November 06, 2020
Stigma has long been a barrier to access to mental health treatment. These FAQs explain the role employers can play in eliminating it, opening doors to employees in need of mental health services.
Mental Health Employer FAQs
Mental health stigma is the negative attitude among the general public toward people with mental illness or substance use disorder (SUD). Mental health stigma contributes to the silence, shame and suffering that a person with a mental health condition may feel. Stigma is one of the reasons why people with mental health conditions do not seek and/or sustain participation in treatment.
Public stigma is the “perception held by others that the mentally ill individual is socially undesirable.”
Self-stigma develops when people “internalize perceived prejudices and develop negative feelings about themselves.”
Eliminating mental health stigma is important to employers because of the underutilization of mental health and SUD services and programs. Research shows that stigma can prevent people with mental health conditions from obtaining treatment and therefore may be detrimental to recovery. Reducing negative attitudes among employees about mental health and creating a culture where it feels safe for employees to discuss their condition and seek care has the potential to increase positive health outcomes and work/life satisfaction.
As described above, stigma is one reason why people do not seek care for mental health conditions or engage in employer-sponsored mental health programs and benefits. Other barriers to care include access challenges such as cost, limited providers or networks, availability of quality care, and difficulty getting time off work.
Fifty percent of the large employers surveyed by Business Group on Health reported that they will have an anti-stigma campaign in place in 2021, up from 18% in 2019. There is a clear employer desire to ensure that employees are comfortable expressing their mental health needs and seeking appropriate treatment.
Employers are seeking to reduce mental health stigma using several tactics, including:
- Communication campaigns, including those that leverage health observances such as World Mental Health Day;
- Storytelling through leader and employee testimonials;
- Executive leadership buy-in and endorsement of anti-stigma initiatives;
- Manager and peer training;
- Mental health resource toolkits for managers or site leaders;
- Anti-stigma pledges, including those that leverage national campaigns;
- Mental health champions/allies;
- Mental health awareness events;
- Partnerships with local advocacy groups to host events and trainings;
- Partnerships with the employee assistance program (EAP), health plans, engagement and concierge platforms and other health and well-being vendors to cross-promote resources; and
- Promotion of mental health benefits and resources.
Some employers focus on training managers or site leaders, likely because research indicates that supervisors are more comfortable having conversations about mental health after undergoing training. Manager support for mental health is also associated with higher worker productivity and engagement. Some employers make manager training mandatory, while others make it voluntary and promote it heavily.
Other employers permit any employee who express an interest in training to participate. And still others target both populations – managers and other employees – with distinct training programs or modules for each group.
A 2016 systematic review examining the effectiveness of workplace anti-stigma campaigns, including mental health trainings, found that “interventions may be effective in changing employees’ knowledge, attitudes, and behavior towards people with mental-health problems.” However, the review also noted that the evidence for their effectiveness “is inconclusive and must be interpreted with caution” due to a number of reasons, including shortcomings in some of the study designs, lack of follow-ups and the heterogenous nature of the studies.
A separate study of stigma and discrimination reduction trainings found that training “resulted in positive shifts in several stigma-related outcomes. Specifically, participants were more willing to engage in social relationships with people with mental illness and they reported more support for people with mental illness.” However, the study did not show changes in stigma awareness or “intentions to reduce discrimination” after the trainings. (Authors noted that this could have been because the baseline levels of awareness and intentions were high.) Importantly, the study authors also cautioned that the trainings seemed to result in the unintended consequence of fostering “the perception that those with mental health problems will never be able to contribute to society,” an outcome that should be tested in future studies.
Anecdotal feedback from employers about mental health training programs is also mixed. A number of employers have reported positive experiences with training programs, while others have expressed concerns that they may cause “more harm than good” due to trained employees overstepping their role and acting as a counselor.
Employers have reported the following considerations associated with choosing and implementing a mental health training program:
- The ability to scale the training to the desired number of employees, as some trainings may only be offered in-person (methods of training vary by program), may be time- or resource- intensive, or may limit the number of participants per class.
- The ability to adapt trainings to a global audience, ensuring that regional and local nuances are taken into account, as well as language capabilities.
- The concern that trained employees may exceed their role and act as a counselor, creating liability issues.
- The need for or ability to provide oversight of trained employees to promote adherence to the intent of the training program.
- The ease of working with other business units to gain buy-in for the training program, as well as communicate about it.
- The ability for employees to easily access mental health benefits, services and treatment once they have been encouraged to utilize resources.
Examples of names and slogans from Business Group member companies include:
- “I’ll Listen”
- “Program #cooltocall”
- “Take Action – Make Traction”
- “Mental Health: Let’s Talk About It”
- “This is Me” – based on a U.K. national campaign
There are research-based guiding principles for message development that employers can use to reduce public stigma within their workforce. These guiding principles include:
- Developing a sympathetic narrative;
- Discussing barriers to care and successful treatment;
- Avoiding messages that include violence or imply blame; and
- Featuring diverse speakers whom employees respect or look up to.
Using research in message design is important because even the most well-intentioned but untested communication campaigns can be ineffective or even backfire. For more information on designing effective anti-stigma messaging, see: Is Your Anti-Stigma Campaign Designed for Impact? Increase Efficacy Using Evidence and Tackling Mental Health Stigma: Guiding Principles for Impactful Strategies.
Mental health stigma is a barrier everywhere. However, how stigma manifests itself is influenced significantly by a country’s culture and local environment, including the policy and legal framework. For example, in some countries, mental health issues are criminalized, and seeking care for suicide attempts can risk imprisonment. In other cultures, an individual can risk being ostracized or labeled as “possessed”. As a result, multinational employers have developed locally relevant anti-stigma campaigns, designed to resonate with the in-country needs of employees and their families. Confidentiality is often a concern as well for those facing severe stigma. Employers can help by reinforcing confidentiality measures for those who seek help and engage in programs. For examples of tools and ideas that global employers are implementing in geographies around the world to address stigma, see Addressing Mental Health From a Global and Local Perspective.
Employers are assessing the impact of anti-stigma campaigns through:
- Participation in trainings, webinars, events, etc.;
- Pulse surveys;
- Employee engagement metrics;
- Employee sentiment and morale, including sense of community; and
- Program or benefit utilization.
Employers can also evaluate the overall success of their anti-stigma campaigns by assessing baseline prevalence of public stigma in their employee populations and conducting a follow-up assessment using the Bogardus Social Distance Scale, one of the most commonly used measures of public stigma.