One silver lining of the pandemic has been the growing acceptance of mental health care by the public. Thanks to COVID, this national health crisis was forced into the spotlight as heightened anxiety, social isolation, provider shortages, and other pressures overburdened a system that was already struggling. Fortunately, these concerns resulted in action.
On the public side, the federal government introduced a sweeping plan for behavioral health care to the tune of $51.7B over 10 years. In addition, states like Massachusetts are now funding programs to divert emergency room visitors with mental health issues to community mental health centers.
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On the private side, the focus on workplace mental health has been dramatically sharpened. Employee Assistance Programs (EAPs) are being bolstered significantly while new telehealth players are rushing in to exploit the growing market demand. (Mostly venture-backed, these splashy new mental health players raised over $6B in VC funds during the pandemic alone.) While EAPs and health plans have long been central to workplace mental health, these digital disruptors are adding a third access point.
Recognizing the skyrocketing need for mental health services, the VC-funded digital platforms were able to do something public mental health companies never had the money to do: they turned millions of investment dollars into compelling advertising campaigns, hired influencers, and worked to normalize mental health — all while simplifying access to providers.
Consequently, the narrative around mental health and care disparities began to change. Ads showed everyday people saying, "I just wanted someone to talk to" and stigma-free mental health became a workplace goal. By mid-2022, it appeared that mental health care would finally be on par with medical care instead of relegated to second-tier status. Today, however, the bloom is starting to fade from the digital rose and the news is somewhat concerning.
Therapy influenced by investor goals
Abundant and increasingly indistinguishable, some VC-backed digital therapy firms are struggling to turn a profit and cutting corners by laying off staff. Additionally, some of their therapists are expressing concerns about oppressive caseloads and unprofessional practices, while a number of patients complain of service problems.
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As an example, in early February, Mindstrong, called "one of the shinier entrants to the mental health space" by Stat News announced that it was suspending services after discovering that they could not find "a way to make money" on digital mental health services.
On top of that, horror stories have recently hit the media that include tales of inappropriate prescribing of psychotropic medicine, lack of safety procedures (such as failing to explain risks and side effects), off-label drug prescriptions without proper patient screening, and concerns about privacy and data integrity. There are also complaints that VC-funded platforms lack the ability to match employees to health plan providers once initial telehealth sessions end.
Moreover, questions are emerging around the viability and sustainability of the disruptors' business models. According to Tom Shjerven, Associate Director of the National Behavioral Consortium (NBC), a think tank trade association for top-tier EAPs and managed behavioral health care companies, "When investors are in the game, compromises need to be made. You can't borrow $6 billion and not find someone on your doorstep looking for good margins. That means some closely held values of clinicians and companies may need to be compromised. What's more, as these digital solutions pass their prime earning and investing capability, a new round of merger and acquisition activity is beginning, and expenses are being streamlined."
Uniting technology and the human touch
As large companies across the U.S. begin to embrace digital entrants, HR consulting firms and employee benefits companies are helping tighten the grip. Each year, these organizations depend on presenting innovative behavioral health solutions to help solidify their renewal. Amidst the pandemic's period of unprecedented need, digital platforms provided a viable new offering.
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By contrast, the Employee Assistance industry is long-standing, built upon the provision of immediate counseling and work-life support for employees and family members, and prevailing through decades of turmoil. With 93% of today's large companies offering EAPs and 60% of the U.S. population employed, many people now look to their employers to guide them to mental health care. This is particularly true in our post-pandemic world, when employees are more vocal about their mental health care expectations and more likely to speak up if services are sub-par.
As a result, top-tier EAPs are thriving, with many growing rapidly. Another growth factor is the introduction of innovative EAP platforms that offer state-of-the-art features such as self-scheduling, self-directed support, and benefits integration. Equally key, EAPs are helping address today's provider shortage by enhancing their clinical networks with coaches, chaplains, peer support, and other specialists. This has led to a richer, fuller set of mental health services that combine the best of digital technology with the warmth of human intervention.
The sensitivities and nuances of matchmaking
One undisputed advantage of VC-backed mental health platforms is ease of access. Employees who were previously unsure about how or where to find support can now effortlessly turn to an app for their answer. In many cases, proprietary algorithms are used to link individuals to coaches or counselors, streamlining the matching process.
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Of course, like other technologies, algorithm therapy can have its flaws. This is particularly true for first-time seekers of counseling or behavioral health assistance, as well as those facing complex issues, which often require multiple referrals.
"When someone decides to get help for the first time, it represents a major milestone, a pivotal decision to open themselves up to psychological inquiry," explains Anthony Brown, CEO of Canopy, a West Coast well-being company and top-tier EAP. "First-time callers need to be welcomed in a very personal way. Disruptors are expecting too much of an online platform when they require it to fully screen someone or distinguish between those needing a therapist and those who can benefit from self-help."
The personal touch that EAPs provide involves a holistic view of each employee and spans from the initial call to follow-up. It is one of the many reasons why employers continue to view EAPs as critical mental health partners, even in the current crowded digital days.
Serving the employee and the organization
Having delivered employee services for over 50 years, EAPs are quite familiar with the onset and sunset of workplace mental health trends. Every few years, a new service enters the behavioral health market, promising to replace "traditional" employee assistance. In the late 1980s, free EAPs bundled with insurance plans were the rage, eventually undone by quality issues. The nineties ushered in managed care and work-life programs, followed by the turn-of-the-century introduction of wellness programs, coaching, disease management, and nurse lines. With each change, EAPs soldiered on, continually disrupting their own approaches to anticipate the evolving needs of employers.
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"Many of the services we provide focus on family, home, and work, and they are key to mental health," says Seth Moeller, President of KGA, a Massachusetts-based EAP. "Someone requesting an elder care referral may need emotional support because they're dealing with a failing parent. Or someone seeking financial advice may also be coping with anxiety. It's so important to integrate the delivery of these services and to ensure employees understand the broad relevance of these services to their lives."
These are just some of the reasons EAPs are flourishing in a market where some may feel it's trendier to switch to a digital telehealth platform. EAPs are experienced and focused on serving others, not on scaling their operations to satisfy investors. They run solid businesses with experience, reliability, stability, and a proven business model. At the same time, they incorporate innovative new technologies where needed, expanding digital access without sacrificing the personal touch.
Protecting against error
No matter how workplace mental health may change, one truth remains: there is no room for error. EAPs conduct a thorough assessment, demonstrate that someone cares, and bring licensed clinicians immediately to the table. Most important of all, decades of experience enable them to do the right thing at the right time for each employee.
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The hospital community learned years ago that there was no margin for mistakes when treating a patient or performing surgery. Safeguards were put in place to protect innocent patients who were vulnerable to medical errors. Mental health needs the same safeguards. Those safeguards require a seamless combination of digital technology, human engagement, counselor matching grounded in nuance, manager training, integrated benefits, and experience. Only EAPs provide it.
