Is a Mental Health Crisis Emerging in the US Workforce?

By increasing access and awareness of mental health services, employers can assist in addressing concerns precipitated by pandemic and racial injustice to curb potentially severe and persistent mental illness, said Joe Grasso, PhD, clinical director of partnerships at Lyra Health.

With more than 80% of US workers indicating in a poll by Lyra Health and the National Alliance of Healthcare Purchaser Coalitions that they are experiencing mental health issues, the importance of early intervention cannot be understated. By increasing access and awareness of mental health services, employers can assist in addressing related concerns precipitated by pandemic and racial injustice to curb potentially severe and persistent mental illness, said Joe Grasso, PhD, clinical director of partnerships at Lyra Health.


AJMC®: Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences’ Medical World News, The American Journal of Managed Care® is pleased to welcome Dr Joe Grasso, clinical director of partnerships at Lyra Health. Can you just introduce yourself and tell us a little bit about your work?

Dr Grasso: Sure, so I'm a clinical psychologist by training and at Lyra, I work with employers on mental health strategy in the workplace and then I also lead the development of our educational content around mental health topics.

AJMC®: Since the onset of the pandemic, adverse mental health outcomes related to stress, anxiety, and depression have been reported as an intensifying trend. Can you discuss some of the factors that have contributed to this, and how the resurgence of COVID-19 cases nationwide may further exacerbate these issues?

Dr Grasso: Yes. So, we know from extensive research that there are phases of response in the face of a crisis or a life disrupting event. In the immediate aftermath, people tend to rally together, feel very motivated and empowered to address the urgent issues of the crisis, but then in subsequent phases, when people start to recognize that the effects or the crisis itself will lead to long-term issues, there's this recognition that this is more of a marathon than a sprint and that can lead people to become discouraged.

So, right now, I think we're at that point of recognizing people are a little discouraged and that's going to lead to more negative mental health effects. So, we're seeing a lot of uncertainty about what happens next–that generates worry, anxiety, and fear for people. There's also the consequences of the best practices for exercising good precaution like isolation or social distancing that creates a feeling of isolation from others and loneliness and that's certainly a risk factor for mental health issues like depression.

There's also role overload. Many parents I'm sure can relate to this–having to simultaneously take on multiple roles. Working, being parents, sometimes being a teacher, spouse or partner. So, having to navigate all of those different roles and feeling overwhelmed by the circumstances of the situation, in addition to all of your responsibilities can take a mental health toll.

Then lastly, I just want to highlight the loss of routine. We know that routine and predictability in one’s schedule is really beneficial for mood. Right now, with many people working from home, routines have shifted, and there may not be the same sense of predictability day to day and that can worsen people's mood and undermine their motivation, and that certainly can go hand in hand with negative mental health outcomes.

AJMC®: In a recent study by Lyra Health and the National Alliance of Healthcare Purchaser Coalitions, the mental health of US-based employees who receive health insurance through their employer were examined. How was the study conducted, and were there any trends you were especially interested in learning more on?

Dr Grasso: We jointly conducted this survey of a nationally representative sample of over 1200 employees who are currently employed full time across a spectrum of industries that map on to broader participation in these industries across the US workforce. We wanted to learn specifically about the impact of each of these life disrupting events that we're seeing across the past 6 months. So, that means the pandemic, the racial justice movement, and also the financial instability that many households are facing right now.

We also wanted to learn more about not only how those events are impacting mental health, but also how they're impacting attitudes towards employers around how well supported employees feel in accessing mental health care and feeling that their employer is empathizing and supporting them right now. Lastly, we wanted to learn about what access and engagement has looked like around mental health support–are people utilizing mental health services at a greater rate, because they're seeing more mental health effects from these events.

What we saw was rather eye opening as indeed, there is widespread agreement on there being mental health effects. There are various different symptoms that people are endorsing, from loneliness to sadness to anxiety and fear, but we don't see that there's a huge proportion of people who are accessing mental health services right now.

In fact, we see a fair amount of employees who feel that their employer isn't doing enough to support mental health right now, and that this perception can then make it more likely that someone would consider changing jobs or looking elsewhere for work.

AJMC®: Mental health implications are additionally tied to the growing conversation on racial injustices and disparities, with an almost equal mental health impact to that of the pandemic being reported by the study. Can you speak more on this, especially how Lyra Health has worked with employers to address these concerns?

Dr Grasso: Absolutely. I think it's a fair point to highlight that not only are there mental health implications around racial injustice for certain communities, communities of color, but that those communities have also been disproportionately impacted by COVID-19. That means additional mental health effects for those communities.

So, right now we're partnering with many employers on educational programming to help highlight the mental health effects and also help people to feel empowered around taking action around the mental health effects. So, this has looked like partnerships with ERGs, or employee resource groups, to put on mental health programs that specifically speak to the mental health issues in those communities.

Right now, this racial justice movement is putting the spotlight on race based stress, and the fact that there are very real mental health consequences due to systemic racism. So, here at Lyra, we want to make sure employees are aware that there are providers who are specially trained to deal with these issues and that there is a need to prioritize things like self care and reaching out for support when you need it.

Another way in which we've supported employers is by co-hosting listening sessions or dialogue sessions that give employees who feel directly impacted by recent tragedies around race to discuss how this is affecting them in the workplace, and also provide this opportunity for community building among employees who are sharing in that experience in the workplace because of shared background or shared racial ties to these tragic injustices.

AJMC®: In the study findings, a stark 83% of American workers said they are experiencing mental health problems, with 40% feeling unsupported by their employers as you addressed before. With the current state of the country, has the reportedly looming mental health crisis come into fruition?

Dr Grasso: Yes, I think that before COVID-19 and the onset of the pandemic, employers were already increasingly interested in supporting employee mental health. There were already signs that employees were feeling increasingly burned out and overworked and I think COVID-19 has just accelerated those initiatives and has really opened employers’ eyes to the need to prioritize mental health right now.

I think pretty much all of the employers that we speak with are motivated by the quality of life issue. They want to make sure that their employees are well supported, because they don't want to sit idly by as they see employees suffering, but there's also an economic toll knowing that employees who are experiencing mental health issues and don't feel that they have ready access to mental health care are more likely to experience losses in productivity, there's greater rates of turnover, greater absenteeism, and so it's in everyone's best interest to prioritize mental health right now, including the employer.

I think right now we see employers reaching out to us, because they're recognizing this and they're also recognizing the need for a solution that addresses all points along the mental health spectrum, because you don't want to wait until someone has a severe and persistent mental illness. You also want to support those who have the milder concerns around things like stress management or dealing with day-to-day challenges that maybe don't meet criteria for a clinical diagnosis, but by treating those employees with the less severe issues earlier on, we can help to prevent those issues from worsening and again, that's to everyone's benefit.

AJMC®: As more than 1 in 10 study participants reported severe mental health problems, as well as growing feelings of worry and fear, what interventions are warranted by employers to address this issue before it balloons further?

Dr Grasso: It's a great question and I think what it comes down to is prevention and early intervention are key. The best way that an employer can help ensure that they're addressing this issue before it balloons further is to equip managers to notice the signs of concern early on.

If an employee is showing deficits in their work performance or they're showing a shift in their mood or behavior that manifests at work–being sure that managers know how to broach those issues with employees of concern and support them in an appropriate way around accessing the benefits that the employer makes available, because we know that if if an employee's able to get support and professional treatment earlier on, it could potentially prevent the mental health issue from worsening and leading to some of the more severe effects that we talked about like thoughts of self harm or suicide or more severe and persistent mental illness.

AJMC®: Lastly, do you have any other concluding thoughts?

Dr Grasso: The main thing I would want to emphasize right now is we are all likely experiencing some mental health effects from these uncertain times to some degree and that means there's an opportunity for all of us to normalize the discussion around mental health and to create a culture in the workplace where people feel empowered to talk about their mental health, and to let people know when they're struggling so that they can get connected to the right kinds of support.

So, the more that we normalize these issues, the more that we break down stigma starting at work, the more likely it will be that people get the support that they need when they need it.

AJMC®: To learn more, visit our website at I’m Matthew Gavidia, thanks for joining us!

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