May 19, 2021
Rarely, if ever, has the mental health of people worldwide been as strained as it has been in 2021. A global pandemic continues to rage across much of the globe, while people have become increasingly isolated from each other. Caregiver burden is higher than ever as schools and childcare centers have been shuttered for more than a year in many countries. Tens of millions of people have lost friends and family members to COVID-19. To make matters worse, the traditional ways of coping with mental health challenges, such as being outside, seeing friends, exercising at a gym, and finding appropriate health care services, have been more difficult to access. The list goes on.
Before the pandemic, mental health care in the U.S. and around the globe was difficult to access, and mental health issues were a major concern. In fact, as some countries begin returning to some semblance of pre-pandemic normalcy, it is likely that depression will continue to be the number one cause of disability across the globe, an opioid epidemic will take the lives of tens of thousands in the U.S. each year, and seeking care will be significantly stigmatized in most places.
Large employers have been doing their part during the pandemic to implement new services or vendor partnerships to increase access to virtual care (76% of large employers according to the Business Group’s 2021 Health Care Strategy and Plan Design Survey) and mental health care (43%) in 2020/2021. Utilization of these sorely needed services during the pandemic have been sky high. But to truly impact the long-term mental health of their populations, employers need to think comprehensively about how they approach the full continuum of mental health in their workforces, and they need vendor partners who can tackle longstanding, difficult issues related to continuity of care, access, quality and stigma.
A Roadmap for an Optimal Mental Health Care Benefit Strategy
Business Group on Health, guided by several of its most progressive, innovative member companies representing millions of employees across the globe, is in the process of creating a comprehensive “Roadmap for an Optimal Mental Health Benefit Strategy” to be published in the coming year. For employers and their partners grappling with mental health care strategy questions now, the key considerations below capture many of the themes that have emerged from conversations with employer leaders guiding the Business Group’s work on a comprehensive and forward-thinking roadmap.
Key Considerations for Employers and their Vendor Partners to Improve Mental Health Benefits
Employers and industry partners that work with them should keep the following considerations in mind as they approach how to increase access to high- quality mental health services to their employee populations.
- 1 | Ensure that your strategy supports employees across a spectrum of mental health issues, from those who are subclinical, with few if any symptoms, all the way to those in serious mental health crisis. Among people experiencing mental health issues, there is a wide range, from the relatively healthy to someone in need of more intensive services; this continuum of need is extremely fluid. Many industry partners address one slice of an employer’s population based on the level of severity of their condition. Employers considering how to respond to employees’ mental health needs should consider both 1) what condition(s) their proposed strategy or vendor partner addresses and 2) what level of clinical intensity that strategy or vendor can provide for people along a spectrum of mental health needs.
- 2 | Remember that mental health is more than anxiety and depression. When we talk about mental health, anxiety and depression are often the central focus. Almost all mental health vendors are going to have some approach for addressing those issues, but not all incorporate supports for people living with conditions like autism spectrum disorders, epilepsy, ADHD (attention deficit hyperactivity disorder), or cerebral palsy. Employers and their industry partners are behooved to think expansively about how they support employee mental health conditions, particularly since many occur alongside one another.
- 3 | Sacrificing quality for access does not benefit employees or patients. There are well-known issues related to access to care for mental health. Services in many areas of the U.S. and across the world are scarce for several reasons, so existing providers are often able to drive up prices because of a lack of competition. Still, employers must resist the urge to expand access to care that may be of lower quality or not based in evidence for the sake of the appearance of increasing the breadth of their benefit. Quality and outcomes metrics can be more difficult to come by in mental health compared to some areas of “physical” health, and adherence to evidence-based approaches can be lacking, but they do exist and employers should demand of their vendors a transparent accounting of their performance and evidence-based protocols.
Employer Response to COVID
According to the Business Group on Health’s 2021 Health Care Strategy and Plan Design Survey, the most common step employers have taken to support their employees through the pandemic has been to make changes to allow for better access to virtual care solutions. The fourth most common was to add new mental health benefits or offerings for employees new to working from home. .
4 | As employers and their industry partners consider any new approach to providing care or benefit strategy, they need to be clear about their goals. Some of these goals could include:
- Protecting and safeguarding the overall brain health of your employees and their dependents;
- Offering tools for serious harm reduction (e.g., suicide or overdose prevention);
- Improving employee productivity and reducing absenteeism;
- Retaining high-performing employees; and
- Promoting the diversity, inclusion and equity goals of your organization through culturally competent communications and framing.
Some, if not most programs or services, will address more than one of these and/or other goals. Identifying what you’re trying to do in support of employees and patients will impact how you communicate – to senior leaders and employees alike – and craft your program or strategy.
- 5 | Industry partners providing mental health programs or services to employers need to think aggressively about expanding the scope of services they’re able to provide and the populations they’re able to care for. Point solution fatigue is at an all-time high for employers, 76% of which implemented new virtual care programs or strategies in 2020/2021 to expand access for employees at home during the pandemic. Dozens of vendors in the mental health care space provide excellent services for particular sub-populations within an employer’s workforce. However, for many employers, this has resulted in several vendor partnerships, each of which may each make sense in isolation but fail on integration and create employee confusion. The mental health care industry will be “won” by companies who can deliver a comprehensive set of services addressing the needs of a significant portion of an employer’s population. Whether this is achieved through consolidation, partnership or growth doesn’t really matter, as long as it’s effective for employers and their employees.
- 6 | Relatedly, those providing mental health care services will see the greatest success if they are able to diffuse innovations across the globe, rather than focusing their efforts on the U.S. market. Addressing mental health from a global and local perspective is incredibly challenging, given the scope of the issue (almost 8 billion humans on planet Earth in 2021!), variation in mental health burden and services across the globe, and push-and-pull between employers’ desire for customization within regions and standardization across their markets. Leading employers have expressed frustration that many of the vendors they successfully work with inside the U.S. often are not able to offer those services to employees outside the U.S. While this is a great challenge, it is a challenge worth solving, given the opportunity to help billions of people and make money doing it. That being said, employers need to be willing to pay for this diffusion of innovation where it is necessary.
- 7 | Employee assistance providers (EAPs) have a key role to play in an employer’s mental health strategy, but they cannot be everything to everyone. Nearly all large employers work with EAPs to deliver mental health care services to their employees, alongside whatever benefit they have through their standard health plan and additional mental health-focused vendors. The breadth of services that EAPs are able to provide is extensive, but they cannot solve all of the employer needs and considerations listed above, nor can any vendor currently in the market. Employers need to think expansively about how they approach mental health benefits and appreciate the significant advantages and limitations of their current approaches.