The growing demand for mental health benefits and the gap in access
Once considered an afterthought among employee benefits, enhanced mental health-related benefits have in recent years become a must-have for employees and an essential offering for employers.
When it comes to acknowledging and addressing mental health challenges, we’ve made significant progress. Mental health is no longer an unspoken or hidden issue, dealt with in secret. It’s about everyone, everywhere: year after year, surveys by the Harvard Business Review have shown that experiencing symptoms of mental health conditions – from stress and anxiety to mood disorders – is the norm for all employees, from entry-level positions to the C-Suite1. These challenges can affect our personal and professional relationships, our productivity, and our abilities to engage, perform, and grow.
In response, employees are increasingly looking to their employers to offer ways to increase access to care. According to the American Psychological Association, 81% of workers say that an employer’s support for mental health would be an important factor in new job decisions2. This should come as no surprise, given that the rising cost of mental health services – often accessed outside of insurance coverage – has become unaffordable for most. The average cost of a single one-hour therapy session in 2023 is now $100-$200.3
For employers too, mental health has become a financial issue with a direct impact on the bottom line. It goes without saying, employees’ inability to be present, engaged, and energized affects the quality and quantity of their work. It also affects their overall job satisfaction and influences employee turnover. The rising operational expenses and medical costs due to decreased productivity and increased employee turnover have led to an estimated annual cost of approximately $225.8 billion.4
Furthermore, HR leaders are being tasked with helping to find effective solutions. In total, 94% of HR leaders reported feeling an increased responsibility to improve their company culture by supporting employee mental health.5 However, this has proved to be a significant challenge: a recent study by Gallup found that only 24% of employees believe their employer cares about their well-being.6
This metric matters enormously, as – according to the same study by Gallup – employees who strongly agree that their employer cares about their overall well-being are:
- Three times more likely to be engaged at work
- 69% less likely to actively search for a new job
- 71% less likely to report experiencing burnout
- Five times more likely to strongly advocate for their company as a place to work
- Five times more likely to trust the leadership of their organization
- 36% more likely to be thriving in their overall lives
Whether we draw from our own lived experiences or from the growing body of research in this field, it’s abundantly clear that the demand for effective mental health benefits is very real and very widespread.
The gap in meeting today’s mental health needs
Historically, EAPs have been the go-to mental health benefit for employers. They are designed to provide crisis support, referral services, and short-term counseling services, typically capped at five visits. This, however, is clearly at odds with the data, which continues to reveal the ever-increasing demand for more robust mental health benefits. Moreover, employee utilization rates are woefully low: in 2022, only 2-3% of eligible employees used a traditional EAP.7 This confirms that the traditional EAP is far from seen as a valued benefit. We call this the “access gap.”
We know that employers and employees both want effective mental health benefits. The problem is that, even when EAPs are made available, employees aren’t using them. Our research has revealed the following factors relating to access and affordability that have negatively impacted EAP utilization rates:
Access barriers to EAPs
- Employee privacy concerns. Whether or not it is accurate, employees tend to suspect that the networks contracted to provide EAPs could be feeding data back to the employer about individuals’ mental health issues.
- Limited networks. EAPs generally operate through a network of contracted care providers (e.g., therapists, psychologists and psychiatrists). However, only a limited portion of providers in any given field agree to the terms of EAP networks. If an employee wants to see a practitioner who is not contracted with the EAP, they have to pay for it themselves. This is a well-known issue: only 34% of employers feel that their behavioral health directories reflect what should be available to employees.8
- Lack of diverse representation. Only 27% of organizations are satisfied that their service providers are tailoring their benefits to diverse communities.9
- Limited availability. Employees’ concerns include whether therapists provide hours outside of the workday, how long it takes to get an appointment with a provider, and whether they are accepting new patients.
- Limited session counts. Research shows that effective outcomes take between eight and 20 sessions,10 yet many EAPs only cover up to five visits per issue, which often leaves employees unmotivated to begin treatment.
It is important to recognize that traditional EAPs serve a vital purpose. Coupled with other mental health resources, they help many people to navigate and understand personal and professional challenges, and to find referrals for complex mental health issues like substance abuse. However, in our post-Covid reality, the traditional EAP alone cannot meet the multiple and intersecting mental health challenges – and expectations – of all employees.
In recent years, there has been a surge in point solutions and apps looking to complement traditional EAPs. Typically made available by employers able to secure additional budget, point solutions have offered new telehealth and virtual-only EAP networks, and apps have provided self-help programs like meditation and stress management. While improving certain accessibility factors, point solutions and apps have not come near to addressing the gap for employers.
Like EAPs, most point solutions still come with constraints like network choice, limited session count, and in some cases, a lack of first dollar coverage. As a result, for the extra cost, utilization remains low.
Apps have shown better utilization, but few address the needs of employees looking for mental health services beyond the specific topical areas the apps cover. For example, an app designed for mindfulness is not an effective solution for an employee experiencing depression.
As a result, employers still face a significant gap in fully addressing employees’ mental health needs.
The real need
Rather than offering a patchwork of narrow and often underperforming mental health solutions, employers should be able to offer a solution that covers a wide breadth of mental health care options, including individual in-person therapy. Furthermore, the design of the coverage should be intentionally comprehensive and flexible, and employees should be able to choose the type of therapy and therapist they consider most effective for their unique needs. Ultimately, the truest test of a solution should be its track record of high utilization.
Learn how Level’s Mental Health HRA and the Mental Health MAP offer simple and effective solutions to close the access gap.
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1 K. Greenwood and J. Anas, “It’s a New Era for Mental Health at Work", Harvard Business Review (October 4, 2021). Link
2 APA, 2022 Work and Well-being Survey. Link
3 A. Lauretta, “How Much Does Therapy Cost In 2023?”, Forbes Health (May 4, 2023). Link
4 Lyra, “The State of Workforce Mental Health in 2023”.
5 Headspace, “Fifth Annual Workforce Attitudes Toward Mental Health Report” (May 2023)
6 D. Witters, “Showing That You Care About Employee Wellbeing”, Gallup (April 18, 2022). Link
7 Witters, Gallup Survey 2022. Link
8 According to a survey by the National Alliance of Healthcare Purchaser Coalitions and the HR Policy Association. Link
9 Ibid.
10 Cerebral, “How long does it take for therapy to work for anxiety?” (May 24, 2023). Link
