Although mental health is approached differently in workplaces around the globe, most multinational employers want to ensure a continuity of care and maintain a similar experience for all employees, while respecting local cultural and legal considerations.

For Scotiabank, these considerations include focusing on what types of support are needed, what the employee experience is going to look like and how to balance that with the associated cost, says Ayman Alvi, the bank’s vice-president of global pensions and benefits.

“A key piece as a multinational employer that we need to think about is how our programs interact with the local marketplace [and] local health-care structure — whether there’s public support or not — and the socio-cultural piece, because it’s not one size fits all. [With mental-health support], it’s also about how it links with time off, disability and ensuring inclusion throughout the process.”

Read: Scotiabank supporting employee well-being by aligning benefits offerings across global markets

In Canada, employer-sponsored benefits plans typically supplement provincial health coverage, but in other countries, that support will often look different. Multinational employers have to consider how local tax implications work and whether public support is available. “Some countries put limitations on certain things and they have different laws than . . . Canada. We need to be very mindful of that to make sure we’re not offside of anything [while] still trying to meet employees’ needs.”

Silvia Pothoven, national manager of corporate benefits for Arthur J. Gallagher & Co. in Australia, agrees the biggest difficulty for multinational employers is understanding what is culturally acceptable to address as well as the underlying issues around the causes of mental health.

“Employers have to consider cost and access of support in each country, as well as the delivery. It’s important to take a global approach to a program and ensure the same employee experience for everyone. This can be achieved through clear communication and transparency on how to access support when it’s needed.”

Global mental health by the numbers

In 2023, Telus Health’s monthly mental-health indexes found:

• Among countries included in the index, the U.S. had the highest average mental-health score of 68.9 out of 100, followed by Australia (64.5) and Canada (64.3)

• Average scores among Asia-Pacific countries were considerably lower, including Hong Kong (59.9), Malaysia (59.6), Japan (58.1) and Korea (57.8)

• Canada reported a high mental-health risk population of 32% and a low-risk population of 25%

However, barriers to mental-health support exist in many global markets, says Alvi, noting in Canada, many people have difficulty finding counselors that fit their specific needs. “Employers need to be mindful of what the conversation looks like locally, but at the same time, being an advocate and pushing where it makes sense. I think finding that balance is critical to ensuring we’re moving forward.”

Multinational employers can maintain equitable mental-health coverage by having a global strategy or clear objectives for employees, says Paula Allen, global leader and senior vice-president of research and client insights at Telus Health, adding this approach varies from market to market. For example, in markets where crisis services see the highest rates of utilization, plan sponsors focus on communication and ease of access to support prevention.

Read: Expert panel: Employers taking preventative, holistic approach to employee mental health in 2024

Differing approaches to diagnosis and treatment also provide challenges for multinational employers, says Luke James, workforce health consultant leader for Europe at Mercer. “For example, [some countries may take the approach of] psychiatry first as opposed to psychological therapies. In addition, and unfortunately, there remain cultural issues in terms of stigma around mental health in some regions of Europe, making it all the more important that companies employ strategies to recognize mental-health issues and support the affected employee before the issue becomes acute.”

While many countries are just starting to discuss mental-health support, Canada has advanced the conversation dramatically in the last several years, says Alvi. “There’s always room for improvement, but in Canada we have some excellent social programs, whether it’s our foundational health care or the recent launch of the 988 [suicide crisis helpline]. Things like that don’t necessarily exist everywhere for people to access when they’re vulnerable.”

Global comparisons

When comparing global mental-health support, one of the biggest differences is the level of support that organizations provide, says Allen, noting while employee assistance programs are fairly standard in Canada and the U.S., they’re not widely available in all markets.

“[Depending] on who you’re analyzing, about 90 per cent of organizations have it either directly or through an insurance carrier. That’s certainly not the case in Latin America, the Caribbean, Asia and some parts of Europe.”

While she notes there are changes happening — particularly in Asia, where EAPs are becoming increasingly available as part of a push to support mental health — the reason behind providing EAPs varies between markets, as does Telus Health’s approach to delivering the service in each country where it operates.

Read: EAPs increasing virtual delivery, taking proactive approach to meet employees’ shifting needs

“We have to be very sensitive to the culture and what’s accepted. In Japan, coaching of a manager would be your entry point more than anything else. [In some countries] you wouldn’t talk about it as a mental-health service, you would talk about it with different language. How an organization matches with the culture of the population is probably the biggest success factor.”

Telus Health also found an interesting pattern when comparing mental health in different countries, says Allen, explaining while the percentage of people who were at moderate mental-health risk was consistent across markets, there were differences in the percentages of individuals at high mental-health risk versus low risk.

The impact of mental-health issues

According to the World Health Organization’s guidelines on mental health at work, an estimated 15% of working-age adults have a mental-health disorder at any point in time. Globally, as of 2019, 301 million people were living with anxiety, 280 million were living with depression and 1.6 million were living with schizophrenia or bipolar disorder. It also noted the most prevalent mental-health conditions, such as depression and anxiety, are estimated to cost the global economy US$1 trillion each year, with the cost driven predominantly by lost productivity.

According to the organization’s 2023 mental-health indexes, Poland’s high-risk population was the largest at 49 per cent, while its low-risk population was 10 per cent. By comparison, the Netherlands’ high-risk population was the smallest at 19 per cent, with a low-risk population of 32 per cent. Canada’s high- and low-risk populations stood at 32 per cent and 25 per cent, respectively.

“This speaks to the extent of preventative services and if you have more people moving into high risk, then you’re not catching them early on and that’s showing up in our research.”

In some countries, employers don’t play the same role as they do in Canada, says Alvi, noting while Scotiabank provides $10,000 a year fully paid for its Canadian employees for mental-health coverage, that’s not necessarily provided to employees in other global markets. In 2023, the bank launched its global inclusive standards of care to equalize the employee experience and bridge gaps in systemic issues.

Canada’s approach to mental health

Despite the availability of mental-health resources, employees continue to experience burnout, says Katharine Coons, national workplace mental-health specialist at the Canadian Mental Health Association.

Read: Survey finds a third of Canadian employees currently experiencing burnout

“Many workers don’t have access [to] or aren’t given time to utilize programs, training or mental-health supports at work. Organizations need to go beyond the standard to create wrap-around support for their employees.”

Although employers feel the effects of poor mental health on their business, many organizations still don’t have a workplace mental-health strategy in place, she adds. “[Employers] should provide access to programs and training for mental health and enhance psychological benefits. But most importantly, [it starts] with understanding your employees’ unique needs.”

To ensure psychological safety for employees, Canada implemented the National Standard of Canada for Psychological Health and Safety in the Workplace in 2013, which set the tone and led the way by developing the first standard of its kind in the world.

“[The standard] contains a robust set of voluntary guidelines, tools and resources for organizations to lean on when promoting mental health and preventing psychological harm at work,” says Coons. “It has been around for 10 years now and organizations outside of Canada frequently refer to it as well. So, the conversation has been happening for a while now within Canadian workplaces and we are seeing more and more organizations using the standard as a resource.”

Canada can improve by having more of a keen focus on psychological health and safety at the workplace level, says Allen, adding some countries in Europe are a little further ahead with this.

Read: Are workplace mental-health programs evolving beyond the National Standard for Psychological Health and Safety in the Workplace?

“There are clear laws in some countries in Europe and there are expectations in terms of psychological safety that are sometimes more embedded in certain countries compared to North America. We have our own standard in Canada, and Quebec is implementing procedures that are a bit more stringent in terms of the expectations of employers, but Europe is further ahead in that respect.”

The European perspective

In Europe, one of the main focuses for employers when it comes to mental health is ease of access, whether through a digital “front door” or in person, says James.

Key Takeaways

• The best way to approach global mental-health coverage is by ensuring a seamless experience for all employees.

• Local cultural and legal aspects must be taken into consideration for multinational employers in each country.

• When it comes to mental health, the main difference between countries is the percentage of people at high risk versus low risk.

“Digital channels can help overcome some of the stigma associated with the initial check-in around mental-health challenges and virtual cognitive behavioural therapy can help teach employees coping skills for dealing with different problems.”

European employers have also embraced manager training as an essential part of helping employees who are experiencing mental-health concerns and some larger employers also offer in-house counselling and psychological support, with some expanding these services to cover employees’ dependants, especially children.

While there aren’t many significant differences in mental-health coverage between Canada and Europe, he notes the strain on public health systems across Europe is resulting in greater use of employer-provided benefits.

Australia’s approach

Employers in Australia are moving away from the reactive approach of simply keeping in touch with employees on mental-health leave to focus on the causes of mental-health issues and what can be done from a preventative and inclusive space, says Pothoven.

Read: Lessons from Australia, England in addressing access to mental-health care

“They’re putting more of a focus on education and training with things like mental-health first-aid training, harassment training, financial coaching and enhancing internal communications on benefits to increase utilization.”

In Australia, Pothoven says employers often overlook financial health when considering their mental-health coverage and need to be encouraged to take a more holistic approach.

A study by NobleOak Life Insurance in March 2023 found 35 per cent of Australians said their mental health has declined since before the pandemic. In addition, diversity, equity and inclusion is playing an increasingly larger role in mental-health support, given the country’s vast multicultural makeup.

Sadie Janes is an associate editor at Benefits Canada and the Canadian Investment Review.