Mental Health in the Workplace: Employee Assistance Programs

Kim LaMontagne Lead Worth Living New England Chapter

I share my personal story of being a high functioning business woman balancing a career and family while fighting (and hiding) major depression, anxiety and persistent suicidal thoughts. By sharing my story, I help individuals find the courage, power and strength to accept and love who they are and rise above the fear, stigma and shame of mental illness and talk openly about it.  I fought my battle alone because I was afraid of stigma. Especially in the workplace.  No one should suffer alone.

Mental Health in the Workplace: Increasing the Usage Rate of Employee Assistance Programs to Foster Employee Mental Wellness

In 2014, a mental health survey of 800 voters in Massachusetts was conducted by National Alliance on Mental Illness, Massachusetts Chapter and Martilla Strategies. The following responses were gathered around mental health and peer support in the workplace;

  • Question #1: It is best to tell your family about mental health issues OR is it best to keep it quiet:
    • Answer: 92% responded best to tell family.
  • Question #2 – Is it best to tell your friends about mental health issues OR is it best to keep it quiet:
    • Answer: 76% responded best to tell friends.
  • Question # 3 – It is best to tell your co-workers about mental health issues OR is it best to keep it quiet.
    • Answer: 27% suggest telling a co-worker

The responses are a clear indicator that employees do not feel safe sharing information with co-workers about mental health concerns.  In the same survey, more than 90% of voters believe mental illness is a serious issue and 60% believe it is a very serious issue.  Additionally, 82% believe most people with a mental illness do not get the treatment they need and more than 75% believe mental illness is an issue that deserves increased attention on the state and national level. Studies further document that stigma and widely-shared negative stereotypes about the causes and effects of mental illness — are the single greatest barrier to treating mental illness and lowering costs (Employee Benefits, 2007).

A recent meta-analysis based on a 174 large scale mental health surveys across 63 countries revealed that common mental disorders (CMD), (e.g. anxiety, depression, substance abuse) were experienced by “18% of adults within the past 12 months and 30% of adults over their lifetime” (Jarman et al., 2016). Approximately two thirds of people with CMD are working with “significant consequences for labor efficiency and economic growth” (Jarman et al., 2016).  The cost of CMD has been forecasted to be $16 trillion over 2012-2032 (Jarman et al., 2016).

In 1974, the National Institute on Alcoholism and Alcohol Abuse adopted the term Employee Assistance Program (EAP) in response to the need for employee intervention and support. An EAP is described as a “job performance-based intervention program in the workplace” (Hartwell et al., 1996).  EAP’s have been widely adopted and implemented in many organizations as “benevolent programs” (Ajunwa et. al., 2016) for employees to seek counseling for mental health, stress and substance abuse issues. In 2002 well over 100 million employees had access to an EAP with much of the growth happening in the 1990’s (The Employee Assistance Trade Association, 2016).

EAP’s can be a job-based program operating within an organization to identify and assist troubled employees or an outside vendor that the organization contracts with to provide an agreed upon set of services to the employees. Every organization has different needs so an EAP is not a one size fits all. Over 500 EAP providers exist in the United States providing access to mental health services for millions of working professionals.

Today over “75% of US employers provide EAP services” (Jacobson & Sacco, 2012).  Although a high rate of employers offers the benefit, the average usage rate of face to face counseling through EAP services in the U.S. is a staggering 3.5-5%.  Additionally, only 1.5-2.5% of all EAP clients present with alcohol or drug (AOD) “substance dependence” related problems (Jacobson & Sacco, 2012).  With that, it is up to the EAP provider to counsel to the stated problem and uncover if there are any underlying issues in addition to what the employee initially presents with.  Participation in a recovery program is voluntary on the employee’s behalf.  Prior research suggests that when an employee engages with EAP counseling and recommendations, there is an increase in participation in a recovery program.  EAP’s “more than pay for themselves by lowering companies’ direct and indirect medical costs” (Hemp, 2004).

There is a gap in knowledge that addresses what the employer is doing to increase engagement and use of the EAP to help ensure employee well-being.  Although 75 % of medium to large employers offer an EAP, there is a stigma around substance abuse and mental health that creates a barrier for EAP use. There is also a fear of confidentiality when using an EAP, thus preventing treatment and intervention. Stigma around mental health leads to the “under treatment of mental illness, with severe financial consequences” (Martilla Strategies, 2014).  How can leadership interventions help decrease the barriers to EAP usage which, in turn, increases the return on the EAP investment?

For maximum participation, employees must have trust that confidentiality will be assured if engaging in EAP services. To increase engagement in EAP services, a leadership training approach should be taken to support employee engagement. Leadership training should provide tools necessary for those in supervisory positions to help identify employees in need and provide intervention to minimize the level of the incident and increase employee recovery. Printable resources and fact sheets about the EAP services should be shared with employees who are at risk.  Additionally, employees should be educated about the myriad of services offered from National Alliance on Mental Illness (NAMI) and other organizations.  Employers can engage in a Mental Health First Aid program and encourage involvement in other NAMI programs.  Providing the tools to the employee is an essential part of addressing the issue.  For every employee in the workplace being treated for depression, 2.3 or 70% are receiving no treatment (Martilla Strategies, 2014).  For the high ‘at risk’ population of employees to seek services or admit to a mental health ailment, they need to build trust in leadership of their organization and be assured support rather than stigma.

The literature suggests the approach to dispelling stigma is multipronged including; education to dispel myths, protest to reduce stigma and “contact to put a human face on mental illness” (Martin, 2008). Sharing experiences of mental illness through direct person to person connections “can create long term attitudinal change and affect behavior (Knapp et al, 2007).  Those individuals who are brave enough to share their story of recovery from mental illness should be invited into the workplace to speak with employees. Sharing their story is a powerful way to start the conversation about mental health. It is also suggested that both consumer/survivor and leadership involvement is “critical to the success” of an anti-stigma campaign (Martin, 2008). Additionally, creating internal anti stigma champions in leadership roles helps to increase long term program participation and commitment (Martin, 2008).

The world’s first National Standard for Psychological Health and Safety in the Workplace (Standard) was launched in Canada by the Mental Health Commission.  The Standard “Provides a framework to promote the mental health of and prevent the psychological harm to employees providing guidance and resources to help organizations of all sizes and sectors” (MHCC, 2016).  It is a global first.  A step by step guide geared to senior level leaders aimed at providing resources and tools to be a responsible employer.

In 2014, a 3-year Case Study Research Project was launched to better understand how employers are implementing the Standard across Canada.  Over 40 organizations participated in research study. Data was collected at baseline, interim and final points. The findings from this 3-year CSRP provide concrete data for HR professionals and CEOs interested in strengthening the bottom line.

Key findings include;

  • 90% of participating organizations indicated their motivator for implementing the Standard was to protect the psychological health of employees
  • 91 % of participating organizations stated implementing the Standard was the right thing to do
  • 60% of organizations have implemented activities to raise awareness of mental health in the workplace
  • 70% are providing employees with EAP services tailored to mental health
  • 72% compliance by participating organizations in the five elements of the Standard (commitment, leadership/participation, planning, implementation, evaluation and corrective action, management review).

Additionally, a 2008 report written for the Mental Health Commission of Canada, provided a review of several anti-stigma programs currently in place around the world to understand the effectiveness of the approaches used.  Programs include;  Breaking the Silence (USA), Change Your Mind About Mental Health (USA), Entertainment Industries Council (USA), In Our Own Voice (USA), Nothing to Hide (USA), Active Minds on Campus (USA), The Kids on the Block (USA), Stigma Watch (Australia), Like Minds, Like Mine ( New Zealand), Beyond Blue (Australia), Mind (England), See Me (Scotland), SAMHSA (Substance Abuse and Mental Services Administration – USA), Mental Health Law Center (Australia), (Martin, 2008).  The aim of the programs includes education, challenging stereotypes, decrease discrimination, increase inclusion, promote self-confidence and encourage legislative change.

As a leader in mental health programs, Australia developed a broad strategy to involve governmental and non-governmental partners to tackle the issue from several angles including a public education campaign (BeyondBlue), anti-stigma initiatives (SANE Australia), workplace education, (Mindframe Australia) and legal advocacy (Mental Health Law Center).  In England, the national lottery recently committed £18 million to a 4-year anti-discrimination program to comprised of a national media campaign, community outreach, empowerment and engagement and “training and education targeting leaders and professionals to reduce discriminatory behaviors” (Martin, 2008).  Other countries have developed similar programs to foster mental health and well-being.

To build a healthier workplace, there must be a team approach to employee health and wellness.  The adage of leave your problems at the door is a thing of the past. Since most employees experience major disruptive issues affecting on the job performance, there must be a comprehensive top down organizational strategy.  A top down strategy ensures proper management of employee health to increase retention and decrease healthcare costs.  The role of the CEO and leadership within an organization is critical to supporting the success (and implementation) of a program to support the well-being of employees.  When mental health is valued by leaders, appropriate resources become increasingly more available, employees are educated about the resources, usage increase and there is a substantial benefit to the organization.

Start the conversation now about mental wellness.

It’s good for the bottom line.


Kim LaMontagne, MBA  

Mental Health Advocate, Speaker and Teacher for National Alliance on Mental Illness, NH Chapter

Ambassador, Keynote Speaker and Lead for Worth Living, New England Chapter

Sr. Learning Consultant, Walden University- National Accounts

Contributing Author, Consultant and Survivor



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