As companies become increasingly global, employers are searching for ways to improve the health and productivity of their employees around the world. One way that employers are working toward this goal is by implementing employee assistance programs (EAPs) globally. To get internal buyin, developing a business case is often necessary. The data in this document can be a helpful resource for doing so.

Why is a Global EAP Necessary?

• Depression is the leading cause of disability globally. The World Health Organization estimates that lost productivity due to depression and anxiety costs the global economy $1 trillion annually.¹
• Worldwide, more than 615 million people suffer from depression or anxiety, an increase of 50% since 1990.²
• Without improvements in mental health, 12 billion working days will be lost each year due to depression and anxiety alone.²
• Ten percent of the global population is affected by mental health disorders.² Even more report high stress levels (see figure 1).
• On average, country governments only spend about 3% of their budgets on mental health. In low-income countries, the percentage is even smaller.² In many countries, community based services don’t exist. Where they do exist, they may be prohibitively expensive. This means that in some locations, EAP may be the only way employees can receive treatment or support for mental health issues.

Higher Costs

Many times, global EAP costs are higher than those for domestic EAPs - even in countries where overall operating costs are typically lower.⁹ The reasons for this include lower employee volume, more expensive phone charges, decentralization in order to make services culturally appropriate, a need for more doctoral-level therapists because of a lack of counselor licensure/standards, higher service rates due to fewer available providers, and the increased time involved in building, maintaining and reporting on an international network.¹⁰ In general, overall cost often goes down with larger volume covered as the per person charge decreases. In some countries, that per person charge can still be higher than local competitors. To evaluate the true cost difference, compare the services offered and consider productivity time involved in managing multiple vendors.

Local Perspective

While it is important that employers have a global strategy for employee health programs, such as an EAP, it is also crucial that they review each location individually to examine local needs and preferences. Factors to consider when implementing a global EAP include the availability of mental health services, the level of mental health stigma in the country, confidentiality and trust among employees, legal issues, and any workplace or cultural issues that may impact acceptance of the program. The best way to determine these needs is by speaking with local HR staff members since they are generally the most culturally competent. Surveying employees may also be useful. Employers should listen and understand individual needs before imparting their own vision of EAP onto the site.

Utilization

Utilization rates are often lower outside of North America,¹¹ and they vary tremendously across regions and countries. According to Global Institute employer members, the most important factor that impacts utilization is promotion. Employers and vendors alike say that the more EAP is advertised and promoted within an organization, particularly by top management, peers and local champions, the more often it is used. It is important that employers not leave this promotion up to the EAP vendor; rather, employers should use many different modalities and opportunities to promote the EAP as often as possible. One caution: Global Institute members sometimes report that EAP vendors may calculate utilization rates differently. In order to have accurate comparisons, several recommend that employers ask their vendors to give them various cuts of data, not just aggregate utilization, so that all the ways that employees are using the program (webinars, referrals, counseling, etc.) are clear. It is also important to have global, regional and country-level data so that employers can see where utilization is strongest.

EAP and Well-being Programs

In conversations with Business Group staff, many employers reported using EAP as a “launch pad” for all their wellness programs around the world. Vendors, in turn, are offering products such as health assessments and lifestyle or health coaching. This increased focus on holistic well-being may be because EAPs are one of the few programs where there are a number of global providers. Another advantage is that all employee support programs can be grouped under the same “umbrella” and unveiled at the same time. However, concerns about utilization rates are particularly relevant in cases where the organization is using the EAP for all their wellness initiatives as well since there are multiple objectives to be met by one program. Employers should be careful to examine, on a country-by-country basis, whether EAP is the appropriate model for launching all well-being programs. Some considerations to keep in mind are whether there is buy-in from local staff (e.g., are local champions available?), whether cultural concerns may play a role in limiting use and whether a chosen vendor has strong capabilities in this geographical and programmatic arena.

Provider Supply

In many countries around the world, there is a shortage of appropriate mental health professionals. In fact, in emerging markets there may be very few or no providers. It is important that global EAP vendors enter new markets with the goal of finding local practitioners and training them so that they become effective EAP providers – while still keeping local needs and culture in mind. This is also an area where vendors can be creative and flexible in finding solutions. Does a provider need to be flown in or does the employee need to be flown to a provider? Is telephone counseling, done with a native speaker of the employee’s first language, appropriate? Can online services be used?

Commoditization

As the EAP industry has grown, both in North America and worldwide, it has increasingly become commoditized to the point that it is difficult to tell one vendor from another, particularly on paper.⁹ This often leads to decision-making based only on price. One of the reasons for this is the capitated pricing structure (e.g. per member per month), which may create an incentive for the EAP to do as little as possible to remain profitable. Capitation is popular among employers, however, because it is inexpensive and allows them to have a fixed budget for EAP.¹² Employers may also contribute to the commoditization problem by asking for services that mirror a North American EAP, which may allow vendors to provide an “off the shelf” approach that is not suited to meeting local needs. It is important that employers feel empowered to work with their vendors to develop unique programs that best meet the needs of their in-country employees.⁹

Technology

Technology, like wellness and well-being, is a focus area for both employers and vendors. Vendors are increasingly offering online booking through websites and apps, and some are offering web-based or video counseling, particularly for employees in remote areas or cities where traffic or travel is a problem. It remains to be seen whether increasing access through the use of technology will increase utilization, but employers should be aware of vendor capabilities in this area as well as ensure that they are protecting the private data of their workforce.

EAP as An Employer Resource

Some providers offer services for human resources and managers when the company is going through tough times such as a reduction in force. Companies have used EAP as the fastest and most effective way to outreach to local employees during disasters or traumatic local events. Without it they may otherwise not have resources or enough staff on the ground to do so.

• Centralized: Headquarters selects a program that covers all subsidiaries across the world. However, headquarters may or may not actually fund the program globally. Strengths of this model include a simple sales process, the potential for lower rates because of more covered lives, standardized reporting and a consistent worldwide program. Also, the company has the ability to manage a more robust supplier management strategy, and can draft a contract to include certain services. Quarterly reviews of utilization and service may help to keep a strong relationship with the EAP supplier and a better chance for engagement. However, subsidiaries may feel like the program has been forced on them, which may affect local-buy in.