Employee assistance programs (EAPs) may be one of the best-kept secrets for
many employers. Instead, EAP resources should be widely publicized to help
encourage participation by managers, employees, and their family members.
Providing support services for employees' personal and workplace problems
that have the potential to negatively affect work can promote vibrant workers
and mitigate risk.
Acknowledgment
Thanks to Dr. Jodi Frey and Jon Kinning for assisting in
the preparation of this article.
Many employers simply "check the box" when signing up for this
benefit, figuring health insurance will cover the mental health needs of their
employees; however, most employers really don't know what the EAP services
entail or the value the services can bring to a workplace. With that said, we
must remember that not all EAPs are created equal, and EAP services vary
greatly. The following are some common features.
- Biopsychosocial assessments, including substance use assessments
- Individual and family counseling
- Financial and legal coaching and referrals for counseling
- Referrals for additional services, with follow-up
- Psychoeducation through workshops, newsletters, and other communication
for personal and workplace concerns including but not limited to stress
management, parenting, mental health literacy, relationships, and
organizational change and individual crisis prevention, crisis response, and
ongoing support
- Mediation and team development
- Leadership consultation, coaching, and development
- Fitness for duty evaluations
- Suicide risk assessment, treatment, and "postvention" (i.e.,
what to do after a suicide)
- Staff training on best practices on how to support someone in
distress
Sometimes the services are very cursory, such as a brief telephone
assessment and referral by a contracted outside provider. Other EAPs provide
robust and high touch services like 24-hour support, online assessment and
information, telephone and in-person assessment and counseling, on-demand
crisis consultation, onsite workshops, incentivized mental wellness promotion,
and much more. Just like with many things, you get what you pay for, so
employers need to decide how much they are willing to invest in the mental
well-being of their workers and conduct a cost-benefit analysis. However, EAPs,
even more customized programs with on-site services, have been shown to be
cost-effective to employers through the years.
Workplaces That Have EAPs
100%
86%
85–97%
68%
44%
27%
Federal Employees
State Employees
Large Private Sector
100–499 Employee Workplace
51–99 Employee Workplace
<50 Employee Workplace
Attridge, et al (2018)
Are EAPs Effective?
While the research on the effectiveness of EAPs is limited, studies have
found that employees' use of EAPs enhanced outcomes, specifically
significant improvement in presenteeism, life satisfaction, functioning, and
often absenteeism.1 In one longitudinal, controlled
study, EAP participants were more likely than non-EAP participants to see a
reduction in anxiety and depression.2 Another
matched control study found that users of EAP services often reduced their
absenteeism more quickly than non-EAP users experiencing similar
challenges.3 In another longitudinal
study,4 86 percent of people who were suicidal when
they engaged with their EAP were no longer suicidal at the 2-year follow-up.
Researchers have concluded that, while not all EAPs are created equal, they
often provide accessible services that are effective at improving employee
mental health and well-being.
Can EAPs Support Employers Facing Employee Suicide?
When it comes to the life-and-death issue of suicide, EAPs have the
potential to provide evidence-based suicide prevention, intervention, and
postvention services to employers. The EAPs' contribution to the
comprehensive workplace suicide prevention strategy is essential, and many
would benefit from annual state-of-the-art training in evidence-based methods
of suicide risk formulation and treatment to help distressed employees get back
on their feet.
Social workers, who provide the majority of EAP clinical services in the
United States, often report having no formal training in suicide formulation,
response, and recovery,5 so annual continuing
education on suicide intervention and suicide grief support is often helpful to
providers. Once trustworthy and credentialed providers have been identified,
they should be highlighted in the "suicide crisis" protocol, so that
companies are not trying to do this legwork in the midst of a crisis.
"[When it comes to supporting someone in a suicide crisis] Where do
we find counselors who know what to do?"
If one of the main messages in suicide prevention is "seek help,"
we need to make sure the providers are confident and competent with best
practices approaches to alleviating suicidal despair and getting people back on
track to a life worth living. Thus, dedicated employers will evaluate and even
challenge their EAP providers to demonstrate continuing education in the areas
of suicide prevention, intervention, and postvention skills. In fact, some
states are mandating that all mental health professionals, including licensed
providers of EAP services, have some sort of ongoing training in suicide risk
formulation and recovery.
Do Employees Know about the EAP and Its Benefit?
In addition to making sure the providers have the needed skills, companies
need to make sure that their employees know when and how to access the care.
Recently, the American Heart Association CEO Roundtable worked with experts in
the behavioral health field to develop a white paper for employers,
Mental Health—A Workforce Crisis,
which includes seven specific actions employers can take to improve the mental
health of their employees.6
Dr. Jodi Frey, expert panelist for the report and internationally recognized
expert in the EAP and broader behavioral health field, recommends that
"employers need carefully consider their workplace's needs when
selecting an EAP, and then should work with their EAP as a strategic partner to
develop programs and communications that encourage utilization of the program
and continued evaluation to improve services over time."
Employers who are mindful of their workers' well-being will continually
promote well-vetted and employer-backed resources throughout the career of the
workers. Leadership testimonials of the efficacy of the resources after the
leaders have used them for their own mental health would bring credibility to
the resources and model appropriate self-care to the employees. Bringing the
resources on-site to the workers (and not waiting until the workers stumble
upon the resources) is another way to break through the barriers to care. The
Employee Assistance Society for North American (EASNA) developed a guide,
Selecting and Strengthening Employee
Assistance Programs: A Purchaser's Guide, to help employers
evaluate EAPs and determine appropriate vendors. The guide also can be used to
help employers evaluate their current EAP and decide if needs are being met or
if more attention to what services should be offered needs to be addressed.
Are There Different Types of EAPs?
Much diversity exists in EAP structure and quality.7 Some companies use internal EAPs, where providers are also
employees of the company. This arrangement often provides the benefit of having
an immediate resource that has a clear knowledge of the company and industry
culture. Evaluation of internal EAPs have found increased utilization,
customization, and supervisor referrals;8 however,
there are some drawbacks. Internal EAPs, because they are so closely connected
to the company, run the risk of being perceived as having blurred lines of
confidentiality and objectivity. By contrast, external EAPs are often more
diverse and can respond 24/7 across a vast geography. Because of these benefits
and consequences, many companies have moved to a hybrid model to get the best
of both models.
Hybrid EAPs often have an internal employee to manage the EAP and to work
with managers and employees on critical incident response, strategic planning,
organizational change, and to provide on-site assessment and problem
resolution. They can be an important ally for the employer to best understand
the potential for an EAP and to help with an ongoing evaluation that EAP
providers are effective in their response and offering high-quality
services.9
EAPs are most effective when they understand the industry and organizational
culture, have business acumen, and can adapt to changes in organizational
structure.10 Thus, employers seeking to find a
"best fit" for their employees will interview mental health providers
about their knowledge of the unique stressors and strengths on the industry.
Some industries (e.g., emergency responders and aviation) have gone so far as
to credential mental health providers as being "specialists" in their
industry to avoid a mismatch.
15 Questions To Ask To Strengthen the Mental Health Safety
Net
Employers should remember they are the customers of their EAP, and
they should do the due diligence of making sure they are getting the
best benefit possible. Here are 15 questions employers should ask about
their EAP to get the best services possible.
- What services does your EAP cover? Are these services available
24/7?
- Who answers the calls of the EAP, and how are they trained and
supervised? What professional and educational preparation and
certifications do they have? Are they licensed?
- How are counselors selected and trained? Are certain licenses and
other credentials required to be a part of the EAP provider
network?
- What types of training have EAP providers received? Specifically,
when was the last time they received training in suicide risk
formulation and treatment?
- How is your EAP reporting utilization? How does your
workplace's utilization rate compare to others in your industry,
and what can be done by the EAP and by you as the employer to
encourage more utilization?
- Do your employees know about your EAP services and how to access
them?
- For those who have used the EAP, how satisfied were they with the
services? Did the services have a positive impact on the problem for
which they were seeking support?
- When employees completed EAP services, did the EAP follow up (or
attempt to follow up) with the employee to make sure all needs were
adequately met?
- How does your EAP interact with health plans? Are EAP providers
also providers of outpatient mental health, and if not, are they
well-versed in the benefits of employees to make effective and
seamless referrals?
- How is your EAP measuring outcomes? Can they also provide you
with a return-on-investment or other cost-benefit analysis?
- How is the EAP promoting "upstream" mental health
efforts like prevention, resilience, positive psychology, and
work-life integration?
- Are there general mental health screening or other wellness tools
the EAP can offer the workers to help them understand and monitor
their mental wellness? Does the organization also assess its own
culture of system-level mental wellness?
- Does the EAP have experience serving clients in our industry? If
yes, what are some recommendations that they have to improve how EAP
services are promoted and offered at our workplace?
- Is the employer receiving regular reports (i.e., biannual or
annual?) from the EAP on utilization, presenting problems,
satisfaction, and other workplace outcomes?
- Does the EAP provide manager or human resources training on how
best to support an employee experiencing a mental health or suicide
crisis? Are there additional staff training on skills needed to
identify and assist employees in distress?