While a majority of workers access their healthcare benefits, mental health resources often go untapped, research suggests. OneMedical’s 2023 State of Workplace Health report collected responses from 800 HR and benefits leaders and 800 full-time employees. 

Most respondents reported using the benefits package for “routine” care — more than preventive care, and more than care related to COVID-19, chronic conditions or mental health. For context, 61% of survey-takers accessed routine care, compared to 19% of workers who said they accessed mental health care. 

When asked why they avoided using their mental well-being benefits, 22% cited costs, 25% said they were embarrassed and 45% pointed to packed schedules.

Per the data, some workers may be falling through the cracks. Since the pandemic’s onset, mental health in the U.S. has been on a recorded decline. As HR Dive previously reported, pandemic-related stress and anxiety reigned throughout 2021. Notably, from the pandemic’s onset to February 2022, Google searches for “how to ask for a mental health day” jumped by 1,000%. 

In summer 2022, HR professionals largely told the Society for Human Resource Management they were prioritizing mental health benefits going forward.

To be fair, about 1 in 4 respondents to OneMedical’s March survey said their mental health has improved over the last year. But almost half of respondents said their mental health stayed the same throughout 2022 and 32% said their mental health worsened. 

Most HR lead respondents expressed a belief that their staff’s mental well-being had improved in 2022. “This indicates that leaders may not appreciate the extent to which their team members may be struggling with their health,” researchers noted.

During the past few years, work scenarios have changed, particularly with regard to mental health issues, employment attorneys told attendees at a recent Florida Bar conference.

With this in mind, presenters discussed some best practices HR pros should keep. The practices are familiar; the key is making sure they’re properly applied to current scenarios.

1. Know your options

Per the National Alliance on Mental Illness, 1 in 5 U.S. adults experience mental illness each year, Stephanie Marchman, a shareholder at GrayRobinson, reminded attendees at the start of her presentation. “Given the prevalence of mental health issues in the population generally, we routinely see employees in need of FMLA, accommodations, or EAP assistance related to mental illnesses,” Marchman told HR Dive in a follow-up email.

It’s important that HR — and front-line managers — know how to deal with the issue “because it affects productivity and because employers care about employee wellness,” Marchman explained. 

When an issue arises, HR should carefully consider what comes next, she emphasized to conference attendees. That is, employers must balance the rights of the individual against those of other employees. If an employer acts too quickly when the employee is not a direct threat, it may incur liability. But it also may incur liability if it doesn’t act quickly enough.

Noticeable changes in behavior, such as mood swings or outbursts of anger, can be a determining factor, Marchman said. HR may then examine the options, including having the employee undergo a fitness-for-duty exam. Under the Americans with Disabilities Act, such an exam is “only permitted where you have reasonable belief, based on objective evidence, that a particular employee will be unable to perform the essential job functions or will pose a direct threat because of a medical condition,” according to U.S. Equal Employment Opportunity Commission guidance.

Marchman offered a hypothetical scenario involving an employee who took leave following her mother’s death. After she returned to work, there were rumors she took leave for depression. A co-worker reported to HR that he heard from other people she was talking to herself and threatened to harm others. The co-worker didn’t witness this behavior but expressed concern for his safety.

In the hypothetical, HR conducted an investigation, but no one confirmed the employee made the statements, and her manager reported that she was satisfactorily performing her duties. According to the EEOC, HR may not require a fitness-for-duty exam because the co-worker’s information was based on rumor and couldn’t be confirmed, Marchman explained. However, HR can check in with the employee to see if she’s okay (but not discuss her health or possible disability) and remind her she has resources available to her, including an EAP, Marchman pointed out.

2. Don’t rush the interactive process

Jackson Lewis attorney Brian L. Hayden presented another hypothetical: What are HR’s options if an employee wants to work remotely because a co-worker is allegedly worsening their mental health?

A reasonable accommodation can be a change in environment due to a health condition, Hayden’s handouts explained. In his hypothetical, if HR determines remote work isn’t viable and there is an empty office available, HR could offer to let the employee work in that space, Hayden suggested to attendees.

Once an employee requests an accommodation, it’s all about the interactive process, Hayden noted. The process may take longer than expected, but HR shouldn’t rush through it, Hayden said.

If HR doubts the veracity of an employee’s request, HR shouldn’t disclose this to the employee, Hayden told HR Dive in an email. Instead, HR should ask the employee to obtain medical documentation supporting the need for the requested accommodation and verifying that it would allow the employee to perform their job’s essential functions.

3. Keep supervisors and managers properly trained

It’s hugely important that supervisors and managers know how to recognize ADA accommodation and Family and Medical Leave Act requests, Hayden stressed. “Managers are on the front line, where problems start and grow if issues are not spotted,” he explained in the email. Training should include how to recognize potential issues, even if the terms “ADA”, “FMLA” and “reasonable accommodation” aren’t used, Hayden wrote.

Remote work doesn’t change the analysis, he added. But it can require more effort to remain connected and in tune with employees’ situations. 

The same goes for spotting mental health issues, Marchman told HR Dive. Supervisors should schedule regular check-ins with an employee working remotely because they may not interact with the employee as much as they would if the employee was in the office, she noted.

Supervisors also should look for the same things they would if they were interacting with the employee in person, Marchman said. Besides changes in behavior and conduct, they can watch for lost productivity and work performance issues, she noted. Supervisors also should be attuned to comments attributing poor performance to depression and anxiety and comments mentioning treatment for such issues, Hayden added.

4. Be diligent about documentation

Employers need to maintain clear, updated and easily accessible policies — preferably in an employee manual, Alison F. Smith, a partner at Weiss Serota Helfman Cole and Bierman, emphasized in her presentation.

With regard to the ADA, job descriptions also have to be kept up to date so employees are on notice of the job’s essential functions and employers have documentation, if needed, to support their position that an employee was not able to perform those functions, Hayden said.

Being diligent about documentation is another must for HR, Smith told HR Dive. Misconduct needs to be documented, as well as the employer’s response, Smith said. She recommended also documenting verbal counseling because this is the first step toward progressive discipline and undercuts a claim the employee was treated unfairly or too harshly.

For supervisors who hate to document, the most persuasive thing HR can do give them specific examples why it’s important, Smith added. HR can also emphasize that as an extension of the company, they could be personally liable, served a subpoena or called to testify. “That generally gets their attention,” she said.

5. Understand the risks

It’s crucial that HR pros understand and communicate the risks at hand, according to one conference attendee. Barbara Hitzemann, HR director for Pasco County, Florida, attended law school and said that while it didn’t change the way she viewed HR, “it certainly gives me a lot of credibility when I am having an argument/discussion, particularly with lawyers on the other side,” she wrote in an email interview with HR Dive.

“I do think understanding where the true risk lies is imperative,” she emphasized. This means understanding what you can and can’t get sued for and allows HR to make better decisions for the organization, Hitzemann said. One of the biggest mistakes HR pros make is not recognizing that “it’s completely legal to treat people differently based on job performance, behavior, etc.” — and failing to create policies that allow just that, she explained.

Undgraduates preparing to end the workforce say their college experience was shaped by COVID-19 — and their mental health is a little worse for wear.

In a recent survey conducted by a higher education wellness provider, these newcomers said that while they’re hopeful for the future, the pandemic worsened their mental health. And that has negatively affected their workforce readiness, they said.

Nearly all respondents said employers should offer mental and emotional health benefits, according to the results, and more than a third said they’re prioritizing companies that do so during their job search.

The students’ request echoes what some in the workforce say, too: Employees have expressed a desire for wellness benefits in several recent surveys, with some voicing a particular interest in mental well-being. 

But even when employers offer such benefits, uptake remains low. A majority of workers surveyed by OneMedical at the end of 2022 said they use employer-provided health benefits to access routine medical care; only 19% said they had accessed mental healthcare. Workers attributed the lack of uptake to cost, embarrassment and busy schedules.

Among other efforts, improved employer communication may help workers take advantage of benefits offerings, sources say; year-round communication about access — in a variety of formats — may help employees make use of employers’ full employee value propositions.

A mental health program recently shared alarming survey results: Nearly half of respondents to a survey — all of whom were men aged 18 or older — scored above the threshold for probable major depression.

The study, conducted by HeadsUpGuys, a program from the University of British Columbia and Community Savings Credit Union, sought input from men living and working in Canada, but researchers have been following the trend elsewhere in the past decade.

Anne Case and Angus Deaton, economists at Princeton, published a paper in 2015 on a marked increase in the mortality rate of one group — middle-aged, non-Hispanic White men — largely due to “deaths of despair,” namely drug and alcohol overdoses, suicide, and chronic liver diseases and cirrhosis.  

How did the crisis get so bad?

“I think that we have been, for good reason, very focused on groups that have historically had less privilege than men,” Laura Putnam, CEO and founder of wellness consulting group Motion Infusion and author of “Workplace Wellness that Works,” told HR Dive. While the pivot to focus on historically underresourced individuals is laudable, men’s issues may be getting dismissed or swept under the rug in the process.

In addition, men are far less likely to seek help, largely due to traditional ideas of masculinity. So while men may often have the resources to access mental health support, cultural factors likely account for resistance to doing so. The phenomenon is well-known enough to have sparked a series of memes about what men will do rather than go to therapy. 

As employers have learned to embrace employees’ “whole selves” and have found ways to address mental health at work, they may need to take a different approach to reach men who are struggling, Putnam said. 

Go beyond the standard resources

Many times, Putnam pointed out, employers see their role as simply offering resources and communicating what those are: insurance-sponsored therapy, counseling through employee assistance programs and access to apps like Calm or Headspace among them. But often, especially for workers who feel a strong stigma about using such resources, this isn’t enough.

Putnam pointed to three separate suicides that occurred in under one week on a single naval ship in September 2019. “This came on the heels of the military, particularly the Navy, having invested heavily in mental health and suicide prevention,” Putnam said. But the investments were in “that old-school model” of identifying mental health as a personal issue and offering the resources workers might use to address it. Tragically, the U.S. Navy experienced a similar event this past April. 

“We need to be taking more of a look at the culture of the workplace itself,” Putnam said. While the military is certainly a unique type of workplace, Putnam has worked with several male-dominated industries, including oil and gas, in which she said the culture could be described as “macho.” 

Employees’ personal lives aren’t always responsible for their declining mental health; the workplace can lead to a serious deterioration in wellness. Putnam noted a Gallup study that attributed burnout to a number of workplace factors, including unfair treatment, unmanageable workloads, a lack of role clarity, lack of communication and support from managers and unreasonable time pressure. It’s not just about employees “not doing enough deep breathing or not practicing mindfulness,” Putnam said.

Putnam suggested employers do a cultural audit of sorts, asking the difficult questions and gathering feedback. The Gallup survey provides a good start, Putnam said: “Do we have issues like unfair treatment at work? Do we have unmanageable workloads? Is there a lack of role clarity? Is there a lack of communication and support from managers? Are there unreasonable time pressures here in our workplace?”

Top leaders need to be fully bought in on the project, as they’re the ones who can issue policies that can get at the root causes, Putnam said. For example, if pay gaps contribute to a sense of unfairness, leaders can do a pay equity audit and let employees know the issue is being addressed. 

Empower managers to prioritize employee well-being

Managers play a unique role in setting the tone for employees and either persuading them or dissuading them from caring for their mental health. “Managers need to first be awakened to the role that they play, and then [they need] to be given the resources through meaningful training,” Putnam said. The training can be largely social-emotional: How do managers start to engage in these conversations around well-being? 

“It’s not about being a therapist, but yes, it is about being an architect of a culture … which people experience when they’re at work,” Putnam said. “Every manager has the capacity to be able to carve out an oasis of well-being, a safe harbor, within their team … so that their team members are healthier, happier, more able to meaningfully address mental health when they’re at work.”

In working with one industry association, Putnam suggested leaders and managers do one simple thing — have a weekly check-in with each of their direct reports, and ask two questions: What are you working on? How can I help? Months later, Putnam heard from one of the managers at the event. “You cannot believe the difference that I have seen in terms of the level of trust that we now have,” he told her, noting that his direct reports had begun adopting the same kinds of conversations with their direct reports.

There’s definitely a trickle-down effect of cultural positivity, Putnam said, with “managers looking to senior leaders to … give them permission” to loosen the reins, have more vulnerable conversations and prioritize well-being.

‘Go stealth’ to engage men  

One strategy employers can use to combat the stigma of vulnerability is to “go stealth” in their treatment of mental health topics, Putnam suggested. “The minute you talk about wellness, or mental health, often, those people who need it most — aka men — are the first ones to run away or check out,” she said. “So you need to be clever how you frame up the message and where you deliver it.”

Employers can look for ways to integrate mental health messaging into existing initiatives, such as safety or leadership. In working with a company in the male-dominated elevator industry, Putnam helped incorporate mental health into a two-day training aimed toward managers who had the potential to move higher into leadership roles. “Every manager wanted to be there,” she said. 

During the training, Putnam framed well-being “as a tool to become a high potential manager,” she said. “And we used their language. One of their core objectives is to build a winning team. So we talked about, ‘How are you building a winning team?’ And well-being needs to be part of that. We even reframed well-being as energy.” Afterward, Putnam said, participants overwhelmingly commented on how “powerful” the workshop was.

Employers can combat the crisis in men’s mental health by being proactive and tackling the root causes. While offering EAPs and apps may work for a few individuals, Putnam said, too many are falling through the cracks.

Employers can adopt a five-point framework in order to help workers recover their mental health and well-being, according to a document published by U.S. Surgeon General Vivek Murthy.

The release of the “Surgeon General’s Framework for Mental Health & Well-Being in the Workplace” follows more than two years of discussion about the COVID-19 pandemic’s impact on mental health. That impact has been persistent, according to a recent Conference Board survey, which found that more than one-third of employees said their self-reported mental health had declined compared to six months earlier.

In the document, Murthy said that while the pandemic changed the nature of work as well as the relationship workers have with their jobs, it also presents “an opportunity to rethink how we work.” Murthy sketched out a process of five “essentials” that he said employers could follow in order to achieve that goal:

• Protection from harm.
• Connection and community.
• Work-life harmony.
• Mattering at work.
• Opportunities for growth.

“This may not be easy,” Murthy said. “But it will be worth it, because the benefits will accrue to both workers and organizations.”’

The framework builds off concepts that may be familiar to HR departments. For example, under the “Protection from Harm” subheading, Murthy said leaders should work to ensure physical as well as psychological safety at work; grant employees sufficient rest time; offer mental health support services; and implement diversity, equity, inclusion and accessibility policies and programs.

Murthy also pointed to a variety of compensation and benefits topics in the document, stating that employers should create flexible and predictable scheduling policies that do not penalize workers for taking time off to care for personal or family needs. He said employers should increase access to paid leave, pay “equitable, stable and predictable” wages and provide benefits that support mental health — such as healthcare plans, retirement plans, workers’ compensation and caregiver support.

The framework also provides guidance for employers to follow regarding normalization and supporting mental health through culture change, Myra Altman, VP of clinical strategy and research at mental health solutions firm Modern Health, said in an email to HR Dive.

“The last several years have seen a significant change in how employers and employees think about the role of work in their lives with much more acknowledgment of the role of work in supporting or hindering mental health,” Altman said. “It is terrific to see the Surgeon General come out and reinforce this important, and often overlooked, aspect of health.”

A July survey by the American Psychological Association found that 8 in 10 U.S. workers said that they would consider an employer’s approach to mental health when looking for jobs, but other indicators show many employers lag in terms of adopting mental health support. Only 23% of employees in an August Yoh survey said their employers offered no-cost on-site or remote mental health resources.

Managers affect employees’ mental health more than doctors or therapists, respondents to a poll by UKG’s Workplace Institute said — and they reportedly have the same impact as a spouse or partner. 

The survey also found that work stress doesn’t stay at work. Employees said it negatively affects their home life, well-being and relationships. Workers recognize the strain and say they’d be willing to make sacrifices, with 4 in 5 valuing good mental health over a high-paying job and two-thirds saying they’d take a pay cut for a job that better values their mental health.

Leadership isn’t immune, either; 40% of C-suite respondents said they’d likely quit within the year due to work-related stress, with younger leaders saying they were the least enthusiastic about work. 

The common saying that workers don’t leave a job, they leave a manager, may be borne out in the UKG data. Previous surveys have backed up the finding. But bad managers are more than just an annoyance, UKG data showed — they have a serious impact on workers’ wellness. 

What makes a bad manager? Previous survey respondents and experts have cited micromanagement, unfairness, poor listening, disorganization, an impersonal approach, not soliciting feedback and withholding opportunity as behaviors and traits exhibited by poor managers. 

On the flip side, effective managers check in with their direct reports’ emotional state, are nurturing and ready to help, keep track of their direct reports’ goals and offer constructive feedback, experts said.

These skills aren’t always natural to those in management positions, whose previous roles may have required different strengths. To help managers more effectively do their jobs — and turn down the dial on direct reports’ frustration — researchers have repeatedly emphasized the importance of training. Specifically, managers can excel when given the tools to coach, researchers have said.

While addressing co-worker relationships may be key to improving employees’ mental health, employers also can look at different methods to ease worker stress, including changing work arrangements to allow for more flexibility and investing in well-being benefits that encourage stress-management activities like exercise.

Conversations around mental health belie the fact that, for many U.S. workers, access to resources and support are “greatly lacking,” according to the results of a survey of 993 employed adults conducted by The Harris Poll on behalf of recruitment outsourcing company Yoh.

Only 23% of respondents said their employers offered on-site or remote mental health resources at no cost to them, and only 14% said their employers had conducted a mental health check-in with either themselves or their colleagues. Despite the pandemic’s impact on mental health, just 23% said their employers had improved strategies for addressing mental health in the past two years.

Moreover, employees are often unaware of the resources their employers offer, Yoh said. One in five respondents said they knew whether they received access to mental health resources as part of their employer-sponsored health plans. “This should be a wake-up call for companies across industries,” Emmett McGrath, Yoh’s president, said in a statement.

The survey results serve as a contrast to poll after poll after of HR professionals on mental health.

For example, in the Society for Human Resource Management’s 2022 benefits survey, 91% of respondents said they offered some form of mental health coverage, and many identified mental health as among the most important benefits to offer employees. Mental health projects strongly as a trend in 2023, too; a recent Business Group on Health survey found that 47% of large employers viewed expansion of mental health services as a top healthcare priority for next year.

Yet the availability of mental health benefits does not always equate to use. Long-running employee concerns about cost, confidentiality or unfamiliarity with how to use services have slowed adoption, according to a 2021 LifeWorks survey, and employees and supervisors may be hesitant to talk about their mental health challenges.

As with other benefits areas, mental health is also tied up in complex sociological issues. A July report from consulting firm McKinsey & Co. found that even when front-line, hourly employees of color have access to benefits that could help stabilize their mental health — leaves of absence and parental leave — 45% said they did not feel they could take advantage of such benefits without jeopardizing their careers.

Beyond benefits, mental health also may have implications for cultural strategy. HR executives previously told HR Dive that psychological safety has emerged as a priority for the profession during the pandemic, with practices such as check-ins and recognition becoming best practices. An Unum survey of workers found that employers could do more to reduce stigma around mental health year-round, in addition to providing additional resources.

Well-being is no longer a “nice to have,” according to Indeed, so employers need to get serious about tracking well-being metrics.

“Workers won’t settle for the bare minimum when it comes to well-being,” the hiring firm said in announcing the results of an employee survey. Nearly half of respondents said their expectations around work happiness increased during the past year.

That means well-being can’t be an afterthought, Indeed said; instead, employers need to consider well-being a business strategy that boosts performance, reduces burnout and increases talent acquisition and retention.

That includes defining and tracking metrics. “You can’t manage what you don’t measure,” Indeed said. The company recommended employers periodically conduct surveys on how employees feel. Being transparent about those efforts may be important, too: Employees who said their employers measure well-being were 80% more likely to say they planned to stay for another year, according to Indeed’s findings.

And to track that metric, employers will need a strong understanding of what drives well-being, the firm continued. Indeed itself, for example, said it measures employee happiness, stress, satisfaction and purpose. “We also look at key drivers such as ‘foundational needs,’ which are aspects like fair pay, flexibility and trust; ‘social needs’ like belonging, inclusion, support and appreciation, and being well-managed; and ‘growth needs’ such as learning, achievement and being energized by your work,” it said; “By examining all of these holistically, you’ll have a better idea of where your organization stands.”