August 25, 2021
On July 13, 2021, over 350 Business Group on Health members convened to address the rising mental health needs of employees and their families. Because the challenges associated with supporting the mental health of employees and their families are well understood, Summit speakers focused their comments on solutions. In particular, speakers discussed ways to close existing gaps in mental health benefits and identify future strategies for executing a comprehensive mental health care strategy.
All Mental Health Summit session recordings are accessible on demand to Business Group on Health members.
Cultivate a Positive Mental Health Culture
Now more than ever, employers realize the influence that organizational culture has on the mental health and emotional well-being of their workforce. As voiced throughout the Summit, employers are turning this understanding into action to create psychologically healthy workplaces. To do this, speakers shared approaches to promoting open discourse, reducing stigma and integrating mental health into workplace practices.
- Establish the workplace as a ‘safe space’ to talk about mental health: Employees shouldn’t feel they have to hide their mental health challenges when they clock in at work. In partnership with its diversity and inclusion business resource groups, CNO Financial created “Safe Place” conversations in the summer of 2020 to provide employees with an ongoing opportunity to discuss pressing topics without fear of judgment. The conversations take place every other week, and hundreds of employees participate in each call. Mental health is incorporated into every conversation, enabling employees to openly share their feelings and allow leaders to understand what’s bothering associates and provide the support needed to alleviate these challenges. Nielsen offers a similar opportunity for employees to engage in topical conversations about mental health in “Safe Space with Dr. Brown” sessions, which include about 10-15 employees. Both CNO Financial and Nielsen work with their legal teams during the planning process for their mental health initiatives, including the “Safe Place” and “Safe Space” conversations to ensure that the information shared is appropriate and within legal boundaries. In 2020, Unilever launched its “Dear Teammate Campaign” to equip and empower teams to have conversations about mental health at work. The tagline of the campaign, “Let’s work together to make things easier,” is intended to convey that everyone has a role to play in creating environments where employees are safe and supported.
- Create a grassroots movement to change norms and attitudes about mental health: An effective mental health strategy will have top- down and bottom-up support and buy-in. Specifically, speakers noted that if you want to reduce stigma across the company, you need employees to model the behaviors you’re trying to achieve. Both Unilever and Kaiser Permanente recognize this and have established networks of mental health champions and advocates. These volunteers spread awareness about mental health resources, and in some cases, share their own mental health stories. At both companies, champions and advocates participate in mental health training and have a special insignia in their email to identify them as a champion or advocate. And at Unilever, there is a dedicated mental health champion section on the organization’s well-being hub, where employees can see the list of champions by location and function.
- Train employees to recognize potential signs of distress and how to respond: Equipping employees with knowledge about mental health conditions, along with associated benefits and resources, can shift culture and improve utilization. Johnson & Johnson uses training as a tactical tool that is key to both prevention and preparedness. More than 100,000 employees have completed the company’s “Energy for Performance” training, which focuses on purpose with skill-building for emotional, physical and mental resilience. The goal is to help employees bring their best energy forward daily, as well as provide a source of support for colleagues in times of stress. CNO Financial Group partnered with its employee assistance program (EAP) to develop a 90-minute mental health training that answers common questions about mental health, including the signs and symptoms of mental health conditions and how to appropriately approach and discuss mental health with those who may have warning signs. Kaiser Permanente’s internal EAP created an online training program called, “Notice, Engage, Support.” The voluntary training is available to all employees and takes 30 minutes to complete (an extra 10 minutes is added for managers). Kaiser Permanente measures the effectiveness of the training at 3 months, 6 months and 12 months, evaluating if trainees were able to use their skills and if the program increased their confidence in having conversations that normalize mental health in the workplace.
- Integrate mental health into everything: To truly support employees, mental health can no longer be a standalone initiative but rather one that is woven into the company culture, policies and practices. Speakers shared their approaches to elevating mental health as an organizational priority. Johnson & Johnson’s Health for Humanity 2025 Goals include a mental health and well-being commitment “to build a diverse workforce representative of the companies we serve and to advance a culture of health, innovation and belonging.” At CNO Financial, the organization is incorporating mental health into communication campaigns, messages from the CEO to associates and Diversity & Inclusion initiatives. Kaiser Permanente has a leadership group across the enterprise, including those outside HR, that meets yearly to develop shared priorities, goals and accountability; in this way, everyone has a role in supporting the holistic well-being strategy, including mental health.
For more on cultivating a positive mental health culture, watch the Summit videos Closing Gaps in Mental Health Care Benefits with Victoria Pavlov, Vice President, Global Benefits, People Team, Nielsen; Kami Reuter, Well-being Manager, CNO Financial Group; and Daryl Tol, Executive Vice President, One Mind and Key Components of a Mental Health Strategy: Culture, Comprehensive Care and Integration in Action with Maria Dee, Executive Director, Workforce Well-being, National Human Resources, Kaiser Permanente and Bronwyn Ott, Well-being, Equity, Diversity & Inclusion Leader, Unilever.
Make Mental Health Benefits and Programs Inclusive
While the mental health system has not well served the needs of Black, indigenous, and people of color (BIPOC) and LBGTQ+ populations, speakers agree that change is afoot. There is a movement to create more inclusive care that improves the patient experience, decreases disparities and pushes us forward to achieving health equity. Speakers envision a transformed delivery system in which mental and physical health are equally valued and accessing mental health services is frictionless and normalized. In this vision, employers and their partners use detailed and specific data to identify differences in ethnicity, gender identity and sexual orientation to eliminate disparities in outcomes across the population. And importantly, all health care stakeholders enact deliberate efforts to repair mistrust with historically marginalized groups and provide access to culturally competent care. To accelerate the attainment of this future vision in their own organizations, speakers encourage leaders to design programs for inclusivity; promote mental health care that’s at least culturally competent and, ideally, culturally or racially concordant; and use data strategically for these purposes.
- Ask, listen and design for equity and inclusion: This means asking employees and experts for input, listening for needs and concerns and testing assumptions. Unilever believes employers can no longer ignore the individuality of employees, who experience the world and workplace in different ways and have different health and well-being needs. For all to thrive, the company’s well-being strategy needs to respond with flexibility. For example, in Canada, Unilever created a well-being fund that enabled employees to spend money on health and well-being needs that fit their individual lifestyle. In addition, employers and their vendor partners must consider if the mental health initiatives they’re developing will meet the needs and challenges of all employees. Willis Towers Watson pointed out that mental health stigma may be different for different populations. Understanding these cultural nuances can be particularly helpful in crafting a strategy that will resonate. When making decisions about programs or building a new initiative, Kaiser Permanente strategically involves its Diversity, Equity and Inclusion team from the start and seeks input from business resource group leaders.
- Ensure access to culturally competent and concordant care: As a first step, it behooves employers to carefully consider and seek to address the complex challenges that have impeded culturally competent and accessible care for LGBTQ+, BIPOC and other marginalized employee groups. Speakers from Included Health and Hurdle asserted that virtual care can be a platform for inclusion by enabling LGBTQ+ and Black mental health providers, who are in short supply, to work across a much broader geographic area. Additionally, specialized navigation services that focus on BIPOC or the LBGTQ+ community can offer a more comfortable and potentially more effective patient experience by identifying therapists and other providers who, through their own lived or learned experience, can best relate to clients from historically marginalized groups.
- Collect the data, identify differences and organize to address disparities: Because data drives decision-making, employers and their vendor partners need to collect and maintain more complete and specific data on ethnicity, race, gender identity and sexual orientation. Voluntary self-identification by employees is legal in the U.S. and encouraging employees to see the value in sharing their information will allow for more informed decisions. Ultimately the goal is to identify disparities and take deliberate steps to overcome them by repairing mistrust, leveraging the tools we have and know how to use.
For more on making mental health care inclusive, watch the Summit video with Kevin Dedner of Hurdle, Rachel McCann of Willis Towers Watson and Ian Tong, M.D., of Included Health, Grand Rounds and Doctor on Demand.
Address Significant Gaps in Mental Health Supports: Substance Use Disorder and Care for Kids
Although employers have greatly expanded their mental health benefits to meet the evolving needs of employees and their families, significant challenges remain. Two areas of increasing need and urgency include evidence-based substance use disorder (SUD) treatment and pediatric mental health care. Tragically, in 2020, almost 100,000 Americans died from a drug overdose – an all-time high – yet only a small percentage of people who could benefit from treatment for SUD actually receive it. What’s more, stigma is rampant. For kids and teens, stresses associated with the pandemic, virtual schooling and social isolation have dramatically increased the need for support, but providers who accept insurance are hard to find and vendor programs are mostly just emerging. The expert speaker from Eleanor Health identified several approaches to have a positive impact on SUD treatment:
Speaker Nzinga Harrison, M.D., shared her framework for analyzing any strategy that she considers implementing. She looks at a strategy’s potential impacts on:
- 1 | Access to support
- 2 | Efficiency of delivery
- 3 | Effectiveness of approach
- 4 | Satisfaction of end-users
This framework also can be translated to each employer’s benefit strategy.
- Implement evidence-based coverage for medication-assisted therapy and opioids: Some of the most critical evidence-based SUD-related therapies include coverage of all formulations of Suboxone (pills and strips), Vivitrol (even a one- month injection can have an impact on outcomes) and Methadone. Employers can also use the Shatterproof Atlas Tool to identify high-quality residential treatment programs.
- Analyze data to better understand disparate impacts of the SUD strategy on different employee populations: The level of stigma associated with SUD varies based on race and ethnicity, too often leading to inadequate treatment for those who are BIPOC. To the extent possible, employers should assess the impact of their benefit strategy based on race, ethnicity, sexual orientation and gender (geography or income band can also serve as proxies).
- Assess vendor capabilities for addressing SUD and include it as a high priority for selection: Drug overdose increased by 30% in 2020. Alcohol sales have spiked during the pandemic. A significant portion of workers have admitted to drinking on the job while at home. Never before has there been a stronger case for considering a vendor’s approach to SUD as a top criterion for selection.
- Encourage leaders to champion SUD programs: Leadership can help normalize conversations about SUD and encourage help-seeking behaviors. The Hartford’s CEO, Christopher Swift, has led a national conversation on supports for employees struggling with SUD. In any communications about mental health services, having executive leadership sharing personal experiences can be helpful.
Speakers offered a number of ideas to increase access to pediatric mental health providers:
- Offer incentive payments to mental health providers, including those focused on children, to join plan networks: Due to a mismatch between the low supply and high demand for pediatric mental health services, Blue Cross Blue Shield of Massachusetts is paying higher reimbursement rates to pull more providers into networks to increase affordable access for plan members, something that other health plans and employers may need to consider as well.
- Reduce or eliminate cost-sharing and prior authorizations for pediatric mental health providers and patients seeking their care: Employees report that out-of-pocket costs are a top barrier for accessing mental health services, and mental health providers say that health plan network requirements are a significant reason why they go out-of-network. Reducing or eliminating cost-sharing and prior authorizations in concert has increased network participation for Blue Cross Blue Shield of Massachusetts and reduced friction for plan members seeking mental health supports.
- Reassess the capabilities of in-network providers to see if they can treat children: A review by Blue Cross Blue Shield of Massachusetts found that several of the company’s currently contracted mental health providers weren’t identified as being able to treat children even though they could.
- Incorporate comprehensive care payments into value-based contracts with provider groups to incentivize the integration of pediatric mental health into family medicine: Many employers have taken the step of turning on “comprehensive care” payments to reimburse primary care providers for incorporating and coordinating mental health services and providers in their practices. Employers should assess their claims data to see if those payments are being made; if not, it means that your employees likely aren’t benefiting from these payment arrangements and your health plan may need a nudge to better implement programs to increase access.
- Make your mental health supports available to kids under 18 where possible: As noted by Strategic Benefits Advisors, there are legal, logistical and privacy reasons why not all vendors offer services to kids. Nonetheless, many providers do offer these services or are growing their capabilities to do so. Employers should inventory the capabilities of their EAP and virtual mental health services through health plans or standalone providers. Additionally, there are many new companies that provide virtual mental health services to kids, which may help expand access.
- Communicate frequently about pediatric mental health and available benefits: Education about suicide is something that employers are starting to implement, which can be a good kickoff to a discussion about supporting kids. Relatedly, supports for caregivers can have a positive trickledown effect on kids (though this is harder to measure) because they have more capacity to take care of their dependents without getting burned out in the office and at home.
For more information on addressing gaps in SUD treatment, see the Summit recording with expert Dr. Nzinga Harrison. For more on increasing access to pediatric mental health care, catch the Summit session with experts Dr. Joel Axler and Dr. Gregory Harris.
What’s Next on the Agenda?
Promoting positive mental health was a difficult task for employers and their employees long before the pandemic. Without comprehensive, evidence-based and integrated solutions, it will continue to be challenging. Employers have a unique and powerful opportunity to push for real progress in the mental health care system to improve health outcomes of their employees. As we look out beyond the immediate problems identified above, what do the next few years look like for the mental health landscape? Employers and their partners must continue to implement upstream approaches that aim to mitigate the underlying root causes of mental health diagnoses and the societal challenges that lead to limited utilization of evidence-based care, poor outcomes and low engagement. Mental health will expand as a key component of any health care strategy as the impact of the brain on the rest of one’s body is better understood. Employer leadership in mental health is vital, and the Business Group will continue to provide resources and support to help employers improve outcomes for employees and their families.