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White Paper: The EAP Industry Must Change

On the News |

We are in the midst of a mental health crisis in Canada. Every year, 
1 in 5 Canadians will experience a mental illness.1 Suicide is now the second leading cause of death for children and teens, and over 500,000 employees miss work each week due to mental health challenges.2 While we’re fortunate to have a universal health care system in our country, it is primarily constructed to handle a person’s physical health ailments, rather than mental health concerns. If you break your arm, you can get x-rays and a cast free of charge. If you’re struggling with depression, paying for counseling is your responsibility. What’s the result? Mental illness goes untreated, leaving us in a crisis that has negative impact on individuals, families, and employers.

One means of providing mental health support is through Employee Assistance Programs (EAPs). The Employee Assistance Society of North America summarizes EAPs as “a voluntary and confidential service, to help employees at all levels, and in most cases their family members (dependents), who have personal concerns that affect their personal well-being and/or work performance.”3 These programs are often offered in tandem with employee benefits packages. For those accessing their benefits, EAPs “represent a first-line response to providing prevention, triage and short-term problem-resolution services.”4

EAPs began in the 1940s as a way to offer addictions counseling to “alcohol-impaired employees”.5 In the 1950s these programs began to expand and include mental health support. They were originally offered as in-house company programs, before growing to become their own external industry. As the program model grew, it began to “imply that EA clinicians generally function as private practice therapists, providing one to eight visits about 60-70% of the time, preventing “costly” referrals beyond the EAP to the benefit plan.” Basically, offering a capped number of sessions with a counsellor helped re-route people away from using the costlier psychologists offered in some benefit plans. The model evolved according to the needs of the benefits providers rather than what was best for the employees.

While there had previously been a diverse number of EAP companies of varying sizes, a series of mergers and acquisitions has now led to there being a limited number of large service providers in Canada. Market consolidation has led to publicly-traded corporations controlling the majority of the EAP industry. The needs of their shareholders determining the quality and volume of mental health care made available to the employees and families using their programs.

What happens when large players set the standards for care in the EAP industry?:

  • The number of sessions is capped regardless of the mental health challenge being tackled. Clients either have to stop or pause treatment and wait until the new year because they’re out of sessions.
  • Strict, outdated parameters on who qualifies as “family”.
  • Clients are stuck with the counsellor they receive, whether or not it’s a good fit.

As spelled out in Chestnut Global Partners’ 2017 Trends Report, the design of the current EAP model is fundamentally flawed, because it is based on the principle that “the less you do, the more you make.” Turning people away from getting care is profitable.6

So, if the traditional EAP model is so flawed, why does it continue to be the industry standard?:

  • Stigma – Informing HR about a negative EAP experience requires an employee to admit that they used it, and the stigma around mental health and/or a desire for privacy often prevents employees from speaking up.
  • Lack of Data – Information on utilization often has to be sought out by employers, rather than readily and regularly provided to them. As a result, many employers don’t know what percentage of employees are using the EAP or the average number of sessions being used.
  • Hidden Costs – EAPs are often partnered with benefits packages with the costs rolled together. Many employers don’t know what they’re paying per employee or whether they are getting value for the money that is being spent on the program.

Despite these shortcomings, EAPs can be a valuable service that can
make a meaningful difference in the lives of employees, their families and their companies. Research has shown that “EAPs contribute to improved productivity and reduced absenteeism by addressing and improving mental health symptoms”7 and “the greater the number of contacts the employee had with the EAP the more likely they were to remain employed.”8 Providing any mental health support is better than none; but, what if there was a better way to use EAPs to push back against the mental health crisis?

The Alternative – Social Impact EAPs

Impact driven businesses exist in many different forms and names – social enterprise, triple bottom line businesses, socially responsible businesses,
 B Corps – but the core feature is that they value the social impact of their business as much, or more than, traditional business metrics. Revenue and profit are still important – without them there’s no “business” in social business – but they are seen as tools to achieve impact objectives.

At FamilySparks, we embarked on a customer discovery process, speaking with human resource managers, CEOs, COOs and benefits brokers about their experience with traditional EAPs and gathered their common pain points. We then applied a social impact lens to determine what could be done to increase the positive impact on client mental health by reducing, but not eliminating, the standard profit margin. Here are the core differences that define our approach to EAP delivery:

  • No arbitrary caps on the number of counselling sessions per client. Instead, we create a care plan with their counsellor to help the client have their best chance at overcoming their challenges.
  • Employees may have aging parents, a common-law partner, adult children or even a roommate who is struggling. Living situations and family homes have changed substantially with the rising costs of housing and the definition of “family” for coverage purposes must adapt.
  • Have all counselors adhere to our clinical philosophy. This ensures that employees using the program feel welcomed and receive excellent care. We also pay a higher rate to affiliate counsellors to attract and maintain a higher caliber talent.
  • Boost utilization wherever possible. We increase utilization by continually educating managers on the value of our EAP for their bottom line, reminding employees about the program and encouraging them to use it, while collaborating with them on identifying solutions that match their goals.
  • Provide quarterly utilization reports to clients that include information on the quality of the user experience, rather than just usage stats.

Understanding the client experience is our vehicle for continuous improvement. We conduct client surveys about customer experience and the impact of the program on their lives. Our social impact metrics are analyzed on par with our utilization data and revenues to determine whether or not we are hitting our goals and fulfilling our mission. We are proud to have a Net Promoter Score (NPS) of 89 for Customer Experience and 100 for Social Impact while continuing to maintain a gross profit margin.

The Time for Change is Right Now

The mental health crisis will not improve by waiting on the government to fund a health care system that better supports mind and body. While changes to our system are integral to addressing this crisis, private industry has the ability – and even a responsibility – to provide meaningful support for employees and their families. Mental wellness is key for individuals and corporations to thrive. Traditional models are no longer sufficient to address the rapid changes that are redefining our complex world. It’s time for the EAP industry to evolve, and for employers to embrace and encourage that evolution by expecting more of the EAP providers who are tasked to support their employee’s mental wellness.

To learn more, head to: www.FamilySparks.com/employers

References

  1. Children First Canada (n.d.). Retrieved from: childrenfirstcanada.com
  2. Mental health Commission (n.d.). Retrieved from: https://www.
    mentalhealthcommission.ca/English
  3. Workplace Strategies for mental health (n.d.). What is an Employee Assistance Program (EAP)? Retrieved from: https://www. workplacestrategiesformentalhealth.com/employee-resources/what-is- an-employee-assistance-program-eap
  4. Richmond, M. K., Pampel, F. C., Wood, R. C., & Nunes, A. P. (2016). Impact of employee assistance services on depression, anxiety, and risky alcohol use: A quasi-experimental study. Journal of Occupational and Environmental Medicine, 58(7), 641-650. doi:10.1097/ JOM.0000000000000744
  5. William White Papers (n.d.) EAP History Trends. Retrieved from: http:// www.williamwhitepapers.com/pr/2003EAPhistorytrendsEAPDigest.pdf
  6. Chestnut Global Partners (2017). Trends Report 2017. Retrieved from: http://chestnutglobalpartners.org/Portals/cgp/Publications/Trends- Report-April2017.pdf
  7. Richmond, M. K., Pampel, F. C., Wood, R. C., & Nunes, A. P. (2016). Impact of employee assistance services on depression, anxiety, and risky alcohol use: A quasi-experimental study. Journal of Occupational and Environmental Medicine, 58(7), 641-650. doi:10.1097/ JOM.0000000000000744
  8. Hughes , D. , Elkin , C. , & Epstein , I. (2004). Long term counseling: A feasibility study of extended follow-up services from high-risk EAP clients . Journal of Employee Assistance , 24 ( 1 ), 15 – 18.