When an employee suffers a heart attack and needs to be rushed to the hospital, he's concerned only with the medical crisis, then with subsequent treatment. Along the way, he taps whatever medical insurance he has through his employer to pay the bills-as he works on returning to productive work and home life.

It would be nice to think that when an employee suffers from a crisis that is mental or emotional, he would be equally sure about his course of action and access to treatment. And that his employer could play a major role in his recovery and return to a more productive life.

Despite the differences between physical and mental afflictions, the bottom line is that both can be debilitating to employees and costly to employers. The good news is that the employee benefits business, aided by increasing data on effective treatments and more open public discussion of mental health, is making progress in its handling of mental wellness.

Kathy Greer, a licensed mental health counselor who founded the Massachusetts-based HR services firm, KGA, Inc., in 1982, believes that an employee assistance plan (EAP) is the most effective way to deliver mental wellness services. Mental health issues require a strong personal connection between patient and clinician, as well as privacy, which a well-constructed EAP can deliver, she says. A study commissioned a year ago by Fidelity Investments and the National Business Group on Health (NBGH) found that of 150 corporations with wellness programs, 97% had EAPs. (See "Benefits Business," April 2014 issue of Rough Notes.)

Greer spoke at a recent seminar titled "Worksite wellness: Moving Beyond the Physical Dimension" sponsored by The New England Employee Benefits Council (NEEBC) in partnership with the International Foundation of Employee Benefit Plans (IFEBP).

Greer explained that she first became interested in mental wellness during her days at Babson College when, as an undergraduate and parent of a young child, she was overwhelmed trying to be a full-time mother as well as carry a regular class load.

"After a sleepless night with my child who was sick, I was driving to class to take an exam that I had not prepared for. I found myself struggling to breathe and pulled over to the side of the road and began crying. I went straight to the office of the dean of students-I didn't know him-and told him, 'I just can't do this anymore.' He spent about an hour with me, talking about what was wrong. Then he said he would call one of my professors and withdraw me from one of my classes. 'You're taking five classes, and four is plenty,' he said.

"I felt this huge stress release, and was glad I had talked to him. But then," Greer explained, "the dean did something else. He handed me a business card and said, 'I want you to talk to this counselor and report back to me in a week how the conversation goes.' I wasn't familiar with counseling and not at all sure I wanted to do it, but now I was committed because of his help. I ended up going to counseling and became very interested in it."

The same principles-good access to initial help and a follow-up commitment-apply to mental wellness offered as part of an employee assistance plan, Greer explained.

"Mental wellness is all about having the right counselor available at the right time. The mental wellness clinician needs to be friendly, warm and available. When an employee makes the initial call to a mental wellness counselor, a phone conversation has to take place on the spot. Employees shouldn't have to go through prompts, voice mail or page people in order to talk to a senior level person. They may be calling from a conference room and can't just leave a message or call back later.

"Privacy is really important too," she added. "Group intervention, which might be used with other types of wellness, just isn't going to work."

Then, there's the follow-up. "We think it's important for employees to be able to talk to the same person they talked to the last time. It doesn't work as well when it's a really large call center approach and everything is being triaged." Working through an EAP, Greer said, there will be referrals to counselors specializing in individual problems, but those referrals are pre-vetted and targeted to an individual's specific needs.

And what are those needs likely to be? Among the leaders on the list compiled by Greer for her work with EAPs are problems related to: legal issues (19%); emotional/stress (11%); couple/marital issues (8%); family (8%); financial situations (7%); work-life balance (7%); and alcohol or drugs (6%).

"Most people don't call with just one problem," Greer said. "They get blended together. For example, someone who comes because they have just gotten separated and is starting to move toward a divorce may have financial issues, legal issues, child care issues and counseling needs-all at the same time. We start with what may be the most urgent and go from there. It's good to have senior level clinicians who can begin to unravel all of it and figure out what the root cause is."

One of the trends that EAPs must address, Greer said, is dealing with problems involving elder care. It's a growing concern for three reasons, she pointed out. First, the population of older adults is rising; second, most people tend to deal with it only after there's a crisis, such as when an elderly parent falls and needs immediate care; and third there is somewhat of a stigma attached.

"The stigma attached to elder care needs resembles the way many people dealt with child care needs in the '80s," Greer said. "Now there is no stigma attached to dealing with child care needs; those needs are openly recognized and addressed."

For elder care today, the objective should be to prevent a crisis, Greer said. That means encouraging employees to address the emotional side of care giving, such as preparing for difficult conversations between generations. It also means dealing with lots of paperwork-Social Security, housing, medical, legal and insurance.

After a crisis occurs, she continued, the focus turns to issues involving hospitals, in-home services or residential services.
Greer concentrated her discussion largely on the discovery phase of mental/emotional issues-when an employee starts to confront a difficult phase of his life that he is just learning to recognize. A second speaker at the NEEBC/IFEBP seminar, Debra Lerner, Ph.D., a professor of Medicine and Psychiatry at Tufts University, focused on the workplace needs of employees with depression. Many of these employees already recognize their condition but need help with adjusting to it in the workplace.

As director of the Program on Health, Work and Productivity at Tufts Medical Center, Lerner heads up a program called Be Well at Work, which oversees the work of EAP counselors who serve the mental wellness needs of employees via phone consultations. About half of the employees participating in the program are on medication for depression.

The business case for managing depression in the workplace is convincing. Lerner pointed out that 10% to 20% of the population is stricken at least once during their lifetime; the average depressed worker misses from half a day to four days of work per month; and the average depressed worker is limited in his ability to work 35% of the time.

One of Lerner's former colleagues calculated the direct cost of depression (medical and pharmaceutical) at 24% of the total costs, while the indirect costs are absenteeism (6%); presenteeism (63%); short-term disability (6%); and long-term disability (1%).

Be Well at Work encourages coordination with any other medical care the employee may be getting for depression, but its focus is on the workplace, Lerner states. "Whereas the regular medical system starts with symptoms, such as a lack of sleep or appetite, this program ties depression to work-related functions.

"When people first come into the program, they feel very beat up and defeated in their jobs, but when we talk to them for a while we can almost always find some glimmer of opportunity to change something-to feel better and function better. Sometimes they aren't aware that doing small things can have a big impact-like wearing earplugs in areas that are too noisy or going outside during a lunch break to separate yourself from the stress at work.

"Other times it's learning to recognize when negative thinking may be happening and reframing it or training yourself to think about other things.

"We find that when we are able to slow people down and get them to be more analytical about their work, they have tremendous insights into what kinds of things can be helpful to them and are willing to try it," Lerner said.

Although the study covered only a four-month period, the employees in the Be Well at Work program achieved significant improvements in standard measurements of a wide variety of job functions including time management and working in teams, Lerner noted. They also showed reduced rates of absenteeism.

The mental and emotional difficulties that employees carry with them to work will always have an impact on their job performance, just as physical problems do. Within employee assistance programs mental wellness initiatives have achieved some success. Long term, it is reasonable to expect company benefit plans to take a greater interest in mental wellness.

The author
Thomas A. McCoy, CLU, retired in 2013 as editor-in-chief of Rough Notes magazine.