How EAPs are a highly effective complement to the NHS

Mental illness caused or exacerbated by the pandemic crisis is predicted to be as big a threat to NHS resources as the virus itself. Up to 20% of adults in the UK are expected to need mental health support in the coming year, says the Centre for Mental Health: 8.5 million people dealing with depression, anxiety and PTSD.

It’s a stark picture showing how employers providing EAP services are an essential wellbeing resource and outlet for demand. EAPs are helping to ease the burden on NHS services, and crucially, offering easier access for employees to mental health support, when and how it’s needed, and at an earlier stage.

A new analysis comparing the use and waiting times for NHS services with EAPs is a clear demonstration of how that’s been working in practice. This looks at data from the NHS Improving Access to Psychological Therapies programme (IAPT) for people dealing with depression and anxiety. When IAPT was first introduced in 2008 it was a major step forward in terms of recognising the importance of mental wellbeing, putting in place a sensible ‘stepped’ approach where patients with mild to moderate symptoms could move from a low intensity intervention (such as guided self-help) to higher intensity therapies (CBT) if necessary.

But the past ten years has seen growing demand for services – alongside higher expectations. The analysis of data from 2018/19 shows that the average waiting time from referral to treatment was 20 days. Waiting times varied substantially across England, from 4 days in Basildon and Brentwood to 61 days in Manchester. Most worryingly, of the patients who needed to ‘step up’ to a second session, half of them had to wait more than 28 days. One in 6 waited over 90 days.  In contrast to this and even given that the EAP data is now quite old, it does show that the average waiting time from referral to first assessment date was 8.8 days.

Higher numbers of patients going through IAPT don’t complete their treatment, for whatever reason, whether that’s because symptoms have improved or people are frustrated by waiting times. Around 43% opt-out of further treatment, compared with 27% using EAPs. The clients who did complete their treatment with IAPT took an average of 6.9 sessions; with EAPs this was four. 70.5% of EAP clients reached a planned ending with a ‘reliable improvement’ (in terms of recognised measures of anxiety and depressive symptoms such as the GAD-7 and CORE-OM scores). Through the IAPT, 67.4% achieved a reliable improvement.

There are caveats about the comparisons. The IAPT deals with a wider range of cases on the mental health spectrum than an EAP, and the data on the EAP side is now quite dated. But overall the analysis demonstrates some principles around how EAPs are a highly effective complement to the NHS. They widen access, making sure more people are seen more quickly and before symptoms worsen, especially for mild to moderate mental health conditions. Most of all, EAPs are playing their part in keeping people in work through the most difficult of times.

How EAPs help keep the workplace human

More than 400 staff at an electric bicycle firm in the US were made redundant in March via a two minute Zoom call. Anyone who missed the call had no idea why their logins suddenly failed to work. Uber has also reportedly used a three minute Zoom call to part company with 3,000 customer service and recruitment team members. Cineworld staff in one location in the UK first became aware they’d lost their jobs through Twitter, before an email was finally sent.

Most recently, staff at newly-launched streaming platform Quibi, backed by £1.5 billion in funding, were told about the closure of the business via group video call. The CEO, former Disney and DreamWorks chief Jeffrey Katzenberg, told staff they should listen to the song ‘Get Back Up Again’ from Trolls to make themselves “feel better”.

Legal implications

In the wake of the trend for digital lay-offs, employers have been warned by employment law firms that rapid decision-making, not following procedures and using these kinds of methods of communication open them up to more legal claims from employees. Staff are more likely to consider whether they have suffered constructive dismissal or look at the Equality Act 2010 and whether there might be a case for unlawful discrimination.

Law experts have stressed the need to ensure bad news is communicated in a “thoughtful and sensitive manner”, and that employers need to ensure there is the offer of “extensive wellbeing support”.

Stay human

“Digital comms are an essential part of doing business – their speed and efficiency, and in helping people stay connected,” said EAPA UK chair Eugene Farrell. “But when it comes to employee relations, genuine engagement and trust, there is no replacement for personal contact and relationships.

“Modern employers want staff to be flexible and adaptable. The danger is that, with the dependence on digital forms of communications, they begin to de-humanise their staff as just an account at the other end of a laptop that can be switched on and off as needed.

“Under lockdown restrictions, human contact is at a premium. It means that EAPs and services that provide access to personal attention, the chance to speak to someone by phone or video, is an ever more important way for the best employers to demonstrate they care, the difference they offer.

Don’t alienate

“And if the organisation is going through a period of considering or making redundancies, EAPs are a much-valued source of support to help employees deal with the added stresses and come to terms with changing situations.

“When times are tough, people remember acutely how they have been treated, and for the long-term. For those businesses not being conscious of the importance of focusing on ‘being human’ that means the alienation of a mass of potential customers and people with useful skills and experience they will need the in years to come.”

How to prepare for a pandemic winter

The next six months will be a greater test of mental wellbeing than the initial Covid-19 lockdown, suggests a new survey. The shorter, darker days being faced by a workforce already worn down by the first wave experience are seen as an additional factor for concern.

Weather warning

Of 2,000 employees surveyed by Vision Direct, 41% said they were feeling “more anxious and isolated” than ever before; 40% that WFH for a further six months will be damaging to their mental health. The biggest challenges were seen to be missing out on office banter; the poor substitute for communication of using video and voice calls; and issues being created by balancing work and home life pressures.

Psychologist Dr Becky Spelman said: “It is understandable that people are feeling low. We’re not just still dealing with a frightening pandemic, but also with the onset of the winter months. The world can seem a less friendly place when it is dark and cold outside. In the summer, long walks out of doors – with or without friends – were a real lifeline to most of us.”

Baby steps

With progress on dealing with the pandemic stalled and the likelihood of more spikes of infections and stricter restrictions for the autumn and winter, employees need to be supported to deal with the challenges one day at a time, argues EAPA UK chair Eugene Farrell.

“The coming months look daunting for all of us, whether you’re WFH or needing to go into the workplace under Covid-safe conditions. How are we going to cope if restrictions ratchet up even further? What happens at Christmas when we’ll want to be with our friends and relatives, including those who are most vulnerable to the virus?

“March was a series of shocks: threats to health and threats to our ways of working, financial security and mental wellbeing. We’ve all learnt a great deal from that experience, however not everyone coped well, and some continue to struggle. EAPs really came into their own as an essential employee benefit, helping more staff deal with all the difficult personal issues that the crisis has caused, keeping people at work. And many more people have become aware of the dangers of poor mental health and the importance of maintaining good mental wellbeing both for themselves and others around them.

Resilience defences

“Now will be the real test of that new resilience. That includes understanding how we all need to stop thinking about the pandemic as something we need to take on as a single, giant problem. We need to keep on living from one moment to the next, to remember we cannot control everything and only bother with those things we can have some control over.

“Many of those will be positive moments, all the ordinary things we enjoy about our daily lives, the people we see, the conversations and fun, the rewards from making a contribution through our work. And then there’ll be the difficult moments, worries, arguments, the limitations to what we want to do – but all of them small and temporary, things that can be fixed or forgotten.”

“It’s a time to look differently at things, not at what we don’t have or cannot do, what we have been denied and things we might miss, but get the most out of all the things we can do. When you look back in the future: what do you want to remember about this time and how we made it through Christmas?”

Get ready to beat the darker days

Clocks going back is traditionally a signal for the start of autumn comforts: an extra hour in bed in the morning, cosy evenings in, Halloween treats, Christmas on the horizon.

As per many of the other annual routines we’ve become dependent on, Covid-19 means that’s changed too. Seasonal Affective Disorder (SAD), a form of depression caused by a lack of sunlight, is reported to affect 1 in 3 of the UK population. This year the shorter darker days are going to make more of us understand what SAD really means and feels like. 

WFH and living under higher tier restrictions will mean fewer opportunities for being outside. Getting out after work is more difficult. Going to the gym in the rain may seem too much of a bother, walking the dog is a chore. Low mood tends to create a vicious circle of low motivation to get out at all.

What if-Christmas

For hundreds of years Christmas has been used as a release valve, a celebration that takes advantage of the dark days as a time for rest and feasting – as well as the solstice marking the beginning of the return of the light. But this year we have a “what if” Christmas – what if we’re not allowed to celebrate together, what if we go into a national lockdown, what’s it going to be like being at home alone? The pressures of the festive season can be tough enough in themselves but the new uncertainty may cause significant anxiety and other mental health issues, as well as encouraging rule-breaking and risk-taking over health.

Mindset matters

It’s worth looking to Scandinavia and populations who have a culture of coping with what might be only two to three hours of light a day. How do they do it? Research suggests it’s all about attitude. If you just think in terms of the benefits that the winter months bring – the cosy feelings, the particular charms of winter light and scenery, the chance to do things you can only do in cold weather, whether that’s outdoors or indoors – then you are going to build a positive mindset that sees you through.

And, of course, talking always helps, being open about how you’re feeling, accepting that simple things like a lack of sunlight can have a real impact on our state of mind. Then it’s possible to start finding straightforward, practical ways to thrive through the winter.

Can robots provide better mental health support to employees than people?

Robots are the solution to dealing with the global pressures on mental health, says new research carried out by Oracle and HR research firm Workplace Intelligence.

More than 12,000 employees, HR leaders, managers and senior executives across 11 countries were surveyed for the study on the impact of Covid-19 on levels of stress and anxiety, with the conclusion that “they prefer robots instead of other people to help”.

UK differences

In the UK, employees were found to be more resilient, with 62% saying they were feeling more stressed and anxious at work (compared with 70% internationally). 77% in the UK wanted more access to technology to support their mental health, with 69% being receptive to the idea of a robot therapist. Overall, however, UK staff were more sceptical about using AI to support mental health (60% were in favour, versus 75% globally).

Robots at work

The research suggests that staff are looking for more action by their employers on mental health – with technology being the easiest answer. 76% said they thought their company should be doing more to protect their mental health. 83% would like their company to provide technology to support their mental health: self-service access to health resources (36%), on-demand counselling services (35%), proactive health monitoring tools (35%), access to wellness or meditation apps (35%), and chatbots to answer health-related questions (28%).

Only 18% of people would prefer humans over robots to support their mental health, the study claims. This is because robots provide a judgement-free zone (said 34%), an unbiased outlet to share problems (30%), and quick answers to health-related questions (29%). 68% of people would prefer to talk to a robot over their manager about stress and anxiety at work; 80% of people are open to having a robot as a therapist or counsellor. 75% said the use of AI had already helped their mental health at work: providing the information needed to do their job more effectively, automating tasks and decreasing workload to prevent burnout.

People need people

EAPA chair Eugene Farrell said: “The increased demand for advice and support during the pandemic has led to more organisations introducing online support resources, Q&As, videos and podcasts around mental health . That’s been valuable in making sure everyone can have immediate access to a fundamental level of help and ideas, signposting them to the EAP if they want to speak with a human being or arrange personal, one-to-one counselling to explore issues in a more thoughtful, psychologically reassuring way.

“We’re in a world where automation is the norm. It’s a tool for completing tasks, whether that’s at work, for shopping or buying insurance. But it’s important that counselling and the principle of mental health support, is based on a core of human relationships and care. Who wants to open up about a psychological issue, struggling to find reassurance and sense of meaning, while knowing that they’re really only opening up to a blank space, an automated void?

“EAPs will always be about people helping people.”

Are you ready to handle WFH diversity? 

A survey of around 1,000 UK businesses by the Institute of Directors (IoD) has revealed how 74% are intending to keep to the home working regime they already have in place. 

More than half also have long-term plans to cut back on their use of physical workspaces. As Roger Barker, policy director at the IoD has pointed out, WFH isn’t good news for everyone: “Directors must be alive to the downsides. Managing teams remotely can prove far from straightforward, and directors must make sure they are going out of their way to support employees’ mental wellbeing.”

Downsides

Managers are struggling in the new context: 72% of senior executives have experienced poor mental health due to the pandemic experience (meaning insomnia (22%), lack of energy (31%) and anxiety and sadness (23%) according to Bupa’s Global Executive Wellbeing Index of 2,000 high-net-worth individuals.

58% of HR leaders say they believe the added strain of home working leads to stress and burn out (Mental Health Foundation research). Also, with more people being away from the workplace, fewer are taking holidays. An e-Days survey has suggested 37% of UK workers still have 14 or more days of holiday left to take until Christmas. 

Supporting diversity

EAPA chair Eugene Farrell said: “Employers are becoming much better at recognising the diversity of their people, more actively alert and willing to accommodate and respect difference, rather than expecting individuals to change themselves to suit the company culture. Now there’s a new – and bigger – challenge around WFH.

“Working from home works on a practical level for some and not others. Then there’s the more complicated level of psychology. More working-age people than ever live alone – so what does the prospect of being alone all day, with no workplace to go to, feel like? Even those living as part of big busy families can find being at home alone during the day something to dread. Long-term, all of these worries can turn into far more serious threats to mental wellbeing. 

“Most importantly of all HR need to make sure their people feel able to be open about their concerns, and that they know how to get help, via EAP resources and talking with EAPs. Managers need to be equipped to recognise signs of problems and know how they can help by flagging professional support.”

Cut hours not people and prevent a mental health crisis, says the University of Cambridge

Some level of employment – even just one day a week – plays a fundamental role in securing mental wellbeing and prevent a mental health crisis, according to new research. 

The Cambridge sociologists found that UK employees who were either furloughed or shifted to a part-time position during April and May 2020 were at the same risk of poor mental health as full-time colleagues. But those who’d lost all their working hours were twice as likely to suffer from poor mental wellbeing. The work was carried out as part of the Employment Dosage project among more than 7,000 UK people.

Sharing hours

In the wake of their findings, researchers have called for the UK government to encourage more employers to share out available working hours rather than cut jobs. This would be in line with the ‘short-time working’ approach being used across Europe – seen as a less expensive option than furlough schemes and less likely to cause a long-term legacy of damage to mental health from redundancies.

“As well as the individual misery caused, the costs of poor mental health to the UK’s productivity and health service are vast, and cannot be afforded at this critical time,” said Professor Brendan Burchell.

Stay together

EAPA chair Eugene Farrell said: “We’ve always known that while workplaces can be a serious source of stress, any negatives are far outweighed by the benefits. Being part of a team, sharing a mission, overcoming challenges, the recognition and status; as well as all the day-to-day pleasures that come from just being among people, being part of something together, even if it’s only digitally for the moment.
“That’s what EAPs have been doing all these years: helping people stay at work, able to keep the benefits from being in work and contributing, while also managing to deal with all kinds of personal issues. EAPs help save people from long term absence. Getting the equilibrium right, between work and home lives, is going to be essential to everyone as we work our way though the pandemic age.”

How to get a grip on the new world of absence

Covid-19 related absence led to 32,397,966 lost working days in the months of April, May and June 2020. That’s according to UK figures compiled by absence management company FirstCare.

Higher rates of mental health and musculoskeletal issues among employees are predicted for the coming year. One in five adults experienced some form of depression during the pandemic in June 2020 (a doubling on the figures pre-March 2020, says the ONS).

What does ‘absence’ mean?

For HR teams, ‘absence’ has become a catch-all term to cover a fog of inter-related physical and psychological concerns. It’s also a term that covers employees taking advantage of the opportunity for days off. Only 16% of employers taking part in a recent survey believed their sickness absence costs data was accurate; 42% said they just didn’t know if their absence costs data was accurate or not.

Organisations find it hard to understand what’s happening because of the lack of a clear picture of specific reasons for absence. It’s harder to assess future needs and put in place the best forms of support for wellbeing at work. In other words, a limit on measures to prevent minor issues from escalating into serious long-term reasons for absence.

Alert to EAPs

EAPA chair Eugene Farrell said: “The lives of many employees have become incredibly muddled. One consequence has been how the clear lines between what constitutes absence and what doesn’t have become clouded. People are suffering from stress and burnout, juggling care responsibilities, worried about their wellbeing at work in many different ways.

“At the same time employers need their people to be engaged and do all they can to re-build levels of productivity. Taking charge of absence means HR and managers working together to be more alert than ever to the immediate needs of employees. They need to make sure they are aware of the range of EAP services, their accessibility. Good communication of EAP services as an everyday support system is essential. Once an employee is in touch with an EAP there’s a professional channel for understanding root causes and related issues and for the right support to be provided.”

How the pandemic means work just got personal

For all the social change in the UK over the past 30 years, employees have still been expected to leave their personal lives at the door. Work life and home life were expected to be kept separate.

As Andrew Hill, management editor at the FT, has pointed out in a new piece on the Future of Work, the pandemic has “triggered a radical re-think” of how we work, including new attitudes to the work/home divide: “before coronavirus struck, the future of work looked uncertain: algorithms and artificial intelligence; shifting demographics and globalisation; the move to outsourcing and part-time work; the endless demand for new skills.” The human element to working life was increasingly under pressure.

But the shift to working from virtual spaces, spare rooms and kitchen tables, has “made leaders appreciate not only staff members’ hidden skills but also their personal hinterland… the many responsibilities of individuals’ matrix workers, if you like, not only to line managers but to their families and communities”.

Hill concludes that an urgent priority for businesses and the ‘hybrid workplace’ is not only to find ways to integrate employees who are working from a physical HQ with those working from home, but close the divide between those who have a comfortable set-up for continuing to work and those having to manage multiple caring responsibilities, who don’t have a quiet place to work from – where home life brings disruptive challenges.

“Personal lives have always been seen as the enemy of efficiency and productivity. Staff have been expected to show their commitment by minimising or even forgetting any other kinds of responsibilities,” said EAPA chair Eugene Farrell.

“It’s also clear that some people are not only enjoying, but preferring, WFH and the new way of life it has given them. Now is the time for employers to have those conversations with employees about what they want and how it can work as a long term solution.

“Covid-19 and the sudden, enforced blurring of work with home lives – along with the universal impact of the pandemic threat – has exposed the fundamental interdependence between the two. People might not have been talking about issues at home, but that didn’t mean they weren’t always feeling them, that their work performance wasn’t being affected.

“Employers can no longer ignore the range and complexity of stresses that people are under – or the importance of providing professional support for the long-term. Because it’s all the strength, energy, creativity of motivated and engaged people that will see us through the ongoing crisis. ”

Are younger generations holding on to the mental health taboo?

Three in ten UK employees have hidden a mental health issue – explaining their absence as being caused by a physical illness – according to a survey among 2,000 office workers by Helix Resilience. 

Strikingly, it is the 18 to 24 year-old age group that is most likely to feel the pressure to conceal the real nature of their absence, 37% compared with 26% of those aged 33 to 44, and 13% of employees over 55. 

The scale of the issue is highlighted by another of the study’s findings: 83% said the lockdown period had a major negative impact on their mental wellbeing. 32% of men and 42% of women said they had felt anxious; 42% of men and 50% of women had experienced problems with sleeping.

“There has been great progress over the past 10 years in terms of attitudes to mental wellbeing, more awareness of what’s involved, more openness and discussion, more acceptance that forms of mental illness can affect anyone,” said EAPA Chair Eugene Farrell.

“It might be expected that younger staff, coming fresh into this new work culture, would be the most progressive and comfortable with talking about mental health. But that’s to underestimate the additional pressures that younger people can be under: less financial security, maybe a less stable network of people behind them, and a sense they have more to prove to an employer – how they’re strong and committed.

“It’s always going to be a difficult conversation, raising mental health with an employer – much easier to say it’s back pain – and it’s critical that HR make their EAP offering as accessible as possible so that employees can start being honest, with themselves as much as anyone else; that they have someone they can talk to anonymously as a constructive way forward in recognising what’s happening and minimising the impacts so they are feeling better more quickly. Digital offerings, access via smartphone apps, through chat functions and video counselling can all help.”