The Business Case For

Workplace Mental Health

An overwhelming majority of employers acknowledge that workplace mental health must be a priority for the well-being of their workers and for the health of their business. According to a 2022 survey by Willis Towers Watson, 86% now list it as a top concern. Roughly half of companies report they are planning or considering a mental health action plan, which would catch them up with the one-third of companies that already have one in place.

The recent surge in employer action on workplace mental health is a recognition of the serious challenges that the COVID-19 pandemic has magnified, as well as a growing awareness within the business community that employers have a responsibility to identify and reduce causes of workplace stress and burnout. 

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Mental illness is the single greatest cause of worker disability worldwide. That’s because our mental health affects how we show up for work—and whether we show up at all:

• Employees who are depressed miss nearly 5 days of work every 3 months, and up to 25 days more per year than other workers.

• Depression also results in 11.5 days of reduced productivity every 3 months, including impaired performance for 1-2 hours of every 8-hour shift.

• 62% of missed work days are attributed to burnout, depression or anxiety.

• For every employee experiencing mental distress, employers incur $15,000 per year in lost productivity, health care costs and turnover. (You can estimate the financial impact of mental health in your workplace using the National Safety Council’s Cost Calculator.) 

• 50% of full-time U.S. workers have left a previous job due, at least in part, to mental health reasons.

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The good news is, investing in workplace mental health not only improves the lives of your employees, it also makes smart business sense. Employers see a $4 return for every dollar invested in employee mental health support and treatment. 

The incentive for investing in workplace mental health goes beyond the costs you’ll recover in productivity and retention. It’s also what workers expect. Seventy-six percent of workers believe their company should do more to support their mental health. Efforts to champion workplace mental health can improve employees’ sense of purpose, boost customer loyalty and attract values-based investors. 

Great gains don’t have to come at great cost. In fact, according to a 2021 Mind Share Partners survey, the mental health resource employees wanted most was a “more open” mental health culture at work. In a separate survey by the American Psychological Association, “regularly recognizing employees” was just as important to workers as additional mental health resources. 

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Moving to Action: The Role of the Employer

As an employer, you are responsible for identifying work-related causes of mental health stress and reducing them through institutional and cultural change. Leaders across the business community—from CEOs and C-suite executives to human resource professionals and line managers—can take meaningful actions to create more supportive environments for everyone. And, for employees who need professional care, you can provide resources and benefits to make it easier for them to access treatment. 

Taking action to address workplace mental health is a clear path to a healthier workforce and a stronger, more resilient business.

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This Playbook is designed to help you take action.

How to Use This Playbook

This Playbook provides employers with recommended actions, key policy considerations and tools you can use to:

1. Create a positive, psychologically safe workplace culture.
2. Improve access to quality mental health benefits and treatment options. 
3. Center equity in your workplace mental health strategy.

It is designed to help companies at any stage in their workplace mental health journey to evaluate their existing program, level-up their offerings, measure their progress and celebrate wins along the way. 

Need help developing your workplace mental health strategy?  Our team of experts offers free coaching and training to help employers develop or evaluate their program. Contact us at hello@healthaction.org to schedule a free consultation.

MEETING THE MOMENT

The Mental Health Impact of COVID-19

During the COVID-19 pandemic, about 40% of employers expanded their mental health offerings to address employee trauma, stress, anxiety and isolation. It’s a critical move considering that the risk for depression has more than tripled since the start of the pandemic. 

The American Psychological Association’s 2022 Stress in America survey uncovered alarming trends:

• 47% of adults have been less active than they wanted to be since the pandemic started.

• More than 1 in 5 Americans have been drinking more alcohol.

• Half of adults, particularly essential workers, have not been able to see loved ones in person since the pandemic’s start.

As a society, we are emerging from a collective trauma that has tested people’s resilience, even more so for workers from disproportionately affected communities. The impact of this experience, the loss of life, financial upheaval and sense of helplessness will stay with us well beyond the pandemic’s end. 

Of course, the pandemic has not been the only traumatic event that’s unfolded over the past two years. The murder of George Floyd in May 2020 shed light on the racism and violence that Black Americans continue to face. Violence toward Asian Americans increased by 339% in large U.S. cities in 2021. Russia’s unprovoked invasion of Ukraine has left many Americans feeling saddened, shocked and powerless. Consumer fears over inflation are at record highs. We spend our days trying to process all that is happening in the world.

Employees are bringing all of this trauma and stress to work, along with whatever personal or family struggles they may be experiencing. If workers don’t have access to tools, resources, or benefits that adequately address their mental health needs, their work performance—and the work environment—will be impacted.

GETTING STARTED

Fundamental Psychological Principles 

Our mental health is influenced by individual factors such as genetics, brain chemistry and personal history, as well as our relationships, circumstances and the places where we live and work. 

Employers are not therapists, and are not responsible for diagnosing individual conditions or providing psychological care. Rather, employers are responsible for creating psychologically safe work environments, establishing systems that reduce workplace stressors, improving access to care and fostering supportive relationships.

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As you build your company’s workplace mental health program, it’s important to understand three foundational psychological principles:

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1. The Mental Health Continuum 

Experts are working to shift the perception that mental health only needs to be addressed at times of crisis. Instead, they’re broadening the understanding that we’re all on a mental health continuum that’s constantly changing. Part of being human is to experience the ebb and flow of your mental health. Some of us are thriving, others are experiencing struggles or burnout, and still others are in distress.

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The workplace can support employees at every stage of that continuum by:

• Protecting the mental health of employees who are thriving by creating an environment that minimizes exposure to stressors.
• Making sure managers are equipped to ask the right questions and provide support for employees who are newly experiencing mental health challenges.
• Offering appropriate benefits for individuals and their family members who have greater or prolonged mental health needs, including access to high-quality benefits and reasonable accommodations.
• Connecting employees in crisis to immediate care and treatment.

2. The Role of Stigma 

Mental health conditions are common and treatable. Yet, eight in 10 workers say shame and stigma prevent them from seeking the treatment and care they need. That’s because negative stereotypes about mental illness persist both in and out of the workplace. 

Even in the most progressive workplaces, many employees keep their conditions secret. They may be afraid that being open about them will hurt their reputation, compromise work relationships or even jeopardize their job. Stigma can prevent employees from seeking help and getting better.

Employers can reduce stigma by creating a supportive workplace culture. That includes normalizing discussions about mental health struggles, making it easier for employees to ask for help and providing tools for managers to lead caring conversations.

3. The Hierarchy of Needs

 In order to thrive at work, employees must first feel secure in their basic needs. If an employer isn’t providing a livable wage, employees may struggle with food and housing instability or may be unable to afford child care or reliable transportation to get to work. These stressors are cognitively consuming and can thwart other efforts to foster worker well-being.

APA’s 2022 survey reveals that stress about money is the highest it’s been since 2015. Financial stress may cause individuals to cope through unhealthy behaviors like smoking or alcohol and drug misuse. These, in turn, translate into real costs for employers in the form of increased absenteeism and impaired performance, higher insurance expenses, requests for leave or accommodations and, ultimately, higher rates of turnover. Supporting an individual’s basic needs can stop this domino effect.

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Connecting Science to Opportunity

As we emerge from this period of collective trauma, it is especially important to take bold action on workplace mental health. Your company can support employees through each phase of the mental health continuum, combat stigma and fulfill their essential needs through: (1) a healthy workplace culture, (2) quality benefits that expand access to treatment, and (3) an equitable approach to mental health.

CREATING YOUR GAME PLAN

I: Workplace Culture

The workplace has an outsized impact on the mental health of employees. That’s because most of us spend more time working than on any other activity apart from sleeping. Plus, our jobs can affect the foundations of our mental wellness, like financial stability, feelings of self-worth and meaningful relationships.

So, to start, employers can acknowledge this impact. Your company’s management practices, the design of the work, and the physical and social environments where employees operate all shape the mental wellbeing of your workers. That’s why it’s your responsibility, first and foremost, to reduce sources of stress within your workplace.

You can identify and reduce work-related stress by creating a culture of psychological safety, where workers know they won’t be punished or humiliated for speaking up with ideas, questions, concerns, mistakes or their own mental health challenges. You might also need to redesign work schedules, redistribute workloads and address the unique needs of specific categories of workers.

Importantly, you may need to challenge your organization to do more. Workplace surveys have found a stark disconnect between the quality of support employers believe they’re providing and what workers perceive—and this is especially true for frontline workers. 

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Here are five steps you can take to create a workplace that’s psychologically safer.

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Step 1: Engage leadership.

Leaders are uniquely positioned to help employees feel more comfortable and open talking about causes of workplace stress and identifying potential solutions. They set the tone that lets employees know they’ll be safe talking about burnout, anxiety or depression without being viewed as incapable of doing their jobs.

Modeling a supportive workplace culture is key to building trust and laying the foundation for a psychologically safer environment. When CEOs, executives and managers express their own vulnerabilities, they help fight stigma. Opening up about our own mental health challenges sends a message that it’s okay to ask for help, even at work. It signals that the workplace is an environment that will be supportive and understanding.  

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• Host town halls, discussion forums and other workplace events where leaders can break down the stigma around mental health and let employees know they’ll be recognized, not penalized, for taking care of themselves.

• Encourage leaders to share their own stories in order to make it okay for others to do the same. Our Leadership Storytelling Guide will help leaders, supervisors and managers share their own experiences in a way that’s empowering and inclusive. 

• Make mental health support a routine part of executive team meetings and one-on-one check-ins with supervisors. Routinely communicate your organization’s commitment to supporting your workforce’s mental health and well-being. 

• Treat time off for mental health reasons the same way you do for other sick leave.

• Model behavior that promotes rest and self-care. Taking vacation time, maintaining a healthy work-life balance and making a point of not checking in with the office while you’re away will contribute to a culture that values restorative time off. 

• Pro Tip: At Eventbrite, all employees take off the first Friday of every month and are encouraged to spend time taking care of themselves and connecting with their families.

• Incentivize leaders and managers in your organization to make workplace mental health a priority in their teams. Set performance benchmarks that reward leaders who contribute to a healthier workplace culture.

• Recognize that fatigue and a lack of sleep due to shift work and long hours carry risks for health and productivity. Low-wage hourly workers may be juggling multiple jobs.  Consider ways to redesign work schedules, adjust recovery times, offer scheduling regularity and provide dedicated support for workers who may have unique circumstances or special needs.

• Consider hiring a Chief Wellness Officer or Mental Health Ambassador who is responsible for creating and maintaining a system-wide culture of well-being. 

Step 2: Offer manager tools and training.

Managers are “first responders” to employee mental health challenges—which makes them key to building a supportive culture. They are often in the best position to know when employees may need targeted support or when workplace changes may be required to improve mental health outcomes.

‍Many employers encourage managers to check in regularly with employees about their mental health and remind their teams about available benefits and support services. Some employers also invest in dedicated workplace mental health training for managers. Guiding managers to support their co-workers also builds cohesive and resilient teams. 

There are many workplace mental health training and certification programs available for managers, and even some that provide custom coaching for specific industries with unique mental health needs. The Job Accommodation Network (JAN) provides a list of workplace mental health training programs you might consider. As you evaluate these programs, look for trainings that will help managers: 

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• Identify common workplace stressors and mental health challenges. Managers should feel equipped to recognize early signs of workplace stress and burnout, as well as urgent warning signs of mental health distress. Training should also help managers recognize the combined, or “intersectional,” impacts of family challenges, personal identities and off-the-job stressors on work performance.

• Offer psychological first aid. Managers should be trained to help employees recognize a crisis and assist until professional help can be accessed.

• Use inclusive terminology. Four in five managers say they worry about using the wrong language when addressing issues like mental health. Over 90% of workplace leaders want access to tools on inclusive language.

• Practice supportive conversations. Training or certification programs that invite managers to practice open-ended check-in conversations can help build their confidence to respond to a range of potential scenarios. Our Conversation Guide for Managers offers tips for leading productive, supportive conversations.

• Foster a supportive team dynamic. Managers should be able to encourage team members to check in with one another, too, and create space for group discussions about mental health and support options. 

• Share workplace resources. Managers should be aware of your company’s mental health benefits and EAP resources, and know how to connect employees to care. 

• Understand, practice and encourage self-care. Self-care is a valuable, protective factor that managers should be prepared to encourage for others and themselves.

• Identify opportunities for ongoing education. Workplace mental health is an area for continual improvement, which means you should seek out training that offers ongoing education and updated resources.

• Pro Tip: Jacobs Engineering Group involves managers and peers in mental health support. All managers receive training to foster psychological safety, and over 2,000 employees (including members of the C-suite) have been trained as “mental health champions” to offer support to peers. The company also tailors support to its remote and hybrid employees by encouraging them to connect with colleagues through virtual coffee breaks or meditation sessions.

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Some industries like veterinary medicine, healthcare and manufacturing are at higher risk for suicide, substance misuse or financial instability driven by low wages. General training programs won't be adequate here, so you’ll want to explore more advanced training for managers in these and other higher-risk settings. The Suicide Prevention Resource Center offers a guide to selecting a training appropriate for your setting.

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• Pro Tip: As an employer of over 15,000 veterinary health and pet care workers, Mars, Inc. prioritizes mental health from an employee’s very first day on the job. Every new employee is assigned a “buddy” to support their journey through the first full year of employment, and a dedicated team of in-house social workers provides ongoing support by caring for the unique mental health needs of the company’s veterinary workers.

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Step 3: Utilize feedback loops.

Use anonymous employee surveys and other feedback mechanisms to better understand the unique mental health needs of your workforce, workplace stressors and challenges accessing treatment.

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• Design a strategy that feels natural to your organization. Ensure you include workers at all levels of seniority and from communities with unique needs. Commit to a timeline for following up.

• Pro Tip: Kearney, a global management consulting firm, hosted a “Global People Care Jam,” a week-long virtual session to collect feedback from employees. Thousands of workers across the organization joined the event, submitting over 300 ideas for workplace wellness. Kearney refined these into 10 actionable initiatives currently underway.

• Report back on your findings, opportunities for action and progress made. Employees need to feel they are being heard, otherwise they'll be unlikely to continue sharing their perspectives. 

• Consider pulse surveys on mental health culture like this tool developed by One Mind at Work and Quantum Workplace. 

• Set rigorous goals for employee satisfaction with your organization’s commitment to mental health. Remember, you’re measuring your performance and not trying to stifle employees’ feelings.

• Explore making mental health metrics part of managers’ performance reviews to align incentives around a supportive work environment. 

• Get managers together for a series of focus groups on the most pressing areas of concern within their units.

Step 4: Foster community & peer support.

Peer support is a great indicator of a healthy workplace culture. Team members who engage in open dialogue about mental health will reduce stigma and foster a more resilient culture.

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• Be intentional about building a sense of community. This will look different across and within organizations, depending on operational needs and current working environments. Direct organizational leaders at all levels to be responsible for reinforcing connections with and between colleagues. 

• Establish or empower employee resource groups (ERGs) or other affinity networks that build community among workers. These groups can help share information about support options and available resources. They also create space for employees to build trust with one another and more openly speak about their mental health needs.

• If your organization already has ERGs, encourage their leaders to embrace mental health as a key priority. Offer tools or training for ERG leaders to become mental health ambassadors, and encourage them to surface and share unique mental health challenges that might exist within their networks. ERGs are also a great forum for inviting a trusted community leader to speak with employees about mental health and support options.

• Pro Tip: Many employers, including Johnson & Johnson, RetailMeNot, Verizon Media Group and Zillow Group, have created ERGs dedicated to employee mental health. When employees know others who have experienced a mental health condition, have a place to go for support and are armed with knowledge, they are set up to feel psychologically safer at work.

• Some companies have established mental health ally programs, where employees volunteer for dedicated peer support training. 

• Pro Tip: At Google, more than 2,000 employees have received training to listen with compassion and offer support. These mental health allies are part of the company’s Blue Dot program, and can be identified with blue dot stickers on their laptops, name badges and email signatures.

• Smaller companies can facilitate supporting relationships through less structured approaches. Consider representative team building activities, team lunches, encouraging coffee meet ups (in person or virtual) or pairing mentorship and coaching relationships between employees. 

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Step 5: Reinforce your workplace culture with a written mental health policy.

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A written workplace mental health policy articulates your company’s commitment to preventing and addressing mental health issues among your employees. It’s an important way to communicate your values, establish company norms, break stigma and prioritize transparency in benefits, treatment, care and support options. Be sure to request employee feedback as you draft your policy, and consult legal counsel before finalizing. And, build in timelines to revisit the policy as members of your workforce and their psychological needs shift over time. 

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Use this checklist to help you draft a policy that’s right for your company.

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• Reiterate your company’s view that mental health is as important as physical health, as well as your commitment to identifying and mitigating workplace stressors.

• Offer support for employees who face mental health challenges, along with an overview of your company’s mental health benefits and resources, including health insurance coverage, EAPs and other support options.

• Articulate steps your company is taking to create a psychologically safe workplace in collaboration with managers, employees and health experts. 

• Offer steps you’re taking to prioritize equity and address the unique needs of disproportionately impacted workforce populations.

• Provide an overview of your company’s mental health leave policies, which may include paid mental health days, paid time off for therapy or mental health appointments, sick leave for mental health reasons, flexible use of vacation time, additional unpaid or administrative leave for treatment or recovery, etc.

• Communicate employee rights and reasonable accommodations under the American Disabilities Act and the Family Medical Leave Act.

• Commit to company norms that support psychological safety and mental well-being (e.g. open door policy, designated break spaces, flexible work policies, etc.)

• Prohibit discrimination of employees who experience mental health conditions, and articulate a process to safely report violations. 

• Set standards for employee education and manager training on workplace mental health.

• Set clear expectations about what employees should expect from managers or leadership if they disclose a mental health-related difficulty or a documented condition, as well as expectations following a mental health leave of absence.

• Designate people in the organization whom employees can reach out to if they don’t feel comfortable reporting a condition or mental health need to their manager (e.g. trained mental health allies, a mental health navigator, Human Resources, etc.).

• Recommended community resources and national hotlines for support.

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‍Pro Tip: Consider implementing company policies designed to promote both mental health and productivity. Nike, LinkedIn and Bumble have all experimented with company-wide week-long vacations or offering birthdays off with pay. Other companies have weekly designated “deep work” days without external meetings, or mental health day policies that match no-questions-asked sick days.

CREATING YOUR GAME PLAN

II: Benefits, Treatment & Accommodations

As you address workplace stressors and reduce fatigue and burnout through a culture of psychological safety, know that some sources of psychological stress and mental illness originate beyond the work environment—from individual genetics affecting brain health, to family circumstances, community crises or world events. Though outside of an employer's control, these can impact how, or whether, an employee shows up to work. 

The good news is, mental health treatment works. Eighty percent of employees who pursue treatment report an improvement in symptoms, workplace satisfaction and productivity. Unfortunately, many employees are unable, or afraid, to access the care they need. High out- of-pocket costs, restricted networks, lack of information and stigma can prevent employees from using the services your company already provides. 

It’s important that you learn how your company can make the most out of your healthcare benefits and employee assistance programs. If your company doesn’t offer health benefits or EAPs, there are national and community services to enhance your employees’ access to mental health care. 

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Here are five steps every employer should take:

Step 1: Comply with the Mental Health Parity Act.

Under federal law—the Mental Health Parity and Addiction Equity Act—health plans that provide mental health and substance use disorder coverage must make the financial requirements (like co-insurance) and treatment limitations (like visit limits and provider access) no more restrictive than those for medical and surgical benefits. 

Many employers don’t know about the Mental Health Parity Act or, if they’ve heard of it, assume their health plans automatically comply. It may not be safe to make this assumption. According to the Society for Human Resource Management (SHRM), employers, not health plans, are responsible for complying with the law.

That’s not the only requirement. With the enactment of the 2021 Consolidated Appropriations Act, employer-sponsored group health plans—whether fully insured or self-insured—must also conduct and document an analysis of treatment limitations. Recent guidance from the U.S. Department of Labor lays out the details of employers’ legal responsibilities.

To help plans comply, the Department of Labor has a Self-Compliance Tool to measure mental health parity. Employers can request that their insurance carriers provide analyses or, if they’re self-insured, work with their third-party administrators to conduct them. If changes are required to bring plans into compliance, they should be thoroughly documented.

To find out if your health plan is compliant, talk to your head of Human Resources or contact a plan representative. Carefully review your plan’s summary of benefits and coverage and compare the mental health and physical health benefits. 

Here are five key areas you should review for compliance:

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• Copays. Your employees should pay similar copays for mental health and substance use disorders as they do for primary care visits and other comparable medical services.
• Deductibles. Your plan should include mental health treatment and medical treatment under a single deductible. 

• Limits on visits. If your plan has no limits on outpatient physical health care, then there should be no limits on outpatient mental health or substance use care.

• Prior authorizations. Your plan’s requirements for prior authorizations should be similar or less restrictive for mental health and substance use disorders as it is for physical health services.

• Proof of medical necessity.  Your plan should have transparent and reasonable standards to guide their proof of medical necessity decisions. 

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For more information about the Mental Health Parity Act and how to confirm whether your company’s health plans comply, visit the American Psychological Association’s resources for Mental Health Parity.

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Step 2: Offer quality coverage that makes it easy for employees to access mental health care in primary care settings.                        

Comprehensive health insurance coverage offers a wide range of benefits. These benefits include visits with primary care providers and specialists, emergency room services and treatment for mental health disorders. 

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Here’s what good mental health coverage looks like:

• Low copays or deductibles
• Broad provider network
• Broad prescription medication coverage
• Low or no visit limitations
• Telepsychiatry options
• Wellness programs
• Healthy lifestyle perks and discounts
• Counseling care phone line
• 24/7 crisis support line, with immediate access to a qualified crisis counselor

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Many plans are shifting toward a Collaborative Care Model that provides holistic care by delivering both medical and mental health care in primary care settings. This works well for people with common mental health conditions like depression and anxiety, as well as substance use disorders, by offering convenience with one-stop healthcare in a familiar setting.

As healthcare purchasers, employers have tremendous leverage to improve the quality of mental health care delivered to employees and their families. Asking questions and engaging health plans on mental health treatment and outcomes will lead to greater accountability in delivering effective care. It also promises employers a higher return on their healthcare investment.

• Pro Tip: If you find your plan limits access to quality mental health services, you may want to consider out-of-the-box solutions. When Capital Group employees reported that their preferred providers didn’t accept the company’s health insurance, the company made an additional investment to cover costs itself at in-network rates. 

‍Learn more about quality coverage and the Collaborative Care Model from the Center for Workplace Mental Health.

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Step 3: Expand and promote EAP benefits.

Most employers across the country offer Employee Assistance Programs that provide free, confidential mental health services, including a limited number of sessions with a licensed counselor or therapist. But only 4% of employees use EAP services, according to Mental Health America (MHA).

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MHA cites three reasons for the lack of employee engagement:

1. Employees are unaware or unfamiliar with EAP services.
2. Employees fear their supervisor will track their EAP usage.
3. Employees fear the stigma associated with EAP usage.

Note that none of these reasons indicates a lack of effectiveness, or even a perceived lack of effectiveness with the EAPs themselves. Indeed, expanding EAP benefits may be well worth the time, money, and effort. The Department of Labor estimates that employers save between $5 and $16 for every dollar they invest in an EAP. According to SHRM, EAPs can help employers: 

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• Reduce absenteeism
• Lower healthcare costs
• Reduce workers' compensation claims
• Field fewer grievances
• Address safety and security issues
• Improve employee productivity and engagement
• Reduce costs related to employee turnover 

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Here’s how to make the most of your EAP:

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• Educate your employees. Post EAP flyers and announcements regularly. Discuss your company’s EAP offerings at department meetings and company-wide events. Tell employees how to use the service and what types of issues it addresses. Reassure them about confidentiality.

• Train leadership. Help company leaders and managers recognize when an employee may benefit from EAP services and how to access support. 

• Promote EAP family benefits. Make sure employees know that EAP services are typically available to an employee's spouse or live-in partner and children. 

• Make it easier to access EAP benefits. Work with EAP providers that offer convenient office hours and telehealth visits, as well as an 800 number with 24-hour counseling.

• Promote EAPs’ other benefits. EAPs offer services that can help address various sources of stress, including child or elder care issues, relationship problems, financial struggles, work/life balance difficulties and legal challenges.

• Offer EAP workshops. Invite EAP coaches to present departmental or company-wide workshops on relevant topics. Give associates a chance to develop relationships with EAP providers, making them more apt to seek help in a crisis. 

• Pro Tip: Capital Group worked with its EAP to host timely small group discussions on specific sources of stress, including the conflict in Ukraine, anti-LGBTQ legislation, and a session for women of color focused on anxieties about returning to the office.

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Step 4: Provide accommodations.

Under the Americans with Disabilities Act (ADA) and other nondiscrimination laws, most employers must provide reasonable accommodations to qualified employees with disabilities, including mental health conditions. Reasonable accommodations are adjustments to a work setting that make it possible for qualified employees with disabilities to perform the essential functions of their jobs. The majority of accommodations can be made for minimal, if any, cost and a small investment of time and planning. Moreover, effective accommodations can be good for business because they help employees return to work more quickly after disability or medical leave, eliminate costs due to lost productivity, and help recruit and retain qualified employees.

It's important that you and your managers know that accommodations are meant to level the playing field, not to make more work for others or to treat employees unfairly. The right messaging around accommodations can make a meaningful difference in how an organization as a whole supports workers experiencing mental health issues.

Not all employees with mental health conditions need accommodations to perform their jobs. For those who do, it is important to remember that the process of developing and implementing accommodations is individualized and should begin with input from the employee. Accommodations vary, just as people's strengths, work environments and job duties vary.

Employers covered by the Family and Medical Leave Act (FMLA) should inform individuals with mental health conditions about the availability of job-protected time off from work to seek medical treatment. Time away from work for mental health treatment is often covered under the FMLA. While time off from work can be provided as an accommodation under the ADA, the FMLA provides an employee with additional job and benefit protection and reinstatement rights. Leave that qualifies for protection under both the ADA and the FMLA can run concurrently.

The U.S. Department of Labor and the Society for Human Resource Managers (SHRM) offer the examples of accommodations that have helped employees with mental health conditions to more effectively perform their jobs. Many of these interventions will improve worker productivity, regardless of their mental health status. See Sample Accomodations for Mental Health Conditions for a summarized list of the most effective and frequently used workplace accommodations. 

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Step 5: Identify other free or low-cost services, especially if your small business doesn’t offer worker health benefits. 

If your small business can’t afford or doesn’t offer employer-sponsored health insurance or access to EAPs, guide your employees to free or low-cost services in your community. For those organizations based in rural areas or locations where access is a challenge, community resources can help to fill in care gaps.

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• The Affordable Care Act requires that plans offered through the health insurance exchanges cover services for mental health and substance-use disorders. If your small business doesn’t offer an employer-sponsored health plan, consider ways you can help your workers sign up for coverage through the exchange. Most state Medicaid programs also cover mental health services.

• Direct employees to community, state-funded, or federally funded mental health centers with free or low-cost services. FindTreatment.gov offers a confidential and anonymous source of information for persons seeking treatment facilities in the United States for substance use, addiction and/or mental health problems.

• Post crisis hotline numbers, such as the National Suicide Prevention Lifeline at:
  
  Call 1-800-273-TALK (8255) or text TALK to 741741
  ‍Spanish: 1-888-628-9454
  TTY: 1-800-799-4889

• Search for online or local support groups. Someone in recovery or a trained therapist often leads these groups. You may find an in-person group at a church or community center in your area. Mental Health America and The National Alliance on Mental Illness have published lists of online support groups.

• Negotiate a discount on behalf of your employees with a local mental health provider.  

• Consider offering employees access to a high-quality mental health app to help monitor mood symptoms and access therapy-inspired exercises and lessons. Note, however, that many apps have never been studied or evaluated in feasibility or clinical trials, and the Food & Drug Administration doesn’t regulate these services. So you may want to use this Mental Health App Advisor to review and select an app that’s right for your organization. There are also a number of free mindfulness apps now available that you can share with employees.

If you’re a small business with fewer than 50 employees, the Small Business Health Options Program (SHOP) can help you offer health insurance to your employees—affordably, flexibly, and conveniently. Enrolling in SHOP insurance is generally the only way for eligible small employers to take advantage of the Small Business Health Care Tax Credit.

CREATING YOUR GAME PLAN

III: Mental Health Equity

Certain communities within your workforce may have unique mental health challenges. These may be the product of systemic inequities in community conditions that underpin health, inequitable or harmful experiences when accessing medical care, cultural stigmas, discrimination or other factors. You can help combat these challenges and support your workforce by prioritizing equity in your approach to workplace mental health.

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Here are six steps you can take to center equity in your workplace mental health strategy:

Step 1: Pay livable wages and address other sources of financial stress.

Low wages are the top cause of work-related stress. Financial stress is compounded by the current record level of anxiety over surging prices, which disproportionately impacts low wage earners. And people of color, women, LGBTQ+ people and people with disabilities are significantly more likely to work in low-wage positions. 

According to Mercer, employees who are financially stable are more productive since they are less distracted by financial worries, have improved physical health and are more loyal to their organization.

In addition to paying all employees a living wage that accounts for inflation, identify where there are disparities in opportunity, experience and pay. Then, implement targeted policies to close these gaps. Finally, make any financial benefits you offer, such as retirement plans, financial wellness workshops and tuition support, available to all employees. 

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Here are additional steps you can take to reduce financial stress across your workforce:

• Offer all non-standard employees access to workplace health and mental wellness programs and EAPs.

• Develop vacation or sick leave pool programs to help employees during hardship.

• Prepare employees for retirement with an employer-sponsored retirement plan. According to a study by SHRM and Morgan Stanley, employees consider retirement plans to be the most important financial wellness benefit.

• Help employees build a safety net by offering life or disability insurance. 

• Partner with an expert consultant to offer classes or coaching sessions on financial wellness.

• Consider additional financial incentives such as tuition reimbursement or loan repayment plans, childcare stipends, professional development funds or reimbursement for home office equipment, phone bills and internet.

Step 2: Ensure your employees feel heard—and that you’re hearing from all communities. 

People across your workforce will only feel supported if you commit to collecting—and responding to—feedback. Offer surveys that are anonymous but capture demographic data to be sure you’re getting a representative sample of your full workforce. (In smaller companies where a person’s identity might be revealed through their demographic data, create a safe environment for one-on-one conversations.)

Additionally, make sure the teams making decisions about mental health programs reflect the demographic makeup of your workforce. 

• Pro Tip: Mars, Inc. holds routine calls, pulse surveys and listening sessions with ERGs to improve its understanding of what specific populations are facing. The company keeps its programming relevant to a global workforce by offering support in different languages and adapting programs to cultural nuances, particularly in countries where mental health is strongly stigmatized. For example, in some areas they do not ask about mental health directly, and instead ask about sleep patterns or energy.

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Step 3: Familiarize yourself with the unique challenges faced by employees from specific groups, and take appropriate action.

Black, Hispanic, Asian American, Pacific Islander, American Indian and Alaska Native communities face unique mental health stressors as a result of both current and historical discrimination. In the workplace, people of color often experience numerous forms of racial discrimination, including microaggressions and bias.

Women face higher rates of intimate partner violence, sexual harassment and trauma, both in and outside of the workplace. They also experience barriers to advancement, higher rates of poverty and a disproportionate responsibility for family caregiving. These challenges can increase women’s daily stress levels, leading to greater mental health burdens and burnout.

LGBTQ+ employees may experience social stigma and discrimination in their personal, public and professional lives. They are more likely to be victims of violence than heterosexual adults, and twice as likely to experience depression, anxiety or substance misuse. LGBTQ+ people also face greater barriers to healthcare, including harsh or offensive language and attitudes on the part of care providers and, in some cases, outright denial of care.

Adults with disabilities are five times more likely than other adults to report that they have experienced mental health challenges. People who are immunocompromised face the threat, as well as mental stress, of infection from COVID-19.

Fact sheets from the American Psychiatric Association will give you greater insight into the challenges faced by specific groups so you can tailor your approach.

Keep in mind that people have complex and overlapping identities, not all of which are outwardly visible. For instance, a person can be Black, a caregiver, LGBTQ+ and have a disability—and any or all of these traits may affect the support they need. Lead with kindness, curiosity and understanding for conditions you may have no experience with personally, and let people embrace their whole selves without having to choose which “box” they fit into.

Step 4: Embrace authenticity in the workplace.

When employees do not feel psychologically safe or accepted for their identities in the workplace, they may feel pressured to “code-switch”—or adjust their style of speech, appearance or behavior in order to conform and be accepted by the dominant work culture. Code-switching can take a toll on mental health when employees have to routinely and consciously monitor their speech and behavior. Inviting people to be their whole, authentic selves in the workplace can reduce stress, as well as promote social connection and greater engagement with the job.

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Here are more ideas to build on that approach:

• Practice authentic leadership. Employees thrive under leaders they can trust, connect with and relate to. Authentic leadership models self-awareness, empathy and ethics, accountability and relationships so that employees feel safe to do the same.  

• Communicate diversity, inclusion and belonging as a core company value in your policies, hiring process, onboarding materials, company website, social media and other company communications.

• Hire and center diverse leadership. Encourage mentoring and coaching relationships that help facilitate upward mobility across varying identities.

• Review your dress codes and correct for policies that disproportionately target specific groups. 

• Include pronouns routinely during introductions, on name tags or email signatures. 

• Consider company-wide participation in various heritage and pride celebration days.

Step 5: Take steps to prevent discrimination and bias in the workplace.

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Discrimination at work is a major source of stress. As an employer, you’re in a position to promote education and awareness across your workforce to prevent discrimination—whether it’s intentional or not—against members of your staff. Review, update and remind your employees about your company’s anti-discrimination policies. Here are some additional steps you can take:

• Use a team approach to develop a company-wide Code of Ethics that values inclusion and outlines a shared agreement for mutual respect. Share this as part of your hiring and onboarding process for employee acknowledgement.

• Educate your team to recognize, prevent and correct microaggressions and bias in the workplace. 

• Provide multiple channels for employees to safely report harassment or discrimination. Note that not all employees feel safe reporting to their manager or human resources. Consider alternative reporting options through a designated diversity officer or employee resource group, and be sure to follow up on all reports.

• If your company offers a hybrid work arrangement, take steps to mitigate proximity bias toward in-office workers, understanding that women and people of color are happier working from home because of the treatment they regularly face (as mentioned above). 

Step 6: Offer a wide range of mental health solutions. 

Given the complicated and overlapping factors that affect the mental health of people from historically excluded communities, support will not be one-size-fits all. To ensure you’re making the workplace as welcoming as possible and that the support you’re offering will be accessible by all, consider these actions:

• Make sure that mental health information is available in the languages spoken by members of your workforce and that all materials are available in a variety of accessible formats.

• Invite trusted messengers who can speak personally to the unique concerns and culturally specific experiences of your staff. 

• Partner with community organizations that offer culturally responsive mental health support. 

• Seek out and partner with gender- and sexuality-affirming care providers and resources. 

• Support parents and other caregivers through flexible work schedules, paid family leave, assistance with childcare and spaces such as lactation rooms for new parents.

• During the COVID-19 pandemic shutdown, the Montana Hospital Association turned a hospital conference room into a one-room school for 22 children of its employees, equipping students with laptops to connect with their virtual teachers and hiring an in-person teaching assistant to support online learning. 

• Invite your ERGs to take on mental health in your company. Let them identify specific challenges and potential remedies, then provide them the resources they need to lead on proposing, implementing and evaluating solutions.

Taking the Next Step

The steps outlined in this Playbook can make a profound and lasting impact on your employees’ health, productivity, and satisfaction on and off the job. In turn, thriving employees are more creative, better at problem- solving, more loyal, and more invested in company success—a win for all.

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The latest Edelman Trust Barometer underscores that employer action on health and well-being matters now more than ever before. The actions you take to prioritize employee mental wellness can reverberate beyond the work environment and affect a broader culture of care, support and trust.

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This Playbook will help your organization lay the foundation for a strong workplace mental health program. Our Workplace Mental Health Maturity Ladder offers additional steps your company can take to sustain your momentum, level-up your mental health offerings, measure your progress, and celebrate your wins along the way.

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Remember, healthy minds contribute to a healthier business. Thank you for prioritizing the mental health and wellbeing of your employees and the communities where you operate.

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Need help developing your workplace mental health strategy?  Our team of experts offers free coaching and training to help your company climb the workplace mental health maturity ladder. Contact us at hello@healthaction.org to schedule a consultation.

ADDITIONAL TOOLS AND RESOURCES

‍Our Employer Tools and Resources

The Health Action Alliance—in collaboration with Ad Council, One Mind and Mental Health Action Day—has created a digital resource hub with free tools to help your organization effectively lead conversations about mental health and build a culture of psychological safety. 

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For Executives and HR Professionals

• Workplace Mental Health Maturity Ladder
• Key Questions for Benefits Providers
• Sample Workplace Accommodations

For Managers

• Conversation Guide for Managers

For Communications Professionals

1. Tips for Leadership Storytelling
2. Sample CEO Letter
3. 988 Communication Tips & Tools

We also offer free training, events and coaching to help you build your workplace mental health strategy. SIGN UP to receive our latest resources and event invitations, or reach out directly to schedule a consultation at hello@healthaction.org 

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Supporting Employees in Crisis

The 988 Lifeline offers 24-hour, toll-free, confidential support for people in distress. 

Call 1-800-273-TALK (8255) or text TALK to 741741

Spanish: 1-888-628-9454 

TTY: 1-800-799-4889

suicidepreventionlifeline.org

The SAMHSA National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

Call 1-800-662-HELP (4357)

TTY: 1-800-487-4889

Online Treatment Locator

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Crisis Hotlines for Specific Communities

• National Domestic Violence Hotline: Call 1-800-799-SAFE (7233) or text START to 88788
• National Sexual Assault Hotline – Call 1-800-656-HOPE (4673)
• The Steve Fund (Supporting Young People of Color): Text STEVE to 741714
• The Trevor Project (LGBTQ+ Crisis Hotline): Call 1-866-488-7386 or text START to 678678
• Veteran Crisis Line: 1-800-273-8255 | Press 1

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Additional Workplace Mental Health Resources

• American Psychological Association: Psychology in the Workplace
• American Psychiatric Association Foundation: Center for Workplace Mental Health
• CDC | NIOSH: Total Worker Health®
• Employer Assistance and Resource Network on Disability Inclusion: Checklist for Mentally Healthy Workplaces
• Mental Health America: 2022 Mind the Workplace 
• Mental Health Coalition: Mental Health Roadmap
• National Association on Mental Illness
• National Council for Mental Wellbeing: Mental Health First Aid at Work
• National Safety Council: Mental Health Toolkit
• One Mind At Work
• SHRM Foundation: Workplace Mental Health and Wellness

Special Topics in Workplace Mental Health

Americans with Disabilities Act

• The Job Accommodation Network (JAN) is a free consulting service from the U.S. Department of Labor's Office of Disability Employment Policy that provides individualized accommodation solutions and information on the ADA and services related to employment for people with disabilities. JAN can be accessed at 1-800-526-7234 (V/TTY).  
• The Center for Psychiatric Rehabilitation's Reasonable Accommodations page includes specific tips for employers on developing and implementing accommodations.
• Ten regional ADA National Network Centers, sponsored by the U.S. Department of Education's National Institute on Disability, Independent Living and Rehabilitation Research, provide ADA information, training and technical assistance across the nation. They can be contacted at 1-800-949-4232 (V/TTY).
• The Equal Employment Opportunity Commission's Enforcement Guidance on the ADA and Psychiatric Disabilities answers some of the most common questions about the ADA and persons with psychiatric disabilities.

‍Climate Change & Mental Health

• Climate Mental Health Network
• Mental Health Coalition: Roadmap to Climate Change Mental Health

Disordered Eating

• National Alliance for Eating Disorders

Domestic Violence

• National Domestic Hotline
• National Resource Center on Domestic Violence
• Stalking Prevention, Awareness & Resource Center (SPARC) 
• Stalking and Harassment Assessment and Risk Profile (SHARP): A 48-item questionnaire that produces a personalized risk assessment and tailored safety plan.

Harassment & Discrimination

• Anti-Defamation League
• American Psychological Association: Racism, Bias and Discrimination Resources
• National Sexual Violence Resource Center
• New America: #NowWhat: The Sexual Harassment Solutions Toolkit
• Race Forward
• Right to Be (formerly Hollaback!): Training and campaign resources to speak out against discrimination and harassment.
• The Safe Zone Project

Substance Abuse

National Safety Council:

• Drugs at Work
• Impairment ‍
• Substance Abuse and Mental Health Services Administration (SAMHSA)

Suicide

• American Foundation for Suicide Prevention

Workplace Violence

• National Safety Council: Workplace Violence

Campaigns for Specific Audiences

• Don’t Wait. Reach Out.: A collaboration of the U.S. Department of Veteran Affairs and the Ad Council for veterans to proactively seek support and resources.
• How Right Now: A communications campaign supported by the CDC and CDC Foundation to strengthen emotional well-being and resiliency in populations adversely affected by COVID-19 related stress, grief, and loss.
• ICU Program: An awareness campaign developed by DuPont’s Employee Assistance Program designed to reduce stigma associated with mental health and foster an emotionally supportive workplace culture.
• Mental Health Action Day: Powered by MTV Entertainment Group, Mental Health Action Day is an annual tentpole moment in May to mobilize mental health awareness into action.
• Mental Health America: Provides a series of free toolkits for annual awareness campaigns such as Mental Health Month in May, National Prevention Week in September, and Mental Illness Awareness Week, World Mental Health Day and National Depression Screening Day in October.
• Seize the Awkward: An initiative of the Ad Council, American Foundation for Suicide Prevention, and the Jed Foundation to help teens and young adults initiate conversations about mental health.
• Sound it Out: A collaboration between the Ad Council and Pivotal Ventures that uses the power of music to help caregivers start conversations with their kids about emotional well-being.
• Start by Believing Campaign: A global campaign by End Violence Against Women International (EVAWI) transforming the way we respond to sexual assault.