Insecurity blanket – supporting mental ill health through the use of EAPs

mental health

Between Brexit, ‘working poverty’ and rising workplace and financial insecurity, it is perhaps little surprise that mental ill health and anxiety is on the rise. An Employee Assistance Programme can be one solution but, argues Eugene Farrell, employers need to work with occupational health and HR to identify the right service and level of provision.

We’re living in an age where insecurity has become the norm. It’s become accepted by employees as a feature of the workplace, a part of working in a competitive world where there can be more opportunities as well as more potential for uncertainty and instability. The essential insecurity of modern times, though, has been heightened to a new intensity in recent years by Brexit.

A recent London School of Economics study among 35,000 people – mostly Remain voters – pointed to an escalation in mental health problems since the 2016 ballot. A YouGov poll has suggested the EU withdrawal situation has led to mental health concerns among a third of voters. Another study has suggested that the increase in uncertainty has led to an increase in antidepressant prescribing. It’s worse for EU nationals working in the UK where there have been increased reports of panic attacks and suicidal feelings.

About the author

Eugene Farrell is head of the UK’s Employee Assistance Professionals Association (EAPA) and mental health lead at AXA PPP healthcare

The climate of uncertainty over the impact on the economy, on jobs, has a particular effect on employees struggling with their finances. Being in work is no longer any guarantee of financial wellbeing.

The Joseph Rowntree Foundation has pointed to sharp rises in the number of people in “working poverty”, with a job but struggling to pay for the basics of food, housing and clothing, due to the increased cost of living and relatively low increases in wages. Around four million people, or one in eight employees, the charity says, are ‘working poor’.

Financial insecurity at a more general level is a bigger problem, affecting a much larger range of staff. A report in 2018 by the Centre for Economics and Business Research claimed UK workers take four million days off a year because of their financial worries, costing £1.56bn.

We’re also living in an age of increased individual responsibility – and the role for HR is far from clear. Organisations continue to struggle with how to cope with employee mental health issues – particularly in a context where NHS services can no longer be relied on for early support.

Employers are recognising the need to take action to address these issues and mitigate their impact on business performance. The Brexit situation presents a stiff challenge and test of the actual quality of provision on offer from employers, how comfortable employees feel with making use of services, of talking about problems.

According to a Business in the Community study in 2018, 61% of employees have experienced mental health issues as result of work; only 54% felt comfortable talking in the workplace about mental health. More than a third (38%) of employees wouldn’t be open about a mental health issue because of concerns about how it would affect their career, according to the Mental Health Foundation.

An Aegon report has said 45% of employers feel they would be intruding in their employees’ lives if they approached them about their financial concerns, while nearly half feel it isn’t their placed to get involved.

At the frontline is the Employee Assistance Programme (EAP) or, as most OH practitioners will know only too well, confidential support services, on demand, when they are needed, and free of charge to employees.

The 2013 Market Watch survey for the EAP industry concluded that 47% of the UK workforce, approximately 13.79 million people, were covered by an EAP. Despite being part of the benefits offering for 30 years, EAPs are still not being used to their full potential when it comes to addressing mental health issues.

What differentiates the EAP from any other form of mental health counselling, coaching or private counselling is that it is proactive in helping people to anticipate and deal with problems early on, employees can self-refer 24/7 and in total confidentiality.

With many employers, however, the EAP continues to be positioned as the last resort. EAP market research commissioned by UK EAPA and published by The Work Foundation in 2016 concluded that employers are missing opportunities to do more with their EAPs and take advantage of the expertise available through their provider.

Everyday mental health support

EAP services shouldn’t just be about crises, a way to cope when there’s some form of breakdown, but be more of an everyday life support.

Brexit is an example of the benefits there can be for people to open up about what uncertainty means, looks and feels like for themselves and those around them.

Managers in general are task and performance-oriented. It’s not their area of interest and, frankly, they can typically tend to avoid situations where they have to deal with these kinds of sensitive and personal emotional and psychological questions.

There needs to be a release valve, and HR (via occupational health) should be using the current situation to open up more channels for more staff to be accessing – or at least considering – EAP support.

There’s no such thing as a standard EAP. It is important employers are aware of the range of services available – and any restrictions – and that a package has been introduced specifically to suit an organisation’s structures and culture.

The “all-inclusive” EAP service, for example, also includes access to focused counselling, which can act as a valuable short-term solution to concerns, particularly in a context of long waiting times within the NHS system.

Alternatively, EAP providers also offer a telephone and online services model: a reduced cost alongside the benefits of offering staff more anonymity. An “embedded” EAP is provided alongside another service or insurance policy such as group income protection, group risk insurance, cash plans and benefits providers.

This EAP model is sometimes presented as being complementary to the client organisation, but in fact the operating costs are embedded within the fees paid for other products purchased as a “package deal”.

Variations in this model might include a number of counselling sessions per referral, promotional materials, access to relationship management and management information reporting.

An EAP can also be the focal point for a broader, more holistic approach to workforce wellbeing, and for introducing a visible culture of proactive support.

Providers can be the one-stop-shop for access to a much wider range of specialist, added value services. This might include mental health first aid training, critical incident and trauma support for individuals and group post trauma psycho-education. It might cover consultancy services on developing a health and wellbeing strategy, workplace mediation, specialist psychologist assessments, or specialist whistleblowing helplines.

Beyond this you could be looking at access to specialist therapeutic interventions such as computerised cognitive behavioural therapy (cCBT), cognitive behaviour therapy (CBT), eye movement desensitising and reprogramming (EMDR), trauma-focused CBT, training workshops on a wide range of mental health and wellbeing topics and on-site promotional support.

Employers should also be looking at exactly who is providing which of the services available under the broad EAP services umbrella.

Working to recognised standards and accreditation

When it comes to counselling and therapy, this has to mean professionals who work to recognised standards, clinicians who are recognised and accredited by their professional bodies.

As part of this they will be expected to be receiving regular supervision of their practice and have training in working within the tripartite relationship that exists with the client (the employee) and the employer and EAP provider.

All UK EAPA-registered providers manage a network of affiliates who can see employees close to either their home or workplace. It is important to choose an EAP where affiliates have their credentials and individual professional accreditation checked, where supervisor references are taken up, and where case management is in place to ensure the clinical safety of the client.

These factors are more important than selecting a therapist on the basis of geographical location, for example. Some providers may require Disclosure and Barring Service (DBS) checks on counsellors. However, this isn’t a mandatory requirement for providers who are members of the UK EAPA.

To conclude, Brexit is an opportunity, for raising awareness among management and staff, making looking after psychological wellbeing something normal, something we all keep an eye on.

And it is important to remember that keeping staff in work isn’t only good for the organisations. It’s a critical part of any recovery, for retaining a sense of normality, being part of a social circle, for having a clear sense of purpose, receiving recognition and rewards.

References
Powdthavee, N et al. Who Got the Brexit Blues? The Effect of Brexit on Subjective Wellbeing in the UK. Economica, 01 February 2019, https://doi.org/10.1111/ecca.12304
available online at https://onlinelibrary.wiley.com/doi/full/10.1111/ecca.12304

More than four in 10 people say Brexit is impacting their mental health, he New European, 28 January, 2019, available online at https://www.theneweuropean.co.uk/top-stories/more-than-four-in-10-people-say-brexit-is-impacting-their-mental-health-1-5868139

Brexit: Antidepressant prescriptions increased in wake of EU referendum vote, study shows, The Independent, 21 November 2018, available online at https://www.independent.co.uk/news/health/brexit-depression-antidepressant-mental-health-final-say-peoples-vote-eu-referendum-a8643796.html

‘They say we’ll be fine. Well are already not fine’: EU nationals ‘suicidal’ as no-deal Brexit looks increasingly likely, The Independent, 05 January, 2019, available online https://www.independent.co.uk/news/uk/home-news/eu-nationals-brexit-suicidal-mental-health-anxiety-depression-uncertainty-a8698216.html

Financial wellbeing in the workplace, Aegon and Centre for Economics and Business Research, available online at https://www.aegon.co.uk/content/dam/ukpaw/documents/financial-wellbeing-CEBR-condensed.pdf

Working-age poverty, Joseph Rowntree Foundation, https://www.jrf.org.uk/data/working-age-poverty

Poor financial wellbeing costs UK businesses £1.68bn each year, Business Leader, October 22, 2018, available online at https://www.businessleader.co.uk/poor-financial-wellbeing-costs-uk-businesses-1-6bn-each-year/54406/

Seizing the momentum, Business in the Community, Mercer, and YouGov, available online at https://wellbeing.bitc.org.uk/system/files/research/mental_health_at_work_2018_-_summary_report-compressed.pdf

A survey of the experiences of people with mental health problems within the workplace, Mental Health Foundation, 2002

Employee Assistance Programmes 2013 Market Watch, https://www.eapa.org.uk/wp-content/uploads/2014/02/UK-EAPA-MARKET-WATCH-REPORT-2013.pdf

Employee Assistance Programmes: supporting good work for UK employers?, Dr Zofia Bajorek, http://www.theworkfoundation.com/wp-content/uploads/2016/10/410_EAP_Supporting-Good-Work.pdf

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