Be cautious in interpreting an Oxford study critical of employer mental health programs
January 25, 2024 Written with my colleague, Carrie Khan, MBA
New York Times, January 15, 2024 LINK
A New York Times headline on Monday grabbed my attention. We have an unprecedented mental health crisis, with about a third of adults under 65 reporting major symptoms of anxiety and depression. Virtual mental health care has improved access and employers play an important role in funding and arranging for mental health care. Despite this, many employer health plan members find that access through the medical plan is poor. This article suggested that employer programs to improve mental health access were not working, which may not be accurate.
The study the NYTimes references, published in Industrial Relations Journal earlier this month, looked at data from surveys of over 46,000 workers in 233 British companies and compared those who participated in a wide variety of workplace mental health programs in 2018. These programs included volunteering, mindfulness, resilience, well-being apps, massage, coaching, financial wellbeing, sleep and online coaching. Since the researchers only looked at a single point in time, they were not able to see the impact of a program on an individual and could only report on the mental health of those who used vs. those who did not use these programs.
Although the study tried to adjust for important factors, like age, gender, ethnicity, job level, commute, self-reported stress and other factors, it is likely that those who used the programs were fundamentally different from those who did not. For example, the study included programs for sleep. However, those with sleep apnea were more likely to have insomnia, so in this type of analysis it appears that those using an app had more difficulty with their sleep than non-users! The workforce of 2024 is also substantially different from the workforce of 2018.
This study highlights some of the challenges of studying the impact of employer-based programs. More, and better, studies are needed to better understand the full effects of workplace-sponsored mental health programs.
Implications for employers:
Employer-sponsored mental health initiatives are more likely to yield tangible benefits when they offer a comprehensive approach, including a diverse network, multi-modal access, digital coaching, therapy, and training. This approach is aligned with current trends in employer mental health strategies and is designed to promote overall well-being.
Employers should approach the evaluation of mental health programs with caution, considering the limitations of studies that rely on a single point in time and potential confounding factors. Recognizing the nuances in interpreting data is crucial to avoid drawing misleading conclusions about the effectiveness of specific programs.
Employers should evaluate the effectiveness of their MH interventions and shouldn’t wait until they can see outcomes like lower medical costs or less time away from work. They can assess program structure (does the program have promised staff and technology in place) during implementation, and engagement (did the program enroll and retain the expected number of plan members) during the first year of operation.
Recognizing the need for more and better studies, employers may consider investing in research initiatives to evaluate the impact of mental health programs specific to their workforce. This can contribute to a more evidence-based approach to decision making.
Employers should tailor their programs to benefit all members. A one-size-fits-all approach may not capture the varied needs and experiences of a diverse workforce.
In summary, employers should approach mental health initiatives with a nuanced understanding, tailor programs to meet diverse needs, continuously evaluate their effectiveness, adopt a holistic approach, promote a positive mental health culture, and consider investing in research to enhance their understanding of the impact of workplace-sponsored mental health programs.
Here’s an article that my colleague Elodie Olsen FSA MAAA and I had on vendor evaluation in Human Resources Executive last spring.
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