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Employers recognize their workforce as a highly valuable resource. Over the past few years, employers of all sizes and representing diverse industries began to focus on more effectively addressing workplace mental health. No longer was it an afterthought, but a business imperative.

Now, with the COVID-19 pandemic, our nation is experiencing a surge in people showing signs of depression, anxiety, and other serious mental health distress. Recent data from the U.S. Census Bureau shows nearly a tripling of people experiencing signs of depression and anxiety¹.

In this unprecedented time, the pandemic is causing high levels of stress, anxiety, and uncertainty about job security, health, finances, and the future.

Essential workers have remained on the job causing fears and distress for them and their families. For those working remotely, many are learning their employers are preparing for them to return to worksites. This will come as a relief to some but cause high stress for others.

Employees' Concerns about Returning to Work

A recent PwC survey² identified these areas of employee concern about returning to work:

• Fear of getting sick from being at work (51%)
• Unwillingness to use public transportation to commute to work (24%)
• Managing responsibilities as a parent or caregiver (21%)
• Taking care of ill family members (15%)

The PwC survey also identified ways in which employees want their employers to keep them safe:

• Provide personal protective equipment (56%)
• Provide assurances that employees will be notified if a colleague gets sick (51%)
• Require customers to follow prescribed safety and personal hygiene practices (51%)
• Provide assurances on cleanliness and disinfecting practices (50%)
• Provide a clear response and shut-down protocols if someone tests positive (49%)
• Promote and enforce social distancing (45%)
• Require mandatory testing for employees returning to work after being out sick with the virus (45%)
• Provide a method for employees to give feedback on COVID-19 policies and practices (42%)

This survey and other reports make clear that employees are anxious about returning to work, which is likely to cause higher levels of stress, distraction and to impact productivity. In recognition of these challenges, some employers are offering employees the option of working remotely permanently.

Whether employees are essential, working remotely or returning to the workplace, there are critical steps that employers can take to support the mental health and well-being of employees.

Supporting the Mental Health and Well-being of Employees

Employers are uniquely positioned to support employees in managing stress, building resiliency, and connecting them with needed services and supports.

Three groups are most at risk when it comes to mental health and substance use disorders.

1. People who may develop a mental health or substance use condition for the first time.
2. Those living with conditions that are likely worsening and those who have lived well in recovery and are now at great risk of or experiencing relapse.
3. Young adults are showing the highest incidence of distress associated with depression and anxiety during this pandemic.

L.E.A.D.

Employers can make a positive difference for all employees and their organizations by focusing in four key areas represented by LEAD: Leadership, Effective Communication, Adapt to Change, Double Down on Access to Care.

Leadership

Whether employees have remained on the job, continue to work remotely or are transitioning back to work, leadership at the highest levels of organizations are well positioned to address key issues on the minds of employees. People are experiencing unprecedented fear, stress, uncertainty, grief, and loss, so increased support and finding new ways to lead are essential. Here are recommendations to consider in supporting employees:

Reassure

People need reassurance to feel calmer and more in control. Leaders can build key alliances with employees by sharing that management and employees have many of the same concerns and questions.

Even if leaders do not have all the answers, calm reassurance and normalizing how these difficult times are impacting everyone, including leaders, is helpful.

Also, for employees who have remained at work and those transitioning back to work, each of the issues identified in the PwC survey and cited above should be addressed.

Leaders should consider convening employees to reassure in multiple ways including individually – to the extent feasible, in small groups, online town hall meetings, and at organization wide forums.

Model Good Behavior & Show Empathy

Acknowledge the disruption people and communities are experiencing from the pandemic, and with community protests around the country. Emphasize this is difficult for everyone, including leaders in the organization.

Leaders set the tone and culture of organizations. They should remind people to take care of themselves and share what they are doing to stay healthy and well. This may mean leaders must get outside their comfort zone.

Employees are likely to be reassured by the willingness of leaders to show vulnerability and share how they are coping. This conveys to employees that they are not alone in what they are feeling and experiencing. Ideally, it communicates we are in this together and you are supported. Also, it demonstrates the organization's commitment to transparency and continuous communication.

Make Mental Health Visible

Multiple reports show depression, anxiety, substance misuse and other mental health conditions on the rise. Now is the time for leaders to talk openly about mental health, a topic that has often stayed in the shadows and not been confronted head on.

Speak to employees about rising rates of mental health and substance use conditions, remind them of the need to get help early for these conditions, and discuss how to connect with services and supports. When this is communicated from the highest level of organizations, it opens the door to employees feeling safe to seek care when it is needed.

Effective Communication

You can model effective communication with these tips.

Make It Routine

Leaders, HR and supervisors should check in often with employees about life and work.

Use these regular, weekly if possible, checkins to remind employees where they can find resources on key topics like self-care, stress management, building resiliency, connecting to mental health care and more. Ask what support is needed.

Listen

Be available to employees through these challenging times. Create reliable feedback loops for employees to share questions, concerns and to seek information on key issues.

This might include online and digital options, Q&A during online meetings, one-on-one virtual meetings, and via other modes of communication. If questions and issues come up that all employees should know about, create an online space for frequently asked questions (FAQs) and related information.

Create safe spaces for discussions with supervisors and peers and ask employees how they would like those spaces to be structured.

Be A Trusted Source

Conflicting information is emerging about staying safe during the pandemic and what the future holds. This fuels fears, anxiety, and stress for many.

Although no one currently has all the answers on the pandemic, employers should acknowledge the uncertainty while gathering and sharing reliable updated information from trusted sources.

Make this information easily accessible online and routinely remind employees where they can find it and when it is updated.

Being transparent and communicating timely updates builds trust with the workforce and shows the organization's commitment to a culture of caring.

Adapt to Change

Position your organization or company to deftly adapt to change with the following tips.

Realign Organizational Policies And Practices

People are distracted, stressed, and taking on additional personal responsibilities. Yes, jobs must get done, but in these uncertain times setting reasonable expectations sends a message of support for employees.

This includes, to the extent possible, addressing flexibility with deadlines, options for working remotely, flexible work schedules, and leave policies, among others.

Organizations should review their policies and practices to address those needed to keep people healthy and safe.

Be Willing to Modify Leadership Style

Depending on the size of the organization, there are likely managers and supervisors with multiple leadership styles. Now is the time to work with supervisors on the importance of empathy, support, and open communication with their teams.

Ideally this message comes from the top and reinforces the need to lead with compassion and empathy, supporting employees, while working together to achieve the goals of the organization.

Working collaboratively across the organization during these tumultuous times is likely to result in creative solutions and positive outcomes.

Create Employee Connections

For employees working remotely, transitioning back to work, and continuing essential on-site work, employers should consider forming peer groups and employee resource groups (ERGs) to connect employees around key issues.

This may include ERGs focused on mental health or ERGs focused on addressing COVID-19 and related issues. These peer support networks are important vehicles for feedback loops and to support employees through challenging times.

Double Down on Access to Care

With the surge in mental health and substance use conditions associated with the pandemic and with protests taking place in many communities, addressing employee mental health and well-being has never been more important. Before the pandemic, navigating mental health and substance use care was extremely challenging. It is likely to get even harder with more seeking care.

Employers have a key role to play in ensuring employees can access effective, timely and affordable care. This includes helping to dismantle long standing barriers to mental health and substance use care - like stigma, fear of judgment, discrimination, and concern for negative job consequences.

Here are ways employers can make a positive difference in breaking down barriers, supporting employees in accessing care and supporting employees' mental health and well- being during and beyond the COVID-19 pandemic:

Share mental health and well-being resources with employees.

This can be done through emails, on Intranets, in newsletters and through other modes of communication⁶.

• Share signs of common mental health conditions like anxiety, depression, substance misuse and more.
• Encourage employees to NOTICE changes in themselves and/or others, TALK by checking in and letting a person know that you care, and ACT by offering to connect the person with services and supports.
• You may observe changes in appearance, behavior, mood or thinking. Although everyone is likely experiencing some degree of change during this time, it is still important to check in with one another.

Focus on strengthening prevention efforts that support mental health and well-being

Consider the following:

• Offering resources on managing stress during the pandemic. The CDC released and linked to resources on this topic⁷. Employers may also consider offering digital, interactive stress management training.
• Promoting resiliency⁸.
• Creating a mental health Affinity Group or Employee Resource Group (ERGs)⁹.
• Promoting meditation, mindfulness, and coaching by offering employees apps to download or free online resources. Apps promise to address issues like anxiety, sleep, focus, well-being and more. Employers may also consider scheduling a virtual meeting with an expert offering guided meditation and mindfulness sessions so employees can learn how to use these tools on their own.

Increase employee engagement with your Employee Assistance Program (EAP) and learn what innovative approaches the EAP is using to connect with employees.

Consider these approaches:

• Promote information about the EAP and the resources provided to employees and families through multiple communication channels like emails, newsletters, and weekly check-ins. With so much information coming out, it is good to rise above the noise by pushing out information often and repeatedly on how to connect with the EAP.
• Review the mental health services offered through the EAP and consider adding additional options, like well-being coaching sessions, additional counseling sessions, online assessments, and information, 24-hour support, and on-demand crisis intervention. Consider expanding your EAP and health plan benefits to include free counseling sessions for employees.
• Ask the EAP to expand the availability of online self-care tools focused on stress management, mindfulness, meditation, and resilience training. Ask whether the EAP intends to offer subscriptions to apps designed to address mental health and well-being issues.
• Request the EAP vendor provide weekly aggregated data summarizing the number of employees accessing support, and the concerns, questions and conditions being raised. This allows you to know what employees are experiencing and to proactively support managers in working with their teams.
• Collaborate with the EAP to create solutions that work if there is a spike in requests for support or if there is not, to find new and innovative ways to reach employees with support.
• Request the EAP's plan for handling increased requests for support. Ask how the EAP is making referrals to mental health professionals and triaging needs as the demand for mental health care rises.
• Set regular meetings with the EAP to strategize on new online trainings, apps, and other tools to meet the needs of your employees.

Improve Access to Timely, Affordable and Effective Mental Health & Substance Use Care.

Employers are well positioned to work with their health plans and third-party administrators (TPAs) to improve access to care in three ways¹⁰.

Sustaining momentum and ensuring quality in the delivery of tele-mental health.

Our health care system quickly pivoted to virtual care delivery helping to ensure people have access to mental health and substance use care during the pandemic. This included the federal government making rapid regulatory changes, health plans reimbursing telephonic and video-based care, and psychiatrists and therapists setting up virtual practices. It is essential that employers work with their health plans and TPAs on the following:

• Continue offering employees a choice in the modality of care delivery. People may wish to continue receiving care virtually now and into the future,
• Reimburse treating health care providers at comparable rates whether care is delivered virtually or in an office setting,
• Ensure that care is reimbursed whether delivered by phone or video to not exclude those without video available and at a rate on par with comparable telehealth care delivered by other medical professionals, and
• Ensure the quality of the services provided and request that providers report on outcomes achieved.

Supporting expansion of the evidence-based Collaborative Care Model in primary care.

With the surge of people experiencing mental health and substance use conditions, and the national shortage of mental health providers, primary care providers will be on the front lines in delivering care. The Collaborative Care Model¹¹ (CoCM) is effective in producing positive outcomes and cost savings, based on more than 80 randomized control studies¹², and commercial insurers are covering it, yet availability is still the exception rather than the rule. Here are recommendations for employers to support the expansion of the CoCM:

• Ensure health plans and TPAs are promoting the CoCM and providing primary care providers with technical assistance to implement this effective integrated care mode¹³, and
• Request data from health plans and TPAs showing whether providers are billing the CPT codes for the CoCM and if not, asking them to be proactive in working with providers to expand the model.

Expanding screening for Mental Health and Substance Use Conditions.

Standardized tools exist to screen for common conditions and should be used to both detect conditions early and to track treatment progress to improve outcomes.

Employers should request that their health plans and TPAs request that all treating providers use existing behavioral health screening tools, like the PHQ-9 and GAD-7, to identify common mental health and substance use conditions and to track progress throughout treatment. This helps build greater accountability and improves treatment outcomes.

In closing...

We may still be in the early days of this pandemic, which means the plan for recovery will be long-term and require sustained efforts. Supporting the mental health and well being of employees during the pandemic and these tumultuous times is not just the right thing to do but is good for business.

References

1. U.S. Census data published in the Washington Post on June 14, 2020.
2. PwC Covid-19 US Employee Pulse Survey
3. Center for Workplace Mental Health: Working Remotely During COVID-19 and Beyond.
4. U.S. Census Household Pulse Survey: May 14-19, 2020
5. Multiple resources are available for creating a safety in the workplace plan, including the National Safety Council's Safe Actions for Employee Returns and the U.S. Department of Labor, Occupational Safety and Health's Guidance on Preparing Workplaces for COVID-19 (.pdf)
6. Center for Workplace Mental Health: Knowing the Warning Signs of Mental Illness, American Psychiatric Association's Warning Signs of Mental Illness, and Right Direction
7. CDC's Coping with Stress
8. Center for Workplace Mental Health: Resilience: A Strong Workforce Needs It
9. Mind Share Partners's The Case for Mental Health Employee Resource Groups
10. The Path Forward Initiative's Preparing for the Second Wave: The Path Forward for Mental Health and Substance Use in the Face of COVID-19 and The Case for Collaborative Care During COVID-19
11. Center for Workplace Mental Health: Infographic on The Collaborative Care Model
12. American Psychiatric Association's Resources for Implementing the Collaborative Care Model
13. AIMS Center's Evidence Base For the Collaborative Care Model

More References