Benefits Strategy

Taking Action on Mental Health: A Business Group Viewpoint

Employers must ensure they drive value in their mental health strategy, which needs to be comprehensive, rooted in evidence and focused on improving outcomes.

November 22, 2024

Introduction

Mental health is on a broad continuum ranging from positive emotions and healthy functioning to more challenging and complex needs and conditions. As with physical health, prevention, early intervention and treatment are crucial, especially because of the impact mental health has on overall well-being.

As understanding of mental health has expanded over time, so have the programs and benefits offered by employers. Correspondingly, employers have seen increased utilization of mental health benefits, although this varies across the globe. While these increases can be viewed positively (more people have access to and are engaging with mental health services), for the first time since the Business Group began tracking conditions driving health care cost increases, mental health appeared in the top five in 2024. Because these cost increases are unlikely to abate in the future due to the persistent need for support across the mental health continuum, it is imperative that employers assess the design and outcomes of their mental health strategy. In particular, employers must ensure that they are driving value in their mental health strategy, which needs to be comprehensive, rooted in evidence and focused on improving outcomes for employees and dependents.

Mental Health Strategies Need to be Comprehensive

To develop a comprehensive workforce mental health strategy that supports employees across the continuum, employers and their partners should design their approach based on three pillars.

Employers must continue to prioritize the promotion of mental health throughout the organization: Despite progress made in recent years, mental health stigma remains a significant global issue and a barrier to seeking care.¹ Thus, it’s incumbent upon employers and their partners to continue to normalize mental health by educating employees, talking about it regularly and encouraging employees to use available benefits and programs. In 2025, just under half of employers (49%) will deploy anti-stigma campaigns, and nearly 70% will offer manager training to help managers recognize and support employees with potential mental health challenges. Where available, employers can also leverage employee resource groups (ERGs) to communicate about and gain feedback on programs designed to promote mental health.² Employers must view these efforts as ongoing initiatives, largely because the evidence suggests that the impact of efforts like manager training, for example, may be time limited to 6-12 months.³
Providing benefits across the mental health continuum, including treatment for those with mental health and substance use disorders, remains paramount: For many employers, providing a robust mental health benefit has become table stakes, but some areas of mental health remain under-addressed. For example, employers must work with their partners to provide programs and benefits that focus on pediatric and adolescent mental health, maternal mental health and suicide prevention and postvention (i.e., the response and support after a suicide death). Employers must also ensure that the programs and benefits they offer have the specialized expertise necessary to address these areas effectively. Some of these conditions are stigmatized in many parts of the world, which means that coordination between mental health vendors is needed, along with efforts to promote mental health across the organization (see bullet above.)
Underlying organizational factors can either protect or hinder employee mental health: While work can bolster mental health by providing employees with the space and opportunity to make positive connections, feel a sense of belonging and experience purpose and fulfillment, it can also contribute to issues like chronic stress and burnout. Benefits and well-being professionals must advocate for and work across the organization to implement policies that cultivate an organizational culture where mental health is supported as part of the employee experience. Without this organizational foundation in place, employer investments in mental health programs and benefits may prove ineffectual.

Mental Health Programs Need to be Rooted in Evidence

To increase the impact of their mental health strategy, employers must align their mental health communications and benefit coverage with the best available evidence.

As employers design and roll-out anti-stigma campaigns, they should use research on successful communications strategies to improve attitudes and promote treatment-seeking behavior:⁴ These approaches can prevent even the most well-intentioned messages from proving ineffective or even backfiring. But even when relying on evidence, employers should consider testing communication campaigns for their effectiveness using employee focus groups or surveys; this approach can be particularly helpful for multinational employers rolling out campaigns in different markets as they account for cultural variation and nuances.
When it comes to mental health benefits, employers must take a judicious approach to ensure they’re covering and promoting evidence-based treatment: While this recommendation applies broadly, employers should pay close attention to specific areas, including substance use and eating disorders, as the quality of care (and costs) for these conditions can vary greatly among providers. Evidence-based treatment matters because when patients receive it for mental health conditions, clinical improvement is very possible. For example, the success rates for individuals who receive appropriate care for substance use disorder, which includes access to medication-assisted therapy, mirror those for other conditions like hypertension or asthma.⁵ To promote positive outcomes, employers need to work with clinical leaders, internally and with their partners, to: 1) assess if current benefit and provider networks align with the best available evidence and quality and 2) identify any gaps in evidence-based care (e.g., medications for substance use disorders).
Employers must work with their vendor partners to ensure that mental health support and/or referrals are incorporated into other health benefits and well-being programs: Weight management programs, for example, are ripe for integration with mental health services, with studies showing a co-occurrence of obesity and conditions like depression and eating disorders. This can be an effective approach to expanding access to mental health support in regions and countries that lack a robust mental health infrastructure.

Mental Health Care and Benefits Need to Drive Value

As health care costs rise, including mental health costs, employers will increasingly need to focus on the value of these services. Value can be generated in part by aligning benefits with the best evidence as described above.

Employers can generate value by setting more rigorous expectations related to patient outcomes: Measurement-based mental health care (MBC) is an evidence-based practice that involves the routine assessment of patient- reported outcomes that clinicians can use to target and alter treatment and ultimately determine if patients are improving.⁶ This data can also be used to determine the quality of care that providers are delivering. Although some mental health vendors, like newer employee assistance program (EAP) models, require their providers to use MBC, various studies have found that fewer than half of psychiatrists and psychologists practice in this way.^7,8
Employers must press mental health and substance use disorder vendor partners to provide outcomes data that includes but goes beyond basic utilization and assessment (e.g., PHQ-9, GAD-7) trends: The data may include the percent of providers integrating MBC into their practices; time to treatment; provider quality, including adherence to evidence-based protocols; and patient experience outcomes such as therapeutic alliance (i.e., a cooperative working relationship between client and therapist) and patient satisfaction. More specificity provides employers with a deeper understanding about whether the benefits they’re offering are making a meaningful difference in the lives of employees or if they need to explore other vendor partner options.
Increasing mental health burdens require employers to refine their strategy and demand more of their partners: A global mental health vendor, like an EAP, cannot deliver value if few people use it. Appropriately, employer expectations about their partners’ performance and capabilities have increased significantly. Unacceptably low utilization of EAPs remains a serious barrier to driving value from this benefit, with significant variation across countries.

Conclusion

For the first time, the Business Group's annual Employer Health Care Strategy Survey found that mental health appeared as one of the top five conditions driving employer health care costs. At the same time, mental health has a tremendous impact on employee well-being, resilience, engagement and productivity. The confluence of rising costs, growing burdens of mental health conditions and employee demand for services highlights the need for comprehensive strategies that drive greater value for employers. A thorough, high-quality health and well-being strategy must include a strong approach to promoting positive mental health and providing access to treatment when it is needed. This requires employers to carefully consider their workplace dynamics, programs, communications and benefits so they all work in concert to support employee mental health. As cost increases accelerate, employers must make sure that what they are paying for is based on evidence, provides a positive experience and is improving employee health.

Taking Action on Mental Health: A Business Group Viewpoint

Introduction

Mental Health Strategies Need to be Comprehensive

Mental Health Programs Need to be Rooted in Evidence

Mental Health Care and Benefits Need to Drive Value

Conclusion

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