Kim
Kim, hello everyone. I’m Kim Thiboldeaux, and it is my pleasure to welcome you to NEBGH voices. In the midst of mental health awareness month we’re honored to welcome Clare Miller, a global expert and mental health and strategy consultant with Workplace Mental Health and Sandi Stein, Global Head of total rewards at Brown Brothers Harriman, who together bring both strategic insight and real world employer experience to this important conversation on advancing mental health well being in the workplace. Thanks for joining us. Clare, I want to talk about your your path a little bit because it is an interesting career story that you had. You you’ve had a unique journey from Mental Health America nonprofit to Meta, a huge global company centered on the business case for mental health. So what first drew you to this work, and how have you seen employer mindsets evolve since you began in this work.
Clare Miller
Thank you so much for the question. Kim, so I think what, what really sort of locked me into this path was an experience that I actually had pretty early on in my career. And I was actually working at Mental Health America, and I was learning a lot about this idea that if you invest in mental health, that there’s a case to be made in terms of economic reasons, cost savings, for productivity, et cetera. And so that was sort of in the backdrop of my mind. This is many years ago, and so the idea we didn’t yet have mental health parity, as we of course, do today. But what really sort of solidified it for me was I had a conversation with a colleague. I had a long history of mental health issues, clinical depression, et cetera, and I sort of thought I was powering my way through it. And a colleague came up to me in the workplace and basically said, like, I’ve been noticing something’s going on with you, and I’ll never forget and here we are at a mental health organization, but I’ll never forget the word she said, she was like, you don’t have to live like this. And that was sort of this idea of, like, hope. And so I finally, sort of got proper treatment, and for me, it had this very powerful impact of realizing, like, the role of the workplace. It gives you structure, purpose, connection to others, of course, a certain source of income in the US, health insurance. And for me, that was it. That was, you know, sort of my path. How can we work with employers to harness their power and really show this idea that if you pay for mental health, you, you know, will not only help people, but you will also have an economic return.
Kim
So that’s really interesting. Clare talk for a minute about when you think about, sort of the arc of your career, and you’ve been in some interesting settings, how has the landscape changed? I mean, we think about the pandemic, we think about rising burnout, we think about Gen z’s, you know, expectations. So what have been some of the shifts that you’ve experienced, and some of the trends and innovations that you’ve seen implemented in the world.
Clare Miller
Sure. So I think we’ve seen a tremendous amount of attention before the pandemic, of course, doubled down during the pandemic, just as growing awareness with stigma decreasing and people talking about it more. And of course, younger generations that maybe, you know, didn’t have sort of the baggage about things being taboo. They grew up, you know, talking about these sorts of things. So that has been a major factor in the change. I think another change is just all of the innovation. I mean, there is an explosion of new products and companies solving various aspects of, sort of what’s broken in the mental health world. I think that, you know, as we look forward, the thing that I think is going to really be sort of the next reckoning is not just looking at benefits. Those are, of course, critically important, and there’s so much work to be done that space, but also looking at the intersection of mental health and work, and what can we do with work itself and chronic, you know, unmanaged work stress to, you know, get even further upstream and prevent people from needing mental health services in the first place. So lots of exciting, exciting developments on the horizon.
Kim
Yeah, so how do you talk to employers, Clare? About mental health, about meaningfully investing in mental health. And are there, you know, policy, recent policy shifts, you talked about parity, maybe mentioned mental health parity, or other changes that have affected employer behavior and investing in this space.
Clare Miller
Yeah, so I think, you know, one is just how society has changed in terms of talking about it. I think there’s also just a growing appreciation that, you know, mental health parity isn’t going away. Maybe there’s going to be less, you know, enforcement of it, but it is still the law and and, but I think even beyond that, employers realize that they really, you know, they need to invest in this space. And you know, when I started this work, we talked all the time about the economic case for. Or having better benefits or investing in this space. You know, employers aren’t really talking about that anymore. What they’re talking about is, what the heck do we do? What are the practices? What are so I feel like the conversation has shifted in a very productive way so that it’s not just about compliance with the law. It’s about what are the things that are going to enable quality, what are the things that are going to enable people to have really good experiences getting connected to care?
Kim
So, let’s get into that. But before that, for folks who don’t know Clare, can you just say quickly what mental health parity means? What that is.
Clare Miller
Sure. Yes, yes. Great question. So Mental Health Parity Law was passed that basically says that mental health benefits have to be at equal or, or no less, no more restrictive than benefits for mental health services, I’m sorry, benefits for physical health services. And that carries over across the entire benefit, so in all categories, outpatient, inpatient, etc. And then secondly, and part of the challenge, frankly, is it’s so complicated. The other thing is that it’s not just quantitative numbers in terms of limits, et cetera. It’s also about the processes. So as you develop, as the health plan develops, you know, reimbursement for particular services, the way that they’ve gone about that has to be the same for mental health and substance use disorders as it is for for medical illness.
Kim
Right? That’s great to clarify for our folks. I want to talk a little bit more about what’s moving the needle, right? So we’ve got all these innovations, but you know, how do employers measure impact? We’ve got recharge days, we’ve got wellness stipends, but you know what strategies are moving the needle? How should employers evaluate what’s truly effective?
Clare Miller
So I think I love this question so much, because I think that it’s very easy to look at what others are doing and say, Okay, we need to put this in. We need to do this. And I think that it is useful for employers to start with, okay, we’re put if we’re going to put in this thing, what is it we’re really trying to solve for? So at its most basic element, I think part of the conversation should start with, what are the unmet needs and is this thing that we’re thinking of putting in going to address those? Of course, you also want to be competitive with your, you know, your peers and and have a good package to present to prospective employees. But if the challenge is people actually having time off to take advantage of, you know, all the benefits and mental health, is a new well being program going to help? Or is looking at the work practices, etc, and the norms that would allow people to have the flexibility to take time off, is that the better place to go? So I think crystallizing, what are you trying to solve? And then is it working to solve that?
Kim
I think it’s very interesting. I know that one of the things that our employers are struggling with is around access, right? We know that there’s a predicted shortage of healthcare workers across all segments of healthcare, but I think especially in mental health. So what can employers do to ensure that their employees get timely, you know, high quality care. It’s one thing to have the coverage. It’s one thing to allow the time, but if they can’t get connected to the resources, it’s all for naught, right? So, so how can employers make sure that their employees have that access?
Clare Miller
So I think it’s, I think that, first of all, it’s a really complicated question, because there’s so many different dynamics that go into why there’s a shortage, etc, etc. But right now, today, any employer, in my mind, can do two things. One is to literally raise the question with their health plans, what? What are our ratios? What is the number of days for someone to get an appointment with your current network, etcetera? The other is to look at what you already have. So there are all these, you know, new innovations and companies that actually are available through health plans today. There’s a incredible program that looks at eating disorders, which is a very challenging area to treat. It keeps people out of the hospital. It’s covered by pretty much every medical plan right now, but a lot of folks don’t know about it. So what are we not using that we have access to? And then the longer story is collaborative care and approach that basically has a tremendous amount of research behind it that improves the connection from mental health services from primary care, which is where you know most people are showing up for mental health support anyway.
Kim
You know, I just want to, I’ve heard you say, Clare, and I love this – that toolkits aren’t enough, right? That we’re we’ve got these toolkits, or we’ve got this idea that we’re going to meet in our coverage mental health parity, but it’s just not enough. So what are you seeing as some of the barriers to implementing effective, you know, workplace mental health programs. And I know folks are so well intentioned, you know, on this topic, and they want to do the right thing for their employees, but how do they turn that good intention into impact?
Clare Miller
So and I, and I don’t want to begrudge the toolkits, because I think there’s definitely a place for that. Sure, sure. I think that the fundamental challenge, I think facing so many bad. Benefit managers is time, you know, there’s under increasing pressure to show value for what they’re already spending. And you know, they don’t have often, you know, specialized subject matter expertise right there focused on mental health. And I think that the whole thing can be a little overwhelming with where to start. And so because of that, I think, you know the the and this is part of the reason I think the toolkits aren’t enough, is that the the first few steps should really, I think, be dependent on what is going on with that company. What are the key challenges that that company is is facing? Because oftentimes there is a way of thinking of something through a mental health lens that can make improvements in that space? Is it uncertainty? Double down on that, and you know if you go on about what you might do in that space. So So figuring out, where are the quick wins, where you don’t have to implement a huge new framework, although that would be amazing. Who has time for that? Where can you start now and just bring mental health in from among the things that you’re already facing or you’re already doing.
Kim
Clare, I know one of the things that our employers struggle with is evaluating point solutions. Right? There are a number of point solutions in the mental health space. Do you have any tips for our employers as they evaluate point solutions in mental health?
Clare Miller
I think the flashing light answer for me is too many choices equals paralysis. Okay? And if you’re going to put in a point solution, just as important as picking that point solution crystallizing what it is you hope to solve, you have to put in just as much work to make sure that it is integrated into the ecosystem, or else it’s you’re not going to get the utilization you want, and it’s probably not going to solve the original problem. So I think that, you know, gone are the days, and I think most employers have seen this, that we’re going to put this thing in, it’s going to solve everything. No, it’s one more thing for you to promote, for you to connect all the pieces among so, so it’s not the silver bullet, I guess.
Kim
Right? So. But maybe what you’re suggesting is really doing a deep dive, looking for that integration, talk about what kind of data you’re going to get back, what kind of impact you can expect from the partnership. Is that what you’re saying exactly
Clare Miller
and looking at the member experience related to all of these other things that you have in place. So, you know, mental health touches so many things. If you have a program that’s focused on family benefits, for example, are you connecting those family benefits to financial well being, to a mental health solution? Because all of those factors, you know, are co-mingled and intersect.
Kim
Great point. So all of that, they’re all interconnected, and you have to make sure you’re you’re sort of creating a patchwork, a quilt, of all these benefits, and they have to be really woven together and integrated.
Clare Miller
Yeah, and thinking of those pathways like, I always just go back to, like, the basics. You have an employee here, you know, give them a persona, and think about what that journey is going to be like for them, and the number of ways that they’re going to say. I always think about this, what are the ways that someone is going to say? I’ll come back to this later, because you’ve lost them, right? And so too many choices, etc, can can exacerbate that.
Kim
That’s great. That’s great advice. Clare, if you had a magic wand and have every employer do one thing differently tomorrow, or, you know, take a little bit of a different approach. What would that be? What what gives you hope for the future? And what other advice do you have for our employers?
Clare Miller
So I’ve been waiting for a magic wand for a really long time. So yeah,
Kim
You and me both.
Clare Miller
So I think it sort of come comes back, actually, to where we started. I think that if I could wave a magic wand, I would want employers to recognize sort of the power that they have in all of these different spaces. I think that you know, one of employer alone can can make, you know, a certain amount of impact in their space with purchasing, but they can really make a huge impact in terms of the workplace. And so if I could wave a magic wand, it would be increasing that conversation within companies, from the benefit managers to be talking to the folks who are doing performance management and strategic planning and talent development and and bringing those folks together to see how they can work together to focus on increasing access to mental health care and making sure folks know about it, and looking at the workplace factors
Kim
That’s really helpful. Clare, thank you. Thank you so much. Let’s bring Sandi Stein into the conversation to hear the employer perspective. Sandi, we’ve taken a broad look at what’s happening across workplaces when it comes to mental health, but let’s ground this in your experience. How have you approached mental health within your organization, and how has that evolved over time?
Sandi Stein
Thanks, Kim. When I joined Brown Brothers, we had an interesting approach to mental health. We had two on site clinicians that were there for a very long period. Period of time, and the evolution of that was kind of interesting, but we also had a sliver of an external EAP resource through Optum, and I would say that it wasn’t what I would deem the most commercial type of program. But then again, who did 13 years ago, right? So when I, when I started to kind of dig in, I looked at it from two angles, and I really started to focus on the external part, the carrier side, the Optum side, and I really started to push on them and put pressure on them to improve their network. That’s really where I started down that path in terms of people, members, you know the provider books right here. Here’s the provider book. Look for someone. And I would always say three things would happen. One, you’d call one of the providers, and you would never get a return phone call. That’s a problem. Two, you get a call back and they’d say, I’m not seeing new folks. That’s a problem. Or three, you would get an appointment in five months, and that was problem, which is where I really started to put pressure on the carrier. So that was kind of the landscape that I said, you know, this is not great, kind of no bueno. Didn’t love that.
Kim
Yeah. But Sandi, let me back up even a little bit further. You know, we heard Clare talk about the importance of having a strong foundation, whether it’s values driven or tied to a broader strategy when you were even thinking about this, when you joined the firm, is there a particular philosophy or a framework that sort of anchored your approach, aside from drilling down on the data, looking at the carriers, what was the sort of bigger picture thought about the need for mental Health Support?
Sandi Stein
And I absolutely love this question. And I’ll back it up a little, if you don’t mind. I’m just, I’m just returning from Lyra’s breakthrough conference, client conference. We have been a Lyra client since January 1, 2020, and this was, this was an event that I particularly wanted to attend because of a really great need that we had within BBH, because I think we need to do more. And one of the great takeaways So, so the short answer is, Kim, I don’t have a great strategy. And I left there feeling like I need to work on a strategy. I need to work on a mental health workplace strategy, because I don’t feel like we’ve got one. I can’t even say we don’t have a good one. I don’t think we have one. So that’s missing.
Kim
Interesting, interesting. Well, I appreciate your honesty in saying that, and I’m glad that the I’m glad that that conference helped to sort of crystallize that for you, because then that becomes a path forward for this work, right? Yeah, yeah. I think that’s great,
Sandi Stein
Yeah. And I can tell you that there was a reason that I made the commitment to travel across the country, no direct flight there, and I went there. It was a very intentional trip, because I knew that there were very specific goals I had in mind that I needed to leave the conference with and and I needed some kind of secret sauce, because there were things I knew we had to improve upon. I didn’t know what I knew, some of the things that weren’t exactly working in the way that I had hoped, what we did when we set out to work with them in 2020 now it’s six years later, and we haven’t moved the needle, and that’s not great, but I knew I needed to meet with them. I needed to see what other employers were doing. And I did leave with a plan. I
Kim
Love that. I love that. That’s great. Sandi, I know we talk a lot in our work about the power of leadership in shifting culture. You’re in finance. You know, high performance, tough it out, environment. How do you, obviously you’re, you’re leading right now with vulnerability and telling us that you’re that you need a better strategy. But how do you personally lead with vulnerability? What role do you see leaders playing, especially in your field, in normalizing mental health conversations?
Sandi Stein
Yeah, so Yeah, so this was, this is data point number two, and this was so so again, one of the really important parts of my time with Lyra was to meet with their new CEO, and I had a really great opportunity to spend time one on one with her. And as she actually took to the stage on day one, I was preparing in my mind what I was going to talk to her about. And I think we all know as benefit leaders that success in all of our programs is is typically, is typically or the underpinning is typically when we have senior leadership support and sponsorship in this well being space, and I would love the opportunity to engage our senior Leaders, I think, better than we’ve done in the past. And in that conversation that I had with the new CEO, I kind of, I kind of chickened out. She has a financial services background before joining lira, so the kind of, the kind of thing I cooked up with her a little bit was maybe she wants to come in and meet with some of our senior leaders to talk about why this topic is so important and at the heart of of of our people. But she challenged me and said, Sandi, I think you can do that very thing, and you can have that conversation. So I kind of left with, yeah, I’m going to do that, I think. And what I thought was interesting. There were other folks there that I spoke with, and she talked about, and she talked about some of the, some of the statistics around how, kind of the next thing, which, you know, I’m waiting for the data on this are, are, and I don’t know the definition of middle aged men, middle aged men and, and, you know, mental health issues is kind of like the next thing that’s happening. I don’t know that until I kind of see the data myself, but that could be a place for me to kind of anchor my conversation. And I think when these senior leaders role model this behavior, it really does, you know, help destigmatize these issues and really give permission for people to really avail themselves of these resources?
Kim
Yeah, yeah, I think that’s great. Sandi, I want to stick with that the generational question while we’re on it, we heard Clare mention how the how the pandemic really brought mental health to the forefront, really, especially for younger generations. So have you in your workplace noticed generational or post pandemic shifts and how employees engage with mental health? Yeah, absolutely.
Sandi Stein
And I think it’s what I could say. From my experience, I definitely see it, and I don’t know what generation it is, but it’s not my generation. It’s the younger generation. It’s the folks in their 20s, whatever generation that is, Kim, maybe you know it. And people talk about this really broadly, and they talk about, oh well, my therapist and my therapist, and in conversation with my therapist, their suggestion to approach this particular issue is to do that, and it’s like talking about, oh, you know, when I went to the dentist and I had a root canal, it’s, it’s part of their conversation, no different than the dentist visit or the root canal or what have you, or I got them all removed, or something like that, and that in that has really been a game changer for that particular, that particular cohort, which I love, I absolutely love to see. What I’m also seeing are the parents of that generation, where the parents are advocating on behalf of their kids, where those kids are requiring these, these multi degreed clinicians like they have, these really, really, really complex issues. Place where you, you know, you don’t need, you know, three PhDs, unless they’re really complex issues, okay, like, really, really complex. But it’s really interesting to see how the kids are really, you know, getting their parents attention. And those are the ones that are, are our employees. They they want to see, like, you know, all these credentialed clinicians in the network, it’s like, you know what? It’s not really necessary. Like, the breakup in college doesn’t require, you know, ADHD. It’s just really, really interesting.
Kim
Yeah, that is, that is interesting. I think, yeah, I think they’re Gen Zs, Sandi, I think they’re okay, well, late 90s, you know, 2000s I think they’re the Gen Zs, which is definitely not you and me. So, yeah, but it is, it is interesting to see how that they, how they are sort of normalizing, you know that that conversation in the workplace? How about the mental health of of LGBTQ, plus employees, any steps there that you’ve taken specifically, or any challenges or learnings to share.
Sandi Stein
I think one of the areas that I’ve kind of pushed on both Lyra and Optum, and this was, this was really in the in the midst of the pandemic, where our Employee Resource Groups super, super active, grassroots, very organic. We’re very, very engaged at a at a firm level. Our employees are very, super active. I’m a co chair of our pride network. So I am the living, breathing place of intersectionality, if you will. So benefits and pride all in, you know, in we I very, very close with, with, you know, benefits and these networks. So one area which I found really fascinating and talking to Optum and Lira is they would talk about, when they talk about diversity within their provider network, they used language like, we’ve got LGBTQ plus supportive providers. I said, What does that mean? They’re like, Oh, you know they, they are, they are LGBTQ plus. I said, Okay, that’s great. But are they LGBTQ plus community? Are they in the community? Mm, hmm. And more often times than not, they’re like, We will come back to you with the answers on that, and we’re like, Okay, well, that’s fine, you know? It’s like, you can’t like, we don’t want our members to have to explain what the lived experience is, you know. So that’s something that we’ve worked very closely with our providers to make sure that there is representation within their provider network. We want our we want our members to be able to, from the outset, be able to select, you know, through through the providers, their algorithms when they’re selecting a provider not be LGBTQ plus supportive. They have to be part of the community, whether it’s, you know, in that community, whether it’s race, ethnicity, all of it. So I’ve really pushed back on them to really get to the place where that is as diverse of a network as as possible.
Kim
That’s terrific, Sandi, we’re getting close to the end of our time, but I have two quick questions that I just wanted to run by you. One is around impact, right? We have a lot of conversation around impact, but I think that what was emphasized today is that ROI alone doesn’t capture the full impact of mental health programs. What kind of feedback are you looking for? What kind of data are you looking for, what is meaningful for your team to understand these programs are working?
Sandi Stein
Yeah, and this is a, I think this is a really important point. First and foremost, let me say that I have been fortunate enough to work for employers where that is not the goal. We are not looking for return on investment. This is more about voi when I think about these programs, I think about being in a position to offer programs that help our members that help our employees. What I would say is we are in a position. My team is in a position to provide benefits to people, high quality benefits, access to benefits in a timely fashion. In doesn’t have to be for all 6000 but for those that avail themselves of these benefits, that’s all that matters. Yeah, yeah, we’re not. This is not about return on investment. These are table stake benefits, no different than health care. It’s not, I’ve not been asked to demonstrate that ROI.
Kim
I love that. I love that. Yeah, it really is about that holistic wellness. Lastly, Sandi, we’re really we’ve been talking about what it takes to build a mentally healthy workplace. And one thing that stood out was the importance of guidance for those just getting started. So if there’s a more junior person in an organization and they are trying to think about strategy, or trying to think about how they assess a vendor, or thinking about maybe building a philosophy around offering these services, just what a couple pieces of advice or tips you may have for those folks just getting started.
Sandi Stein
I think going back to what I just said, This is table stakes. Just like medical care, pharmacy benefits is table stakes. This is part of your core benefit offerings. This isn’t a nice to have. That’s number one. I will tell you that when we we it’s, it was me that was making the recommendation to really change our approach to employee assistance programs. It was a different financial investment. But one really important consideration when thinking about making that pivot, the cost associated with the EAP program we have today, as compared to the medical benefits, this is, this is a drop in the bucket. So while it seems like it’s very expensive, number one, you get what you pay for, but in comparison to the medical benefits, it’s a pittance, yeah, but it really is a very, very highly valued benefit for the folks that take advantage of it.
Kim
Yeah, mental I’ve heard folks say mental health is health, right? Yeah, well, I just Sandi and Clare. I want to thank you both for joining us today, for sharing your thoughts and experiences around this very important topic. I have no doubt that what you’ve shared today will spark inspiration for many and will help us continue the conversation at NEBGH, this has been NEBGH voices, thank you for tuning in as always. I wish you wellness,
Voices
and I am one of the voices, and I am one of the voices, one of the voices… of NEBGH.
