July 18, 2023

Engineering Mental Health: Building a Strategy from the Ground Up

This Guide informs the development and execution of a comprehensive mental health strategy built on three pillars: 1) Organizational factors that impact employee mental health; 2) Initiatives to promote mental health; and 3) Benefits and programs to treat mental health conditions and substance use disorders.

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Assessing and addressing psychosocial risk factors are necessary but not sufficient to developing a strategy that supports all employees on their path toward positive mental health. Actively promoting mental health throughout the year, for employees at all levels, through a variety of methods is critical to creating a workplace where employees feel safe and supported no matter where they are on the mental health continuum.

Well-being and benefits leaders are in a prime position to create a workplace that doesn’t just promote mental health, but champions it, by:

• Reducing stigma associated with mental health conditions and substance use disorders;
• Equipping managers with the skills necessary to respond appropriately to employees who are showing signs that they may be struggling;
• Creating a network of employees that can both inform mental health strategies, as well as promote available resources; and
• Offering programs that help employees develop the skills necessary to withstand the ill effects of stress and promote positive emotions.

Promoting Mental Health

Develop and implement anti-stigma campaigns:

Even before the COVID-19 pandemic, there was evidence that stigma related to people with mental health conditions, particularly depression, had decreased in recent years.¹ Unfortunately, negative attitudes among the general public toward people with mental health conditions and substance use disorders remain. This stigma may vary across demographics and regions, including within and across the globe. The workplace isn’t immune to these negative attitudes and feelings. For example, one survey of employees and employers conducted in late 2020 found that 80% of employees said there was mental health stigma in their workplace, with the majority of employers reporting the same.²

The repercussions of stigma associated with mental health and substance use disorders are serious: people living with these conditions often internalize feelings of shame because of it.^3,4 In fact, 37% of employees with mental health conditions said they avoided treatment to prevent people from finding out about their condition, and this number increased to 52% among those with substance use disorders.⁵ Even for people who do seek treatment, stigma can be detrimental to recovery if people in the community do not (or are presumed to not) support the person going through treatment.

According to the World Health Organization (WHO), “the stigma surrounding mental health conditions remains a dominant barrier to disclosure at work, to the implementation of support at work for people living with mental health conditions or, indeed, to the uptake of available support for workers.”⁶ This support includes employer-sponsored benefits and programs, as well as workplace accommodations that can promote employee retention and productivity.

The business case for taking action is strong, which is why the majority of large employers have multi-pronged strategies in place, including anti-stigma communication campaigns, which were deployed by 64% of employers in all/most countries in 2023.⁷

Ideas for Action

Employers can develop and implement effective anti-stigma communication campaigns by:

• Incorporating evidence-based guiding principles to increase the potential impact ofanti-stigma campaigns. This includes developing a sympathetic narrative – personal stories can be highly engaging – discussing barriers and successful treatment and avoiding messages that include violence or imply blame. For global employers developing anti-stigma campaigns, consider tailoring personal stories to various localities since messages may be best received when there are similarities between the messenger and target audience.
• Testing messages for effectiveness with a diverse set of employees using focus groups, ERGs and employees with lived experience of mental health conditions and substance use disorders. This is particularly important for multinational employers, as different messages may resonate with different populations across the world.
• Encouraging leaders to communicate supportive messages about mental health, including sharing their own stories about how they have been impacted.
• Evaluating success using baseline and follow-up surveys that assess levels of stigma related to mental health conditions in the workplace.² One such assessment tool is the Bogardus Social Distance Scale, which is among the most commonly used public measures of stigma.⁸

For more information, see: Reducing Mental Health Stigma: Employer FAQs.

Offer mental health training to managers:

In addition to anti-stigma campaigns, training managers to recognize the signs that a colleague may be experiencing a mental health condition and/or substance use disorder and how to respond appropriately is an important tactic in reducing negative attitudes about mental health in the workplace.

According to a research analysis by the WHO, there is moderate evidence that mental health training has a strong beneficial effect on managers’ knowledge of mental health issues.⁶ Importantly, the analysis found that training may also reduce stigma in the workplace. Manager training can also play a role in transforming work culture; research indicates that it may positively impact managers’ supportive skills or behaviors, leading to increased likelihood that they encourage employees to seek help for mental health challenges.⁶ For these reasons, the WHO recommends mental health training for managers as a part of their guidelines on mental health at work.⁶ In 2023, 41% of employers offered manager training in all/most countries to help recognize mental health issues and direct employees to appropriate services.⁷

Ideas for Action

Employers interested in offering manager training should consider several things that can impact program effectiveness:

• Determining training frequency. Research suggests that the direct benefits of manager mental health training lessen after 6 months.⁶ However, training managers every 6 months can be onerous for many organizations, so talk with prospective or existing training partners about ways to increase the efficiency of follow-up sessions while maintaining the integrity of the curriculum (e.g., virtual delivery, shorter sessions). Additionally, per the recommendation below, consider evaluating training effectiveness at 6 months to assess the longevity of the training benefits.
• Deciding when and how to scale manager training across the workforce. Training can be time intensive, and there may be pent-up demand, as research shows that managers are interested in training to increase their knowledge about mental health issues.⁶
• Considering who will conduct the training is another important decision that has to be made. Training should be delivered by skilled and competent experts. Involving people with lived experience can be powerful. As multinational organizations offer training around the world, they’ll also need to ensure that programs and trainers are culturally competent given their location and audience.
• Determining the type and frequency of mental health information and resources (e.g., toolkits) to provide to managers who have been trained so that they are up to date on the benefits and programs offered.
• Evaluating training to assess its organizational impact. Assessment measures could include decreases in stigma expressed by managers, increases in knowledge and utilization of mental health benefits (by managers and their employees), and increases in employee feelings of managerial support for mental health.

For more information, see: Reducing Mental Health Stigma: Employer FAQs and Is Your Anti-Stigma Campaign Designed for Impact? Increase Efficacy Using Evidence.

Assess peer mental health training for alignment with organizational goals and effectiveness:

In pursuit of reducing stigma and creating a healthy culture from the bottom up, 24% of employers offered mental health training to employees in non-managerial roles (i.e., peer training) in all/most countries in 2023.⁹ These types of trainings help employees better understand how to support peers who may be struggling with something or those who directly reveal a mental health diagnosis. They do not train employees to treat, diagnose or pry into co-workers’ personal lives, but rather give them the tools to talk empathetically and make connections to mental health benefits where appropriate.

Evidence is more mixed on the benefits of peer mental health training than it is for manager training. According to a research review by the WHO, peer mental health training may have some impact on improving mental health knowledge and reducing stigma among those who are trained, but this knowledge does not necessarily translate into helping behaviors.⁶

Ideas for Action

Because the evidence is limited on the impact of peer training, employers considering this type of training for the first time should think about:

• Considering implementing training for managers before peers to build experience and momentum with training.
• Ensuring that their organizational objectives and expectations for offering such a program align with its potential benefits (i.e., increasing mental health literacy and reducing stigma).
• Assessing program effectiveness to determine impact. This should include asking prospective vendors for data on training outcomes before selecting a partner and creating a plan to assess impact after training has been implemented. But because an employee who has gone through this training cannot be obligated to provide support to coworkers in the same way as a manager, assessment and accountability may be less clear.
• Providing ongoing support and oversight to employees who have been trained. According to the WHO, “[those who are trained] should preferably be provided with mental health supervision or support to manage boundaries with colleagues, identify needs and channels for referral, confidentiality and the impact on their own mental health.”⁶ No employee should be put in the position where they feel they need to diagnose their co-workers because they went through a basic mental health training, nor should they feel they have the right to be intrusive because they have some training.

Utilize ERGs to gain and deliver information about mental health:

ERGs represent an excellent opportunity for HR professionals to solicit input from employees with different backgrounds and interest areas to help guide their mental health program strategy. Some employers have even created mental health- specific ERGs to connect employees who are personally impacted.

Employers can partner with ERGs to better understand mental health and substance use disorder challenges, solicit feedback on the effectiveness of existing mental health benefits, uncover gaps in offerings and test communications with different populations to maximize the positive impact of their mental health strategy. Organizations can also use ERGs to promote understanding of mental health and substance use disorder supports by sharing information or resources that are tailored to the group.

Ideas for Action

Employers interested in continuing or starting partnerships with ERGs should consider:

• Establishing a regular schedule of check-in meetings between the ERG and HR staff. This enables regular, two-way communication – allowing for questions or hearing concerns from employees in ERGs – and the coordination of company-sponsored or ERG-hosted events and speakers focused on mental health. These check-ins can also provide the opportunity to establish boundaries for ERGs and their activities, which some employers have reported as important.
• Co-hosting events throughout the year to raise awareness about timely or top-of-mind topics focused on mental health. Conversations about mental health need not be tied to a given “awareness” month, as many issues that might arise as a topic of conversation throughout the year will have an impact or be impacted by mental health concerns.
• Providing ERGs with information about mental health and substance use disorder benefits and programs that they can share with their peers. Sixty nine percent of employees say that ERGs are an effective source of information about mental health and emotional well-being programs.¹⁰

Offer and evaluate programs designed to promote positive mental health:

In 2023, employers offer a variety of programs supporting positive mental health, including those focused on mindfulness (83% of employers), stress management (73%), resiliency (70%), happiness (51%) and sleep improvement (46%).⁷ There’s a strong business case for addressing each of these areas, as positive moods increase worker productivity and creativity. In fact, high- performance teams demonstrate higher positivity ratios than low- performance teams (6:1 positive to negative emotions vs. 1:1).¹¹ Furthermore, sleep loss has a negative impact on mood, increases anxiety, reduces the desire for social interaction and reduces the ability to problem solve. Chronic stress can also impact mood, the ability to focus attention and even impair memory.^{12, 13}

Interventions designed to promote positive mental health aren’t associated with a particular mental health status, and thus can reach a larger employee audience without the stigma that benefits or programs explicitly targeting mental health may carry. Indeed, large employers have indicated that sleep programs, for example, can be an effective initial point of care for mental health and substance use disorder programs.

According to a research review by the WHO, there is some evidence to suggest that psychosocial interventions intended to build stress management skills (e.g., mindfulness programs, cognitive behavioral therapy, positive psychology programs or “happiness programs”) promote positive mental health, reduce emotional distress and improve work effectiveness.⁶ The evidence for this impact is “low certainty,” meaning the researchers are not confident of the effect; nevertheless, the WHO points out that employees value these programs, particularly when they are offered alongside other “organizational and managerial interventions.”⁶

Ideas for Action

Employers interested in designing and/or deploying programs to promote positive emotions and reduce stress should consider:

• Getting creative, including providing opportunities for employees to express gratitude and optimism, practice kindness and engage in mindfulness.
• Integrating programs to promote positive mental health with communications about other mental health conditions and substance use disorder benefits so that employees with the desire and/or need to access other or higher levels of care can do so easily.
• Educating and encouraging managers to promote these programs to employees.
• Evaluating programs for effectiveness, including assessing impact on employee mental health, as well as employee experience and satisfaction across workforce demographics and job roles. Employers should be as clear about their expectations with vendors that have positive mental health programs as they would for a vendor delivering clinical interventions.
• Communicating about programs, including tying messaging to organizational efforts.

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