Mental Health in the Workplace: Stats & Trends

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 US dollars annually. 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, the most common workplace mental health issues are major depression (1.8-3.6%) and anxiety (25%).^1,2,3 However, workplace mental health is likely to be underreported, as many employees choose not to share issues such as anxiety or feelings of burnout 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 In fact, 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 US dollars each year.⁵ Also, workplace practices often contribute or worsen existing mental health problems, like work burnout and work-related depression.

Trends to Support Workplace Mental Health

The Affordable Care Act (ACA) 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:⁹
  • 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 insurance

Nearly all company-sponsored health insurance plans, even those provided by small businesses, are ACA-compliant and offer mental health coverage.¹⁰ These plans typically include preventative care, depression screening, substance abuse screening, behavioral assessments, and screening for children’s issues like autism.¹¹

What Can Make Mental Health at Work Worse?

Certain workplace dynamics or environmental stressors may exacerbate mental health problems for employees. Poor communication, limited support, or insufficient training can all decrease individual morale. The more obstacles someone has to face at work, the more likely they are to feel overwhelmed or resentful. This can become a compounding effect that worsens over time.

Potential work-related stressors that can damage mental health include:

Poor Relationships With Managers

It is important to feel like you can rely on your manager. There’s a common saying, “people don’t quit their jobs, they quit their bosses.” Poor management may coincide with infrastructural problems, including high employee turnover rates, unclear job descriptions, poor feedback, and favoritism in the office. All of these factors can increase work-related stress.

No Support for Employees

When employees feel unsupported, they’re often left guessing how they should complete certain tasks. They also may feel like their company doesn’t have their best interest at heart. These effects may create hostile or unproductive work environments where employees feel underappreciated. This can amplify depression or anxiety symptoms.

Performance Pressure

Some stress is inevitable at work, but chronic pressure can lead to feelings of perfectionism, and it can drive burnout and a poor work-life balance. Employees may end up overworking to try to meet demands, and this can affect everything from their sleep hygiene to their personal relationships to their physical health.

Bad Decision-Making From Employers

Employers hold significant power, and when they consistently make poor choices, the aftermath can trickle down onto their employees. You may be forced to essentially clean up a mess you didn’t make. In other cases, when employers make bad decisions, the entire team’s reputation or compensation suffers, which can cause employees to feel more stressed.

Declining Company Revenue & Low Morale

Good morale is essential in a workplace, as it keeps employees feeling motivated and connected to the work they do. But the opposite can also be true. When people feel disillusioned or disempowered, they no longer care about investing in their work. They are no longer proud of being part of their team or organization at large. This can drive high turnover and make the workplace feel unhealthy.

Inadequate Safety & Health Policies

If you feel worried about your physical well-being at work, you will likely experience heightened anxiety. And while workplaces are legally required to follow safety laws, many companies sidestep or overlook such measures. In addition, some employees simply don’t feel comfortable voicing their safety concerns with management directly. If that’s the case, you may find yourself dreading going to work.

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.

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

The 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.

Mental Health Parity and Addiction Equity Act (MHPAEA)

The Mental Health Parity and Addiction Equity Act of 2008 is a federal law that prohibits health insurance carriers from providing less favorable benefit options when providing mental health or substance use disorder (MH/SUD) benefits. This act was amended by the Affordable Care Act in 2010, and it applies to employment-related group plans and self-funded insurance plans.²²

Financial requirements and treatment limitations that apply to MH/SUD benefits can’t be more restrictive than the limitations that apply to all other medical benefits. They also can’t be subjected to distinct cost-sharing requirements. Finally, any denials of benefits must be disclosed upon request. Exceptions for this law do apply for self-insured small private employers of 50 or fewer employees.²²

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 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).

Health Insurance

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.

Family Leave

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.

Flex Schedules

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.

Reasonable Accommodations

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

How Employers Can Promote Mental Health at Work

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.

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
• Spend time training management: 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 explicitly prohibits all types of discrimination and harassment
• 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 an 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.
• 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.

What to Do If You’re Stuck in a Bad Company Culture

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.