The statistics are sobering. Each year, about 1 in 5 adults in the U.S. experiences a mental health issue, and studies show such struggles don’t just happen before 9 a.m. and after 5 p.m. A 2013 Gallup-Healthways Well-Being Index found that full-time workers with depression missed, on average, four more workdays in a year than their peers and that the American economy takes a $23 billion productivity punch to the gut annually because of workers’ mental health issues.
But scarier threats can loom. Each year, nearly 2 million Americans say they have been victims of workplace violence, according to the U.S. Department of Labor’s Occupational Safety and Health Administration. In Chicago business circles, that statistic resonates after the July 31 workplace shooting of ArrowStream Inc. CEO Steven LaVoie by an executive who had recently been demoted. The gunman, 59-year-old Anthony DeFrances, then fatally shot himself in the LaSalle Street office. At press time, Mr. LaVoie remained in serious condition at Northwestern Memorial Hospital.
The odds of such assaults are extreme. But how much responsibility an employer must shoulder in preventing them is receiving fresh scrutiny nationally in the wake of Obamacare as well as such tragedies.Thankfully, there are plenty of resources if you know where to look. “Like almost any illness, the earlier you treat mental health issues, the better off you are,” says Mark Heyrman, chair of public policy at Mental Health America of Illinois and an instructor in mental health law at the University of Chicago. Since 43 percent of Americans get their health insurance through their employer (according to a Gallup-Healthways report on the first quarter of 2014), instead of viewing mental health programs as a cost, business owners should view them as an investment.
Simply put, “It’s going to be better for the company financially if you’re able to keep folks mentally healthy,” says Elliot Richardson, CEO of the Small Business Advocacy Council in Chicago.
“EAP programs, usually they’re very good at dealing with real-life problems and stresses,” says Royce Lee, associate professor of psychiatry at the University of Chicago. “And they will act as a transition to get the person to the next phase.” For workers facing ongoing issues with depression or other mental illnesses, the EAP can help secure ongoing treatment with an outside provider.
That’s a good thing, since the statistics show more people, particularly working-age adults, in crisis than before. From 2000 to 2011, the suicide rate rose 41 percent for 55- to 64-year-olds, says Timothy Classen, an associate professor at Loyola University Chicago’s Quinlan School of Business, who researches health economics. “Through the recession,” he says, “the working-age population has really suffered in terms of suicide.”
Small businesses with fewer than 50 employees are not required by law to sponsor health insurance or mental health coverage. But more are taking the option: 3 out of 4 American businesses use EAPs. For businesses with more than 50 employees, the terrain is changing. In November, the U.S. Department of Health and Human Services published the final rules implementing the Mental Health Parity and Addiction Equity Act, which applies to group plans sponsored by employers with more than 50 workers. Not all such plans must provide mental health and substance abuse benefits, but, if they do, the benefits must be on par with medical and surgical benefits. Visits to counselors or treatment programs, co-pays, deductibles and caps on doctor visits, for example, must match those you’d receive for a typical medical issue or surgery.
ABOVE: “We make sure our employees know (the EAP is) there for everything,” from marriage problems to line-of-duty deaths, says Brian Adcock, training director at the Frankfort Fire Protection District. Photo: Manuel Martinez
Of course, not all EAPs are equal. The most basic plans—some of which are free and tacked on to standard health insurance contracts—consist of little more than a toll-free number that is staffed 24/7 and that employees can call confidentially. Usually counselors are trained to field a variety of issues, from depression to life changes such as births, deaths and divorces.
“Certainly phone works if someone merely needs information or is in crisis,” says Bernard Dyme, CEO of Loop-based EAP provider Perspectives Ltd. But Mr. Dyme and other experts argue that businesses should, in the least, consider plans that include some sort of in-person, short-term counseling, whether it’s conducted by an EAP counselor or referred out. Some EAPs also offer “critical incident stress briefings,” in which counselors visit a workplace after a traumatic event, such as an on-site robbery, the unexpected death of a staffer or an industrial accident.
The cost? For a basic “hotline” plan for a company with fewer than 100 employees, $2,000 to $2,500 annually, which typically works out to the employer paying as little as $1 or $2 a month per person, says Peter Bensinger, president of Loop-based EAP provider Bensinger DuPont & Associates. This year, his firm initiated a $2,250 program for businesses with fewer than 150 employees; it includes five face-to-face sessions. Other providers let employers pay a retainer and then a $350 to $600 hourly fee for evaluations of individual employees.
At ComPsych Corp., a 30-year-old Streeterville-based EAP provider that covers some 62 million workers in 120 countries, plans range from $12 to $24 per employee per year for midsized and larger companies. With very small employers, ComPsych charges a flat fee of $2,000 to $3,000 per year for the entire workforce. Both pricing structures are a capitated fee, or a set payment per employee, regardless of how much the person uses the EAP. “People get work-life help, legal and financial help, child care help, with everything under the same umbrella,” says neuropsychologist Richard Chaifetz, founder and CEO of ComPsych, which had $372 million in revenue in 2013. “It’s a phenomenal bargain.”
Usage varies, but on average, providers say only a range of 3 to 8 percent of workers use the plans in any given year. “We make sure our employees know (the EAP is) there for everything—marriage problems, gambling problems, addiction problems and even line-of-duty deaths if they were to happen,” says Brian Adcock, training director at the Frankfort Fire Protection District in Will County, which uses Bensinger DuPont’s EAP. “It’s a resource, a confidential outpost. If you just want to pick up the phone and talk to somebody, nobody knows about it.”
For remaining employees, counselors can be stationed to talk through changes in the organization. Group gatherings, which occur within 72 hours after an incident, let people identify coping strategies and resources they can use to help them.
Sometimes there are cases, too, in which a worker makes his peers feel uneasy, Perspectives’ Mr. Dyme says. EAPs can facilitate or provide “threat assessment services,” in which an employee is evaluated.
AT RIGHT: Bernard Dyme, CEO of EAP provider Perspectives Ltd., says businesses should consider EAP plans that include short-term, in-person counseling. Photo: Stephen J. Serio
Typically a manager calls the EAP with concerns about the employee’s behavior and then does either an informal referral, encouraging an employee to see the EAP for counseling sessions, or a formal referral, requiring the employee to see the EAP to keep his or her job (usually following direct or indirect threats or positive tests for drugs or alcohol), according to ComPsych. The EAP, which consults with human resources on how to handle a threat-of-violence situation, also should help in any return-to-work activities and provide counseling to employees who may have been victimized or who are having a reaction to the event or person.
While the issues can be delicate, employers are ethically obligated to protect their employees.
“If somebody is a danger to themselves or a danger to other employees, the employer can step in,” says Thomas Mandler, a partner at law firm Hinshaw & Culbertson LLP in Chicago. “It is not realistic to expect an employer to protect employees from all dangers caused by other employees. There are some legal obligations, but they are not the only reasons to be concerned for the safety of employees.”
One sticky spot for managers is initiating the conversation. The Americans With Disabilities Act protects people with mental disabilities, not just physical ones. An employer can’t go up to an employee and say, “I think there’s something wrong with you,” says Margaret Spence, a West Palm Beach, Florida-based expert panelist at the Society for Human Resource Management and founder and CEO of Douglas Claims & Risk Consultants. It’s OK to say, “ ‘You’re showing some challenges getting the job done.’ Then you’re connecting the dots, which is legal,” she says.
Ms. Spence offers this anecdote as an example: An employee kept forgetting where she put her work. Instead of trying to diagnose or label the problem, her employer was advised to approach her and say, “Your work performance is not good right now because we cannot find anything on your desk.” From there, her supervisor encouraged her to speak to the EAP provider, and she agreed. With her permission, the EAP provider contacted her family, which disclosed that the employee had early-onset Alzheimer’s. The business ultimately arranged for her early retirement.
If the employee acknowledges a problem, Ms. Spence recommends that the employer step out of the room and let the staffer call the EAP and discuss the issue confidentially. If the employee denies having a problem, it gets tricky for those in command.
If a major problem is hurting job performance, bosses can speak up, but carefully. “You can’t go up to an employee and say, ‘Are you crazy or are you having nightmares or are you having suicidal thoughts or are you going to kill me?’ “ Mr. Mandler says. “You can’t lay somebody off and say, ‘Don’t come back with a gun tomorrow.’ “
He and other experts recommend careful documentation of how someone’s work performance is suffering—if, say, a typically punctual and responsible employee starts chronically showing up late or missing workdays altogether. Legally, employers can act only if an employee’s circumstances affect the job. Start by documenting the behavior and constructively confronting the employee. Then consult a lawyer or an EAP representative or both (see “When you suspect an employee is in trouble”).
“Companies are not in the business of diagnosing mental health issues,” Mr. Chaifetz says. “They’re in the business of making sure their employees are performing at optimal levels.”
Show interest in special events in a colleague’s life, she says. “Just saying ‘Good morning’ to them and ‘Would you like to have lunch with me?’ goes a long way.” If an employee seems to be struggling, see what kind of support you can offer, Ms. Heybrock says. Ask if the employee’s workload could be reduced or if a team member could help with a project. Offer flexible hours, if appropriate. And if you offer insurance with mental health benefits, make sure the employee knows about it, she says. Let people know that they are available for a wide range of issues, not just life-and-death situations.
At the end of the day, experts say, bosses should make sure they stop and say hello to their employees. “Every small-business owner is wearing 10 hats,” Ms. Spence says. “If employers ask someone, ‘How are you doing?’ and ‘Is there anything I can do to help you?’ just passing that question on to employees gives them the sense that somebody cares. As organizations, I think you have to put back the caring, the empathy and the understanding into the work.”