How Employers Can Support Mental Health in the Workplace

In 2022, nearly one in four adults (23 percent) were estimated to have a mental health condition in the previous year. It was even more pronounced for young adults, affecting more than one out of every three people between the ages of 18 and 25.

Mental health problems don’t stop when people arrive at work; from 2022 to 2023, 61 percent of all workers had at least one mental health challenge, such as anxiety, depression, or burnout. Some aspects of work can even worsen workers’ mental health. For example, stressful and dangerous working conditions put workers at risk of long-lasting health conditions and injuries.

In addition to the toll on workers and other societal costs, unsupported mental health challenges are expensive for employers and the US economy. Inadequate employee mental health support adds direct costs, such as medication expenses, and indirect costs, like when employees work while sick and are less productive, known as “presenteeism.” The effects of major depressive disorder alone bring economic costs of more than $300 billion, more than half of which (61 percent) come from workplace costs.

In their 2021 literature review, Ashley Wu and her coauthors summarize the evidence on successful workplace mental health practices from more than two decades of research.^[i]

Key findings from the literature:

• Mental health has a two-way relationship with the workplace. Work can drive some causes of poor mental health, and poor mental health can lead to negative work outcomes such as absenteeism and reduced productivity.
• Work is one of the leading causes of stress for US adults and is specifically linked to poor mental health.
• Poor mental health has a high cost for employers and the overall US economy, including direct costs from the health care expense of treating comorbidities associated with poor mental health conditions, as well as indirect costs via lost productivity and absenteeism.
• Workplaces see measurable gains from improved employee mental health and effective mental health support systems and policies, which together are shown to lead to improved employee outcomes with regards to existing health conditions and access to care.
• Mental health apps are not enough on their own. Employee assistance programs, such as memberships to applications such as Headspace, are commonly offered but rarely used by workers (2 percent average utilization rate).

Following these key findings, the authors propose a set of employer strategies proven by research to improve mental health outcomes. Employer practices that lead to better employee health and well-being, reduce turnover, lower health care costs, and improve productivity fall intoeight types of practices to be implemented together:

1. Culture

• An important yet often overlooked component, organizational culture encompasses the workplace values, norms, and behaviors that feed into practically all other variables and aspects. These include aspects of workplaces’ physical and social environments, such as hierarchical structures of relationships, official policies, guidelines, and expectations.
• Research shows organizational culture sets the tone and can result in supportive or unsupportive groundwork with regards to the awareness, utilization, and impact of mental health programming efforts. Organizational culture can support better mental health by helping make programs and practices more effective.
• Employer action examples: Create a supportive environment by involving employees in day-to-day decisionmaking, building trust, and eliminating hierarchal structures, which are associated with worse team effectiveness, more conflicts, and increased stress. Set official policies that support workers and complement other organizational mental health efforts.

2. Leadership support

• Leadership support includes training leadership to address general workplace issues, as well as having leaders at all levels showcasing support for and commitment to mental health efforts.
• Research shows the best mental health programs have strong support from senior and middle leadership and incorporate employees’ input in developing goals and objectives.
• Employer action examples: Leaders normalize and model using mental health benefits. Managers demonstrate supportive supervising techniques.

3. Robust mental health benefits

• Many workers face barriers to accessing mental health services, such as narrow provider networks and high out-of-pocket costs.
• High costs for mental health services remain a significant barrier for workers. This is despite the Mental Health Parity and Addiction Equity Act of 2008, which requires comparable coverage between physical and mental health benefit plans when provided. Yet research finds employees face higher costs to access mental health services compared with physical care within private, nongovernmental health insurance.
• In addition to improving employees’ health, high-quality health insurance is linked to positive organizational outcomes such as reduced absenteeism, higher employee retention, and higher productivity from the treatment of conditions such as anxiety and depression.
• Employer action examples: Provide robust mental health benefits that address known barriers, such as securing broad provider networks and ensuring low out-of-pocket costs. Provide additional resources to help cover out-of-pocket costs.

4. Employer-sponsored mental health resources

• Employee assistance programs help workers with personal and work-related challenges, such as workplace stress, which is one of biggest sources of employee anxiety and depression.
• Employee assistance programs are frequently offered but rarely used by workers (average 2 to 8 percent utilization). Workers are more likely to use—and therefore benefit—from assistance programs when they’re tailored to employees’ needs and combined with other efforts.
• When used, employee assistance programs effectively address difficulties that affect workplace productivity, such as work-related stress and personal difficulties; provide support for immediate needs; supplement other employer-provided benefits; and result in clinical improvement in employee conditions.
• Employer action example: Ensure employee assistance programs are offered, informed by and tailored to employee needs, and well-advertised to employees to encourage use.

5. Workplace policies and practices

• Workplace accidents and injuries, discrimination, sexual harassment, and violence can lead to psychological distress and physical harm for employees, as well as link to chronic health issues from such toxic conditions.
• Workplace policies and practices can prevent and address these issues for workers.
• Employer action examples: Educate employees on their rights. Provide policies and trainings to address toxic behavior. Ensure a safe work environment by reducing the risks of workplace injury, reducing exposure to hazardous conditions like extreme heat and cold, meeting reasonable accommodations by providing ergonomic office equipment, and addressing other employee needs to create an accessible workplace.

6. Healthy work environment

• Healthy work environments promote positive mental health practices across physical spaces, social environments, and organizational systems.
• A healthy work environment includes fostering social connections between staff, providing accommodations for employees’ mental health needs, and creating an environment conducive for well-being.
• Employer action examples: Provide physical spaces where employees can recharge. Support employee nutrition and fitness goals.

7. Outcomes measurement

• Establishing and keeping track of metrics tailored to an individual organization are key to understanding current conditions and measuring impacts of organizational mental health efforts.
• Employer action example: Define metrics and positive target outcomes tailored to an organization while keeping broader trends from research in mind.

8. Innovation

• Innovation involves leveraging new technological advances and increased interconnectivity for the purpose of advancing workplace mental health supports.
• Some e-health innovations, such as mobile apps offering mental health services, can lead to positive outcomes, though interventions and their effectiveness vary widely. Interventions that lead to the best outcomes depend on having the right intervention for the specific group of people.
• Employer action example: Partner with behavioral health providers to develop options tailored to each workplace.

Policy and practice implications

The authors identified the following implications for employers:

• Employers could reduce the costs associated with poor employee mental health—the expenses of turnover, health care, and lost productivity—by implementing all eight of these practice areas in ways tailored to their specific organizations. (See employer action examples.)

WorkRise has identified the following implications for other actors:

• Policymakers could implement paid sick, family, and medical leave policies to set a minimum standard across the country. A lack of any paid sick leave is a key barrier to health care use, which is an important driver of several of the outcomes informing the eight strategies discussed above. Paid leave, which evidence shows is important for health and economic stability, is an area in which the United States lags behind its peer countries. This is especially crucial for low-wage workers and workers of color, many of whom disproportionately work in jobs without paid leave benefits.
• The Occupational Safety and Health Administration and policymakers could strengthen and enforce workplace safety laws to help curtail violations that affect workers’ mental health. Addressing workplace safety, including injuries and discrimination, is crucial for employees’ mental health. Though various laws already protect workers, underfunding and inadequate enforcement limit their impact.
• Policymakers and advocates could promotehealth care reforms that bolster employee coverage to address their challenges accessing mental health services. They should also enforce existing policies such as the 2008 Mental Health Parity and Addiction Equity Act.
• Environmental, social, and governance rating agencies could include mental health provisions and metrics in their evaluations of companies as both an informative signal and motivator for employers.

This research provides employers with a set of specific workplace mental health policies and practices that have been shown to collectively result in positive outcomes for employees’ mental health and well-being. These mental health policies and practices also affect outcomes for businesses by reducing turnover costs, health care costs, and lost productivity associated with poor employee mental health. By enacting practices in all eight categories, employers can begin or continue their efforts to design effective mental health policies and promote a healthy workforce.

^{[i] The study analyzes peer-reviewed research on workplace and employee assistance programs from academic journals and industry sources published from 2000 to 2021. The authors exclude studies on workplace wellness programs that lack a focus on mental health. They also exclude research not focused on the United States, given the specificities of US employer benefit structures, primarily employer-sponsored health insurance.}