Once rooted in mental-health support, employee assistance programs have evolved exponentially in recent years to meet the changing needs of employees.
During the coronavirus pandemic, the use of virtual care exploded as most people were forced to stay at home, so EAPs had to adapt quickly to provide virtual support to many struggling Canadians.
“By necessity, because of the lockdown across Canada, EAPs moved their services to a virtual delivery for the majority of the pandemic,” says Darren J. Harris, director of well-being, equity and disability management at WTW. “So I think that increased the comfort level for people to use virtual services for their well-being needs.”
Read: How the pandemic has evolved the meaning of an EAP
When the pandemic was first declared in March 2020, most people expected to just ride it out for a few months, he says, but after a year of restrictions and hardships, it really started to wear on people, translating into a rise in EAP usage.
Before the pandemic, Dialogue Health Technologies Inc. didn’t offer an EAP, says Jean-Nicolas Guillemette, the company’s chief operating officer. Instead, it was primary care-focused and included a mental-health program with limited consultations.
By the numbers
• Two-thirds (62%) of benefits plan sponsors offered an EAP in 2021, dropping to just 42% in 2022.
• Among plan sponsors that offered an EAP in 2021, 40% reported increased use in the previous year, compared to 7% that reported a decrease.
• Among the 47% of plan sponsors that reported lower than expected health benefits costs in 2021 due to the pandemic, 14% took it as an opportunity to invest in their EAPs.
Source: The 2021 and 2022 Benefits Canada Healthcare Surveys
But when Dialogue asked its benefits plan sponsor client advisory board what types of products they’d be interested in, it found an EAP was at the top of the list. After analyzing the market, the provider acquired a well-known EAP in October 2020 and soon launched the program.
“During the pandemic, the whole issue of mental health as a major driver of productivity became very clear even at a senior level, so employers’ dependence on EAPs really increased,” says Paula Allen, senior vice-president and global leader of research and total well-being at Telus Health. “They’ve always been valued, but the perception of value actually reached the [chief executive officer] level.”
Read: 3M incorporating flexibility, digitization into benefits plan for 2023
Jacqueline McLennan, benefits specialist at 3M Canada, says the company definitely saw an uptick in EAP usage during the pandemic, which she views as a positive. “Some might look at that as a negative because it’s an increase in use, but we look at it as a positive step for our employees because now they’re more comfortable reaching out before the issue becomes more serious. . . . I like that our employees are being proactive [and are] taking it upon themselves to reach out earlier rather than later.”
Investing in mental-health support
Almost everyone has experienced some type of stress or mental-health challenge in the last few years, says Guillemette, so people have become more comfortable talking about these challenges, with EAPs facilitating this progress.
Joe Blomeley, executive vice-president and head of health services and enterprise growth at Green Shield Canada, says EAPs have done a good job of removing the stigma around mental health. “People are much more open now in talking about their mental-health issues and I think it’s incumbent upon thoughtful, innovative and progressive organizations [to] offer mental-health services like EAPs.”
Even before the pandemic, mental health was one of the biggest drivers for short- and long-term disability claims, he notes, adding mental health can create major challenges for organizations related to productivity and absenteeism.
Read: More than a third of disability claims in 2022 due to mental-health reasons: survey
Guillemette also highlights that investment in mental-health support is beneficial for productivity. “When you offer quick access to mental-health services, you’re reducing short and long-term disability claims, absenteeism and productivity. I also think an integrated approach is key to a successful health journey. The combination of seeing both doctors and therapists is essential in some cases and will deliver a much better result.”
In the past, people who were struggling with their mental health were put on disability leave, notes Allen, which was unfair and discriminatory. “Even if you don’t need to go on disability leave, there are so many demands on employees in terms of having to be at their best for innovation and customer service. All those things are compromised if you don’t have good mental well-being, so the workplace impact is really important right now. We can’t put half of the population off on disability leave.”
A big change for EAPs in recent years is a tremendous amount of merger and acquisition activities, says WTW’s Darren J. Harris, noting EAPs are coming together with virtual care companies and wellness providers, whether it’s a straight merger or acquisition or developing partnerships for a coordinated offering.
“It’s all about a better user experience so employees can go to one spot to figure out the best care option,” he says. “I think part of the value proposition for EAP firms going forward is how they fit themselves into the overall well-being space and how they can become more of a one-stop shop.”
Attraction and retention are also big issues during the pandemic, says Harris, because a lot of employees have decided to make their own exit strategies and leave their employers. “Well-being is part of a larger attraction and retention strategy and EAPs are essential to the well-being aspect. If employers want to establish that they have a strong culture of well-being, they can use EAPs as a means to keep employees or to attract new ones.”
Does the traditional model still work?
When EAPs were introduced, they were very limited, says Allen, noting they used to be referral-based, typically with respect to alcohol use in the workplace.
“They’ve been evolving ever since to become more of a platform of multiple services and more proactive. And the pace of evolution really was sped up by the pandemic.”
Read: Alberta Health Services adding new mental-health resources to EAP
In addition to mental-health support, EAPs now include many other services such as financial coaching, she says, noting the awareness of these other offerings is growing. At the beginning of the pandemic, people experienced job loss and financial uncertainties, so financial consultations became very important.
Leadership training offered through EAPs also took off during the pandemic. According to a September 2022 report from Telus Health (then known as LifeWorks Inc.), four out of five managers were dealing with employee mental-health issues they didn’t feel competent to deal with.
Allen has also noticed an increasing partnership aspect as part of the evolution of EAPs. “During the pandemic, [employers] were reaching out for support from their EAP in terms of coaching and guidance. That new partnership, with an EAP providing support as opposed to just being a vendor or service provider, I think it’s going to continue to increase. The best EAPs don’t just do the job, but they help coach the organization in terms of what [it] can do when it comes to flexibility and culture as well.”
When Dialogue launched its EAP during the pandemic, it examined the traditional model to see what was and wasn’t working. “We realized utilization was very low in traditional EAPs and the main reason was that people didn’t know where to go, so we knew we had to address the accessibility piece,” says Guillemette.
Read: Dialogue buying Optima Global Health, expanding further into EAPs
The other aspects Dialogue wanted to improve were wait times to start therapy and the limit of EAP sessions, so employees could have more time with a counsellor with whom they’d already made a connection. “Mental health needs to be treated in the same way as primary care,” he says. “Companies need to understand that a ‘bank of hours’ approach is not good for employees and their families, so I think this is a place where the traditional model doesn’t work anymore.”
The traditional EAP format that relied on a call centre to set up appointments experienced long delays during the pandemic, says Harris, noting everyone was experiencing staff shortages so when calls started increasing exponentially, they had difficulty keeping up. Some providers were also supporting the federal government’s publicly available initiative for free counselling, so they were doing double duty.
• The pandemic forced EAPs to evolve in terms of moving to virtual delivery and offering a wider range of services for employees, as well as support for employers.
• EAPs have helped to remove the stigma around mental health by making it easier and more comfortable for employees to seek treatment.
• Virtual care is leading the industry, but due to varying demographics within each company, a hybrid model is ideal moving forward to accommodate all employees.
“With the move to more virtual services, some of the newer providers have taken away the call centre so [employees] can go online and set up everything [themselves]. There’s a lot more self-selection and control on the part of the user to pick the counsellor, put in their preferences and make the connection directly rather than having to rely on a call centre do all that for you.”
Hybrid is best
However, Harris also believes EAPs will continue to include call centres, due to certain demographics and job types within the workplace, but he acknowledges that virtual care is leading the way forward.
“I think it’s become a hybrid. The industry is leaning more towards virtual delivery and putting more control in the hands of the user, but the call centre is always going to be there because during a mental-health issue some people want direct communication.”
Read: Proactive, customized health and wellness strategies must consider pandemic impacts
Indeed, employers don’t necessarily want to lose the traditional aspect of EAPs because some employees prefer an option that doesn’t include technology, says McLennan, noting 3M Canada has staff who prefer virtual therapy and others who still want the face-to-face experience.
“We have production operators who aren’t always necessarily near a computer, so they like using our onsite counsellors where they can easily schedule an appointment and go speak with that person.”
Going forward, Blomeley believes EAPs that leverage technology will be important to the continued growth of the industry. “I think the challenge for traditional EAPs was that they hadn’t invested in digital solutions to a significant degree over previous years, so it opened a door for other organizations to step in and start providing those virtual services.”
For some medical appointments, people prefer to see their doctors in person, he adds, but there isn’t always a need to go into an office to meet with a therapist for mental-health support. “We’ve seen, through digital interventions, the efficacy is as good through virtual communication as it is in person. “Looking at our utilization data, even though we offered telephonic and in-person services, over 70 per cent of our users still preferred to use digital means to connect with their therapist.”
Sadie Janes is an associate editor at Benefits Canada.