The issue of mental health support for the American workforce continues to be a huge problem for employers. It has become as important as employee physical health. And the mindset of the employer regarding mental health priority is as essential as the mindset of the employee. According to the National Institute of Mental Health, well-being and mental health at work are continuing to decline in 2023. With a growing tug of war between bosses and employees and deepening mistrust, company leaders are still missing the mark when it comes to workplace mental health priorities. Deloitte research indicates 77% of employees have reported burnout at their current job, and a massive 91% report that feelings of stress and frustration have a negative impact on the quality of their work.
In 2021, I reported a survey conducted by OnePoll, which showed that 62% of American workers are worried their bosses would think less of them for taking mental health days. The study polled 2,000 employed American workers, 57% of whom said mental health isn’t a good enough reason to take time off. Seven in 10 said they’d rather take an entire day off work than a few hours—all to avoid telling their employer why they’re taking the time off. An additional 67% said they’re more likely to keep it vague and just tell their employer they have “an appointment” if they have to take time off for mental health care. Over half (56%) of respondents also felt like their employer would think they're unable to perform their job if they requested time off for mental health care.
Two new studies conducted in June and July of this year indicate that mental health problems in the workplace continue to worsen due to six mistakes employers are making:
ResumeLab’s Mental Health July, 2023 study of over 1,000 U.S. based employees found that 60% of the workers surveyed feel discriminated against because of their mental health condition. A full 68% are concerned that disclosing their mental health issues would harm their professional reputation. And 49% report work pressures and 42% say excessive workloads cause mental health struggles. Additional top findings include the following:
“This data confirms that fear and stigmas surrounding mental health in the workplace still exist,” says Agata Szczepanek, career expert at Resumelab. “While much progress has been made to support workers, continuing to improve policies and building inclusive and accepting work environments should remain a priority for companies,” Szczepanek concluded.
A June survey by the Northeast Business Group on Health (NEBGH) found that about one in four respondents (26%) say employers never identify what their employees’ mental health needs might be, nor do they test whether workers are aware of mental health programs and how effective those programs might be. Nearly three in 10 employers (29%) do not use social media and internal online tools to enhance their mental health strategies. On the positive side, a little less than half of respondents (47%) believe managers are always or usually engaged in breaking the mental health stigma, and 49% say their managers know how to respond to an employee’s mental health needs and steer them toward necessary resources.
Ellen Rudolph, founder and CEO of WellTheory—inspired by her own autoimmune disease—believes employers remain in the dark about what provisions they should make for their employees. She identifies four ways they can raise their awareness and support employee mental health:
Rather than simply checking boxes, Rudolph concludes that employers should be looking to provide holistic offerings that promote long-term wellness and view their employees as a whole person.
Employers missing the mark can raise their grades by holding discussions with workers on the importance of self-care, work-life balance and the de-stigmatization of mental health issues. Plus, they can encourage micro-breaks throughout the workday and stress the importance of PTO, vacations and self-care plans for each worker along with offering consultations on these plans. Lastly, employers can prioritize a mentally well culture by developing written policies so all employees know where the organization stands on mental health priorities. One thing is certain. Any action leaders take to support employee well-being and mental health will boost the company’s bottom line in the long run.
U.S. employers feel that they are coming up short when it comes to meeting the mental health needs of their employees, according to the Northeast Business Group on Health. (Vichai Phububphapan/iStock / Getty Images Plus)
Employers give themselves poor marks in terms of providing mental health services to their employees but high scores for supporting initiatives to improve diversity, equity and inclusion among their rank and file, according to a new survey by the Northeast Business Group on Health (NEBGH).
A Northeast Business Group on Health survey, published Monday, found that 26% of employers never identify the needs of employees, nor the “awareness and effectiveness” of their mental health programs. About three in ten respondents don’t have messaging campaigns through social media and internal platforms on mental health.
While employers and health organizations in the northeast region say they promote positive work qualities such as a flexible environment and work-life balance, many are still falling short of meeting the mental health needs of their workforce, according to a survey released Monday.
Overall, 52% of employers said they always or usually provide easily accessible information about mental health resources to their employees through a range of platforms, according to a survey conducted by the Northeast Business Group on Health, a coalition that focuses on employer health benefits issues.
Additionally, 26% of companies do not identify needs or test the effectiveness of their mental health programs, and 29% do not incorporate messaging campaigns through social media or internal marketing campaigns into their mental health strategy, the survey found.
The Northeast Business Group on Health conducted its Well Gauge survey to understand how employers are supporting a mental well-being culture. More than 140 corporations who are members of the coalition and are based in New York, New Jersey and Connecticut responded to the survey.
Three-quarters of employers said that they always or usually support a healthy work-life balance and 85% support a flexible work environment.
Amy Tippett-Stangler, senior vice president leading the organization’s mental health initiatives at NEBGH, said that businesses need to improve on identifying mental health needs and testing the effectiveness of current mental health programs.
“I do think doing a pulse check against small targeted surveys on the very specific benefits that they're offering, on a fairly frequent basis, would go a long way,” Tippett-Stangler said. She added that awareness campaigns and efforts to ensure mental health is a part of the core business model would also further support workforce needs.
The Northeast Business Group on Health, based in Midtown, has employer and purchaser members that cover 8 million lives in the U.S. and 12 million across the globe.—A.D.
The data come from 245,055 employees enrolled in an employer-sponsored health plan between Jan. 1, 2010, and Dec. 31, 2018, of which 42,326 eventually switched to an HDHP.
“To reduce risks of selection and voluntary bias, we only included individuals whose employers did not offer a choice between HDHP and non-HDHP plans,” the study said.
The enrollees were separated into ethnic and racial categories because Black and Hispanic individuals with diabetes experience hypoglycemia- and hyperglycemia-related ED and hospital visits significantly more often than white patients. In addition, they’re less likely to enroll in health savings accounts, which can offset the costs of healthcare for enrollees.
These realities have not gone unnoticed by employers. Last April, the Northeast Business Group on Health released a guide for employers looking to tackle obesity and diabetes through a racial lens.
The JAMA Network Open study found that the detrimental outcomes caused by HDHP enrollment should encourage employers to offer a variety of benefit packages to workers and provide more transparency about costs in different clinical settings. Often, employees aren’t familiar with the details of the health plans that they sign up for and might focus on the relatively less costly monthly premiums for HDHPs.
In the wake of the coronavirus pandemic, many employers expanded their mental health benefits to improve employee wellness. However, research has indicated that more mental health benefits do not necessarily equate to a robust wellness culture, which leaves employers wondering: what is the alternative?
The pandemic delivered a severe blow to employees’ mental health. Initially, employers responded with an influx of mental healthcare benefits. More than nine in ten employers reported that they would increase mental healthcare and wellness programming in 2021.
The benefits may not have had the intended effect. Although mental health benefits multiplied, wellness culture continued to suffer.
Half of employee participants agreed with most employers that mental healthcare access had improved, but only a little over a third of employees said that this was due to employers’ resources (35 percent), according to a study from The Hartford. Less than half of employees said that their companies promoted conversation about mental health and an inclusive environment.
Meanwhile, almost eight out of ten employers said company resources were partly responsible for better access to mental healthcare. Additionally, more than 80 percent of employers said their workplace environments were open to conversations about mental health and were inclusive atmospheres.
Clearly, there is dissonance between employers’ and employees’ perspectives on mental healthcare benefits. These trends may point to the distinction between having more mental health benefits and having a company culture that promotes wellness.
Recognizing this divide between employers and their workforces, Amy Tippett-Stangler, senior vice president at Northeast Business Group on Health (NEBGH), rallied a team of fifteen executives and mental healthcare providers to address the issue. Companies including Anthem, the National Alliance on Mental Illness–NYC (NAMI-NYC), and PepsiCo converged to ascertain how employers can create a wellness culture.
“What we have heard across the board from point solutions from health plans and employers is that offering benefits is a given today, but the utilization, the engagement is a whole different story,” Tippett-Stangler told HealthPayerIntelligence. “Building the culture is certainly about communicating why you have these benefits, why they're important, but also it's about walking the talk.”
After months of conversations and workshopping, the committee came forward with a cohesive vision of what a workplace wellness culture should look like and produced a tool that employers can use to assess their internal culture around mental and behavioral health.
The committee’s first priority was to develop a mission statement. Tippett-Stangler described the committee’s goals as a pie with five slices, each slice representing the key areas that the group wanted to tackle. The five areas that the group addressed were:
However, in the committee’s first meeting, the participants recognized that a key portion of wellness culture was missing from that visual: inclusion.
“Our multi-stakeholder group committee said, ‘Wait a minute, all of those things are important, but we can't even talk about that until we address what we call inclusion—diversity, equity, stigma, belonging,’” Tippett-Stangler recounted.
The committee emerged with a new visual in which equity was central: five slices representing access to care, telebehavioral health, measurement-based care, collaborative care, and parity arranged around the goal of inclusion.
These elements are what set offering mental health benefits apart from building a wellness culture, Tippett-Stangler indicated. A company with a wellness culture will assess why employees are not using mental health benefits, what employers can do to create a safe space for employees to communicate their needs, and will be characterized by inclusion.
Once the committee had established the mission statement, they explored how to turn their vision into an actionable resource. The result was Well Gauge, a free tool that employers can use to both assess their company culture around mental health and behavioral health and to ascertain potential steps toward improving their culture.
The first step in solving any problem is understanding what the problem is. Employers who want to create a culture of wellness centered on inclusivity must first be aware of their company’s current culture and its proximity to their wellness culture vision.
One of the key challenges that employers face in assessing wellness culture is distance.
“You see it in survey after survey: the employer thinks they're doing X, Y, and Z and they're offering the moon and the stars, and employees are saying, ‘No, you're not,’ or ‘you're not hitting the things that matter to me,’” Tippett-Stangler explained.
Employers have implemented various solutions to address the mental health crisis, including offering preventive care, employing collaborative care models, and using employee assistance programs.
However, research from organizations like The Hartford and McKinsey has highlighted the disconnect between employer and employee perceptions of wellness culture. In these studies, most employers reported that their companies successfully supported employee wellness, while significant populations of employees voiced that their mental and behavioral health needs remained unmet.
These conclusions indicate that employers may be too distant from the employee experience of the company culture to identify mental and behavioral healthcare barriers.
It is crucial that employers assess the impacts of their programs and benefits and genuinely seek to understand whether these resources are meeting employees’ needs.
Well Gauge walks participants through four areas of wellness culture to provide that feedback. Participants answer questions about how mental health and behavioral health show up in the company’s communication, leadership engagement at all levels, companywide equity efforts, and their endeavors to create an environment of total health.
The survey’s 22 questions provide a temperature check on any organization’s wellness culture. While the NEBGH committee initially designed this tool for benefits managers and senior management, committee members and employers have also administered the survey among employees who are not as involved in benefits decision-making to gauge the broader experience of wellness in the company.
“One of the key things is making sure that mental health is part of the company strategy, that it is something that's talked about in earnings calls, in town halls, and it is really incorporating that language into everyone's thinking,” Tippett-Stangler said. “I have heard from some folks that have completed this survey: ‘we talk a good talk, but we're not walking it yet.’ It's baby steps. But this is a way in which we can raise the flag to say, ‘We need to do a better job in this area.’”
Insights into a company’s wellness culture are only useful if employers act on them. While Well Gauge users’ initial feedback focused on the tool’s usefulness as an assessment, the survey also offered insight into actionable steps.
“Take a moment to assess what they are doing as an organization that is meeting the employees' needs, but also what isn't,” Tippett-Stangler said. “Internal surveys to employees are great, but if you don't act on them, they're kind of worthless.”
The survey results are accompanied by a list of follow-up suggestions so employers can integrate wellness culture strategies. Tippett-Stangler highlighted three possible actions.
First, employers can ensure that mental health is incorporated into the company’s agenda, including earnings calls and annual reports. When the topic is featured in these public forums, employees might feel more confident about voicing their mental health needs.
Second, employers can ensure that ongoing training is a part of their policies and procedures. For example, some health insurers have partnered with vendors to offer educational mental health programs for employers. Through such programs, employers learn to identify and address employees’ mental health needs compassionately.
Finally, employers can engage with mental health vendors to pursue health equity. For instance, they might work with a vendor to improve access to culturally competent care. Additionally, they might partner with other organizations to expand access to mental healthcare in mental health deserts. Employers can overlay social determinants of health data over their employee data to understand regional access to care challenges and other social determinants of health barriers.
“The next step is to look at the data with your health plan partners. That can help you define what your strategy going forward should be. Where's the utilization? What are you hearing from the plan side as well as what you are seeing internally?” Tippett-Stangler said.
“From a health plan perspective, they want to offer services, they want to offer programs, expand their network, but are not necessarily sure what it is that people need and want. If you don't step back and assess that, clearly you're offering things that people aren't going to use.”
Health systems can also support employers’ efforts, particularly in expanding access to care and telebehavioral health.
The NEBGH committee is already considering ways to improve the Wellness Gauge. Tippett-Stangler hinted that a Wellness Gauge 2.0 might be on the horizon.
“While this was very rewarding work for sure and it will continue, if I could leave you with one thought it is: having all of the stakeholders represented over many, many months is remarkable because it isn't about finger-pointing, it isn't one sector's fault that the mental health crisis is what it is,” Tippett-Stangler emphasized. “The collaboration was remarkable.”
Concerned about the disappointingly low levels of COVID vaccinations in the U.S., the Northeast Business Group on Health (NEBGH) has stepped into the fray to help plan sponsors tackle the issue with their members.
“Creating a Vaccination-Friendly Culture: What Employers Can Do,” is intended to serve as a guide to develop and implement strategies to boost vaccination rates for seven medical conditions, including COVID, in employee populations, and hopefully, their families and significant others.
“The public’s mixed response to COVID-19 vaccines has highlighted the urgent need to create a more vaccination-friendly culture if we are to reap the benefits of scientific advances in fighting disease and illness in the future,” says Candice Sherman, CEO, NEBGH. “The data shows that employers are a trusted source of information and therefore in a unique position to fight misinformation, promote vaccination as an essential part of overall wellness and set an example by communicating their commitment to vaccination.”
In compiling its 40-page guide, NEBGH surveyed 103 large employers about their vaccination policies. The big picture: 85% don’t set targets for employees to be vaccinated, and 75% cite misinformation and vaccine hesitancy as barriers to boosting vaccination rates among their employees.
Other survey results:
71% of employers say they host vaccinations campaigns.
83% say they have launched vaccination communications campaigns for employees. (Far fewer have included family members or retirees in these campaigns.)
75% have reduced or eliminated out-of-pocket costs for vaccines.
33% offer vaccination incentives.
50% provide paid time off for vaccinations.
3% offer transportation for vaccinations.
To give plan sponsors and advisors a better understanding of the subject, the association’s guide includes information on vaccination history; data on uptake; racial and ethnic disparities in vaccination status and barriers to vaccination; and more.
Here are the eight steps offered by the guide to raise the vaccination rate among plan members. The guide discusses each step in detail:
“The critical focus over the past two years has been on vaccinations to fight COVID-19, but employers recognize that vaccinations against other diseases and illnesses can play a significant role in improving the overall health and wellbeing of their employees, families and beyond. And it starts with creating a vaccination-friendly culture. We are hopeful that employers will take specific actions described in the guide and work hard to boost vaccination rates in the coming years,” says Sherman.
Although health care costs are increasing, Mercer found that most employers do not plan to shift costs to their employees by raising deductibles or co-payments.
In fact, many employers are planning to expand their health benefit options in 2023, focusing on improving affordability and access. According to a July survey of 700 employers from Mercer, more than two-thirds said they planned to enhance their health and benefit offerings next year, and 61% are currently surveying employees on their benefit preferences.
Some benefits that employers are considering adding include mental health benefits, such as meditation apps and substance use treatment, and family planning benefits, such as in vitro fertilization treatment. According to Modern Healthcare, data suggests that these benefits, among others, are highly important to younger employees.
Outside of providing more benefits, some employers are working to better communicate with employees about the benefits already offered.
According to Candice Sherman, CEO of the Northeast Business Group on Health, many employees at the group's member companies do not understand the full scope of their benefit plans.
"Many of our members talk about employees saying they've got this issue, and they're surprised to learn they have benefits for that," Sherman said. "Members are focused on how to communicate and promote benefits."
In addition, Sherman said she believes businesses will focus on providing more "wraparound, holistic" benefits in the future, including more family-building resources, financial wellness, child care, gym memberships, and even pet care.
The Northeast Business Group on Health launched a new tool Thursday to help employers determine if their company provides adequate mental wellness support to their staff.
The survey tool, called Well Gauge, asks participants a series of questions through four sections: communicate a commitment to mental health, engage leadership at all levels, demonstrate a commitment to mental health equity and foster environments that support total health.
Northeast Business Group on Health’s tool comes as more employers are looking to bulk up their mental health support for employees. A recent Willis Towers Watson survey of 455 employers found that 67% are looking to make mental health and emotional wellbeing programs a top priority in the next three years. It also found that 88% of respondents have already acted on mental health in the last year, with some of their top strategies including covering telebehavioral health services, providing employee assistance programs and giving access to digital behavioral health support.
But while mental health benefits and programs are necessary, companies need to do more for their employees, Tippett-Stangler said.
“Providing benefits coverage and offering programs for mental health are essential — but not sufficient — to support employee well-being,” Tippett-Stangler stated. “Creating inclusive environments in which mental health is a priority, mental illness is de-stigmatized, and employees feel valued as whole people is central to building a healthy, productive and committed workforce.”
The cost of providing health insurance in New York in the last year is higher than the national average and could continue to rise because of worsening inflation and increasing premium rates.
A new health benefits report from the Kaiser Family Foundation that surveyed more than 2,000 employers shows that in 2022 the national average annual premium for family health insurance was $22,463, about a 1% increase from the $22,221 average reported in 2021. In the Northeast, the average cost for covering a family was $24,126, about a 2% increase from 2021.
Nationally, employers paid just under $21,000 for point-of-service plans; just over $21,000 for high-deductible health plans; nearly $23,500 for preferred provider organization plans and almost $23,000 for health maintenance organization plans. By comparison in the Northeast, those figures were all higher: employers paid nearly $22,000 for POS plans; about $23,000 for HDHP plans; just over $24,000 for PPO plans and more than $28,000 for HMO plans, which experts say can be attributed to increasing premium rates and the rising costs of health care, which are climbing more steeply in New York and New Jersey than the rest of the country.
Leslie Moran, the senior vice president at the New York Health Plan Association, pointed to insurers asking for higher rate increases within the last few years, and continuing to do so for 2023, as another indication that New York is bucking national trends.
The state Department of Financial Services, which approves insurance plans’ requests for rate increases each year, or how much the cost of paying for certain types of coverage will change reports that in 2022, insurance firms that are part of the individual market requested to increase their rates by more than 11%; companies in the small group market requested to increase their rates by 14%.
For 2023, companies requested to increase premiums by nearly 10% for insurers on the individual market and almost 8% in the small group market.
The prices New York consumers pay for their health care are already high, Moran has said, because state law requires that more than 3,000 procedures be covered by insurers, such as second opinions for cancer patients. High costs–for the employer or employee–can lead to concerns around care accessibility.
Inflation compounds the issue of rising health care and health insurance costs. The premium growth rates Kaiser collected from employers have kept pace with inflation and wage increases over the last five years, according to Matthew Rae, the associate director for the program on the health care marketplace at KFF and an author of the study. But "keeping pace” can get tricky when inflation is soaring in the city.
New York’s inflation rates squash those in other parts of the country. The Consumer Price Index shows that the price of medical care has surged in the New York and New Jersey area by 8% from Sept. 2021 to Sept. 2022. For all urban consumers in the country, meanwhile, the cost of medical care services has increased by 6.5% for the same period. The “modest” insurance cost increases from 2022 might not hold up in 2023 as inflation climbs higher, Kaiser’s report warns.
All of these factors are coming together at a time when employers are particularly concerned about staying competitive amid the great resignation–and as employees are asking for more from their benefits packages. Larger and smaller employers are handling that differently, whether it be by offering in-demand benefits such as fertility treatment coverage or by struggling to afford providing insurance at all.
A company’s size can also impact how it shares insurance costs with employees. According to Kaiser’s newest survey, in 2022 workers at small companies with less than 200 employees paid $7,556 on average for family coverage, while employees at large firms on average paid $5,580.
This trend “holds true” for many larger New York companies, said Candice Sherman, the chief executive of the Northeast Business Group on Health, a coalition of businesses and benefits providers in the region.
“Given their interest in retaining valued employees and attracting new ones, [larger] employers are reluctant to pass on any higher premium costs to employees right now,” she said.
In the aftermath of the pandemic, there is one area in which New York’s employers are sticking with national trends: mental health coverage. According to Kaiser, about 27% of employers surveyed nationally added mental health providers to their networks in 2022. Experts say that employees continue to rank mental health as one of the most important aspects of coverage, and New York employers are figuring out what to add to their packages. Many venture capital investment firms are beginning to invest in New York City startups tackling serious mental illness, as well. —Jacqueline Neber