2016 Survey Shows Employer Progress and Challenges in Promoting Workplace Mental Well-Being

The 2016 DMEC Behavioral Health Survey, the sixth biennial survey in the series, highlighted the continuation of several important trends in employer mental well-being programs.

• Mental well-being is going mainstream as health plans (73.9%) and disability insurance providers (33.5%) are integrating mental health services, with fewer separate “carve-out” programs (13.3%).
• Stigma around mental health issues appears to be decreasing slowly. In 2016, 18% of respondents thought stigma in general had decreased since 2014, 15% thought it had increased, 58% thought it was unchanged, and 9% felt no stigma exists.
• Highest-ranked issues for mental health screenings to identify are depression, stress/anxiety, and substance abuse disorders.

Several trends were persistent from 2014 to 2016, which suggests continued challenges for progress in workplace mental well-being.

• More than half of respondents do not screen to identify psychological or psychosocial issues for employees who are off-work with claims or leaves (56.1%, up from 54.6% in 2014).
• Training and education about mental well-being has decreased substantially since 2010.
• Use of mental health professionals decreased across several categories.

The 2016 survey results suggest that workplace mental health is an important area of concern for most employers, with 86% indicating interest in the impact of behavioral risk. Fifty-six percent of respondents include a mental health management component in their absence management program, which is similar to 2014 (60%) and a significant increase from 2012 at 40%. Mid-sized (1,000 to 10,000 employees) and large (10,001+) employers are more likely to have a mental health component (63% and 59% respectively) than small employers (43%), which may be due to the fact that many smaller employers have fewer resources available to manage workplace mental health.

Survey Composition

In 2016, the survey participants were recruited from a broader population. Among the 213 respondents, 78% were taking this survey for the first time, 12% had taken it once before, and 10% had taken it twice or more. Larger employers provided nearly 52% of the participation, with lower participation from mid-sized and smaller employers compared to previous years.

Similar to 2014 and 2012, participants most commonly specialize in human resources and disability. In 2016, however, 14.5% specialize in absence, particularly if they have more than 10,000 employees (compared to 6.7% in 2014).

With the substantial increase in larger employers, and the influx of many new participants, the survey’s changed composition may have affected some trends. The survey analysis is focused on larger trends across the last several biennial surveys, some micro-trends in 2016 related to sub-categories are noted inside the larger trends.

Trends to Watch

The 2016 survey had 46 questions, with four new questions. One addressed return-to-work (RTW) processes that are in place to help employees with mental health disabilities. The leading choice, at 64.7%, was engagement in the interactive process. This surpassed referral to the employee assistance program (EAP) and other programs (at 55.1%) and development of transitional job modifications (44.9%).

For compliance with the Americans with Disabilities Act (ADA), it is a best practice to integrate the mental health disabilities RTW process with the ADA interactive process. If the ADA out-ranked EAP in this question, perhaps it is because by the time an employee is returning to work, any mental health issues already should have been addressed by appropriate mental health professionals.

Healthcare providers have a prominent and often misunderstood role in the ADA interactive process. In 2016, similar to earlier years, employers placed doctors high on the list of barriers to RTW from mental health conditions. Reasons for this include doctors not providing clear  timeframes for when the employee will regain full work capacity (61.8% in 2016), employees relying on primary care physicians for mental health treatment rather than mental healthcare professionals (58%), and doctors failing to conduct RTW planning (55.7%).

In the area of using mental healthcare professionals (MHPs), employers have lower rates than in recent years across many categories. The rate of using MHPs to review all psychiatric or psychological claims was down to 55.0% in 2016 (from 76.1% in 2014 and 64.0% in 2012). Telephonic consultation with MHPs was down to 38.3% in 2016 (from 48.6% in 2014 and 60.0% in 2012). Using MHPs to review physical claims with potential underlying psychosocial or psychiatric issues was down to 26.7% in 2016 (from 38.5% in 2014 and 42.0% in 2012).

The perception that doctors are barriers to RTW from mental health conditions, together with reduced use of MHPs, suggest that employers are dissatisfied in their relationship with providers, non-MHPs especially.

As mentioned already, fewer than half of the participating employers screen for mental health risk factors that may affect RTW from a leave or disability event. Among employers that screen, use of tools such as EAP or health risk assessments were used by 40.9% in 2016, supervisor communication with human resources at 40%, followed by 35.5% using “red flag” risk criteria. Review by an MHP was at the bottom of the list at 14.8%.

Training and education to support workplace mental health continues to be in a downward trend across several categories. Wellness promotion was at 72.5% in 2016 (down from 91.1% in 2010). Management training was at 65.5%, virtually flat from 66.5% in 2014 (the first year for this item). Communication skills were at 54.2%, down from 72.3% in 2010. Stress management/resilience training was at 50.7%, down from 76.2% in 2010, and substance abuse support was at 23.2%, down from 53.5% in 2010.

Supervisors play a leading role in identifying behavioral risk and communicating to HR, yet employers are decreasing training. This suggests that either employers are dissatisfied with training programs or are unable to successfully implement effective programs. Among the panel of workplace mental health experts who reviewed the survey results, one found this trend an area for concern. Another expert suggested that the increase of large employers in the 2016 survey may have driven the results for 2016. Large employers may face challenges in rolling out a training program across disparate operating units, while small and mid-size employers may not.

Among uses for EAP, the option to use it as a delivery channel for behavioral health treatment was ranked third in the 2016 survey at 61.8%. More survey participants liked to use EAPs for financial counseling (75.8%) and legal services (68%). While EAP can be an effective tool in early identification of mental health needs, new regulations have made it more difficult to directly link EAP to full mental health treatment.

Conclusion

In the complex environment of workplace mental health and the ADA interactive process, employers are engaged and looking for solutions. Results from the 2016 Behavioral Health Survey suggest that increasingly, employers are not satisfied with many of the traditional solutions. It appears that the field is wide open for significant changes to traditional solutions, and introduction of new solutions. DMEC members can download the survey report at http://dmec.org/2017/03/27/2016-dmec-behavioral-health-survey-white-paper/.