Helping Employers Respond to the Rising Call for Workforce Mental Health Services

“If someone was choking, you’d do the Heimlich (maneuver) or you’d want to have someone who knew CPR. But when someone is having a panic attack or an anxiety attack, I wasn’t sure what action to take,” recalled an employee at Cerner Corp. in Kansas City, Missouri. Cerner responded in 2017 by creating a mental health training program based on Mental Health First Aid, which began in Australia in 2001, says William Stadler, Cerner’s director of behavioral health, in an article for the Society of Human Resource Management.¹ Cerner’s training program, he says, is structured on a mnemonic, ALGEE:

• Assess risk for suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

The mnemonic is a useful summary of how to respond to a mental health incident. Drawing a parallel with a person choking is also effective. The need to respond to someone in the throes of a mental health episode should not be any more mysterious, discussed in whispers, or stigmatizing to an individual than when a piece of meat or salad lodges in the throat and causes a person to gag and gasp for air.

If mental health has held a mystique or been difficult to discuss in workplace conversations in the past, that may soon change on a larger scale than ever before as millennials and Generation Z employees become an increasingly large (and dominant) segment of workforces nationwide.

A societal shift sparks greater workforce awareness of mental health

Among the many societal shifts confronting employers and increasing the need for occupational health services is this one: Millennials and Gen Z are highly aware of mental health, discuss it more openly, and insist their employers address it – far more than prior workforce generations.^2,3

In 2021, millennials are 25-to-40 years old. In 2030, Gen Z will be 18 to 31.⁴ Millennials became the largest generation in the workforce in 2016, and now represent just over one-third of working adults.⁵ By 2030, Gen Z will make up about one-third of the workforce.⁶

By their sheer size and candor about depression and anxiety, these generations are becoming a force for increased workplace attention on mental health – particularly mental health training and easy referrals to low-cost or no-cost professional mental health resources. Mental health is unmistakably an important fulcrum in the lives and career trajectories of millennial and Gen Z employees. Half of millennials and 75 percent of Gen Z respondents in a study reported in the Harvard Business Review in 2019 left roles, voluntarily or involuntarily, due to mental health reasons.⁷

Money: The root of all...anxiety?

Heightened millennial awareness of mental health is not a limited, post-pandemic phenomenon. Nor is it an indication that this generation’s self-help or coping abilities are generally any different than their parents or grandparents.⁸ Depression and anxiety are growing problems among all adults, as researchers from Quest Diagnostics and Johns Hopkins University documented in a March 2021 article in the Journal of Occupational and Environmental Medicine.⁹ They noted:

• Each year, one in five adults in the United States experiences a mental condition.
• Rates of depression and anxiety have increased 15 to 20 percent in the last decade.
• The coronavirus pandemic has increased adverse mental health symptoms, substance use, and suicidal ideation. Anxiety symptoms have tripled and depression has quadrupled.

In 2015, with no hint of the coming pandemic stresses five years later, American University journalism students conducted an online survey of 890 millennial students. While the survey was not scientific, its results aligned closely with those published by a leading scientific and professional organization devoted to psychology. The American University survey found that money was the lone factor listed as a top three mental health stressor by all four age subgroups questioned. Money was cited by: 49 percent (ages 18-22), 60 percent (ages 23-25), 64 percent (ages 26-29), and 51 percent (ages 30 to 33). An American Psychological Association survey released in February 2015 concluded that money was the dominant stressor for 72 percent of adults overall (ages 18-69 or older).¹⁰

So, millennials have inherited a tendency to be highly stressed by financial concerns. While excessive financial stress is certainly nothing new, when coupled with their heightened activism and interest concerning mental health services, it presents some interesting questions: Given that millennials and Gen Z recognize the need for mental health care, how will they afford it? Are they worried that admitting to a need for mental health care will jeopardize their job or make it difficult to get hired? If job loss does result, will this further compound their anxieties about money – and what then? In addition to not knowing how to pay for services, nearly half of millennials said they don’t know where to go for mental health care, the American University survey showed.¹¹

Delving deeper into the health of millennials

In addition to money and financial debt, other significant stressors for millennials, according to Blue Cross Blue Shield, may include:¹²

• Social media consumption
• Always being connected with work environments
• Working more with fewer resources

The Blue Cross Blue Shield Association’s 2019 Report on the Health of Millennials found that millennials’ health had continued to decline, largely driven by behavioral health conditions.¹³ Key findings were:

• Nearly one-third of millennials have a behavioral health condition, and rates are rising by double digits.
• Millennials with a behavioral health condition have a two times greater risk for having a chronic physical condition.
• Millennial behavioral health conditions are likely to be underdiagnosed in certain communities.
• Substance use disorders continue to rise. Millennials with an opioid use disorder are 46 percent less healthy than their peers.

The report examined six behavioral health conditions and documented three markers of each:

1. Prevalence rate per 100 in 2018 (see BCBS methodology)
2. Five-year growth rate (2014-2018)
3. Years of healthy life lost due to that behavioral disorder

Here’s what the report found for each of the six conditions:

Major depression

1. 5.6 per 100
2. 43 percent growth
3. 7.8 healthy years lost

ADHD (hyperactivity)

1. 6.9 per 100
2. 39 percent growth
3. 1.8 healthy years lost

Psychotic disorders

1. 0.9 per 100
2. 26 percent growth
3. 15.4 healthy years lost

Substance use disorder

1. 2.1 per 100
2. 17 percent growth
3. 10.2 healthy years lost

Tobacco use disorder

1. 5.9 per 100
2. 10 percent growth
3. 0.7 healthy years lost

Alcohol use disorder

1. 1.6 per 100
2. 5 percent growth
3. 10 healthy years lost

In the BCBS report, 95 percent of millennials said the pandemic had a negative impact on their mental health, leading them to increase alcohol consumption, smoking and vaping, and non-medical drug use.

Consider what these results and trends may mean for employers. If you hire and want to retain millennial and Gen Z employees, it is almost certainly essential that you address mental/behavioral health with the same vigor as physical health to achieve a strong and healthy workforce. As described earlier, millennials and Gen Z expect employers to talk with them about mental health in a way that removes all fear of repercussion or job loss, to direct them to effective mental health resources, and to help with the cost of mental health care, either entirely or partially.

The Centers for Disease Control and Prevention (CDC) is a champion of addressing mental health issues in the workplace, not only to alleviate the burden on individuals but to significantly reduce health care costs for businesses and their employees, as we’ll see next.

Mental health impact on businesses, resources to help

The CDC recognizes that excess stress, anxiety, and all mental health issues are a substantial burden that can compromise job performance, productivity, communication with coworkers, daily functioning, and enjoyment of life for millions of people. When employees with mental health issues also have physical conditions, treatment costs can double or triple. A recent study estimates that almost $40 to $70 billion in reduced costs could be realized by combining medical and mental/behavioral health care.¹⁴

While the CDC acknowledges there are certain activities for managing mental health that must be addressed by health care providers, public health researchers, community leaders, and government, employers also can fulfill an important role in the work environment, as well as in the community.

The CDC outlines a number of workplace action steps that employers can take.¹⁵ They include:

• Make mental health assessment tools available to all employees
• Provide free or subsidized clinical screenings for depression from a qualified mental health professional, with subsequent directed feedback and referral for services, as needed
• Offer health insurance with no or minimal out-of-pocket costs for depression medication and counseling
• Provide free or subsidized lifestyle coaching, counseling, or self-management programs
• Distribute materials, such as fliers and videos to all employees to train them in recognizing the signs of poor mental health and communicating opportunities for treatment
• Host seminars or workshops on stress management and depression
• Create and maintain quiet spaces in the workplace for relaxation
• Communication: Train managers in how to speak with employees about mental health issues and give employees opportunities to participate in decisions about issues that affect job stress

Many people can work successfully with mental health conditions, sometimes with job accommodations. The Job Accommodation Network and the Office of Disability Employment Policy provide extensive information on key accommodations, specific conditions, and resources for individuals and employers.

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NOTES

1. “Why More Employees Should Provide ‘Mental Health First Aid’.” Society for Human Resource Management. April 19, 2018.
2. College-Aged Adults Face Less Mental Health Stigma. Anxiety & Depressional Association of America. April 2016.
3. “Research: People Want Their Employers to Talk About Mental Health.” Harvard Business Review. November 22, 2019.
4. Generations defined by name, birth year, and ages in 2021. Beresford Research.
5. Millennials are the largest generation in the U.S. labor force. Pew Research Center. April 11, 2018.
6. “Gen Z Workers to Triple by 2030, Snap-commissioned Report Says.” Bloomberg. March 10, 2021.
7. “Research: People Want Their Employers to Talk About Mental Health.”
8. “Millennials and Gen Z are more anxious than previous generations: here’s why.” Folio. University of Alberta. January 28, 2020.
9. Fragala MS, Hunter JL, Satish A, Jelovic NA, et al. “Workplace Mental Health: Application of a Population Health Approach of a Proactive Screening to Identify Risk and Engage in Care.” Journal of Occupational and Environmental Medicine. 2021; 63(3): 244-250.
10. Stress in America: Paying with Our Health. American Psychological Association. February 4, 2015.
11. Matters of the Mind: A Look at Millennials and Mental Health. American University (journalism students). 2015.
12. “Let’s Talk About Mental Health and Millennials.” Blue Cross Blue Shield. February 2020.
13. Millennial Health: Trends in Behavioral Health Conditions. Blue Cross Blue Shield The Health of America. October 15, 2020.
14. Mental Health in the Workplace. Centers for Disease Control and Prevention.
15. Mental Health in the Workplace. Centers for Disease Control and Prevention.