Nine years is the average period people live with a mental health condition before seeking help. Why does it take so long? Like so many things related to our emotional wellbeing and mental health, it’s complicated. Some of the reasons people delay seeking help sit outside an employer’s sphere of control. But not all of them. In speaking to over 16,000 individuals in the last 12 months, we’ve heard four themes about seeking support that employers can influence.

1- What to do?  What to say? 
About a third of all emotional/mental health cases start with the individual saying something like,

• “Where do I start?”
• “What do I address first?”
• “I don’t know how to explain what I’m experiencing.”

In short, asking for help of this kind is new territory for most of us. This is certainly reasonable given that people with any clinical training in mental health make up less than half of 1% of Americans. As a culture, we are only learning how to recognize and talk about these issues. On top of that, the stigma surrounding mental health is a powerful deterrent. In fact, 1 in 10 mental health cases start with someone reaching out for support on an unrelated issue, for example, financial coaching. The underlying emotional/mental health issue (e.g., stress or emotional shopping) is discovered while providing other services. It’s worth celebrating that an individual sought help on any issue.  When emotional health issues are brought into the light, it’s often the unexpected ‘big win’ for the individual. 

Suggestions for employers:

• Don’t assume everyone can self-assess mental health issues. Make sure your mental health solution(s) includes 24/7 access to talk with a counselor. Digital assessments are a valuable option for people who have been actively managing mental health issues. They are often sophisticated in identifying what they need. Over 70% of people who receive counseling services through an employee assistance program are addressing an emotional/mental health issue for the first time. When digital self-assessment is the only option available, a significant percentage of people will fail to adequately communicate their needs. This makes aligning the right resources for them much more difficult.

• Equip your workplace community to detect upspoken emotional/mental health needs. Keep in mind, these take countless forms and include everything from someone who becomes quiet and withdrawn, to people overstepping their roles and normal responses to issues. Rarely is it as obvious as witnessing someone who is openly upset. Today there are many training courses available to help managers recognize the signs of mental health issues and appropriately approach individuals.  The goal should not be to train managers to assess issues (leave that to licensed professionals), but for them to become comfortable communicating concern and directing the employee to confidential and expert support.  When managers do this well, use of mental health support increases by 30%.
  
  

2- You don’t see me!
Having a counselor that “gets” you and your issue is essential for therapeutic success. It’s important, but not enough to have a counselor with clinical expertise related to someone’s mental health issue (e.g., depression, marital issues, anxiety, etc.). Equally important is a counselor that has the experience to provide culturally relevant and affirming care. It is critical to connect with a counselor with a deep understanding of how race, gender, sexuality, socioeconomic class and other social factors impact your health and wellbeing. Simply put, understanding of the “whole person” can’t be a secondary consideration.

Suggestion for employers: 
It’s not enough for service providers to have diverse counselors identifiable in their networks - though that is a worthy first step. Employers and providers need to overtly communicate the importance of culturally affirmative care and the capability to deliver it. Employees should “see themselves” reflected in the services offered.  To make it work, providers need to invest in training their counselors in culturally relevant care and proactively assess the whole person. This means asking individuals about multiple dimensions of who they are, what their lived experience has been, and what preferences they have when considering a counselor.  Without this, alignment of support becomes guess work.   

3- Not so fast!
The employee mental health industry is quickly evolving and improving, thanks in part to growing competition in the field. One metric that today’s employee assistance vendors are competing on is the “time to first appointment.”  This reflects a vendor’s capability to identify available mental health professionals and minimize delays in employees’ access to care.  However, it often does not reflect users’ needs and preferences. Speed alone sacrifices alignment and desired convenience. When given scheduling options spanning two weeks, we see the appointments in the second week fill first. People need flexibility as they are managing busy lives, even when seeking support for themselves.

Suggestions for employers:
Take time to assess the service model of your mental health vendor(s). Look for two things.  First, multiple points of access that make it easy for people to engage digitally and over the phone. No generational stereotypes should be applied. Even millennials pick up the phone to ask for support. Second, the availability of services must reflect people’s situations. This means the capacity to address emergencies and the availability of flexibility. The next three days can’t be the only option.   
 

4- What am I paying for?
As every employer knows, employees are very conscious of how much they are paying for health insurance.  While they can receive a set amount of counseling sessions for free through the employee assistance program (e.g., 3 or 6 sessions), they want to use their health insurance for any continuation of support. When programs aren’t equipped for seamless transitions from one mental health solution to the next, it puts the burden of managing this transition on the individual. Often, this leads to the individual abandoning mental health care because finding suitable and available providers is too difficult a task.

What can employers do?
Carefully assess your mental health vendor(s).  In addition to the issues above consider:

• Do they identify counselors based on the health plans they take? Today, many employee assistance providers either do not guarantee alignment with an in-health plan provider, or work with non-health plan networks guaranteeing this connection does not get made.
  
  
• Do they coordinate with in-health plan counselors to ensure the payment of care moves from the EAP vendor to the health plan without a disruption in care? 
  
  

It is an interesting time in employee mental health.  Culturally we are beginning to embrace that mental health is simply part of being human.  We ALL need to manage it like any other aspect or our health.  It is also a period in which new service models are being introduced. Many of them have and will continue to elevate the ‘industry’ of mental health. In all of this, it can be a challenge to hear the employees’ voice, but employers and providers must ensure that it never gets lost.

This post was composed with contributions from KGA staff members Nicole Henry, Communications Specialist, Kristin Mathews LICSW, Chief Clinical Officer, and Seth Moeller, CEO. 
[email protected] / 508-879-2093.