As companies become increasingly global, employers are searching for ways to improve the health and productivity of their employees around the world. One way that employers are working toward this goal is by implementing employee assistance programs (EAPs) globally. To get internal buyin, developing a business case is often necessary. The data in this document can be a helpful resource for doing so.
Why is a global EAP necessary?
- Depression is the leading cause of disability globally. The World Health Organization estimates that lost productivity due to depression and anxiety costs the global economy $1 trillion annually.1
- Worldwide, more than 615 million people suffer from depression or anxiety, an increase of 50% since 1990.2
- Without improvements in mental health, 12 billion working days will be lost each year due to depression and anxiety alone.2
- Ten percent of the global population is affected by mental health disorders.2 Even more report high stress levels (see figure 1).
- On average, country governments only spend about 3% of their budgets on mental health. In low-income countries, the percentage is even smaller.2 In many countries, community based services don’t exist. Where they do exist, they may be prohibitively expensive. This means that in some locations, EAP may be the only way employees can receive treatment or support for mental health issues.
What can an EAP do?
A well-run and well-promoted EAP can have tangible (e.g., reduced absences) and intangible effects (e.g., enhanced reputation) on an organization.
Being Realistic: Opportunities and Challenges in EAP
While EAPs can make a real difference in the lives of employees around the world, it’s important for employers to also know that there are challenges as relates to a global program. Some of these are listed below.
Many times, global EAP costs are higher than those for domestic EAPs - even in countries where overall operating costs are typically lower.9 The reasons for this include lower employee volume, more expensive phone charges, decentralization in order to make services culturally appropriate, a need for more doctoral-level therapists because of a lack of counselor licensure/standards, higher service rates due to fewer available providers, and the increased time involved in building, maintaining and reporting on an international network.10 In general, overall cost often goes down with larger volume covered as the per person charge decreases. In some countries, that per person charge can still be higher than local competitors. To evaluate the true cost difference, compare the services offered and consider productivity time involved in managing multiple vendors.
While it is important that employers have a global strategy for employee health programs, such as an EAP, it is also crucial that they review each location individually to examine local needs and preferences. Factors to consider when implementing a global EAP include the availability of mental health services, the level of mental health stigma in the country, confidentiality and trust among employees, legal issues, and any workplace or cultural issues that may impact acceptance of the program. The best way to determine these needs is by speaking with local HR staff members since they are generally the most culturally competent. Surveying employees may also be useful. Employers should listen and understand individual needs before imparting their own vision of EAP onto the site.
Utilization rates are often lower outside of North America,11 and they vary tremendously across regions and countries. According to GBGH employer members, the most important factor that impacts utilization is promotion. Employers and vendors alike say that the more EAP is advertised and promoted within an organization, particularly by top management, peers and local champions, the more often it is used. It is important that employers not leave this promotion up to the EAP vendor; rather, employers should use many different modalities and opportunities to promote the EAP as often as possible. One caution: GBGH members sometimes report that EAP vendors may calculate utilization rates differently. In order to have accurate comparisons, several recommend that employers ask their vendors to give them various cuts of data, not just aggregate utilization, so that all the ways that employees are using the program (webinars, referrals, counseling, etc.) are clear. It is also important to have global, regional and country-level data so that employers can see where utilization is strongest.
“Promotion is one way to increase utilization. Another is keeping it top of mind for employees. They need to remember it exists when they have a need. One way to do this is to have a contract with a vendor that includes monthly “lunch and learn” sessions that focus on topics of high interest to your employee population.”
EAP and well-being programs
In conversations with Business Group staff, many employers reported using EAP as a “launch pad” for all their wellness programs around the world. Vendors, in turn, are offering products such as health assessments and lifestyle or health coaching. This increased focus on holistic well-being may be because EAPs are one of the few programs where there are a number of global providers. Another advantage is that all employee support programs can be grouped under the same “umbrella” and unveiled at the same time. However, concerns about utilization rates are particularly relevant in cases where the organization is using the EAP for all their wellness initiatives as well since there are multiple objectives to be met by one program. Employers should be careful to examine, on a country-by-country basis, whether EAP is the appropriate model for launching all well-being programs. Some considerations to keep in mind are whether there is buy-in from local staff (e.g., are local champions available?), whether cultural concerns may play a role in limiting use and whether a chosen vendor has strong capabilities in this geographical and programmatic arena.
In many countries around the world, there is a shortage of appropriate mental health professionals. In fact, in emerging markets there may be very few or no providers. It is important that global EAP vendors enter new markets with the goal of finding local practitioners and training them so that they become effective EAP providers – while still keeping local needs and culture in mind. This is also an area where vendors can be creative and flexible in finding solutions. Does a provider need to be flown in or does the employee need to be flown to a provider? Is telephone counseling, done with a native speaker of the employee’s first language, appropriate? Can online services be used?
As the EAP industry has grown, both in North America and worldwide, it has increasingly become commoditized to the point that it is difficult to tell one vendor from another, particularly on paper.9 This often leads to decision-making based only on price. One of the reasons for this is the capitated pricing structure (e.g. per member per month), which may create an incentive for the EAP to do as little as possible to remain profitable. Capitation is popular among employers, however, because it is inexpensive and allows them to have a fixed budget for EAP.12 Employers may also contribute to the commoditization problem by asking for services that mirror a North American EAP, which may allow vendors to provide an “off the shelf” approach that is not suited to meeting local needs. It is important that employers feel empowered to work with their vendors to develop unique programs that best meet the needs of their in-country employees.9
Technology, like wellness and well-being, is a focus area for both employers and vendors. Vendors are increasingly offering online booking through websites and apps, and some are offering web-based or video counseling, particularly for employees in remote areas or cities where traffic or travel is a problem. It remains to be seen whether increasing access through the use of technology will increase utilization, but employers should be aware of vendor capabilities in this area as well as ensure that they are protecting the private data of their workforce.
EAP as an employer resource
Some providers offer services for human resources and managers when the company is going through tough times such as a reduction in force. Companies have used EAP as the fastest and most effective way to outreach to local employees during disasters or traumatic local events. Without it they may otherwise not have resources or enough staff on the ground to do so.
How to offer an EAP
Typically, employers either prefer to implement a single global EAP supplier or utilize a variety of regional or local vendors around the world.9 The argument for a single vendor includes broad geographical coverage, ease of communication, centralized account management and standard data reporting. However, there is a lack of consensus on whether one global vendor can meet the needs of a multinational workforce and whether one global vendor can have sufficient knowledge of country-specific legal issues, cultural norms and local providers.13 Regardless of the model chosen, core services should include high-touch account management, legal compliance, quality local services that are culturally appropriate, quality and access as priority over cost, telephone-based and face-to-face service options, language- and culture-specific electronic services, robust websites and promotional materials and customized data reporting.13 Note: When rolling out an EAP in other countries, companies should connect with their labor and employee relations colleagues as often there my be works council, union notification or consultation requirements.
Organizations also differ as to whether they purchase an EAP on a centralized, decentralized or mixed basis:14
- Centralized: Headquarters selects a program that covers all subsidiaries across the world. However, headquarters may or may not actually fund the program globally. Strengths of this model include a simple sales process, the potential for lower rates because of more covered lives, standardized reporting and a consistent worldwide program. Also, the company has the ability to manage a more robust supplier management strategy, and can draft a contract to include certain services. Quarterly reviews of utilization and service may help to keep a strong relationship with the EAP supplier and a better chance for engagement. However, subsidiaries may feel like the program has been forced on them, which may affect local-buy in.
- Decentralized: Each subsidiary chooses an individual EAP vendor. Strengths of this model include awareness of local needs and a potential for greater buyin and ownership over the program. On the other hand, this model can be a challenge for in-country staff. Local staff may not be familiar enough with EAP to either choose to have a program or to know what type of program to choose. Additionally, the sales process is more difficult and costs may be higher due to fewer employees covered.
- Mixed: Headquarters chooses a preferred supplier and negotiates rates. However, unlike the centralized model, local subsidiaries have the ability to choose whether they want to use the chosen provider or use a different one—or not implement an EAP at all. Strengths of this model include lower costs due to increased employee size and local staff will still feel like they are given a choice. Also, like in the centralized model, corporate can have ownership over the supplier management strategy, contracting and quarterly review process. A weakness of this model is that local subsidiaries may not buy into the program. If there is buy-in, the worldwide launch may be staggered.
U.S. multinational employers differ in how they choose to contract with EAP providers. They may contract directly with a global provider for all their locations or choose to contract with a domestic, U.S.-based, provider that then establishes a contract with a global provider. There are pros and cons to both methods. Advantages to contracting with a U.S.-based provider first may include ease of administration, a more integrated experience, coordination with expatriate benefits where appropriate, and an “apples-to-apples” comparison between the U.S. and other worldwide locations. One of the advantages to contracting with a global vendor is greater access and line of sight to local providers. Even though most global vendors do contract with local vendors or individual providers, there is still a sense among some employers of cutting out the “middleman” by contracting directly with a global vendor. Ultimately an employer needs to decide which method is most appropriate for the company given available resources.
Building a well-promoted and well-run EAP is possible and it has the potential to positively impact your company’s bottom line. Throughout this toolkit, we provide strategies, based on research and employer/vendor interviews, to make your EAP as relevant, efficient and culturally appropriate as possible. Employer examples will also provide illustrations of how companies have built an effective EAP or are in the process of doing so. Our hope is that employers at all stages of implementation will find this information helpful in developing or finetuning their EAP strategies around the world.
View other parts of this guide:
- Global Employee Assistance Programs: Going Beyond EAP for Mental Health
- Global Employee Assistance Programs: Promotion and Implementation
- Global Employee Assistance Programs: Purchasing Materials
- Global Employee Assistance Programs: Vendor Comparison Chart
- World Health Organization. Mental Health in the Workplace. http://www.who.int/mental_health/in_the_workplace/en/. Accessed March 22, 2018.
- Luxton E. This is the surprisingly large economic dividend from investing in better mental health. World Economic Forum, 13 April 2016. https://www.weforum.org/agenda/2016/04/treating-depression-is-good-for-theglobal-economy/. Accessed March 22, 2018.
- International Employee Assistance Professionals Association. Study: EAP works across cultures and borders. http://www.eapassn.org/Study-EAP-Works. Accessed March 27, 2018.
- Li P, Sharar DA, Lenox R, Zhuang W. Evaluating EAP counseling in the Chinese workplace: A study with a brief instrument. Journal of Workplace Behavioral Health. 2015;30(1-2):66-78.
- Attridge M, Cahill T, Granberry SW, Herlihy PA. Study: Industry profile of 82 external EAP providers. Baton Rouge, LA: National Behavioral Consortium;2013.
- Mellor-Clark J, Twigg E, Farrell E, Kinder A. Benchmarking key service quality indicators in UK employee assistance programme counselling: A CORE System data profile. Counselling and Psychotherapy Research: Linking research with practice. 2013;13(1).
- Compton RL, McManus JG. Employee assistance programs in Australia: Evaluating Success. Journal of Workplace Behavioral Health. 2015;30(1-2):32-45.
- Morneau Shepell. The integration of EAP with disability management programs fosters better disability outcomes and economic advantages. http://www.morneaushepell.com/sites/default/files/documents/2595-integration-eapdisability-management-programs-fosters-better-disability-outcomes-and-economic/7161/ms-integratedeapanddmapr2014.pdf. Accessed April 2, 2018.
- Pompe JC. The state of global EAP: A purchaser’s perspective. Journal of Workplace Behavioral Health. 2011;26(1):10-24.
- Board N, Levine D. Expanding EAPs from North America to global workforces. Presented at: EASNA 21st Annual Institute; May 8, 2009; Denver, CO.
- Chestnut Global Partners. Trends Report April 2017. http://chestnutglobalpartners.org/Portals/cgp/Publications/ Trends-Report-April2017.pdf. Accessed March 27, 2018.
- Farris T. A new approach to EAP pricing: Value-based pricing models create incentives for EAPs to increase utilization and help employers understand the benefits EAPs provide. The Journal of Employee Assistance. 2003;June.
- Pompe JC, Sharar DA. Crafting EAPs to support a global workforce. https://www.shrm.org/resourcesandtools/hrtopics/benefits/pages/globaleaps.aspx. Accessed April 2, 2018.
- Levine D. History and business case of global EAP. Presented at: PPC Global EAP/WorkLife Seminar; January 14, 2010; Silver Spring, MD.