Government warned of the dangers of prioritising Mental Health First Aid

When MP Dean Russell first put forward his private members bill to make the training of Mental Health First Aiders a legal obligation, the move was welcomed as a means of “saving lives”.

Since January, former members of the board of Mental Health First Aid England have flagged their concerns over unintended consequences. MHFA should only be one part of the “jigsaw”, they say.

Ticking boxes

The board members have warned that using legislation to push employers to focus their energies and investment onto MHFA could lead to more of a “tick box exercise” around mental health. It would encourage organisations to train just a small number of people rather than look at broader support.

There would be issues of confidentiality around discussions of suicide, as well as a great deal of pressure put onto the First Aiders; and what happens after a case of mental illness has been identified?

Longer-term aid

EAPA UK Chair, Karl Bennett said: “Experience over the past decade or so has shown the value of having trained MHFA staff within the workplace. Peer relationships can make it easier for people to speak up and take the all-important first steps in recognising and talking about wellbeing issues.

“But employees need to know there is somewhere to go next with their concerns, more than being entered into the queue for overstretched NHS mental health support. As EAPA’s new report, Holding it together, has shown, more and more employees are relying on their EAP for immediate mental health support and counselling.

“MHFA is important for early interventions, but employers need to ensure they are thinking in terms of their specific needs and a mental health and wellbeing strategy — and avoid a dangerous situation where people are just being identified as having a problem.”

How EAPs have become an essential pillar to the UK’s mental health provision

Data from a ‘state-of-the-market’ survey among members of the Employee Assistance Professionals Association (EAPA UK) reveal how more people are turning to their workplace EAP.

Holding it together: UK mental wellbeing and the role of Employee Assistance Programmes points to huge growth in the EAP over the past 20 years, up to £118 million compared with £32.2 million in 2003.

An estimated 640,250 employees contacted their EAP in the period between January 2022 and January 2023 — of which, 434,250 (68%) were offered counselling as a result of concerns over their mental health. EAPs delivered more than 1.375 million counselling sessions. On average, 1.7% of counselling cases came with a ‘red flag’ (involving an immediate and serious risk of suicide). This translates to more than 10,000 lives at serious risk from suicide each year. Some EAP providers report red flag cases as being at levels above 3%.

Extended roles for EAPs?

Commenting on the figures, Sir Cary Cooper CBE, 50th Anniversary Professor of Organisational Psychology and Health at the ALLIANCE Manchester Business School said: “It’s critical that the Government, the NHS and other healthcare stakeholders, understand the role the EAP industry has been playing in supporting mental health, providing immediate access to counselling and professional assessment for millions of people every year.

“Given the limitations to NHS resources and both the scale and complexity of dealing with people’s mental wellbeing, more thought and discussion is needed around the place of EAPs — including how else they can help. Maybe there’s a need for extensions to EAP services, to ensure there’s provision for longer-term counselling programmes through to recovery.”

What’s next

EAPA UK Chair, Karl Bennett said: “EAPs have become a pillar of mental health provision for the UK, providing rapid access to professional support for the majority of the workforce, and delivering value-for-money for employers. The question now is what happens in the next 20 years.

“Sir Cary suggests that maybe there’s a need for an extension to EAP services, ensuring there’s provision for longer-term counselling programmes through to recovery. This would mean looking at the impact to providers and a model that adopts a more psychological approach as our core offering, with standardised clinical outcomes.

“Is this something we as providers are equipped to do and if so, is there the appetite to do it? I think once upon a time the answer to this would have been ‘yes’. But when the average cost of an EAP per employee has seen a significant decrease, and with the reliance on our services becoming much higher, I think the answer might be, how can we? If EAPs take on more of a role in supporting the NHS, how do we protect out resources, including our therapists, and what should our standard nonclinical EAP services be?”

A copy of the Holding it together 2023 report can be downloaded from www.eapa.org.uk

NICE recommends mental wellbeing apps to reduce NHS waiting lists

In response to long waiting lists for accessing talking therapies, NICE has made initial recommendations for eight digital technologies that help people with common mental health issues such as depression and anxiety, as well as PTSD and body dysmorphia.

Together, the apps have the potential to help around more than 40,000 people at any time — given that one in six people report experience mental health problems each week in England, according to NHS Digital. Patients, first of all,  need to have a formal assessment with an NHS Talking Therapies therapist before app access is provided.

Subject to consultation, the apps are due for “rapid deployment” across the NHS.

Rapid value

NICE believes digitally-enabled therapies will provide faster access to help, more flexibility around time and location of treatment, and good value in terms of NHS resources.

“Digital technology could transform the experience of people living with mental illnesses,” said Elizabeth Mullenger, a lay specialist member on the NICE committees involved. “It can be incredibly isolating to be on a long waiting list for in-person treatment. You might know that help is coming, you just don’t know when.

“Having access to a digital therapy could help prevent this lonely feeling. Sometimes people need support most in the middle of the night, or after a busy day at work, and it’s hard to know where to turn. Having access to digital therapy, can give people the help they need, when they need it.”

Human contact

EAPA UK chair, Karl Bennett said: “Online resources and apps have become an established part of the toolkit for supporting people with mental health concerns — having immediate access, 24/7, can be vital in terms of early intervention, and helping people not ready to talk openly about their experience. Many people are reluctant to talk to their GP, let alone their employer, about common issues like anxiety and depression.

“Our experience with EAPs shows that, ultimately, employees need the reassurance of a human relationship. A sense of isolation, of being stuck with only digital, artificial relationships, of not being listened to, is so often part of the problem.

“That’s why the offerings that employers put in place via an EAP, their commitment to offering individual attention, empathy and a human voice is so valuable and valued.”

Getting evidence on good mental health ROI

While support for employee mental health and wellbeing generally has become the norm, there’s still a lack of hard evidence of ROI – limiting investment and making the HR approach look woolly. We’ve reached the stage where depression and anxiety is talked about, out in the open rather than dealt with behind closed doors, and people are more able to be people, not forced to adopt a rigid employee persona.

According to the Government’s Thriving at Work report, the cost of poor mental health among employees is costing employers between £33 and £42 billion. UK employers bear much of the burden of the costs of ill-health in general, chronic disease and incapacity, and HR need to have a better grasp of which particular interventions help them mitigate against these costs. In other words, talking about new attitudes to mental health, providing yoga sessions and free fruit, may feel the right thing to do, but there need to be hard numbers on Return on Investment.

There’s been some research on the ROI of some workplace health interventions over the last 30 years. But much of it originates in the USA where employers bear significant healthcare costs and have a direct financial interest in improving workforce health and promoting early intervention. The more reliable research includes a study by the large US insurance firm insurance firm LifeSolutions which found a return of between $5.17 and $6.47 (in terms of increased work productivity) for each dollar spent on the EAP. An academic study involving work with the Australian Fire Service found that mental health training for managers led to real impact on work-related absence and an ROI of £9.98 for each pound spent; while the Government’s Thriving at Work highlighted a significant return for employers investing in mental health interventions: an average of £4.20 for every £1 (with a range up to £9).

And while EAPs are the most commonly used workforce health intervention in the UK with close to half of the workforce (a total of almost 14 million) having access, very few providers or employers are able to collect systematic evaluation data beyond ‘take-up’ or utilisation statistics and satisfaction surveys. To help bridge this gap, EAPA launched the EAP calculator in October last year. Independently developed by the Institute of Employment Studies (IES), this new tool can be used by HR professionals to estimate the value of their EAP investment. Since the launch, there are now 529 users with the average return on investment calculated at £10.44 per £1 investment.

The more the calculator is used, the richer the dataset becomes. In turn this data can be used to revise and update the methodology, building the rigour and realism of the figures put forward to senior executives in boardrooms. There’s then a clear basis for investment in more specific mental health initiatives for employees. And over time, as the UK dataset grows and the anonymous data is collated and analysed, there is the detail needed for organisations and HR teams to benchmark returns and value against comparative employers in their sector and region.

The web tool available here and is available to everyone. We encourage EAPA members to try the EAP calculator and share with their clients to help build the data available. The full calculator has more detail, variables and greater intricacy and can handle employers with over 15,000 employees. Plans are underway to make the full calculator available in the coming months and we will keep members updated as this progresses.

Mental Health Awareness Week 2018

It’s Mental Health Awareness Week next week which makes it the perfect opportunity to review workplace health and wellbeing and think about what more employers could be doing to create, and promote, a culture of acceptance around mental health.

While the majority of work-related stress is attributed to workload, around 1 in 7 people say it is due to a lack of support despite EAPs being the most popular wellbeing initiative provided by employers in the UK. So why the disparity? “While awareness is growing, there’s still a significant disconnect between the EAP services already being provided by organisation to support workplace stress and wellbeing and awareness among employees,” explains EAPA UK chair, Neil Mountford. “There are a number of issues at play that are focused around a lack of understanding of what an EAP is and how it can help but also employee concerns about the confidentiality of these types of services. If employers are serious about creating mentally healthy workplaces, a good first step is dispelling the myths and improving the knowledge that exists around EAPs within their organisation.”

This starts with educating managers about the EAP and its services so that they can better communicate this to their teams and signpost more effectively when needed. Organisations could also think about hosting regular EAP awareness and mental health education sessions. By improving knowledge around EAPs, employers can help increase usage of the service and help mitigate mental health issues from escalating to the level of requiring clinical intervention and time away from work.

“We would encourage employers to talk to their EAP providers about working together to develop tailored communications and education sessions to increase knowledge and awareness around the wide range of services provided by EAPs. Organisations that do this will see the long term benefits of a successful EAP and the positive impact of employees wellbeing on the organisation through improved productivity and fewer days lost to mental ill health,” said Neil.

So if take-up of your EAP is low, Mental Health Awareness Week could be the perfect opportunity to start educating employees about what an EAP is and the different ways it can help.

EAPs can help support mental health among middle managers

Last week, the CIPD launched the UK Working Lives survey, the first comprehensive measure of job quality in the UK. Combining previous research on the factors that affect job quality with a 6,000 sample survey, representative of the whole UK workforce, the results show that while overall headline satisfaction with work and jobs is reasonable, there are significant numbers who feel differently, and importantly some major systemic issues with overwork, stress and a lack of training and development.

It reports that while two-thirds of workers (64%) are satisfied with their job overall, one in four workers (25%) feel their job negatively affects their mental health, while nearly a third (30%) say their workload is too much. In particular, the survey highlights a concerning trend among workers in middle management, indicating that they have too much on their plate, a factor which is having a detrimental effect on their wellbeing. Among its recommendations, the CIPD advises employers address cultures of presenteeism, place a greater focus on wellbeing and encourage more flexible working.

“While many organisations already have an EAP in place to support the wellbeing of their employees, there appears to be a lack of awareness around the coaching and guidance element of many EAP programmes which are there to support line managers specifically,” said Neil Mountford, chair of the UK Employee Assistance Professionals Association. “We urge employers to talk to their EAP provider about these services and to work together to more actively promote the training and coaching services available to line managers which can help them manage their day-to-day pressures more effectively.”

You can ready the CIPD’s UK Working Lives Survey here.

Promoting EAPs during National Stress Awareness Month

According to the Health and Safety Executive (HSE), 12.5 million working days were lost due to work-related stress, depression or anxiety in 2016/17. During the same period, more than 500,000 workers stated that they were suffering from work-related stress, depression or anxiety. GPs also report that symptoms of stress are on the increase in the UK, with the majority of GPs (85%) reporting a rise in the number of patients with symptoms of stress, anxiety and depression in the last five years according to a survey by Royal London.

While the majority of work-related stress is attributed to workload, around 1 in 7 people say it is due to lack of support. Yet we know that Employee Assistance Programmes (EAP) are the most popular wellbeing initiative provided by employers in the UK. While awareness is growing slowly, a gap still exists between awareness and the services already being provided by organisations to support mental health issues. “The issue here is that while some employees are aware their organisation has an EAP, they don’t necessarily know what it means and how it can help,” says Neil Mountford, chair of the UK Employee Assistance Professionals Association.

“Hosting regular EAP awareness and mental health awareness sessions can help give employees a better understanding of mental health , as well as an awareness of the services and support available to them. Improving knowledge of how EAPs can help will also increase usage of the service. If there are concerns around confidentiality of the EAP, it is vital to communicate that any discussions are private and confidential and will not be shared with their employer. It also helps if managers have a better understanding of the EAP and other support services available so that they can talk to employees about these.

“In order for an EAP to deliver significant benefit and value, employers need to work with their providers to raise awareness and provide education for employees. Organisations that do this will see the long term benefits of a successful EAP and the positive impact on employee wellbeing and organisation through improved productivity and fewer days lost to mental ill health. Line manager education and coaching on how best to manage mental health issues is also a key part of the equation and while EAPs have the capability, expertise and capacity to do this, this is less well known and utilised by employers.

“If take-up of your EAP is low, consider creating events or communications to tie in with key events on the wellbeing calendar and help reduce the stigma surrounding mental health. Ultimately, it is in the interest of all EAP providers to raise awareness of the issue of mental health at work and the role we can play in eradicating the problem and April’s National Stress Awareness Month could be the perfect place to start.”