From the article: COVID-19 and employee mental health: What employers can do published by Thompson Coburn LLP

The significant impact of COVID-19 on employees includes not only the many risks to physical health, including, at the most extreme, death, but also the heavy toll on employee mental health. In October 2020, the Kaiser Family Foundation (KFF) reported that mental health illnesses could soon eclipse obesity as the most common pre-existing condition in the United States. Accordingly to data from the Centers for Disease Control and Prevention (CDC), the number of adults reporting symptoms of anxiety or depressive disorder increased from 11% during the period January to June 2019 to 41.5% during the two-week period January 20, 2021 to February 1 2021.

Implications of COVID-19 for mental health

On February 10, 2021, the KFF published an updated brief, titled "The Implications of COVID-19 for Mental Health and Substance Use" (2021 KFF Brief) The conclusions set forth in the 2021 KFF Brief include the following:

• Adults ages 18-24 are almost twice as likely as all adults to report new or increased substance use (25% vs. 13%) or recent suicidal thoughts (26% vs 11%);
  
• Women are more likely than men to report systems of anxiety and/or depressive disorder (47% vs. 38%);
  
• Adults in households with adverse economic circumstances due to the pandemic (e.g., job losses or reduced incomes) reported higher mental health symptoms than other households (53% vs. 32%);
  
• Essential workers are more likely than non-essential; workers to report symptoms of anxiety or depressive disorder (42% vs. 30%), increased or new substance use (25% vs. 11%) or recent suicidal thoughts (22% vs 8%).
  

Employer response to impact of COVID-19 on employee mental health

Employers are taking note of the rise in mental health issues among employees. Unum surveyed 409 employers from August 12 to August 20, 2020 regarding challenges relating to the COVID-19 pandemic. When asked how concerned employers were about their employees' mental health or wellness needs during the COVID-19 pandemic, 85% responded that they were somewhat or very concerned. Only 7% reported that they were not very or not at all concerned about mental health and wellness issues. Among the employers surveyed, 67% indicated that they anticipated that employee use of existing mental health or wellness benefits will increase in the coming months.

The Unum survey also asked employers an open question about specific plans or offerings that were in place to address the mental health needs of employees. Employer responses included the following:

Flexibility/Work-life balance

• Flexible work schedules
  
• Reduced work hours
  
• Flexibility to work from home
  
• On-site space for kids to learn

Counseling/Well-being services

• On-site counseling services/therapy
  
• Access to clergy
  
• Reimbursement for outside services
  
• Group classes/webinar/support groups
  
• Employee Assistance Programs

Facilities

• Meditation rooms, relaxation spaces
  
• Workout rooms
  
• Comfortable work spaces

Enhanced compensation/Benefits

• Increased paid time off
  
• Increased breaks
  
• Expanded health, life, disability and wellness benefit
  
• Telemedicine benefits
  
• Emergency financial assistance
  
• Increased pay/bonus
  
• Targeted assistance, e.g., meal delivery, improved internet access for home workers

Other initiatives

• Management communications and manager training
  
• Periodic health and wellness check-ins/employee hotline
  
• Morale boosting efforts

Willis Towers Watson (WTW) also reports that employers are focusing on mental health benefits. In May 2020, WTW reported that 92% of employees acknowledged some level of anxiety due to the pandemic with 55% reporting a moderate or high degree of anxiety. Seventy percent of employees indicate some distraction from work due to COVID-19 issues and only 32% indicate they are able to balance working from home with other obligations. In a June 2020 survey titled, Reopening the Workplace: Health, Safety and Wellbeing Employer Survey, 47% of the employers surveyed stated that increasing mental health services would be a top priority in the next six months. About two-thirds of the employers surveyed acknowledged that access to high-qualify mental health solutions in their health plans is a top priority.

WTW suggests that employers should take "bold action" with respect to mental health benefits via a four-prong approach. First, an employer must understand the emotional wellbeing needs of its employees. According to WTW, for most employers, the most prevalent conditions reported to employee assistance programs (EAPs) include stress, domestic relationships, anxiety, depression and financial issues. WTW suggests that an employer can determine the wellbeing needs of its employees by evaluating its workforce on the basis of lifestyle risk, disease prevalence and barriers to care.

Second, an employer must design its benefits plan to respond to the identified needs of its employees. WTW suggests that expanding the role of the EAP to include services relating, not only to crisis-assistance, but also work/life resources, is a first step. This can be accomplished by providing increasing hours for trainings and crisis reporting and adding or increasing virtual psychological and psychiatric therapy options. An employers should also reevaluate its coverage of out-of-network mental health providers to determine whether increased cost-sharing serves as a barrier to quality and accessible mental health services.

Third, an employer should take steps to ensure that its culture is in alignment with values such as promoting the health and safety of employees and fostering a work environment that is diverse and inclusive. WTW suggests that a visible commitment on the part of leadership  helps end the stigma sometimes associated with mental illness, making it easier for employees to seek assistance. WTW's 2020 COVID-19 Survey sets forth the following steps that employers  have taken to improve their culture relating to mental health:

• 51% provide, or plan to provide, manager training to recognize anxiety and depression and to understand available referral resources such as an EAP;
  
• 85% have increased video-conferencing for work and non-work purposes;
  
• 73% offer flexible work hours to accommodate work/home challenges;
  
• 26% plan to increase caregiving benefits, such as childcare and eldercare, to address the increased obligations of employees during the pandemic;
  
• 55% have, or plan to start, employee affinity groups to promote discussions among employees with common interests;
  
• 11% have measured employee loneliness/social connection;
  
• 67% will communicate employee  benefit plans or programs, including mental health plans or programs.

Fourth, an employer should also measure the effect of actions it has taken to promote the mental health of its employees. For example, an employer can review summary information, to the extent permitted under HIPAA, including registration rates and utilization rates, that will provide a greater understanding of the mental health needs of its employees and how employer efforts may need to adjust to meet those needs.

Available resources

There are a number of resources that employers and employees can tap for assistance with mental health issues. The American Psychiatric Association Foundation maintains a website, titled "Center for Workplace Mental Health," that includes, among other information, a mental health calculator for estimating the costs of depression and alcohol abuse based on workforce demographics, mental health podcasts for employers, a mental health organizational assessment, recommendations for improving access to mental health care, and a "Working Well Toolkit" to educate employers about mental health best practices.

The Department of Labor also maintains a website for employers that includes resources such as guidance from the Job Accommodation Network (JAN) on supporting employees with mental health impairments, a JAN toolkit that includes training videos on accommodations for mental health impairments, and an employer's guide to employee assistance programs.

The CDC has a website with general information for employers on mental health in the workplace that includes "success stories" describing actions taken by individual employers to address mental health issues. In addition, the CDC has created a webpage that is designed to help employees deal with job stress and build resilience during the pandemic. The webpage includes information on the symptoms of stress, work-related factors that contribute to stress, tips for building resilience and managing job stress and contact information for organizations that can assist with issues relating to suicide, domestic violence and substance abuse and other mental health issues.

Conclusion

The 2021 KFF Brief concludes with the following statement:

History has shown that the mental health impact of disasters outlasts the physical impact, suggesting today's elevated mental health needs will continue well beyond the coronavirus outbreak itself...As policymakers continue to discuss further actions to alleviate the burdens of the COVID-19 pandemic, it will be important to consider how the increased need for mental health and substance use services will likely persist long term, even if new cases and deaths due to the novel coronavirus subside.

Employers are, and will continue to be, on the front lines of the mental health crisis that has been exacerbated by COVID-19. It is critical that employers include in their action plans regarding COVID-19, including "return to workplace" rollouts, a major focus on employee mental health.