Unspoken Symptoms
Businesses prioritize mental health as COVID-19 crisis continues
By Vanessa Orr

lmost one in four American adults will experience a diagnosable behavioral health condition this year, ranging from anxiety and depression to post-traumatic stress disorder to alcohol and opioid misuse. Prior to the pandemic, 39 percent of Americans were suffering from mental health distress, with 31 percent of people experiencing negative mental health conditions also suffering from an addiction. With the onset of COVID-19, the situation is only expected to get worse.

These conditions affect every aspect of a person’s life, and business owners, managers, and human resource departments must prepare for how they might also affect the workplace.

“Many employers find it difficult to deal with mental health conditions; they don’t know how to talk about it or how to provide accommodations for these employees. Human resources decision makers are not always confident in how to recognize or deal with these problems,” said Dan Jolivet, workplace possibilities practice consultant at The Standard, during a recent webinar titled “The Future of Behavioral Health in the Workplace” hosted by the Alaska SHRM State Council. “Making things even more difficult, workers often hide these issues due to stigma, shame, or fear.”

What’s Happening in the Workplace

In addition to taking a toll on productivity, mental health issues carry financial implications as well.

Jolivet estimates that about half of a person’s work week is “eaten up” by mental health issues, meaning that these people are not as productive as they could be.

“People also tend to develop co-occurrent conditions,” he explained, giving the example of employees who, after developing physical disorders, have a high rate of developing mental health and substance abuse conditions as well. “This requires additional treatment and time and results in a much lower chance of that employee returning to work.”

Since the pandemic began, things have gotten even rougher for businesses and their employees. Helplines around the country have reported a 50 percent increase in calls, and prescriptions for anti-anxiety, antidepressant, and sleep medications increased 21 percent between February and March of 2020.

Jolivet adds that that alcohol sales increased 500 percent from April 2019 to April 2020, and one-third of American workers have reported drinking during work hours when working remotely. Reports of PTSD have increased among healthcare workers, those who have had COVID-19, and the general population.

For this reason, it is imperative that employers take the lead in recognizing mental health issues in the workplace and provide resources to help.

“Understanding what behavioral health challenges are and aren’t, and really destigmatizing the challenges that go with them, is important,” says Mike Abbott, CEO of Alaska Mental Health Trust Authority. “Like physical health issues, behavioral health issues can be addressed in a manner that allows people to be productive, positive teammates on the job. Many employers are now coming around to this thinking, putting programmatic supports in place for these employees.”

This is especially important as the COVID-19 crisis compounds employees’ daily stressors.

“Under COVID, we are seeing an increase in employee stress and symptoms consistent with depression and anxiety,” says Veronica Howard, associate professor of psychology at UAA, who specializes in understanding organizations and employee support.

“Employees working remotely may be less comfortable with their work because they’re having to do things in an entirely different way. They are separated from their colleagues and using new tools, and there’s a lot of uncertainly that comes with this,” she adds. “It’s hard enough to be productive in a global pandemic, but now employees could also be feeling stress and guilt from not being as productive as before.”

For a high-functioning employee, it can be extremely difficult to adjust to certain tasks that can take longer than usual, she adds.

“If a person is only getting 50 to 60 percent of their work done compared to before the pandemic, it can be a blow to their perception of themselves as a worker and of how much they contribute to the organization,” Howard says. “Essential employees, who come face-to-face with clients, have an entirely different set of concerns, including the stress of going to work knowing that it’s not as safe as before and working with clients who may not be at their best. We’ve all seen the example of retail workers verbally abused by consumers who were asked to put on a mask; that type of interaction affects employees directly.”

“I think that COVID really highlighted something that we need to understand as a community; it really benefits everyone to prioritize people’s mental health. Many businesses and organizations are shifting in this direction right now, which has the potential to change the way we deliver care.”
Renee Rafferty, Regional Director of Behavioral Health, Providence Health & Services
What Employers Can Do

According to Jolivet, there are a number of things that employers can do to protect themselves and their employees. These include reviewing human resource policies and substance abuse and drug testing policies; establishing coordination between vendors, such as employee assistance programs, pharmacy benefits managers, health insurance providers, and workers’ compensation programs; training managers to identify and help people with behavioral health issues; establishing anti-stigma campaigns, such as; providing evidence-based resilience training to employees; and communicating what resources are available.

“One of the most important things that employers should be prepared to do, if they have not done it already, is to really evaluate what their goals are and adjust their expectations,” says Howard. “As challenging as this pandemic has been, it has also provided good opportunities for businesses to consider what their central mission is and to find innovative ways to meet it.”

She gives the example of restaurants providing takeout services and take-and-bake options and veterinarians offering car side service instead of in-office visits.

“This situation is giving us the freedom to do things in different ways, and we need to consider if the way we’ve always done things is still the best way to do them,” she continues. “For example, some employees really prefer working remotely; they feel better about their work/life balance.”

She also suggests that employers strive to understand employees on an individual level.

“It may be great for a few employees to work remotely while another handful are feeling incredibly disconnected because they are not getting the responsiveness they need from peers to perform the central functions of their jobs,” she says. “Employers need to focus on providing individualized support to help each employee thrive.”

While most employer health plans cover behavioral health as well as physical health, it’s important for employers to make sure that their staff is aware of its options, including the growing use of telehealth services during the pandemic.

“Many providers in Alaska that we have heard from are reporting no reduction in demand for their services, even as some folks are generally reluctant to interact in clinical settings with providers,” says Abbott. “This is one of the reasons why telehealth or distance delivery has increased dramatically for behavioral health services in recent months.

“In many cases, Alaska is on the forefront in the nation in delivering these services through technology and other remote mechanisms which were, in large part, developed to address services in rural Alaska or places where there were not provider networks,” he adds. “Certainly, this approach is the least disruptive to patients and can be significantly less expensive, and if they can access these services through their employer-provided plan, employees are more likely to seek support and treatment when needed.”

“Understanding what behavioral health challenges are and aren’t, and really destigmatizing the challenges that go with them, is important. Like physical health issues, behavioral health issues can be addressed in a manner that allows people to be productive, positive teammates on the job. Many employers are now coming around to this thinking, putting programmatic supports in place for these employees.”
Mike Abbott, CEO, Alaska Mental Health Trust Authority
Putting Programs into Practice

Letting employees know that there are resources available can be the first step in making sure they have access to help. Steven J. Patin, chief human resources officer for the University of Alaska system (UA), for example, sent a letter to UA colleagues advising them of their mental health options, ranging from short-term counseling to virtual care to face-to-face therapy through the UA Choice plan.

“While there’s been a slight uptick in people asking for help, it’s not as much as I would have expected,” says Patin, adding that he believes that people are leaning on colleagues and other support networks like family and friends to adjust to increasing stressors. “When the pandemic first started, we considered that we might need to contract out for extra resources, such as more resident counselors, but so far it hasn’t overtaxed our system.

“Our staff and faculty are doing a superb job of adapting and continuing to accomplish our mission of teaching, research, and service,” he says. “I talk to employees all the time about the pressures of teaching class via a distance learning modality while at the same time helping their children do distance learning at home. They are doing their best to deal with it.”

The university’s Employee Assistance Program, through Deer Oaks, allows for short-term counseling with trained professionals at no cost to the employee; more intensive or clinical services and virtual therapy are available through TalkSpace, an online service with licensed clinicians using private messaging or live video, with costs largely covered through employee health insurance. More in-depth, face-to-face therapy with licensed clinicians is also available through UA’s Premera health plan.

The UAA Psychological Services Center also offers services to the community and is a useful resource for those who may not have organization-provided health insurance and mental health coverage.

“We’ve encouraged our staff to have conversations with their supervisors about their work environments,” says Patin. “If an employee is working to balance telework and distance learning with their own kids at home, there’s no reason why UA, as an employer, can’t help with a solution. They may be able to have a more flexible work environment which includes starting the day earlier or having extended lunch periods or working a four/ten schedule versus a five/eight schedule.”

As employees learn to adjust to changes spawned by the pandemic, front line workers, such as the physicians and staff at Providence Alaska Medical Center, face their own set of formidable challenges.

“Even prior to the pandemic, healthcare workers were experiencing more stress and burnout as the result of struggling with increased burdens in terms of documentation, electronic medical records, and excessive workload,” says Renee Rafferty, regional director of behavioral health at Providence Health & Services. “Now we’re seeing caregivers experiencing even more stress, which is why we are focused as a system on providing mental health support and shifting our organizational culture to prioritize mental health and wellness.

“I think that before most employers as a whole understood the importance of employee mental health and were moving to make changes, but now they’re moving faster,” she adds. “Everyone can see the incredible impact of the pandemic and the stresses associated with it.”

Healthcare professionals are in the unenviable position of having to deal not only with their roles at work but with helping others deal with the disease.

“Healthcare providers are experiencing distress watching people they love fall ill with the disease—not just in their personal lives but at work as well,” says Rafferty. “They are dealing with an increase in cases, a decrease in workforce, and are worried about resources as cases continue to surge.

“Another stressor is knowing that patients can’t have their families visit to provide them with the support they need,” she adds. “Our mission is to care for people and ensure they get compassion and support when having medical challenges, and to not be able to provide this, other than by digital means, is very challenging.”

Providence has a caregiver support line and a crisis debriefing team that provide immediate support when employees are in distress, and there are also peer support teams within the medical center offering help to those having difficulties. In 2021, the Providence St. Joseph System telehealth program will launch a concierge telehealth caregiver support line to provide immediate intervention and coping strategies to workers who are struggling.

“We’ve been conducting town halls, where our executive team talks about the importance of mental health and wellness, and have cascaded leader training explaining how to care for our caregivers,” says Rafferty. “Senior management, and other departments like our spiritual care team, are making sure that people feel recognized for their work and feel valued. Employees are also provided with information on what they need to do to remain physically well at this time—asking for support, using PPE, getting exercise, and eating right.”

Healthcare workers are also encouraged to take a four-hour mental health first-aid class that provides training on how to talk to and comfort their peers.

“I think that COVID really highlighted something that we need to understand as a community; it really benefits everyone to prioritize people’s mental health,” says Rafferty. “Many businesses and organizations are shifting in this direction right now, which has the potential to change the way we deliver care.”