Recognizing employee barriers to mental health services

Each year in the United States, approximately 44.7 million adults aged 18 or older (18.3 percent of all U.S. adults) experience a mental health condition. Of those, 10.4 million are categorized as serious. In addition to the impact on the United States, these conditions are known to produce significant risk and disability globally. According to the World Health Organization (WHO) the global share of disability due to mental health conditions is projected to rise to 14.7 percent in 2020, almost a 50 percent increase in share of disability from 10.5 percent in 1990, making depression the leading cause of disability worldwide.

To address these concerns, organizations and workplaces have made considerable efforts over the past decade to promote employee mental health benefits and services. Yet even when employees know where to go for help, some remain hesitant to reach out, afraid to admit or acknowledge that they are stressed, anxious or depressed. They may not recognize that what they are experiencing is a common, treatable health condition. Despite the prevalence of mental health conditions among adults, approximately two-thirds of people with symptoms matching clinical criteria for mental and substance use disorders do not receive treatment.

There are a number of reasons why employees do not seek treatment. Pervasive social stigma and lack of awareness of resources and their effectiveness are among the most common from keeping employees from seeking care. Furthermore, employees with mental health conditions often face work-related discrimination, such as limited independence, increase in supervision, jeopardized job-security, or restriction on their career advancement. This often results in workers taking great lengths to ensure that co-workers and managers do not find out about their conditions, which includes avoiding employee assistance programs and effective treatment options.

Comprehensive workplace mental health programming

Programs and activities directed toward employees should encourage help-seeking, support efforts to reduce stigma associated with help-seeking and mental health conditions and enhance connectedness in the workplace and in the community. To overcome employee barriers to accessing treatment, organizations must take a proactive approach in identifying and managing mental health problems among their employees.

These efforts, however, must be supported by a workplace culture that is supportive of employees engaged in treatment for mental health conditions. Successful programs take a comprehensive approach to health that may include changes to the work environment to encourage healthy behaviors in multiple domains of health.

Employee Assistance Programs (EAPs) can play a critical role in supporting employee mental health. EAPs are designed to offer confidential short-term counseling and information to employees for work and personal concerns that may affect workplace performance. In addition to services and support for employee mental health concerns, EAPs offer resources and information on child and elder care services, support groups, stress reduction classes, alcohol and substance misuse treatment, and marital counseling for employees and their family members.

In addition to EAPs, support for employees who seek treatment and/or who require hospitalization such as disability leave and planning for a return to work along with health insurance coverage that treats mental illness with the same urgency as physical illness, are vital to comprehensive suicide prevention efforts. Regular communication to all employees about available mental health services and the importance of mental wellness help promote a climate of acceptance that reduces stigma and discrimination in the workplace.

Reducing barriers to help-seeking

Building a culture of well-being paired with mental health services and programming with specific efforts to address employee barriers to help seeking will encourage employees to utilize services offered by their employer. Stigma reduction is a core component in successful mental health and wellness programs. A program developed by DuPont's Employee Assistance Program, the ICU Program, is an awareness campaign made exclusively for the workplace, designed to reduce the stigma associated with mental health and foster a workplace culture that supports mental health help-seeking.

Another stigma reduction program available to employers is Right Direction, an educational initiative developed by The Center for Workplace Mental Health, a program of the American Psychiatric Association Foundation and Employers Health Coalition, Inc., designed to reduce stigma, motivate employees and their family members to seek help when needed, and provide employers with appropriate support tools and resources.

A program at the University of California, San Diego (UCSD) School of Medicine, which was developed after the loss of more than 10 physicians and trainees to suicide over a period of 15 years, aimed to reduce barriers to help seeking, increase mental health service engagement and enhance wellness via education paired with the implementation of the American Foundation for Suicide Prevention's online Interactive Screening Program (ISP). To date, more than 300 physicians, staff and trainees have accepted referrals for mental health treatment through the program; the majority report that they would not have done so on their own. .

Several aspects of the work environment can be leveraged to reduce employee barriers to help seeking and increase mental health service utilization. Key features of mental health programming for workplaces include reducing stigma associated with mental health distress and help seeking and improving access to mental health services such as EAP.

There are currently many occupational fields engaging in new strategies to appropriately frame mental health as a legitimate part of health: making policy changes related to health care access and fitness for duty evaluation, HR and staff training, screening and comprehensive suicide prevention programs to make progress. The good news is that these efforts not only provide a pathway to elevate overall workforce mental health, but these efforts have the added potential to contribute to greater employee engagement and to the financial bottom line of an organization.

Maggie G. Mortali, MPH, is director of the Interactive Screening Program, American Foundation for Suicide Prevention.

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