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Learning Corner with Jeff Pfeffer: It's Time We Talk About Mental Health at Work

Jeffrey Pfeffer

Professor of Organizational Behavior, Stanford University

Mental health is finally getting more attention in the working world. In fact in January, the World Economic Forum held meetings in Davos that featured a dedicated mental health track. The goal? Raise awareness of mental health as a global challenge—outside and inside of the workplace.

According to data from the Kaiser Family Foundation, 18% of adults in the U.S. (some 42 million people) have a mental, behavioral or emotional disorder. And a report from Mental Health America found that almost 20 million Americans have a substance abuse problem, while nearly 9 million people (3.8 percent of the population) reported having serious thoughts of suicide.

The workplace isn't immune to the challenges of mental health. And as the working world strives to master new, unfamiliar technologies, mental health issues could even be exacerbated by work. What's more, a systematic review of studies of work-related stress estimates costs to be as high as $187 billion, with 70% of the sum coming from lost productivity. I believe that learning and talking about mental health issues at work is a necessary first step to improving mental health in the workplace, and by extension, curbing the enormous costs they create.

How Employers Can Do More to Mitigate the Costs of Mental Illness

According to The Center for Workplace Mental Health, nearly 7% of full-time workers experienced major depression during the year, with the total economic burden estimated to be about $210 billion per year. Major depression increases absenteeism, presenteeism (reduced productivity) and has direct medical costs.

Employers bear a lot of these costs and, therefore, have a role to play in addressing mental health issues—both through the medical benefits they provide and by building cultures of physical and mental health in their workplaces through management practices that promote well-being.

In order to get to a place where managers and employees understand the implications of mental health at work, companies should stop treating it as something distinct (and less important) than other forms of illness. They should provide comprehensive mental health coverage as part of their medical benefits, all while working to reduce the stigma.

Understanding (and Treating) the Pervasion of Mental Illness at Work

In 2008, the U.S. passed a mental health parity law mandating equal medical coverage for mental and physical illness, but big differences in coverage and access remain. One study found that in 2015, behavioral care was between "four to six times more likely to be out-of-network than medical or surgical care," and insurers paid primary care providers 20% more for the same types of care than they paid addiction or mental health specialists.

Some of this difference is the result of the stigma associated with mental health problems. A Financial Times reporter recently told me that when doing interviews for a story about mental illness in the C-suite, a board member told her that if the CEO admitted to mental illness, the board would fire that individual. An article about depression in the technology industry noted that admitting to depression could harm company perception and would put obtaining funding at risk.

Another contributing factor in the difference in cost and access is the sense that mental illness is not a "real" illness like cancer or heart disease. But that is completely incorrect: As my Stanford colleague Leanne Williams has demonstrated, neuroimaging studies show real changes in the physiology of the brain diagnosed with depression.

Making access to care more costly and difficult for insured employees and stigmatizing mental health issues just drives people to try and hide issues and not get care—perpetuating the problems and their associated costs.

A Path Forward for Employers and Employees

Ultimately, the best way companies can eliminate the stigma around mental health at work is to just start talking about it. EY (formerly Ernst and Young), for example, launched a program called We Care with the goal of educating employees about mental health issues and encouraging them to seek help. The program is also centered around support for colleagues who may be struggling with illness or addiction.

More employers should take a similarly proactive approach to get mental health out of the shadows. And once the lines of communication are open, HR departments can (and should) consider offering benefits that provide more accessible mental health care.

Mental illness is enormously costly, both to society and employers, yet research advances make the effective treatment of disorders such as anxiety and depression much more possible. For reasons both economic and humane, employers should work to destigmatize mental disorders, increase insurance coverage of treatments and ensure that care uses the best, most recent available evidence.

Photo: Creative Commons

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Why Corporate Wellness Programs Aren't for Number Crunchers

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Why Corporate Wellness Programs Aren't for Number Crunchers

The hype around wellness in the workplace has reached critical mass. Corporations that once rolled their eyes at Google's full-time yoga instructors are now doling out annual wellness stipends of their own — paying for more "Namaste" to retain employees and promote overall wellness. And there's no sign the investment will stop anytime soon. According to the RAND Corporation, companies spend a total of $6 billion annually on wellness programs. Google, for example, shells out nearly $13,000 a pop on its nap pods, while Shutterstock offers employees weekly massages that amount to $50 per hour per employee (plus $800 for each massage chair). This isn’t to say it’s always expensive to run these programs — some can be low to no cost. In 2015, RAND found that most organizations plan to invest the same as 2014 (if not more) into corporate wellness programs. But the question remains: Is this a money-wasting fad or a valuable engagement and retention tool? The Employee Engagement Argument With 70 percent of U.S. workers reporting that they feel disengaged in the office, some companies believe wellness programs will reverse the trend. It makes more sense (even monetarily) to try to re-engage disillusioned employees than hunt for new talent. Studies show that disengaged workers are 2.5 times more likely to leave their jobs. One way to keep them is through these programs. "Employees value wellness-related benefits and want to work for companies that support their health-related goals," says David Roddenberry, founder of health-incentive company HealthyWage. To Roddenberry's point, experts have found that the next generation of workers place value in meaningful workplace perks, sometimes choosing a company with a healthy ethos over one that will simply offer them a larger paycheck. A survey from TechnologyAdvice found that 56 percent of people would trade a salary increase for workplace perks, with gym memberships as the second-most requested perk. The Business Case From a business perspective, however, wellness programs can seem like a money-suck as there's no clear — or uniform — way to measure ROI. Some companies opt to measure retention rates after implementing new practices, while others focus on decreased healthcare claims. It's hard to know for certain if Carol in accounting quit smoking because of the new corporate cardio classes, for example, or because her daughter implored her to make the life change — or maybe both. The difficulty, says Roddenberry, arises when companies simply throw money at wellness, but don't implement an actual program (i.e., they don't set goals or have a great answer to the "why" of the investment). Copycat programs and lack of due diligence do not make for successful employee wellness programs. "Incentives are a great example of something that works well in certain contexts, but not others," Roddenberry notes. "Some employers think that you can offer a $200 reward and expect employees to lose weight or quit smoking. Unfortunately, the money alone is not enough. The $200, when administered as part of a well-structured weight loss or smoking cessation game, can drive significant positive lifestyle change." The Takeaway Probably the most extensive employee wellness study to-date is a seven year study of 67,000 PepsiCo employees. While the study found that the beverage behemoth's chronic disease management programs lowered health care costs (lowering hospital visits 29 percent), lifestyle programs proved less successful (for each dollar spent on lifestyle programs, Pepsi lost $.52 in health care costs). The takeaway? Don't invest in a wellness program if your goal is to save money—invest in it if you want to improve company culture and help employees get closer to the ever-elusive "work-life balance." "Unfortunately, too many companies are trying to implement wellness programs with little to no experience or game plan for success," Kinema Fitness president Joshua Love writes on Forbes. "As a result, more programs fail than succeed. The real problem? Corporate wellness cannot be treated as a band-aid, and you definitely won't be able to find it in a fitness app." Ultimately, an investment can't be about returns. It can, however, foster a community of people geared towards a common goal. Better engagement, higher attendance rate, healthier families and talent attraction are all commonly believed to be by-products of a thoughtful wellness program — the question for HR is whether or not you're willing to take that leap of faith. Photo: Shutterstock

Mental Health Is Top Of Mind For Companies—Here’s How to Make These Efforts Last

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Mental Health Is Top Of Mind For Companies—Here’s How to Make These Efforts Last

Within the first two months of the COVID-19 pandemic, concerns over a potential mental health crisis started to emerge. Enforced quarantines and the massive, sudden shift to remote work left many employees feeling anxious, lonely and depressed. In fact, since the outbreak of the pandemic, 75% of people say they feel more socially isolated, while 67% of people report higher stress levels. Over half (57%) are feeling greater anxiety. In response, some companies have taken actionable steps to support their employees’ mental health. Back in April, Starbucks announced it would offer employees and their family members 20 free counseling sessions a year. Similarly, PwC introduced well-being coaching sessions for all of its employees. While these types of efforts are necessary in light of the current situation, they do not fully address the underlying issue: The continued stigmatization of mental health conditions in the workplace. A 2019 survey of 1,500 employees found that less than half of respondents believed their company prioritized mental health. Further, a majority of respondents also reported that they were afraid to talk about mental health in the workplace for fear of being judged for it. The COVID-19 pandemic, and its resulting economic downturn, have negatively affected many people’s mental health and exacerbated people’s existing mental illnesses. This makes it more important than ever for companies to break the stigma around mental health in the workplace and implement long-term, effective solutions for addressing these issues. Companies should focus on getting better at talking about mental health at work, reexamining their employee benefits programs and encouraging employees to use available mental health services. Talking About Mental Health at Work One of the biggest shortcomings in employers’ mental health efforts is being ill-equipped—or simply reluctant—to address these issues. Only about 25% of managers in the U.S. have been trained in referring employees to mental health resources. But this is a necessary skill for managers to develop. Many mental illnesses can impede a person’s ability to function properly, let alone perform at work. Depression, for example, can cause an employees’ productivity to drop. This is all-too-common in the workplace—in fact, $17-$44 billion in revenue is lost annually due to depression. To better address mental health problems at work, employers need to be sure that their employees feel comfortable talking about these issues. And to do that, there has to be trust—especially between managers and their direct reports. Facilitating regular check-ins between employees and managers can help, but in those meetings, encourage managers to practice vulnerability. When managers describe their personal challenges, whether related to mental health or not, it makes them appear more human and relatable—and employees will feel comfortable doing the same. Invest in Better Services A shocking number of employees still feel as though there is a lack of mental health coverage at their company, and rightfully so: Only 13% of companies provide on-site stress-management programs and just 11% offer mindfulness or meditation benefits, according to a recent study from SHRM. However, a majority of companies today do offer employee-assistance programs (EAPs), which typically provide employees with immediate phone access to a counselor, a limited number of free sessions with a mental health care professional and therapist referrals. But the utilization of these programs is low, averaging below 10%. This is due in part to a lack of communication about the availability of these services—and because these programs typically offer the bare minimum in terms of usable mental health benefits and options for support. EAPs don’t require a lot of effort or money from companies, which is why so many prefer to use them. Most are relatively inexpensive, costing between 75 cents and $1.50 per member per month, regardless of how often staff uses them. Companies need to invest in EAP programs that offer better, more effective treatments. For example, in addition to an EAP’s existing offerings, employers should consider providing onsite counseling services and online programs that use cognitive behavioral therapy to treat patients. There are also other services, such as Psyched In Residence, that businesses can use to bring qualified, accredited and experienced psychotherapists in the workplace—without people needing to specifically ask for it. These days, practitioners can also deliver their professional and emotional therapeutic services in-person or virtually. Reiterating Available Benefits Now—And Later Thankfully, experts predict that a majority of employers that added, or made changes to, their mental health resources in response to COVID-19 will likely keep them long-term. But providing resources is not enough. In order to convince employees that their mental health is important to a company now and into the future, action must come from the top down. If serious about normalizing mental health at work, companies should place CEOs at the center of their mental health initiatives. Most companies do not have a single owner for all their mental health initiatives—instead, they allow many departments, like HR and learning and development, to play different but simultaneous roles in managing them. But without a proprietary leader for these programs, it’s harder to create accountability. CEOs can act as the "normalizer-in-chief." They can oversee all of a company’s mental health initiatives, hold different departments accountable to them and lead more conversations about mental health and the role it plays in the workplace. By making it clear at a company-wide meeting that they understand the importance of removing the stigma around these conditions at work, a CEO sends a message to the rest of their organization that they are serious about creating workplace culture that’s understanding and prioritizing of mental illnesses—while focusing on eliminating associated stigmas. The COVID-19 pandemic exposed a lot of underlying workplace issues—addressing and providing resources for mental health chief among them. But to effectively address these issues, thoughtful changes must be made to how often a company talks about mental health and how it invests executive time and money in supporting these initiatives. For more information on how to support employees’ mental health during this difficult time and into the future, check out this recent article from Cornerstone’s EVP of Learning and Organizational Effectiveness Jeff Miller.

The Do's & Don'ts of an Engaging Wellness Program: Part One

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The Do's & Don'ts of an Engaging Wellness Program: Part One

This is part one of our three part series by Benjamin Prinzing, President of Kadalyst Partners, exploring the 10 things you need to do to engage employees in your wellness program. The number one undisputed challenge employers face in their wellness programs is employee engagement. The big question everyone seems to ask is, "How do we get employees to show up?" But the question we should be asking instead is, "How do we get employees to care?" According to a recent study of nearly 20,000 employers across industries, 80 percent scored "improving overall health" of their workforce as their top-ranked objective. However, fewer than 15 percent of those employers were actually satisfied with the results of their own efforts. Organizations obviously have the best intentions, but many are missing the mark. We need to shift the programming focus from simply increasing "employee participation" to having employees become enthusiastic fans. In this article, I'll outline three of the ten common practices to avoid if you want to your employees to care about your wellness program. 1) Don't Overwhelm or Underwhelm The "throwing spaghetti at a wall to see what sticks" methodology of wellness programming just doesn't work long-term. If you try to launch too many initiatives, you overwhelm your employees, which creates confusion and causes the new initiatives to get lost in the noise of everything else you're doing. The opposite, of course, is not doing enough. This gives the appearance that employee wellness is just not that important and ends up being forgotten. To keep your program effective, keep it simple, set realistic expectations, keep it up and change it up. 2) Don't Program "at" Your Employees When you finally get the green-light to develop your organization's wellness program, you might get overly excited and want to take it all on yourself. But your best intentions will more than likely give off the vibe that you're programming wellness "at" your employees, versus "with" them. To stand the test of time, ask yourself, "If I was no longer in charge of the wellness program, would it still live on without me?" For a wellness program to be sustainable, it has to be rooted within your culture and the only way to do that is to go deep and horizontal. This means gaining support from all levels of management (or at least the ones who'll listen) and have them extend messaging about the program within their departments. Ask for feedback from employees and leadership, form an employee-focused "wellness committee" and give ownership to other individuals in your company. 3) Don't Send Lengthy Emails Effective marketing and communication strategies are extremely overlooked in the area of employee wellness programming. According to Aon Hewitt's 2012 Health Care Survey, only 17 percent of employers are using consumer marketing techniques to drive employee engagement. As HR and benefits professionals, I know you didn't go to school for graphic design, journalism or brand marketing. However, wellness programs are absolutely a product that needs to be properly marketed, and your employees aren't just employees: they're your target customer. Your biggest competitors as wellness program manager are big tobacco, energy drinks, fast food and drug companies. Sadly, they have billion dollar budgets to attract your employees, so though it may appear to be an uphill battle, your main advantage is having their eyes and ears for at least eight hours a day. In that sense, you do have the upper hand. Let's put it to the test. Which memo would you rather read? Does one give off a different "energy" than the other? At Kadalyst, we are limited on the time we have to develop, promote and manage our clients' wellness programs just like you. In the beginning, we found ourselves making these mistakes, so I want only to pass along what we've learned in the hopes you do it right from the start. Check back soon for part two of our series on the do's and don'ts of engaging wellness programs!

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