The UK is increasingly relying on employers – and their employee assistance programmes (EAPs) – for mental health services, writes Karl Bennett.
In the past year (between January 2022 and 2023) we, the Employee Assistance Professionals Association UK, have been seeing a steep increase in both the availability and the use of EAPs, as well as more demand for counselling support around mental health.
This, shown through our report Holding it together: UK mental wellbeing and the role of employee assistance programmes, will probably be of little surprise to anyone working within workplace health.
For occupational health and wellbeing professionals, however, these numbers potentially signal larger issues. There has been a growing recognition of the importance of employee wellbeing – mental and physical – to employers. That is wellbeing as a foundation of productivity and performance, motivation and engagement – and to overall organisational resilience.
Demand becoming more complex
Demand for mental health support has grown and become more involved and complex. This has meant added strains on EAPs and employers in general, leading to questions over how employees can continue to be best supported. Will employers need to start pulling back, for example, and encourage staff to contact NHS services earlier?
Support via EAPs
What’s driving the increase in EAP usage?
EAPs reporting ‘drastic’ surge in demand as employees struggle with cost of living
Two decades ago, in 2003, the market value of EAP provision was £32.2m. EAPs were being offered by around 3,100 UK employers, meaning they were available to an estimated 4.9 million employees.
The landscape now is very different. Around 105,275 employers now offer an EAP to 24.45 million employees; a market value of £118.25m.
This also does not include EAPs provided via insurance products such as group life and group income protection, which would make the figure considerably higher.
Consequently, EAPs now constitute a significant part of the UK’s mental health services, an option that is available to 75% of the entire workforce (estimated by government to be 32.84 million) compared with 15% two decades ago.
As levels of awareness and willingness to talk about mental health have increased nationally, so have expectations around support.
More open conversations and a willingness to look for professional support have been important and positive developments in terms of the state of the nation’s wellbeing.
EAPs under pressure as well as NHS
But the UK’s new world of mental health awareness has meant consequences for the NHS, EAPs and health services of all kinds.
NHS mental health provision has been overwhelmed by demand and continues to be a work-in-progress. An investigation by BBC News in January 2023, for example, claimed that 418,000 calls to new NHS mental health helplines went unanswered in 2021/22.
The crisis lines run by NHS mental health trusts are said to receive more than 200,000 calls every month in England.
In 10 trusts, callers had to wait more than an hour for their call to be answered. Fewer than one in six trusts were able to confirm that crisis line staff were qualified mental health professionals.
EAPs are often being treated as a frontline emergency service and involved with complex, long-term cases of mental illness.”
A study by the Royal College of Psychiatrists published in October 2022 suggested that one in four patients needed to wait 12 weeks before being able to start any treatment, and that many people were turning instead to A&E services.
In this context, EAPs have become a highly valuable resource to employees. Anecdotally, EAP providers know that GPs are increasingly encouraging patients with mental health concerns to contact their EAP if they have one.
As the Holding it together data shows, this means EAPs are often being treated as a frontline emergency service and involved with complex, long-term cases of mental illness.
In all, 68% of employees contacting EAP services in 2022 were offered the support of counselling, 640,250 people used an EAP service, and, due to their situation and symptoms, 434,250 were offered counselling.
In 2022, EAPs in the UK provided more than 1.375 million counselling sessions. On average, 1.7% of counselling cases came with a ‘red flag’ (involving an immediate and serious risk of suicide).
This translates to more than 10,000 lives at risk that EAPs support. Some EAP providers report red flag cases as being at levels above 3%.
Changing status of EAPs
The figure of 68% of people accessing an EAP requiring counselling is a telling one. It is another signal of the changes brought about by the pandemic years; concerns over the lack of timely access to NHS mental health services.
But, for the industry, it’s also a very positive indication in terms of how services are being promoted and used. Employers are becoming more conscious of the hard value of EAPs in terms of employee wellbeing, productivity and absence.
Employers – with their combination of HR, wellbeing and OH staff, alongside their EAP provider – need to be in a position to manage the swell of demand and complexity.”
The status of EAPs has changed. Employees with worries about mental health have the confidence to reach out to their EAP, knowing that access to counselling is an immediate option.
Employers – with their combination of HR, wellbeing and OH staff, alongside their EAP provider – need to be in a position to manage the swell of demand and complexity. They need to be able to ensure services continue to be viable and employers maintain their growing role as a reliable source of mental health support.
One potential future route is for an extension to EAP services: a longer-term package of support to employees. This could be through a programme of counselling that goes beyond the standard six-session solution-focused model and sees people through to a recovery stage, alongside a more psychological approach as a core offering with standardised clinical outcomes.
However, given how prices for EAPs per employee have been steadily decreasing and the limited pool of professional therapists, this approach would need support from employers and state funding.
Instead, securing the offering is likely to involve a reshaping of activities, targeted towards early intervention and the prevention of mental illness.
Complementary OH interventions
Alongside the EAP offering, OH staff would need to ensure there are earlier interventions among employees in order to avoid the need for such extended programmes of counselling.
This would involve a strong non-clinical service dealing with underlying issues – such as the current fallout from a cost-of-living crisis – backed up by more training for OH staff around mental health awareness and helping to encourage a positive and supportive workplace environment.
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Whatever course the evolution of the EAP takes, the new figures are a stark illustration of the value of employer support on mental wellbeing.
The sector needs to continue to share these kinds of insights into the changing levels and nature of demand, both to encourage awareness of the stakes and ensure the best kinds of collaboration and use of resources.
