A hidden crisis made visible

Before the pandemic, mental health was often treated as an afterthought to physical health in the support offered by employers. A steady rise in ‘workforce wellness’ programs has clearly been underway in the US, driven by factors including the need to contain healthcare costs and attract and retain talent. Additionally, more progressive companies have recognised the close links between engaged employees and better business outcomes.

While most employers see employee mental health as a priority—with 96% of CEOs believing they are doing enough, according to one study—the increasing demand for behavioural health services presents challenges. For example, the average annual spending per employee experiencing mental health issues is US$15,000, with these employees costing US$3,000 more in healthcare services annually compared to their peers. Despite the reported return of US$4 for every dollar invested in mental health treatment, organisations have tended not to develop mental health-specific strategies.

Such statistics inspired the Mental Health Parity and Addiction Equity Act, passed in 2008, which stated that mental health benefits in health plans should be comparable to physical health benefits, yet this mandate has not been fulfilled.

This failure is surprising given the prevalence of mental health issues in the US population, where one in five adults has experienced mental illness in some form. Very few get the help they need. One study of over 36,000 people found that 62% of those with mood disorders, 76% with anxiety disorders and 81% with substance use disorders had not received treatment. Reasons include inadequate service provision, with more than 112 million Americans living in areas where mental health providers are scarce; lack of awareness and support systems; and mental health– related stigma. In fact, the American Psychiatric Association suggests that more than 50% of those with mental illness do not get help mainly because of stigma, prejudice and discrimination against those with mental illnesses. “For decades there have been medically assisted treatment programs for mental health and substance abuse which have been underutilised,” says Chester Spell, professor of management at Rutgers University.

Yet economic constraints are also especially salient. In a 2018 survey by the National Council for Behavioral Health, 42% of respondents cited cost and poor insurance coverage as key barriers to accessing mental healthcare. One in four respondents had been forced to choose between obtaining mental health treatment and paying for daily necessities. Piling on top of this existing crisis came the pandemic, through which the impact on mental health has been catastrophic. According to the World Health Organization, global demand for mental health services has risen rapidly since the pandemic began, for reasons including bereavement, isolation, loss of income and fear, just as critical services were halted in 93% of countries.

The US has been especially hard hit. Gallup reported that almost half of US workers were concerned about one or more of four possible job setbacks—reduced hours, reduced benefits, layoffs, or wage cuts. In 2020, more than 35% of the workforce reported experiencing symptoms of depression due to the pandemic, while 70% reported the workplace itself to be a source of stress. “The US has seen tremendous progress in legitimising and acknowledging that mental health is a serious issue,” says Kate Bezrukova, associate professor of organisation and human resources at the University at Buffalo. “We are doing pretty well compared to a lot of countries, but there is much room for improvement.”

Karen Moseley, president of the Health Enhancement Research Organization (HERO), worries that well-being programs are a low-hanging fruit for companies to cut from their budget in economically challenging times, “which we’re still living through. Conveying the value proposition— that it is something to sustain or even increase in the future—is imperative.”

The impact of the pandemic on mental health is long term. First, it has led many people to re-evaluate their lives and the ways they had been struggling in silence prior to covid-19. “The pandemic has made people realise just how stressful work is—just getting to and from work in big cities. It removed the veil, and people have realised things they did not think about before,” says Spell.

Working from home, home-schooling children, reducing social interactions and working more hours under stressful circumstances has had negative consequences on physical and mental health for some, with effects related to individual workers’ demographic characteristics, individual capabilities and occupations. Caregiving and conflicts between work and family have been integral to the pandemic’s mental health toll, but managing the interface between family and work are long-standing problems facing the workforce, argues Bezrukova.

The pandemic will also cast a long shadow in terms of the knock-on mental health effects of lockdowns. Mental illnesses increase the risk of physical health problems such as obesity and cardiovascular disease, and vice versa: poor physical health may increase the risk of mental health problems. As a result, the poor lifestyle habits that some have adopted, including poor diet, sleep and lack of physical activity, may over time create the perfect storm of physical and mental comorbidities.

The pandemic has changed work itself in permanent ways. The shift to hybrid or remote work is the most obvious and arguably the biggest change. Before 2020, only 17% of US employees worked from home for five or more days per week, increasing to 44% during the pandemic. Employers and employees adapted with admirable speed thanks to video-conferencing platforms and new ways of working in digital formats, but this change has had varied mental health implications.

Some employees have welcomed working from home and appreciated reduced commuting time, the lack of distractions of open-plan offices, and the chance it has offered to move to more affordable locations. Survey data indicate that employees from ethnic or racial minority backgrounds were more favourably inclined to remote work for additional reasons, including sparing themselves from ‘microaggressions’ in the workplace and ‘code-switching’ (changing how they talk, dress or behave to fit into majority-white workplaces).

But there is plenty of evidence that some groups are disadvantaged by home working, including those who live alone, those in confined living spaces, those with more extroverted personalities and those with disabilities who may have required employer assistance in ergonomic tools and supports. Working from home has also led to a generalised increase in working hours and a diminished ability to separate home from work.

Showing that mental health matters

The mental health crisis accentuated by the pandemic presents an opportunity for companies to think and act more strategically in regards to their staff’s mental health and psychological well-being—and there is a long list of reasons to do so. Poor mental health related to work is correlated with a range of chronic diseases which are huge financial burdens for companies in the US, where there is limited state-provisioned public health. Stress and anxiety are linked to physical health conditions including obesity, diabetes, heart disease, and cancer. The cost of mental health conditions is projected to reach US$6 trillion globally by 2030, up from US$2.5 trillion in 2010, more than cancer, diabetes, and respiratory ailments combined. Of these costs, about a third relate to direct costs of diagnosis, treatment and care, with the remainder attributable to indirect costs such as lost productivity and income due to disability and death.

Work itself can be a cause of ill mental health through stress, interpersonal tension or anxiety. The field of ‘positive psychology’ frames mental health as a positive, active state achievable through states of ‘flow,’ focused engagement and psychological satisfaction earned by developing skills and mastery. That is to say, mental health is not merely the absence of disease but the presence of positive psychological states. The workplace can contribute by creating an environment that nurtures engagement, flow, mastery and autonomy, which are key positive psychological states. The social networks that form around work are also valuable in sustaining mental well-being, as became evident during lockdowns. Work, at its best, can be integral to personal fulfillment.

There are competitive reasons to pay more attention to employees’ mental health. We are, headlines suggest, amidst a ‘Great Resignation,’ with record numbers of US employees quitting their jobs over the last year. This trend is complex, with many cases resulting from extreme burnout. Now classed as a syndrome in the WHO’s 11th revision of the International Classification of Diseases (ICD-11), burnout is specifically applied in an occupational context, with poorly managed, chronic workplace stress as the cause rather than a symptom.

Turning away from draining and unsatisfying work and instead seeking a better future may represent an American labour force re-examining its values. A recent US survey found that confidence among consumers about labour market prospects was at a two-decade high. The trend will accelerate as a result of demographic transition, with younger people more likely to expect mental well-being to be part of the conversation about their employment—and more likely to be open about discussing it in professional contexts.

Young people are speaking openly about their mental health issues in ways not common in previous periods. A 2020 Deloitte global survey found that around a third of millennial workers said they have taken time off work due to stress and anxiety since the start of the pandemic. Young people are now also more likely to leave their job voluntarily to preserve their mental health. A 2021 survey showed 81% of Gen Z’s and 68% of millennial workers have done so, an increase from 75% and 50% respectively in 2019.