A deep dive on mental health at work

More than half of American workers say they feel lonely, which has major implications for business operations, according to a report from The Cigna Group.

Lonely workers were twice as likely to say they’ve come to work “feeling mentally somewhere else,” as well as more likely to miss at least one workday per month and more likely to look for new work.

As more workplaces integrate artificial intelligence tools, employees are reporting higher workplace loneliness levels and a need for human connection, according to a Moo report. Creating a better onboarding experience and assigning a mentor or peer support can help, the report found.

In Cigna’s survey of more than 7,500 U.S. adults, younger workers reported higher levels of loneliness, while Generation X and baby boomers said they experienced more severe mental health issues tied to loneliness, such as anxiety and depression.

Caregivers, in particular, reported feeling isolated. Parents of young children and those providing unpaid care to adults or disabled individuals noted that they’re rarely alone but often lonely. Caregivers under age 45 had higher levels of emotional burden and stress than older caregivers.

In contrast, workers who aren’t lonely were significantly more likely to say they’re willing to work harder to help their company succeed, the report found. 

In response, employers can create a workplace where people feel less isolated and more connected — and managers play a key role in providing support, the report found. Leaders can empower their managers to advocate for and model work-life balance. For instance, lonely workers who felt their employer supports a healthy work-life balance were 10 times more likely to report vitality at work.

In addition, managers can foster a culture of inclusion and belonging to help their team members feel less lonely. Employee resource groups, team-building activities and in-person or virtual breaks can encourage employees to strengthen connections through social interactions, the report found.

Managers can also build genuine relationships with their team members through empathetic leadership. Workers who felt lonely but understood by their manager were more than twice as likely to report high vitality, compared to those who felt misunderstood. 

In an era of loneliness, workplaces with a sense of belonging can help employees feel seen, heard and connected at work, according to a report from McLean & Co. HR pros can incorporate belonging into the employee experience by creating opportunities for connection, recognition and empowerment, the firm said.

Kaiser Foundation Health Plan Inc., part of Kaiser Permanente, agreed to reimburse eligible members more than $28 million to settle allegations by the U.S. Department of Labor that the company failed to provide “timely and appropriate access to mental health and substance use disorder services,” DOL said in a press release. 

DOL alleged that Kaiser didn’t offer adequate provider networks for mental health and substance use disorder care and used patient questionnaires to prevent members from receiving care, forcing them to find care outside of Kaiser’s network, often at higher out-of-pocket costs, per the release.

The settlement covers eligible Kaiser Permanente members in California who had to pay for out-of-network mental health or substance use disorder care between January 2021 and September 2024 and “does not involve current practices or issues,” Kaiser said in an emailed statement to HR Dive.

At issue are alleged violations of federal mental health parity laws, Kaiser said. 

The Mental Health Parity and Addiction Equity Act requires health plans to cover mental health and substance use disorders in a comparable way to medical and surgical benefits, per DOL. The act requires that financial requirements such as copays and deductibles as well as yearly visit limits, prior authorization requirements and proof of medical necessity are similar. 

Kaiser partially attributed its challenges to the spike in demand for mental healthcare in the past six years since the onset of the COVID-19 pandemic that led to a nationwide “shortage of qualified mental health professionals, clinician burnout and turnover.” 

“These challenges made it very difficult for our members to get consistent access to the care they needed when they needed it. We are committed to reimbursing those members who tried but may have been unable to get timely care from Kaiser Permanente in that time,” Kaiser said.

Kaiser said that while “there is still work to be done,” the investments it has made in the past several years “have resulted in significant improvements in access” for members. 

In addition to reimbursing affected members, Kaiser also will pay nearly $3 million to the federal government and will reform company policies to improve access to care, including reducing appointment wait times, improving care review processes and monitoring network adequacy, DOL said.

Kaiser has been subject to a series of strikes in the past several years, involving thousands of workers and allegations of insufficient staffing levels to meet patient care needs, among other concerns. 

In May 2025, after more than six months on the picket line, about 2,400 mental health workers in Southern California secured a deal with Kaiser for a new contract that addressed employees’ concerns about inadequate pay and time to prepare for patient appointments.

Another roughly 2,000 mental health workers in Northern California went on strike for 10 weeks in 2022 before reaching a deal with Kaiser to improve clinicians’ workloads and reduce patient wait times. 

A 2023 strike, meanwhile, involved more than 75,000 Kaiser workers across the country who raised concerns about wages and staffing levels that they said were insufficient to meet patients’ needs. And, in October 2025, 31,000 Kaiser workers in California and Hawaii launched a strike over pay and inadequate staffing levels. 

Most recently, a strike by more than 31,000 — and growing — Kaiser employees in California and Hawaii over alleged unsafe staffing levels just entered its third week.

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By CuraLinc Healthcare

Behavioral health utilization among commercially insured Americans has surged 44% since 2018. That growth is not entirely surprising. Over the past several years, employers invested heavily in expanding access: anti-stigma campaigns, digital platforms, virtual care options. In many ways, the increase in utilization is a sign those strategies worked.

But with access no longer the primary gap, the conversation has shifted. Over two-thirds of employers now identify cost pressures as a central factor shaping their benefits strategy. The focus is now on holding vendors accountable for matching people to the right support, at the right time, for the right amount of time.

Most employers are finding that their current program was not designed to do that, since two imperfect options have dominated the market. Option one is low cost, low impact: an EAP that keeps costs low but makes care hard to access, leaving employees who need support without a clear path to it. Option two is the opposite: a high-engagement model built for utilization, where costs climb faster than anyone anticipated, and budgets that looked manageable initially become difficult to defend.

No matter how carefully employers evaluated their options, the decision ended in a compromise. In both cases, the costs do not disappear. They just move somewhere harder to see.

When solving one problem creates another

When financial sustainability is not built into a mental health program, the consequences aren’t always obvious at first. Low upfront spend can look like financial control, but unresolved needs do not disappear. They resurface later in lost productivity, medical claims, disability leaves, or even safety incidents. On the other end, when utilization drives the model, everyday stress gets extended into ongoing therapy beyond what is clinically necessary for most people and creates budget overruns nearly every quarter.

In both cases, the employer absorbs consequences they did not fully see coming, which is a reflection of programs that were not designed with financial sustainability as a core requirement.

What better actually looks like

What increasingly separates sustainable mental health strategies from unsustainable ones is clinical and operational discipline that ensures people are connected to the right care, at the right time, for the right amount of time.

In practice, that means a few things working together:

• Immediate access to a licensed clinician who can assess the full picture of what someone actually needs and holds the members hand throughout their journey, monitoring progress and moving care up or down as their needs evolve
• Matching the person to the level of support that fits their situation rather than a default pathway, considering their clinical needs, personal preferences, cultural considerations and available benefits
• A real continuum that includes more than counseling, from a single-session intervention to coaching to structured counseling to specialized care for more serious situations
• The duration of care reflects clinical need and progress, and sessions that are oriented toward resolution from the start

When those things work together, the goal becomes clear. Employees get the support they need to get back on their feet, and they build the tools to stay there. That is the difference between a program that builds resiliency and one that builds dependency, and it is what makes a mental health strategy beneficial for the employee and the organization alike.

What the numbers show

When a solution is built this way, the results are measurable. Peer-reviewed studies on CuraLinc’s  workforce mental health solution shows that 83% of participants fully recovered from anxiety or depression risk after counseling. When problems are caught early and resolved within the program, downstream costs in medical claims drop, producing an average return on investment greater than $5:1, or more than $2.1 million in annual savings for a 20,000-employee organization.

Four questions worth asking now

The fastest way to understand where your current program stands is to pressure-test it against four questions.

Who answers the phone? When an employee reaches out, do they connect immediately with a licensed clinician who can understand their situation and build a real plan, or with an intake coordinator who fills out a form and sends a referral? Does anyone follow up to make sure they actually got help?

Where are the costs actually going? Ask whether employees are resolving their concerns through the EAP or quietly moving into ongoing treatment under the medical plan in ways that never show up in EAP reporting. Those costs accumulate in claims, leave, and disability before they become visible.

How does the mental health benefit connect to everything else? Map where your EAP, medical plan, disability, and leave programs hand off to each other and where they do not. The gaps between systems are where unresolved concerns become expensive ones.

What happens at the acute end? Most programs look fine for everyday stress. The real test is what happens when someone needs urgent psychiatric support, is struggling with substance use, or presents in crisis. Walk through those scenarios with your vendor. Find out who gets involved, how quickly, and what the handoff looks like if the need exceeds what the EAP can provide.

The bottom line

Access was the right problem to solve a decade ago. Today the bar is higher. The solutions that will hold up over time are the ones that serve the employee and organization equally well by getting people back on their feet and building resiliency, not dependency.

Employees in the U.S. said they’re struggling to rebound from stress, disruption or unexpected events, and only 35% said they consistently feel resilient, according to research from New York Life Group Benefit Solutions.

However, the survey also found that employees rated their overall well-being as 7.5 out of 10, with 60% deeming their employer’s support for well-being as “good or excellent.”

Overall, employees said financial pressures (48%) and economic uncertainty (39%) were the top challenges to their well-being and resiliency, ahead of burnout (29%).

The research highlighted a growing disconnect between well-being, meaning how employees feel each day, and resiliency, meaning the ability to bounce back and sustain performance over time.

“Resiliency is a critical aspect of workplace well-being,” Scott Berlin, head of New York Life Group Insurance, said in a statement. “Employers have an opportunity to move beyond traditional wellness programs and take a more holistic approach — one that helps employees recover from challenges, adapt to change and stay engaged over the long term.”

While 75% of employers said they have a responsibility to support employee resiliency, only 43% percent of employees actually expect their employer to do that, per the report.

Some of the biggest gaps between expectation and reality included manager empathy and post-stress check-ins, clear communication regarding available resources and flexible leave during illness or recovery. 

The report added that financial strain, which was identified as one of the biggest stressors, doesn’t exist in a bubble. Employees said it contributed to higher levels of stress and fatigue at home and also led to difficulty concentrating and lower job satisfaction.

Fifty-five percent of employees said that employer-provided resources already help with resiliency. When asked what would make the biggest difference in terms of recovery and resiliency, employees frequently cited paid time off, better work-life balance policies and flexible work arrangements. 

A 2023 study from O.C. Tanner also noted that HR leaders can be instrumental in helping workplace culture become more adaptable and innovative by centering on people, recognizing diverse perspectives and fostering cross-disciplinary collaboration.

“Building a resilient workforce doesn’t happen overnight,” Berlin said. “It starts by understanding what employees need to recover and then thoughtfully aligning benefits, programs, policies and support systems in ways that work together.”

Employers often complain that the Family and Medical Leave Act is difficult to administer, and that’s particularly the case when FMLA leave is intermittent, or occurs at irregular intervals.

Frustrations aside, however, it’s important for employers to keep a good-faith mindset that employees who request such leave do so because they need it, according to Jeff Nowak, shareholder at Littler Mendelson and author of the FMLA Insights blog.

“When we’re dealing with family medical leave, our approach should be employee-centered,” Nowak said in an interview. “When an employer approaches the need for leave with a level of sincerity rather than cynicism, the employer is more likely to be met with sincerity in return.”

Beyond that, there’s much employers should keep in mind around FMLA leave, and Nowak offered a short list of considerations.

1. Intermittent leave requests have grown, partly due to mental health issues

Courts are seeing an uptick in mental health-associated FMLA cases, Nowak said, and mental health conditions are increasingly cited as a cause of worker absences.

Mental health and leave absence firm ComPsych published data showing that 11% of all leaves logged in its platform during 2024’s first quarter were taken due to mental health reasons. That represented a 22% increase in mental health leaves compared to 2023’s first quarter.

Moreover, courts have found in a number of cases that a change in employee behavior and moments of mental health crises can be sufficient notice of the need for FMLA leave, per Nowak. But it can be difficult for employers to both recognize mental health issues and link them to the FMLA specifically.

“It’s really difficult to understand and appreciate mental health issues because they often don’t manifest in ways that are obvious to the employer,” he said. “Naturally, there is a concern whether the employee is using FMLA appropriately in times when it’s not visible or obvious to the employer when that employee needs a leave of absence.”

2. Expectations should be set upfront

There’s no magical solution that can prevent potential misuse of intermittent leave, Nowak said. However, employers can get ahead of any hiccups by setting clear expectations around things like communication of the need for leave, what leave can be used for and how the employee and employer will communicate during the leave.

Good policies on these points resonate with employees, their physicians and courts, Nowak said. Employers, he added, should take time to explain the specifics of call-in requirements, certification obligations, check-in obligations and any other logistics.

“Particularly when it comes to call-in procedures, this is key,” Nowak said. “I find that employers all too often have not established and maintained a consistent call-in procedure for employees to report their absences.”

3. Vague or insufficient leave certifications can be trouble

Employers may use medical certifications to verify the need for intermittent leave. But employers often fail to request a certification and, even when they do, the certification functions as a little more than a “rubber stamp,” Nowak said. Employers should not be afraid to follow up on vague or incomplete certifications, he added.

Physicians do at times forget to outline the medical facts in support of FMLA leave, Nowak said. In other instances, the employee’s primary care physician may reference certain specific and complex medical conditions of the employee that are being treated by a specialist who does not complete the certification form. If that’s the case, the employer might want to ask the specialist directly, Nowak said.

Similarly, if an employer suspects misuse of leave — for example, where an employee has a pattern of Friday and Monday absences — employers can send a letter to the employee and their physician outlining the suspected misuse and asking the physician to clarify whether the leave is needed.

“I’ve found that that tactic is both permissible under the law and the regulations, but is also particularly effective in reigning in employee misuse of FMLA leave,” Nowak said.

On other occasions, the frequency and duration of an employee's health condition may be either unclear or “out of whack with what we might expect of that condition,” he continued. That is another opportunity to follow up on the certification.

Employers may not always receive a perfect answer, “but part of the battle here is to ensure that the employee and physician are being honest with their assessments,” Nowak said. “It also sends the message to the employee that you’re not just going to simply roll over and accept any certification that is incomplete or insufficient.”

4. It’s not always the employee’s fault if a certification is late

U.S. Department of Labor guidance states that employers must allow employees 15 calendar days to obtain a certification. But Nowak cautioned employers on being too quick to deny leave requests in the event an employee is late in doing so.

“I think we can all relate to how difficult it is to see a doctor these days,” he said. “Be careful about denying FMLA leave or delaying it in instances where the employee appears to be making a reasonable effort to obtain that certification.”

To put a point on it, Nowak noted that case law has been “increasingly friendly” to employees in this area, and courts “often give employees every benefit of the doubt to return that certification even if it is not completed in that 15-day time period.”

5. The FMLA’s regulations expect a level of courtesy from employees

Employees must comply with an employer’s call-in procedures unless unusual circumstances prevent them from doing so, according to DOL, and they must provide notice as soon as practicable in the event they cannot.

That’s all the more reason for employers to set a tight window of time for employees to provide notice of their need for intermittent leave, Nowak said. Allowing days and weeks to pass before the employee is required to report an FMLA absence is ill-advised; “that’s a free opportunity for an employee to misuse FMLA leave,” Nowak continued.

Call-in expectations also should outline the manner in which the employee is expected to call in, the consequences of fraudulent use of leave and any prohibitions on secondary employment during leave, he said.

Finally, employers may set expectations around employees’ scheduling of medical treatments. Here, DOL similarly states that when leave is needed for a planned treatment, employees must make a “reasonable effort” to schedule that treatment so as not to unduly disrupt the employer’s operation. Employers may opt to partner with employees to come up with an arrangement that works best for both sides, Nowak said.

6. A manager’s errant comments or actions may lead to a court date

As with most areas of compliance, managerial training is imperative in managing intermittent FMLA leave, per Nowak. Case law, he said, is riddled with situations in which “an otherwise meritless FMLA case is breathed into life because of a manager’s misstep or prejudicial comment about the employee’s need for leave.”

Managers should be given direction as to what they can do with the employee’s notice once they receive it and how to respond to the request, he continued.

Work can either fuel employee well-being or become a source of strain for employees already stressed out by economic volatility and political tension, according to the results of a survey of employee mental health by Inmar Intelligence.

Of the 1,000 U.S. full- and part-time employees who responded to the survey, 34% said their job positively impacts their mental health, while 33% reported a negative impact, Inmar found.

“This near-even split reinforces the importance of thoughtful leadership and inclusive workplace design to support the full spectrum of employee needs,” the business technology firm stated in an analysis.

Job security (45%), reasonable workload (40%) and supportive management (40%) are the top factors employees cited as having a positive impact on their mental health at work, the survey found. Flexible work options (39%) and a healthy work culture (38%) followed closely behind.

Conversely, employees cited poor communication (32%), excessive or unclear workload (30%) and a toxic or stressful culture (29%) as key negative factors. They were followed by lack of recognition (25%) and unsupportive management (24%).

These findings “reinforce that mental health and job conditions are deeply intertwined,” Inmar pointed out in the post.

What drives measurable change? “Improving communication, clarity and leadership support,” the firm said.

Recent studies back this up, confirming that organizations have some control over helping employees with their mental health.

In particular, research released in May by Simon Fraser University found that people were 55% more likely to disclose mental health concerns to their employer when they perceived a supportive environment.

This is important, the study showed, because researchers also found that low disclosure rates and poor employee perceptions were linked to higher absenteeism and anxiety, as well as lower productivity and performance.

In contrast, supportive workplaces saw more engagement, higher job satisfaction and better retention, according to the report.

Another study, out of the University of Iowa, focused on severe mental health issues within the broader context of occupational health. This one found “some suggestive evidence” that paid leave would help reduce the suicide rate, especially if implemented at the employer-employee level.

A third study, by Business Group on Health, found that organizational leaders are taking well-being strategies seriously.

Despite economic uncertainty and rising healthcare costs, 93% of 131 global employers who responded to BGH’s survey said they plan to maintain or expand well-being offerings for 2025.

All respondents said their well-being strategy includes mental health, and nearly half said mental health is the most important part of that strategy.

Common well-being initiatives included employee assistance programs, stress management and mindfulness and resilience programs.

Only a little over half the workforce knows how to access their mental healthcare benefits, according to a poll of more than 2,000 U.S. adults conducted by the National Alliance on Mental Illness in cooperation with Ipsos. 

Further, more than one-quarter of workers don’t know if their employer offers mental healthcare benefits, an employee assistance program, flexible work arrangements or sick days for mental health. More than three-quarters of workers said training would help, specifically on insurance benefits, stress or burnout management, mental health crisis response and more. 

“It takes a commitment for companies to implement mental health education and establish mental health benefits,” Darcy Gruttadaro, chief innovation officer at NAMI, said. “By doing so, organizations will see the individual and organizational impact of increased productivity, connection, and satisfaction amongst employees who are connected to resources.”

HR professionals continually run into a frustrating conundrum when it comes to mental healthcare resources: While workers say they want and would benefit from such offerings, they appear to rarely use them when made available.

Many factors likely contribute to this apparent contradiction. As a 2023 survey from OneMedical showed, 45% of those who avoided using such benefits said they didn’t have time, 25% said they were embarrassed and 22% cited costs — pointing to three very different hurdles.  

HR can potentially bolster usage with the right kind of destigmatizing communication and training, workers have said. 

HR can loop in managers as well; a 2023 survey from MetLife found that one-third of workers prefer to hear from their managers on benefits, but also that many managers don’t feel confident in that role. MetLife researchers suggested empowering managers with training to build their confidence on benefits communication.

A culture that supports use of mental health resources also must start at the top — SHRM researchers released data showing that even one-quarter of HR pros were hesitant to use mental health benefits, and 35% said they didn’t believe their organization truly cared about their mental health.