Employee mental health impacts workplace productivity. That’s why, in addition to health insurance, most larger employers invest in support services such as Employee Assistance Programs (EAPs) and paid time off. Providing workplace mental health services reduces the impact of mental health issues on company productivity and supports a caring, inclusive culture.
In addition, federal laws like the Americans with Disabilities Act (ADA) prevent employers from discriminating against workers with health conditions, including mental health issues. The Affordable Care Act (ACA) also ensures that those who work for firms with over 50 full-time employees are provided mental health care as part of their mandated medical insurance package.
Statistics & Trends of Mental Health in the Workplace
The World Health Organization (WHO) estimates that 264 million people suffer from depression worldwide, and many also suffer from anxiety, costing the global economy as much as one trillion dollars annually (USD). But there’s good news. Every $1 spent to support mental health in the workplace returns an average of $4 in improved health and worker productivity.
Mental Health in the Workplace
While 5% of all adults may experience a mental illness in any given year,1 the most common workplace mental health issues are major depression (1.8-3.6%)2 and anxiety (25%)3. However, workplace mental health is likely to be underreported as many employees choose not to share issues such as anxiety with their employer for reasons such as not wanting to provide a doctor’s note, thinking it’s not their employer’s business, or thinking it unnecessary.3
As an example, 69% of surveyed employees agreed it was safer not to share workplace stress concerns with their employer.4
Cost of Mental Health in the Workplace
According to WHO, mental health issues cost the global economy over one-trillion (in $USD) each year.5 It also notes that workplace practices often contribute or worsen existing mental health problems.
Trends to Support Workplace Mental Health
The Affordable Care Act (ACA), formerly known as Obamacare, made huge strides in providing mental health insurance benefits for workers. It requires compliant health insurance programs to include mental and behavioral health coverage and to cover existing conditions with no spending limits.
Employers are jumping on board— even those with fewer than 50 full time team members typically offer some mental health support services, from stress management training, to wellness programs, in addition to providing their employees with health insurance and EAPs.
Consider these workplace health statistics:
- 79% of all firms offer an EAP program, up 1% over prior year6
- 40% of businesses provide resources such as referrals or stress management tips3
- 54% of firms now offer quality of life perks like work-life balance and flex schedules7
- 69% of businesses with over 50 employees are adding wellness programs8
- 96.8% of employers with 50 or more full-time employees offer health insurance9
- 29% of small firms (under 50 employees) offer health insurance that includes mental health benefits. Employer rates vary by state, for example:
- 17.5% of Utah and S. Carolina small business offer health insurance
- 52% of Maryland and Wash DC small businesses offer health insurance
- 74.9% of Hawaii small business employers offer (state mandated) health insurance9
Nearly all company-sponsored health insurance plans, even those provided by small businesses are ACA-compliant and offer mental health coverage.10 That typically includes preventative care, depression, substance abuse screening, behavioral assessments, and screening for childrens’ issues like autism.11
Generational Differences in Mental Health Awareness & Therapy Acceptance
In recent years, the workplace has become more tolerant of individual differences. This may be driven by workplace laws that prevent harassment and discrimination across a variety of protected classes, including those suffering from mental health issues. In addition, younger generations are more understanding of behavioral issues, having grown up in a time after these federal laws were in place and in a culture that’s generally more inclusive toward all kinds of people.
Over half of those surveyed by the Center for Disease Control (CDC) agreed that “people are generally caring and sympathetic to people with mental illness (range 35%–67%).” In fact, 25% strongly agreed with that statement. Although perceptions vary based on state, age groups, and gender, these percentages are significantly higher than they were a decade ago.12
Men vs. Women Mental Health Perceptions
Men were more likely than women to rate that those with mental illness could lead normal lives, whereas women were more likely than men to indicate that people are caring and sympathetic to people with mental illness.
State Variations in Mental Health Perceptions
Those in midwest states such as Iowa and Nebraska tended to have more positive perceptions than those in coastal and urban areas. However, those in Puerto Rico had the most negative perception of workers with mental illness across US states and territories surveyed.
Perception of Mental Health Across Age Groups
Those ages 25 and up are more likely than younger people to hold the opinion that it’s difficult for those with mental health issues to lead normal lives. There’s little variation across age groups. However, those under 25 aren’t as likely to state that people are generally caring and sympathetic.
Mental Health Workplace Laws
The Americans with Disabilities Act (ADA) was the first anti-discrimination law under the U.S. Equal Employment Opportunity Commission (EEOC) that focused on creating a level playing field for workers with mental health issues. By classifying mental health issues as a type of disability, it paved the way for workers to seek relief in cases of unfair hiring practices, workplace discrimination or wrongful termination.
Federal Laws Affecting Workplace Mental Health
Anti-discrimination laws protect workers with mental health issues as well as employees who have family members suffering from mental health concerns. The primary federal laws that cover mental health in the workplace include the ADA, the Family Medical Leave Act (FMLA) and the Affordable Care Act (ACA).
However, employers should be aware of other laws such as the Health Insurance Portability and Accountability Act (HIPAA) that requires employers to maintain employee confidentiality related to all health issues in the workplace, including mental health information and data.
Here’s how each federal law protects workers with mental health issues:
ADA Addresses Mental Health at Work
Americans with Disabilities Act includes protections for individuals suffering from mental health conditions such as chemical dependency, bipolar disorder and schizophrenia. Employers with 15 or more workers must comply with the ADA. Some states enhance these worker protections.
The EEOC states:
If you have depression, post-traumatic stress disorder (PTSD), or another mental health condition, you are protected against discrimination and harassment at work because of your condition, you have workplace privacy rights, and you may have a legal right to get reasonable accommodations that can help you perform and keep your job.13
FMLA Allows Workers to Take Time Off for Mental Health Issues
The Family Medical Leave Act, managed by the Department of Labor (DOL), provides employees up to 12 weeks of protected leave for any medical issue including mental health issues for themselves and or their family members. Employers with 50 or more workers must comply, however states like California have extended these regulations to smaller businesses.
ACA Ensures Mental Health is a Covered Health Insurance Benefit
The Affordable Care Act requires employers to provide health care insurance coverage that includes mental health care such as behavioral health treatment like counseling and therapy. It also must cover mental health inpatient services and substance abuse disorders. It impacts employers with 50 or more workers, although some states, such as Hawaii, mandate that health insurance be provided by most employers.
HIPAA Protects Workers The Health Insurance Portability and Accountability Act was designed to provide guidance to insurance and medical practitioners. However, it impacts employers and any person dealing with confidential employee medical information — that includes mental health diagnosis, treatment plans, confidential conversations, data and notes.
Refer to the EEOC for specific legislation and details, conditions and workplace enforcement.
State Laws Affecting Workplace Mental Health
Many U.S. states and localities go beyond federal minimums to protect workers with mental health issues. States states like New York, New Jersey and Oregon, mandate employers to provide paid and unpaid sick leave. Others, like California go even further and require family leave to be provided to workers of smaller businesses.
Check your state and local laws dealing with workplace mental health:
- Sick Leave Laws: There’s no federal paid sick leave law, but more than a dozen U.S. states now require sick leave that can be used for purposes such as mental health issues. In fact, some larger municipalities like Oakland, Portland, Seattle and Duluth have their own sick leave requirements.
- Family Leave Laws: California, New Jersey and Rhode Island have expanded family leave laws that allow employees to take time off to address mental health needs
- Health Insurance Laws: Most states follow the ACA’s lead. However, in Hawaii, nearly all employers are required to provide their employees with health insurance.
Employer Mental Health Benefits
Small employers are not required to provide mental health coverage. However, businesses with 50 or more full-time employees are required to provide health insurance that includes mental health coverage. In addition, many businesses add optional benefits such as a Flex-Spending Account (FSA), Health Savings Account (HSA), or an Employee Assistance Program (EAP).
Employers with 50 or more employees are required under the ACA to provide health insurance to their employees. That insurance must provide minimum affordable benefits for a standard list of health issues, including mental health. However, some employers also opt for plans that include additional mental health support like drug addiction treatment.
Flex Spending Account (FSA)
FSAs are offered by employers to give their team members flexibility and offset the cost of care that’s not covered by their insurance plan. These funds can be used for expenses like co-pays, hospital stays, or drug and alcohol treatment plans. However, any money remaining in a flex-spending account belongs to the employer. Funds are forfeited if not used by the employee in a given plan or calendar year.
Health Savings Account (HSA)
Employees who sign up for a high-deductible health insurance plan can also choose a savings plan that works like a 401(k), but is used tax-free for medical purposes. Being designed specifically for healthcare expenses, like deductibles, it can be used to pay for therapy appointments, health service co-pays, or medications like antidepressants.
Employee Assistance Program (EAP)
While completely optional, 70% of US companies offer a free confidential employee counseling service referred to as an employee assistance program. An EAP gives team members an outlet when they’re facing family issues like depression, anxiety, domestic abuse or major mental health issues.
An EAP typically provides up to three counseling or therapist visits per incident to help the worker (or family member) get the help and resources they need. The only downside to an EAP is that some employees fear their manager or employer may know about their issues. EAPs are confidential. Nothing beyond aggregate usage data is provided to the employer.
Paid Sick Leave
Several states have implemented mandatory sick leave programs, both paid and unpaid, requiring employers to give employees time off, not only for their own health issues, but for mental health and issues affecting their family. Some extend this time off to include domestic violence, and contrary to popular belief, a doctor’s note is not required.
Over 60% of firms offer paid sick leave as a standard employee perk according to the Bureau of Labor Statistics (BLS), whether required by state or not.14 However, these non-mandated sick leave and paid time off policies may not cover the kinds of time off that an employee with mental health issues may need, such as a month off to recover from a major episode, weekly therapist appointments, or time a parent needs to care for a mentally ill child.
Employers with over 50 full-time staff are required by law to provide family medical leave. Some businesses offer more than the law requires, such as providing paid leave, allowing extended leave, unlimited PTO, sabbaticals, or offering leave for non-traditional issues, such as time off to complete a drug rehab program.
A popular perk in recent years thanks to cloud-based technology is the option for employees to work offsite, work from home, work remotely and/or work their own schedules. While most employees appreciate the work-life balance afforded by flex schedules, it’s of particular benefit to those with mental health issues as they can remain productive when they can’t manage a normal 8-5 office schedule.
Even when these benefits aren’t provided, under the ADA, employees have a right to ask for, and employers are required to provide, “reasonable accommodations.” For mental health issues like PTSD for example, a reasonable accommodation may be a quieter work location. A mental health provider can assist by providing documentation of both the condition and recommended reasonable accommodation options.14
The Society for Human Resource Management (SHRM) is on the front line recognizing and reminding employers and HR staff that:
Depression, bipolar disorder, anxiety disorders and other mental health impairments can rise to the level of disabilities under the Americans with Disabilities Act and thereby require employers to make accommodations for workers with such conditions.
Company Culture and Mental Health
A culture of caring, acceptance, and inclusion can go a long way toward assisting employees who struggle with their own or family mental health issues. When employees feel safe to share their concerns, the company benefits from improved retention and loyalty— and it’s more likely team members will get the care they need.
SHRM offers a simple formula to create a mental-health friendly workplace that includes little more than providing good management practices and ensuring that all employees are valued and respected.
Good Company Culture
In a good company culture, you’ll find a general attitude of caring and acceptance by managers, executives, and employees. The HR team will have programs in place such as stress reduction workshops or an exercise room to help reduce workplace stressors that exacerbate mental health issues.
Other ways companies can improve the workplace to support all workers, including those with mental health concerns:
- Increase Awareness: Educate employees to recognize and address workplace mental health concerns in a caring informed way
- Train managers to lead with compassion and educate them on laws and resources to improve workplace culture and reduce bias
- Provide Work-Life Balance: When possible, give employees the choice of where and when to work. That can reduce much of the stress within a traditional work environment
- Develop Mental Health Policies: Ensure the employee handbook explicity prohibits all types of discrimination and harrassment
- Provide Resources: Give staff access to resources, such as where to find an AA meeting, brochures from local therapists, or mental health articles in a weekly newsletter
- Offer EAP: Sign the company up with an EAP program
- Be Transparent: The more people talk openly about how they deal with their mental health issues, the more likely workers will feel safe to ask for help themselves.
The World Health Organization (WHO) recommends practices to support mental health that are consistent with what human resources professionals consider HR best practices, including:
- Policy enforcement:supporting a safe and healthy workplace, prohibiting substance abuse, and discrimination
- Awareness: letting employees know that support and resources are available
- Employee involvement: getting staff input on work-life balance and health needs
- Career development: training and career growth that supports an individuals’ goals
- Employee recognition: praise and recognition for employee accomplishments
Bad Company Culture
In a company culture gone bad, you’ll find increased absenteeism, high turnover, and more frequent interpersonal conflicts even if employees never mention mental health issues. Working in an environment that stigmatizes, shames, discriminates, or otherwise devalues individuals can actually make workers’ mental health issues worse.
Employees who feel they are working in a discriminatory environment, dealing with harassment due to their mental health, or otherwise working in an emotionally toxic environment, may want to seek other employment. For issues that rise to the level of a labor law violation, they may prefer to contact the EEOC to file a complaint.
Other options for dealing with workplace issues affecting mental health include:
- Talk to Your Manager:If you have a good relationship with your manager, seek their advice on how best to manage stress and anxiety within the current environment.
- Talk to HR: Firms that invest in HR staff often seek to improve the company culture. Address your concerns with HR or ask for reasonable accommodation.
- Talk to Company Owner/Executive: In some cases, top management is unaware of abuses and harassment of lower level management.
- Document Everything: Keep track of behaviors, such as derogatory words or being passed up for a promotion, should your situation rise to the level of a discrimination case.
- Attorney: You have the right at any time to engage an attorney to help you address workplace labor law violations, such as being fired for having a mental health diagnosis.
- EEOC: The EEOC provides an online form for employees facing discrimination to file a complaint. In addition, whistleblowers are protected from retaliation by law.
Workplace Roles and Mental Health (Laws, Benefits, Culture)
There are many individuals you can turn to for assistance with mental health issues in the workplace. Each has different roles in supporting an inclusive culture, providing mandated benefits, or ensuring labor law compliance. For example, a direct manager may be open to giving time off for therapy appointments, whereas it may take the executive team to launch a work-from-home policy.
As a business owner or member of an executive team, it’s crucial to model non-discriminatory behavior. In smaller firms, consider offering health insurance. In fact, executives play a valuable role in promoting tolerance and can reassure people that the EAP program is confidential. If you have your own mental health story, sharing it with your team helps normalize mental health issues in the workplace and may encourage individuals to seek help.
Human Resources (HR)/People Operations
It’s up to the HR people team to put policies in place that comply with federal and local laws. They’re also on the front line for sourcing and recommending best practices like setting up an EAP program or having a stack of brochures in the office for employees needing counseling, dealing with family issues, or wanting to get help for drug or alcohol abuse.
HR also trains managers and employees on mental health support services, labor laws, company values, and how the EAP works. Typically, it’s the people operations team that identifies and implements programs that help workers with mental health issues such as promoting flextime, work from home days, family leave, and paid time off (PTO) programs.
HR staff can also assist in discerning what types of behaviors may be disruptive to the culture and how to balance employee discipline with legal requirements and best practices when dealing with workplace mental health issues.
As the person employees are most likely to come to with issues like stress, anxiety, or depression, it’s imperative supervisors and managers understand the legal nuances. HIPAA prevents them from sharing confidential employee health information; the ADA prohibits them from disciplining a worker for a mental health-related disability.
Managers are also in the best position to observe the impact of mental health issues on workplace productivity and morale. They can bring these concerns to management, coach employees on options, and provide real-time support for staff dealing with mental health issues on the job.
A work culture that promotes caring and compassion leads to staff members who help identify and support individuals with mental health issues. Co-workers can encourage peers to seek help.
It may be that anxiety is causing a worker to make mistakes while another is having trouble with their medication mix. Employees and co-workers can make the difference between a workplace where individuals with mental health issues thrive versus having this “at risk” population further stressed by job loss and unemployment.
As an employee with mental health issues, it helps to realize you’re not alone. Your employer can’t discriminate against you solely based on your mental health status. However, it’s on you to ensure you’re able to do the job and that your performance is on par with expectations listed on your job description.
You also need to take ownership of your own mental health. Seek help during difficult times, ask for reasonable accommodations if needed, and stay on top of mental wellness through medication, therapy, or holistic techniques like meditation and yoga. Employers have the right to dismiss workers who are disruptive to the work environment or fail to perform to standards.