What are employers getting wrong with mental health?

In the last five years, 40 per cent of Canadians surveyed said they have taken time off work due to mental health.

Notably, nearly half of those took more than a month away from work, says a new report published by the Future Skills Centre.

And if it's gotten to a point where an employee needs to take a month off, it's really bad, says Catherine Connelly, professor of human resources and management at McMaster University in Hamilton, Ont.

“At that point, they probably have high blood pressure or maybe they've tried medication and it's not working — likely a number of things have been tried. And the underlying causes of why somebody is experiencing this are not necessarily being addressed by the company.”

These could include workload, staffing issues, internal processes or stressors, an unsafe work environment, or issues with psychological safety, she says.

“There’s a list of things that you can think of that contribute to a workplace that's leading people to burn out and needing time to recover.”

With the pandemic, workplaces have gone through quite an upheaval, leading many people to retire early or look for a new job, or find a new one but not be given much in the way of onboarding.

“Everyone's doing their best, but I think it could be time for an assessment of what's working and what needs to change,” says Connelly.

And with the huge shift of many people moving online, some of the issues have been kept under the surface, she says.

“It’s easier to be that duck who's swimming furiously, but you can't see the legs going… there could easily be people overworking way too many hours, but it's out of sight out of mind.”

Mental health culprits: Job demands, work environment

The report backs up Connelly’s comments — 80% of the respondents said that their job demands and work environment were the primary culprits for taking the time off work.

This finding suggests that the workplace’s structures, processes and policies may be directly responsible for the deterioration of mental health or the aggravation of pre-existing conditions, according to Improving the Quality of Work in Canada: Prioritizing Mental Health with Diverse and Inclusive Benefits, based on a survey of over 500 Canadians, along with interviews with 35 stakeholders from diverse sectors, and an extensive review of over 100 pieces of literature.

“People are just getting themselves to a point where they're so profoundly burnt out that they can't work for longer periods of time, so they need that recovery period,” says Olga Morawczynski, co-author of the report and founder of Heal-3, provider of wellbeing solutions.

“Often, it does lead to longer-term disability, just to really settle, to ground, to manage their mental health, to not only access to the services they need, but then obviously put into place whatever their recovery process is.”

Employers need to recognize and understand that the way that they're structured or the way that their work happens in the workplace may be causing new mental health issues or contributing to mental health issues that employees already have, and exacerbating that, she says.

“Once those factors are really identified, and you hear what employees have to say, and where they're finding it difficult, and you pinpoint those areas, then you can really start to take action... to make sure that as an employer, you constantly understand what's happening and are constantly taking preventative measures, before things blow up.”

“It's not just about employees doing the work — it's also critical for the employers to figure out which of their policies, practices, culture is not conducive to mental health.”

Economic uncertainty has also been a huge concern. Most Canadians reported that their mental health has been affected by family-related pressures (63%) and financial concerns (62%), says the report, including pressures with inflation and the cost of living.

Are traditional mental health treatments effective?

When it comes to seeking help and support, less than a quarter of survey respondents say they use mental health treatment options that are typically covered by benefit plans, such as therapy (21%) and prescribed medications (25%), found the report.

In talking to some mental health experts, they say that up to 60% of the population is treatment-resistant, says Morawczynski.

“What that means is that traditional therapy, and some of the medications that are covered under benefits, just don't work with this particular group of people.”

And while 80% of those surveyed have access to benefits, 40% still have to take time off work, she says, “so we're already starting to see a disconnect between what's offered and what people need.”

But there could be a few factors behind the lower usage numbers, says Connelly.

“Making psychological counseling available is the bare minimum, but I think it really needs to be high-quality counseling.”

For example, often an EAP will provide a limited number of sessions or provide underpaid or inexperienced counsellors, she says.

“Then there's also the issue of: Are the workers able to access the benefits, in terms of is the scheduling going to allow it? So if you have a worker who's overwhelmed, they're working, they have an unpredictable schedule, they have family responsibilities, and then being able to attend 12 counseling sessions is maybe feasible, but it may not be feasible,” says Connelly.

“So if people turn around and say, ‘Oh, well, workers are not even taking advantage of what's available,’ people need to take a step back and just look at, ‘Why are they not accessing it? And is it because it's poor quality? Or they're not aware of it? Or their schedule just does not allow them to do that?’”

Do alternative forms of mental health support make sense?

Many of the respondents also said they rely on socializing with friends (47%), mindfulness activities (46%), and cannabis (16%) to improve their mental health. A further 55% use holistic modalities and alternative therapies, such as yoga, meditation, acupuncture, reiki, and nutritionists.

The majority of these care and wellness modalities, however, are not covered by traditional benefit plans, says the report.

“If I'm really struggling with my finances or fertility, I don't know if therapy or medication are going to help me. But there could be other expertise that can really help me to navigate these very specific and unique issues,” says Morawczynski.

As an example, flexible spending accounts can provide employees with pools of money to spend on whatever it is that they feel might be helpful, she says.

“If you want to see a fertility doctor, if you want to see a financial coach — whatever it is that you want to do, this type of account should allow you and give you the resources to do so.”

However, employers need to be careful about what they're going to fund, and consider the return on investment, says Connelly.

“There’s a lot of evidence supporting cognitive-based therapy as a treatment for anxiety or depression. The evidence is not there for things like reiki,” she says.

“If it's worth it, then of course they should fund it. But I always worry if a company is providing something like cognitive-based therapy — which, I mean, it's time consuming, it's work for the employee — but then also reiki, which doesn't have evidence supporting it as a treatment for depression or anxiety… And it's even worse if the company is presenting them as two equally valid alternatives.”

Pros and cons to new types of modalities

The survey also found that 30% of respondents would participate in psychedelic-assisted therapy if it were legalized, while 39% would consider doing so if they had more information.

There's space for new types of modalities and new types of therapies, especially for treatment-resistant populations, says Morawczynski.

“From what we're seeing in the research, there is huge cost savings and also a really interesting, positive impact with some of these treatment-resistant populations around PTSD, anxiety, depression. So I think it's something for us to monitor.”

But an employer needs to be careful if it’s going to endorse that approach, says Connelly.

“For the company to suggest that somebody use this as a treatment plan, without a consultation with the person's family physician, then I think that's a risky approach. And it’s not as well supported by the available evidence compared to other approaches.”

Cannabis, for example, has been better researched because it’s been legal for awhile, she says.

“So if a company is deciding on where to spend the benefits dollars, probably they're going to go with something that has more evidence behind it.”

Also promising? Alternative modes of delivery, such as apps, says Connelly.

“We’ve seen a rise in app-based cognitive behavioural therapy. And it's all done by text or on the computer,” she says. “The compliance rate is so high because they're so convenient. [People] can do it while they're cooking dinner or waiting for the bus or you name it.”

Overall, there’s a real opportunity for employers to address issues “before we get to a point where a person is out for a month or more, or goes on longer-term disability,” says Morawczynski.

“That's what we need to think about is how to align benefits to support preventative mental health and give people access to the right resources to do so.”