among adults. (n.d.) National Institute of Mental Health. 

Kohn, R., Saxena, S., Levav, I., Saraceno, B. (2004). The treatment gap in mental health care; 
Bulletin of the World Health Organization, 82; 858-866.