National surveys reveal disconnect between employees and employers around mental health need

Our national survey findings reveal differing perspectives between employers and employees across three areas: level of employer support for mental health, employee access to mental illness and substance use disorder treatment, and workplace stigma (level of shame, prejudice or discrimination toward people with mental illness and substance use disorders perceived in the workplace).

The disconnect is most pronounced when it comes to perceived benefits for frontline employees and access to care for employees with a substance use disorder.

Nearly 80 percent of employers surveyed report at least some concern¹ 1.Defined as respondents selecting “moderately concerned,” “very concerned,” or “extremely concerned.” about employee mental health overall, and about two-thirds report concern about substance use disorder. About half of employer respondents indicate that mental health is a top organizational/CEO priority for them. Employers can prioritize mental health by appointing leaders responsible for mental health at an organizational level, as well as expanding benefits, policies, and programs.

Organizational leadership: About three-quarters of employers surveyed report that they have appointed a mental health leader, with a smaller subset (about 40 percent) appointing a leader(s) in executive roles. Leaders’ responsibilities may include monitoring employee well-being and mental health needs, examining benefits and ensuring access to treatment, and overseeing mental health-related workplace programs.

Expanding resources: A majority of employers (about 70 percent) report they plan to invest in mental health resources by starting, continuing, or expanding benefits in 2021. The most common reasons reported for expanding support are to promote employee productivity, increase satisfaction, and attract/compete for talent. The most common reasons reported for reducing or stopping support (reported by about 10 to 15 percent of employers) are cost, complexity to manage resources, and low employee utilization of resources.

A majority of employees report challenges accessing mental healthcare. The most commonly reported barriers are lack of insurance coverage, difficulty determining covered services, not knowing which resources are available, difficulty finding providers, and long wait times to get appointments.

Certain groups of employees were more likely to report challenges in our survey, especially when trying to access counseling or similar services:

• Gen Z. Providing mental health support for Gen Z is critical for employers from a workforce recruitment and retention perspective, as 60 percent of Gen Z employees surveyed report that mental health resources are important in selecting an employer, and 57 percent say they are important when deciding to stay at an employer.
• Those with unmet social needs. Employee respondents with two or more unmet social needs are about 30 percentage points more likely to report challenges accessing counselling or similar services. Unmet social needs are associated with poor mental health more broadly.² 2."Insights on mental health from a 2019 McKinsey Consumer survey," February 14, 2020, McKinsey.com. Employers can address unmet social needs by offering resources such as transportation or childcare/caregiving support when employees seek care.
• Hispanic/Latinx. As part of a commitment to advancing health equity, employers can evaluate and address barriers in access to mental healthcare that vary by race and ethnicity.

About three in four large employers and two in four small/medium employers report that they offer at least one type of mental health support for employees. Supplemental mental health programs that employers report offering may include digital and/or in-person programs to connect employees to care (for example, virtual counselling, digital recovery support, care navigation). Digital wellness apps offered by employers may include subscriptions to mindfulness and medication tools, or other personalized mental and physical well-being solutions (for example, app-based self-directed behavior change programs).

To communicate with employees about these resources, employers report using a range of communication tools, most commonly their health benefits website and manager-led communications. Still, there is an opportunity to improve employee awareness of mental health resources—for example, about half of employers report that lack of awareness contributes to low Employee Assistance Program (EAP) utilization. Also, while C-suite-led communications can be an effective tool to raise awareness of support and reduce mental health stigma, only a quarter of employers report using this channel. Employers can consider the timing/frequency, content, and personalization of mental health-related communications to improve awareness of resources.

A majority of employers we surveyed report there is workplace stigma for mental illness and substance use disorder today. And employees agree—about 80 percent report mental health stigma in the workplace. Stigma is a pervasive barrier that can inhibit ability to access care, and eliminating it is key to building an inclusive culture to mental health.

Anti-stigma campaigns are one tool employers can use to reduce stigma—among employers we surveyed, however, less than a quarter have conduced an anti-stigma campaign. Only 6 percent of employees surveyed reported being aware of an anti-stigma campaign at work, though about 80 said it would be valuable. This highlights the opportunity for anti-stigma efforts to be more visible and accessible.

Other actions employers can take to create an inclusive work culture include: ensuring that workplace norms support mental well-being, role-modeling by leaders talking about their own mental health challenges, investing in trainings to equip all employees with tools to support each other (for example, recognizing signs of distress), and fostering workplace community and connectivity.

By offering mental health support, employers report aiming to increase employee satisfaction/engagement and reduce healthcare costs. Employers may consider broadening their target outcomes to include uptake of mental heath support, employee experience and satisfaction with support, and the impact of support has on health, productivity, engagement, and equity.

For employers already striving to achieve a robust set of outcomes, there may be an opportunity to improve measurement: for example, across employers that report wanting to increase engagement (close to half), only 38 percent report actually tracking engagement.

Available measurement tools for employers include, but are not limited to: claims or clinical analysis, employee surveys, focus groups, lived experience panels, as well as holistic workplace mental health assessment tools to evaluate benefits and programs.

Among employees surveyed, those with anxiety or depression report missing, on average, roughly 6 times more work days per year than individuals without a mental health condition. Employers have the opportunity to improve these outcomes. For example, depression management as part of primary care has been demonstrated to reduce missed work days by 30 percent.³ 3.Kathryn Rost, Jeffrey Smith, and Miriam Dickinson, “The effect of improving primary care depression management on employee absenteeism and productivity. A randomized trial.” Medical Care, 2004, Volume 42, Number 12, pp. 1202−10, journals.lww.com. In parallel, employers can evaluate and address workplace norms and/or environments that contribute to stress and burnout.

Our survey showed that better workplace mental health support is associated with higher employee return to work rates after mental health-related disability leave. As context, mental illness has been estimated to account for roughly one-third of disability claims and 70 percent of workplace disability costs.⁴ 4.Sarah Chapman et al., “The ROI in workplace mental health programs: Good for people, good for business,” Deloitte, 2019, deloitte.com. Return-to-work rates are critical for employee engagement and loyalty, productivity, and reducing indirect costs (for example, finding and training new employees). Employers that self-reported offering more support ⁵ 5.We define “more supports” as a combination of robustness of mental health benefits and actions supportive of employee mental health. Robustness of benefits reflects number of benefits offered (for example, medical insurance, EAP, telehealth), and self-reported parity between mental health and medical/surgical benefits. Actions supportive of employee mental health reflect the following: frequent company-wide communication about mental health, mental health as a stated C-suite priority, a dedicated mental health leader, perception of how well the company supports employee mental health, and perception of how mental health offerings compare to other employers. were about twice as likely to report a greater than 50 percent return-to-work rate after mental health-related disability leave than employers that reported less support.