Mental disorders are now one of the costliest medical disorders in the United States; the annual spend is above $200 billion according to a study by American Psychological Association. However, the cost of untreated mental health issues is a silent threat to employers. Depression and anxiety are estimated to cost global employers $1 trillion in lost productivity every single year.
Employers are increasingly aware that mental disorders cause problems in the workforce while negatively impacting the bottom line. Alarmingly, the number of mental health problems have tripled during the pandemic, now affecting up to 34% of the U.S. population. The number of U.S. workers experiencing mental health issues has risen from 5% to 18% during the pandemic. Additionally, 95 percent of human resources professionals claim that burnout is crippling their workforce.
Needless to say, mental health has rapidly become a priority in the workplace, and according to a recent study, 88% of employers will offer virtual mental health care for their workforce in 2021 (growing from 69% in 2020). As such, more organizations are implementing treatment for mental disorders as part of their employee benefit options.
However, employers should not turn to telemedicine or other digital solutions blindfolded. They should carefully assess what they aim to achieve and how these solutions will help them get there.
So, what should you look for when evaluating digital mental health solutions? Here are six things to consider.
1. Clinical validation: Only 3% of mobile health apps are validated in clinical trials and many digital mental health solutions don’t have much evidence of true benefit. Don’t just rely on engagement metrics or literature stating that evidence-based therapy modalities are used. These are important factors, but dig deeper to figure out exactly how the solutions will impact your employees. In contrast to common beliefs, not all therapists are equally effective either in their work. According to research conducted to look into how effective and beneficial talk therapy is, worrying patterns of deterioration were found for 5-10% of patients.
Even if you are not an expert in validating the clinical efficacy of a given solution or service, there are simple questions you can ask from your solution provider or broker to validate if a solution can really benefit your employees such as:
- Are you measuring metrics tied to mental health outcomes? There are clinically validated scales for measuring depression (for example PHQ-9) and generalized anxiety (for example GAD-7).
- Are you conducting clinical trials to show the efficacy of your solution? Have you published your results in a peer-reviewed journal or do you have your manuscripts available? Ask if the clinical trials are registered at a clinical trial registry, such as clinicaltrials.gov, where the outcomes measured are clearly defined.
2. Ease-of-access to care and engagement: How accessible is mental health care for your employees? Currently, only 45% of adults suffering from mental health disorders receive help. Almost 37% of adults suffering from anxiety disorders receive treatment. High on the list of barriers to care are stigma issues, busy schedules, costly treatments, fear of medication-first treatments and unclarity over how to get to treatment.
To improve access to care, most companies offer employee assistance programs (EAPs). Ninety-seven percent of large companies with more than 5,000 employees have EAPs and 80% of companies with 1,001–5,000 employees have EAPs.
Although research and common knowledge indicates that EAPs can definitely help some employees, many issues remain with these programs. The median utilization rate of EAPs is only 5.5% according to a study conducted in 2018 by Business Group on Health. The main concerns around EAPs include lack of privacy and the continuing stigma around mental health. The effectiveness of EAPs in helping people get better or get access to the right kind of care is rarely reported by EAP providers. Even when using these programs, the average program length is only 2.5 sessions. To make sure that a digital mental health solution is easy to access and keeps the employees engaged throughout the program duration, ask:
- Does the information about the program get to everyone? Some digital mental health solutions take care of the promotion of the service to your employees, and these systematic reach outs make sure that the option stays on top of people’s minds and has the potential to reduce stigma.
- Can the mental health program be accessed via smartphone, anytime, anywhere? This gives your employees anonymous, easy access to the service. This also ensures flexibility to adjust to the busy schedules of your employees.
- Is there a licensed professional overseeing the treatment program? It has been studied that the dropout rates are much lower in digital solutions that offer human feedback. To ensure high utilization and engagement, make sure that the digital mental health treatment is supported by a licensed mental health professional.
3. Anonymity: If employees have easy access to mental health care, do their identities and concerns remain confidential within the treatment? According to a recent study, 64% of employees feared for their job security if they come forward with a mental health issue. Employees worry about being singled out, terminated, or held back from promotions as a result. Additionally, employers worry about possible discrimination suits if affected employees are disciplined. Providing employees with anonymous access to digital mental health interventions that are strictly confidential is essential to get everyone the treatment they need. If the offerings for mental health care are not fully confidential and easy to use privately, employees are less likely to use them.
4. Licensed medical healthcare professionals: Would you trust an app or a coach to evaluate your physical medical conditions? Mental disorders are medical conditions and in many ways comparable to physical ones. To provide high-quality mental health care for your employees, it needs to be evident that licensed medical professionals are providing care, and that their performance in providing care is actively being measured and followed.
However, the studies show that you don’t have to see these professionals face-to-face. A recent systematic review on guided internet therapy programs for depression and anxiety disorders showed that therapeutic alliance (the relationship between the therapist and individual) can be even stronger than in face-to-face therapy. This is not that surprising as digital mental health solutions can facilitate more frequent and easier access to licensed professionals.
5. Return on investment: On average, for every one dollar contributed to evidence-based mental health treatment, a $4 return on investment occurs with improved employee health and productivity.
However, every company is different and there are practical and validated scales for measuring the return on investment. One such example is the Work Productivity and Activity Impairment scale (WPAI). Also, the clinically validated treatment outcome metrics such as PHQ-9 and GAD-7 can be tied to economic outcomes. There are online tools and calculators that can help you to estimate the ROI for your employee population.
Engagement metrics and clinical and economic outcomes can and should be measured. Make sure you get a digital mental health product that provides you with those outcomes and helps you to monitor how your workforce’s wellbeing is improving and how this affects the bottom line.
6. Side effects: Digital mental healthcare has opened up various possibilities in the mental healthcare field that cater to the unique needs of your workforce. The traditional first line of treatment, antidepressants, has been challenged with evidence-based treatment modalities such as cognitive behavioral therapy, mindfulness-based stress reduction and sleep and nutritional psychiatry. The understanding of our mental health is evolving at a rapid pace and the digitalization of care offers a way to deliver this novel care effectively. One of the greatest benefits of this is the increase in effectiveness and lack of side effects. Contrary to common belief, antidepressants are not that effective for many people and they come with a lot of side effects. Only one out of three people respond to the first prescribed antidepressant while 55% or more get bothersome side effects, some of which are very severe. Medication is crucial for some, but as an employer, it’s important to consider providing access to licensed mental health professionals and comprehensive treatment programs that enable your diverse workforce to get the treatment that works the best for them, without bothersome side effects.
In summary, digital technology offers numerous benefits for providing access to care for mental health disorders. It’s often less costly than traditional face-to-face methods, warrants confidentiality, and helps streamline human resources processes. Digital technology also allows measurement of care effectiveness and engagement which has not been previously possible. However, make sure you’re asking the right questions when implementing these benefits. Educating yourself about the medical validity and the return on investment offered by a digital mental health program will improve both your employees’ health and your bottom line.
About the author
Kristian Ranta is the CEO and Founder of Meru Health. His passion for helping people struggling with mental health issues stems from his own experience: Kristian lost his brother Peter to suicide back in 2005. He suffered from depression and the current system could not help him. That is when Kristian decided to devote his time and energy to finding solutions that would help people heal from mental illnesses.
Meru Health is an online mental healthcare provider, offering a comprehensive app-based treatment combining therapy, psychiatry, biofeedback training, anonymous peer support, mindfulness practices, and habit-changing activities for sleep, nutrition and more.
The company is committed to evidence-based care and has published groundbreaking clinical outcomes with Stanford, Harvard, and UC Davis that demonstrate 2-3X better clinical effectiveness and longer lasting results versus the standard of care in the U.S. today. Meru Health partners with major health insurance providers like Cigna, Humana and Moda Health, as well as leading businesses who want to provide best-in-class mental health care for their employees or members.