Experts are warning of a second wave: a “psychological pandemic.”
What to do when your employees are not OK.
Stephen was Morgan Stanley’s fix-it guy. The financial firm tasked him with untangling the most complex quagmires in its global trading business. The chief operating officer and two-sport Dartmouth alum never met a problem he couldn’t solve—until he did. “I was overmatched,” says Stephen (full name withheld) in his piquant New York accent.
30 years,
for
The pandemic has exacerbated stress and imposed isolation, eliciting a rise in mental health and addiction issues
among workers.
The Problem
These potentially devastating ailments cost billions in productivity, and firms can no longer afford to look away.
WHY IT MATTERS
An explosion of new hybrid teletherapy programs aims to do what past approaches did not: heal the workforce.
THE SOLUTION
When Stephen walked away from his career in 2015 at age 55, he recalls his mother saying, “I thought you’d work there until you were 80.” Rather than an act of defeat, leaving Morgan Stanley was the beginning of an arduous quest for answers that proved all-consuming. One of Stephen’s five children began drinking heavily as a teenager, almost dying a handful of times before his 17th birthday. The binges were interspersed with depression, suicidal ideation, and difficult-to-understand character adaptations. The stress and uncertainty of the situation began to corrode Stephen’s marriage. Neither parent knew what to do. “When you have a kid who is off the rails, you can’t think of anything else,” says Stephen, who threw himself into finding answers, going as far as enrolling in the Harvard Advanced Leadership Initiative to take courses in addiction neuroscience, psychopharmacology, and public health. Today, as executive vice president of the nonprofit Shatterproof, he’s working to educate employers about substance abuse and what they can do to intervene.
His effort, however, only scratches the surface of how pervasive the problem has become. According to a new study from the University of Chicago and the National Safety Council, roughly 15 percent of workers have a dependent with a substance-use problem. Another 10 percent of employees suffer from addiction themselves, a foreboding indicator of the state of employee mental health. While some industries, like entertainment and construction, have higher rates of addiction, a quarter of the workforce across the board, regardless of collar hue, is directly affected by this destructive disorder, and it’s costing corporations billions. What’s more, experts predict those numbers are on the verge of ricocheting upward.
Whether it’s addiction or depression or the countless other psychological maladies on the rise, a growing number of businesses are coming to terms with the magnitude of the mental health crisis, updating old employee assistance programs (EAPs) with so-called "behavioral healthcare” programs. “It's no longer 'pull yourself up by your bootstraps and just deal with it,'" says Mandie Conforti, director of health and benefits for the insurance broker Willis Towers Watson. Even so, experts worry that the pandemic may be making the current plight only more dire. Frank Snowden, a historian of pandemics at Yale and the author of Epidemics and Society: From the Black Death to the Present, has warned of a second wave: a “psychological pandemic.” Not only did COVID exacerbate an entire spectrum of anxieties, it imposed a full year of social isolation—conditions described in the American Journal of Psychiatry as a “perfect storm,” soon to make landfall in the form of rampant mental health afflictions.
Will companies be better prepared to weather the battering ahead? Morgan Stanley’s Mr. Fix-It isn’t optimistic. “The workplaces are not ready," Stephen says. "This is going to be heavy.”
most employers had only one response to emotional and substance-use issues: look the other way. While Conforti says EAPs, the primary means of addressing mental health afflictions in the workplace, have been around since the 1970s, employees never learned how to navigate what were essentially sparse offerings. According to one study, large employers spent $2.6 billion in 2016 dealing with opioid addiction alone, up from $300 million in 2004. Heavy drinking, meanwhile, is estimated to come with an $82 billion price tag in lost workplace productivity (about 500 million lost workdays). Overall, Conforti says, corporate costs of substance use have been on the rise for years, and in many cases have surpassed those of other chronic medical conditions.
FOR DECADES,
Read the full Magazine
WHY IT MATTERS
The Problem
THE SOLUTION
caution
“IT STARTED BY ACCIDENT,”
says Matt (full name withheld). He wasn’t a big drinker. He smoked weed every once in a while but never used drugs beyond that. No one in his family did. And then, in his mid-20s, during a particularly intense period at work, Matt developed a kidney issue. In the months before surgery could be scheduled, doctors prescribed codeine to ease the pain. Not only did the pills relieve the physical discomfort, they lulled the psychic tension as well. Suddenly, he was eager to go to work. He was more productive. Less anxious.
Careful not to drive impaired, Matt—who, until pandemic layoffs, worked in the cryptocurrency department of a major bank in the United Kingdom—would bring an assortment of painkillers and “benzos” with him to the office each day. While others were refilling their coffee mugs, he was methodically gulping pills, either legally prescribed or bought off the dark web, just enough to take the edge off without overdoing it. “It’s a slow thing,” he says. “You don’t realize until it’s too late.” Now 30, he has tried to quit countless times, but the withdrawal always proves unbearable. A 12-step program didn’t feel right, and talk therapy wasn’t enough. Even though the addiction is destroying his life—he’s broke, has significant memory loss, and lives alone to hide his secret—he can’t bring himself to tell family or colleagues. “The benefits are no longer there; it’s only negatives,” he says.
Companies now have a plethora of digital services
to choose from to promote employee well-being, from meditation apps to all-in-one therapeutic-service platforms. There’s even an option for kids.
JOB
inside
headspace
A meditation app designed to cultivate mindfulness and improve sleep.
Offers blended care management with physician direction, as well as self-guided digital tools and content.
Lyra Health
Support for both parents and kids, including speech therapy and fun-for-the-family learning exercises.
Brightline Health
Online therapy with licensed therapists and psychiatrists. Anywhere, anytime, any medium.
Talkspace
Provides a case assessment and care plan, then connects users with the right professionals.
Matt says he wouldn’t hesitate to sign up if his employer offered another solution. Yet a Willis Towers Watson survey in 2019 found that only 22 percent of employers have a plan to address opioid use. New research shows that drugs that alleviate withdrawal symptoms and mitigate cravings are the most effective means of curbing opioid use and potentially even alcoholism. But it can be difficult to find doctors who prescribe these medications, and many people are unwilling—for a variety of reasons, shame not least among them—to show up at brick-and-mortar clinics, where the lines of agonized faces often stretch for blocks. During the pandemic, however, when medicine went online overnight, governments loosened face-to-face prescribing requirements; for the first time, insurers, including industry bellwether Medicare, began reimbursing telehealth providers. Suddenly there was an entire industry of virtual providers targeting employers, offering medical-assisted treatment as well as other wellness approaches.
To be clear, a Zoom link does not a tele-provider make. Simply moving AA meetings, doctor visits, and psychotherapy online is not the equivalent of what start-ups like Workit Health and the online recovery program IGNTD are attempting. These mobile treatment apps are created by UX designers, offer 24/7 services, and curate evidence-based content specific to the patient, including integrating artificial intelligence to tailor nonlinear care. This virtual treatment approach keeps costs low, allows users to maintain stability in their lives, and can easily be included in EAPs. And with the US Food and Drug Administration now regulating apps, digital addiction medicine boasts more oversight than inpatient therapeutic programs.
“This is a big part. First you have to reduce the stigma around mental health and substance abuse. You’re getting people comfortable enough to get help.”
02
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Quis autem vel eum iure reprehenderit qui in ea voluptate velit esse.
03
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Educate
Empower
“Make access to care easy and affordable so there’s no reason not to get help. You have to have a diverse set of offerings so you can meet people where they’re at. That might mean providing a talk-therapy app or inpatient treatment.”
Engage
“This requires a culture change. It needs to be OK to not be OK. If someone has a substance-abuse issue, it’s because something isn’t OK, and we need to be able to talk about that.”
Scroll through to discover what experts say about the Three E's firms should use to improve employee mental wellness.
HOW TO
Stage an
Intervention
In the case of Workit Health’s app, clients start by identifying their problematic relationships, whether with gambling, sex, porn, food, alcohol, or drugs. A treatment plan is built using a combination of therapies, including cognitive behavioral therapy, motivational interviewing, relapse prevention, and, if necessary, medication prescription. Then the user begins daily online exercises and weekly sessions with a coach or licensed counselor. The interactive curriculum continually adapts to each member’s evolving needs and gives real-time feedback. Workit Health, which saw a 325 percent increase in demand last year, doesn’t quantify recovery by total abstinence or a “spiritual awakening.” Instead, it uses a Thrive Meter to measure quality-of-life markers including sleep, physical health, and overall wellness.
These addiction-specific services are not unlike the influx of mental health and well-being apps that have soared in popularity recently. Since the pandemic, the meditation app Headspace has reported a 500 percent increase in interest from companies, with clients from Hyatt to GE to Adobe. Lyra Health, a digital platform for administering and managing mental health care, surpassed 1 million employee members in 2020 and was recently valued at $2.25 billion. There are countless more start-ups vying for space in this ballooning market.
“We saw this shock to the system,” says Harvard health economist Haiden Huskamp, who has published several papers on telehealth this year. And, of course, there are concerns. Without face-to-face contact, it’s harder for doctors to tell when a patient is lying. Perhaps most important, overdose and remission rates remain to be seen. Still, studies and anecdotes are beginning to make a strong case for digital platforms: people are more likely to initiate care, appointment no-show rates have plummeted, and users are sticking around longer than ever.
“For so long, we thought we had to make the medicine difficult to swallow,” says Adi Jaffe, the former UCLA psychology professor who founded IGNTD. “Let’s make it as easy as possible for people to access help.”
Last year, he created an easily digestible e-training course on addiction, consisting of six lessons at just five minutes each, for corporations across the country. First stop: JPMorgan Chase and its 250,000-person staff. Hundreds of thousands of employees at McKinsey & Company and General Electric, among others, have taken the course. “This is where we start,” he says. “It’s very difficult to navigate this on your own. You need to lead people to the resources.”
Whether or not the promise of tele-recovery will deliver is in large part up to companies. “They have a lot of influence over what’s covered and how,” Huskamp says. “It’s a powerful moment.” Employers negotiate with providers, design EAPs, and have the leverage to educate employees. One report shows C-level executives are suffering from mental health issues even more than their employees, which may explain their eagerness to embrace new approaches. When Workit Health first came on the scene in 2016, it was an enterprise product—but the market wasn’t ready, so it went direct to consumers. Now the start-up is partnering with major insurers. “First, we’re getting our folks to start the conversation,” says Brian Bloom, Korn Ferry’s vice president of global benefits. “Then we reinforce that conversation by having programs in place. It’s more than just having a benefit. You have to give folks flexibility and choice.'"
Read the full Magazine
That’s where Stephen comes in.
modern Health
Many employers are sidestepping barriers to in-person therapy—including provider shortages and long wait times—by providing supplemental access to virtual behavioral healthcare, which one study showed can reduce direct-care costs up to 90 percent. “You can’t talk to an employer today who isn’t looking at and refiguring their EAPs,” says Conforti at Willis Towers Watson. A 2021 survey of large companies, comprising more than 9 million employees in all, found that 69 percent of companies are currently offering mental health apps, which will grow to 88 percent by the end of the year. According to the survey, by the advocacy nonprofit Business Group on Health, nearly two-thirds of the companies will provide manager training to recognize deteriorating mental health and substance-use warning signs, and half will launch anti-stigma campaigns. Other employers are negotiating insurance plans that fully cover mental health services and rehab—not just for employees but also for their dependents. Some companies have gone as far as hiring on-staff psychologists.
Stephen’s son has been sober for five years and is hoping to become a psychologist. When Stephen’s nephew recently started to get into trouble with alcohol, right away he was sent to see his uncle, who pulled out a diagnostic manual. In a matter of minutes, they looked at his symptoms and it became clear: he needed help—which he got immediately. Matt, on the other hand, continues to struggle alone. “No sane person says, ‘I want to be addicted to drugs,’” he points out. “We are the invisible addicts. No one suspects us, because we have respectable jobs and nice cars. I would give anything to wake up tomorrow and never use drugs again.”
While no firms would suggest employees seek treatment for heart disease or diabetes outside the primary healthcare system, most do precisely that for mental health and addiction treatment. Meanwhile, residential and outpatient rehabs require people to leave their jobs and families for weeks at a time and cost tens of thousands of dollars, making them inaccessible to the majority. Until recently, most people looking to overcome addiction and alcoholism were presented with the same remedies used a century ago: abstinence and God. Though praised in many circles, Alcoholics Anonymous (AA), the most common clinical recommendation, has never been subjected to clinical trials. “Addiction treatment has been a black market,” says Robin McIntosh, cofounder of Workit Health, a hybrid digital recovery start-up.
Indeed, Conforti says firms have essentially sought to hide addiction as an employee problem by avoiding discussions of the treatment head-on. “Many companies address addiction from the backdoor—‘problems with sleeping, focus, depression, and anxiety,’” she says. “The majority of employers that are addressing this don’t come out of the gate saying here is communication on substance use.”
Providing supplemental access to virtual behavioral healthcare could reduce direct-care costs up to
By Meghan Walsh
Provides a case assessment and care plan, then connects users with the right professionals.
modern Health
Online therapy with licensed therapists and psychiatrists. Anywhere, anytime, any medium.
Talkspace
Support for both parents and kids, including speech therapy and fun-for-the-family learning exercises.
Brightline Health
Offers blended care management with physician direction, as well as self-guided digital tools and content.
Lyra Health
A meditation app designed to cultivate mindfulness and improve sleep.
headspace
By Meghan Walsh
When Stephen walked away from his career in 2015 at age 55, he recalls his mother saying, “I thought you’d work there until you were 80.” Rather than an act of defeat, leaving Morgan Stanley was the beginning of an arduous quest for answers that proved all-consuming. One of Stephen’s five children began drinking heavily as a teenager, almost dying a handful of times before his 17th birthday. The binges were interspersed with depression, suicidal ideation, and difficult-to-understand character adaptations. The stress and uncertainty of the situation began to corrode Stephen’s marriage. Neither parent knew what to do. “When you have a kid who is off the rails, you can’t think of anything else,” says Stephen, who threw himself into finding answers, going as far as enrolling in the Harvard Advanced Leadership Initiative to take courses in addiction neuroscience, psychopharmacology, and public health. Today, as executive vice president of the nonprofit Shatterproof, he’s working to educate employers about substance abuse and what they can do to intervene.
His effort, however, only scratches the surface of how pervasive the problem has become. According to a new study from the University of Chicago and the National Safety Council, roughly 15 percent of workers have a dependent with a substance-use problem. Another 10 percent of employees suffer from addiction themselves, a foreboding indicator of the state of employee mental health. While some industries, like entertainment and construction, have higher rates of addiction, a quarter of the workforce across the board, regardless of collar hue, is directly affected by this destructive disorder, and it’s costing corporations billions. What’s more, experts predict those numbers are on the verge of ricocheting upward.
Whether it’s addiction or depression or the countless other psychological maladies on the rise, a growing number of businesses are coming to terms with the magnitude of the mental health crisis, updating old employee assistance programs (EAPs) with so-called "behavioral healthcare” programs. “It's no longer 'pull yourself up by your bootstraps and just deal with it,'" says Mandie Conforti, director of health and benefits for the insurance broker Willis Towers Watson. Even so, experts worry that the pandemic may be making the current plight only more dire. Frank Snowden, a historian of pandemics at Yale and the author of Epidemics and Society: From the Black Death to the Present, has warned of a second wave: a “psychological pandemic.” Not only did COVID exacerbate an entire spectrum of anxieties, it imposed a full year of social isolation—conditions described in the American Journal of Psychiatry as a “perfect storm,” soon to make landfall in the form of rampant mental health afflictions.
Will companies be better prepared to weather the battering ahead? Morgan Stanley’s Mr. Fix-It isn’t optimistic. “The workplaces are not ready. This is going to be heavy.”
Many employers are sidestepping barriers to in-person therapy—including provider shortages and long wait times—by providing supplemental access to virtual behavioral healthcare, which one study showed can reduce direct-care costs up to 90 percent. “You can’t talk to an employer today who isn’t looking at and refiguring their EAPs,” says Conforti at Willis Towers Watson. A 2021 survey of large companies, comprising more than 9 million employees in all, found that 69 percent of companies are currently offering mental health apps, which will grow to 88 percent by the end of the year. According to the survey, by the advocacy nonprofit Business Group on Health, nearly two-thirds of the companies will provide manager training to recognize deteriorating mental health and substance-use warning signs, and half will launch anti-stigma campaigns. Other employers are negotiating insurance plans that fully cover mental health services and rehab—not just for employees but also for their dependents. Some companies have gone as far as hiring on-staff psychologists.
Stephen’s son has been sober for five years and is hoping to become a psychologist. When Stephen’s nephew recently started to get into trouble with alcohol, right away he was sent to see his uncle, who pulled out a diagnostic manual. In a matter of minutes, they looked at his symptoms and it became clear: he needed help—which he got immediately. Matt, on the other hand, continues to struggle alone. “No sane person says, ‘I want to be addicted to drugs,’” he points out. “We are the invisible addicts. No one suspects us, because we have respectable jobs and nice cars. I would give anything to wake up tomorrow and never use drugs again.”
Last year, he created an easily digestible e-training course on addiction, consisting of six lessons at just five minutes each, for corporations across the country. First stop: JPMorgan Chase and its 250,000-person staff. Hundreds of thousands of employees at McKinsey & Company and General Electric, among others, have taken the course. “This is where we start,” he says. “It’s very difficult to navigate this on your own. You need to lead people to the resources.”
Whether or not the promise of tele-recovery will deliver is in large part up to companies. “They have a lot of influence over what’s covered and how,” Huskamp says. “It’s a powerful moment.” Employers negotiate with providers, design EAPs, and have the leverage to educate employees. One report shows C-level executives are suffering from mental health issues even more than their employees, which may explain their eagerness to embrace new approaches. When Workit Health first came on the scene in 2016, it was an enterprise product—but the market wasn’t ready, so it went direct to consumers. Now the start-up is partnering with major insurers. “First, we’re getting our folks to start the conversation,” says Brian Bloom, Korn Ferry’s vice president of global benefits. “Then we reinforce that conversation by having programs in place. It’s more than just having a benefit. You have to give folks flexibility and choice.'"