Most, if not all of us, can attest to how mental health can impact broad aspects of our lives — how we think, feel and act. We may have seen in others or ourselves how it can manifest across a spectrum, from basic well-being and stress management, to substance misuse, to severe mental illness.
In recent years, mental health care and treatment for substance abuse have gained more acceptance as an essential part of employer health care benefits plans. This is on par with decreased stigma and less employee reluctance toward seeking care when needed. Reinforcing this acceptance is a broader nationwide acknowledgement of pressures from managing daily stressors — family, health, finances, work — amplified by a global, seemingly crisis-prone backdrop that includes a pandemic, war, drought, wildfire, mass shootings and political and economic upheaval.
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Simultaneously, advances in digital treatment options give employers and employees more options for care. One of the challenges is the sheer number of these offerings and options. You can't go online or listen to a podcast without hearing an advertisement for one or several of these digital options. Employers working to provide competitive, helpful benefit plans have the additional important task making those plans easy for their employees and dependents to sign up for and use. The options can be overwhelming: 'Where do I start? Which program is the best for me? Which is the best for my family?' For the employer, too many options can lead to poor integration, redundancies and care gaps, all of which can increase costs, reduce quality and lead to poor outcomes and employee frustration.
As we head toward the end of the year, there's a natural reflection point for employers and employees to evaluate their health care benefits and the new digital modalities available to deliver them. Employers can help make sure their plans are accessible by working to remove as many access barriers as possible including reducing stigma, building trust, and simplifying navigation.
The basics: Stigma and communication
The first thing employers can do to improve access and engagement is work to break down the stigma that can prevent employees and their families from taking full advantage of their mental health care benefits and services. While we have come a long way toward accepting the legitimacy and importance of mental health, a lingering, historic stigma remains. Even today, more than half of adults who need mental health care do not receive treatment. That amounts to 27 million adults in the U.S. who are going untreated. Stigma can play a role in discouraging employees and their families from acknowledging that they might need care and seeking it out.
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Stigma continues to undermine psychologically healthy workplace spend because confidentiality can be a big concern. Employees may be reluctant to take advantage of their mental health benefits or use sick time off for fear their colleagues and supervisor will find out. In addition to the shame that can accompany a mental illness or substance use problem, employees may also worry that seeking mental health care will have a negative impact on their job, such as being passed over for promotion, being let go entirely or having their reputation tarnished.
Employers can exercise two simple yet powerful strategies to reduce employee fear and stigma:
Clear, deliberate communication about confidentiality:
Employer communications strategies for mental health benefits and services need to explicitly state that their use is confidential. Employers should not assume that "everybody already knows that." Surprisingly, employees often fear their mental health care is subject to different confidentiality rules than other employer-sponsored health plan benefits and programs. This is how stigma continues to rear its ugly head. If there are questions or concerns about "health data" and how much information an employer will receive from insurance companies, employers should be clear with employees that data is used in aggregate form as a way to identify what services are useful and working best for employees and NOT used to identify individual employees or their family members who are suffering from mental illness or substance use.
Normalize seeking help:
Where appropriate, leaders can share personal experiences of taking care of their own mental health. A note of caution, sharing needs to be done appropriately and leaders must be careful to not overshare. When done thoughtfully, sharing is empowering and will help to chip away at stigma, making mental healthcare less shameful and on par with other health concerns.
Make it easy to use: Simplify navigation
Navigating health care benefits is complicated for most of us. When we're talking about how to figure out a set of services and benefits for mental health, it can get even more complicated, especially if employees feel like they don't want to ask questions or seek help from a benefits coach at work. As mentioned above, building trust in the workplace so that employees are willing to explore mental health care options is one important step. Equally important is making the benefit plan and services as easy to understand and access as possible.
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This is an area of focus at Blue Shield of California where we're working to find the right balance of "whole-person health" digital programs to support our members and make it easier for them to begin a mental health care journey. Employers can simplify too by making sure the services and programs they're offering are easily distinguishable and accessible. Simplifying navigation where possible helps to take the burden off the employee to figure out where to start and which program or benefit would be most helpful.
As health plans and employers continue to evaluate and improve plans to deliver mental health care and substance use treatment programs, we need to remain aware of how present stigma, trust building, and navigation are also emotional and logistical barriers to engagement. Even with advances in digital options, without focusing on what has inhibited people from seeking help, we will not be able to create meaningful change for our members, employees, and their families. Broadening our perspectives and definitions of the challenges with access — and related solutions — will be our best guide on the path forward.
