The History of EAPs

An Employee Assistance Program (EAP) is an employee benefit program that can assist employees and their family members with personal problems like substance abuse and mental health crises. What makes EAPs unique from other types of employer-sponsored benefits is that they are intended as work-based intervention programs targeted at identifying and providing assistance to resolve personal problems that have the potential to negatively affect job performance. As employee needs have changed, EAPs have expanded their offerings.

And yet, they still fall short.

Since their inception, nearly 100 years ago as programs that were focused almost exclusively on preventing workplace alcoholism, EAPs have significantly expanded the scope and type of services offered.

 Current programs provide a variety of offerings* designed to provide support for much broader employee concerns, including:

 
• substance abuse
 
• work/life balance issues
 
• family issues
 
• financial and legal concerns
 
• physical wellbeing
 
• mental and emotional wellbeing

*It’s important to note that not all EAPs are created equally, and each employer will decide the specific offerings available for that company.

What’s missing from EAPs?

While there are no doubt opportunities to continue improving EAPs, the area that causes the greatest concern involves transitioning from EAP services to follow-up and more long-term mental health care. Typical EAP design does not anticipate obstacles to such transitions and therefore lacks provisions to mitigate their impact. If these transitions are not handled successfully, or if employees don’t participate in recommended follow-up mental health services, issues will likely remain unresolved. Two factors that can be addressed to improve outcomes are referrals and delayed care.

Related: Pros & Cons of Employee Assistance Programs

1. Cost of Referrals

EAPs typically have a limited number of counseling sessions per issue—usually 2 to 6—included in the program. If additional sessions are recommended, the employee can use their medical benefits to cover a portion of the cost. In these cases, it’s common for the EAP vendor to provide the employee with referrals to mental health professionals for follow-up services.

One challenge is that, even when asked to provide only in-network referrals, EAP vendors can’t always ensure that outcome. This is problematic because out-of-network benefits are significantly lower than in-network benefits, and many plans don’t offer any benefits for out-of-network providers. The potential for significant out-of-pocket expense for the employee is high.

The reality is many employees will decide not to proceed with follow-up sessions if they are cost-prohibitive. Social Solutions.com reported that a lack of financial resources is one of the top five reasons stopping individuals from seeking mental health services.

2. Timely Access to Care

Having obtained referrals from the EAP vendor, and assuming the in-network question is favorably answered, the next obstacle the employee faces is learning whether the providers are taking new patients and how long the wait for an appointment will be.

‍Can you imagine being told your arm is broken, you need to follow up with an orthopedic doctor for a cast, and the first available appointment is in two months? ‍

Tragically, this is all too common in the mental health field. The pandemic has stretched an already overburdened mental health care system to or beyond its capacity. Depending on where you live—with rural areas being hardest hit—and the type of specialized care needed it can take months to get an appointment, as reported in a March 6, 2022 Washington Post article.

This is another reason many people are not getting the care they need, as the shortage of mental health professionals was also identified in the top five reasons stopping people from obtaining mental health services.

3. Limited Ability to Foster Company Culture Change

A third factor impacting the success of EAPs, which is much more difficult to address, is company culture. Many companies take EAPs for granted, viewing them as a “band-aid” instead of a company-wide, culture-shifting organizational philosophy that makes mental health a priority.

Mental health support at its best is a part of company culture, and most EAPs do very little to help teach company leaders how to lead conversations on mental health or support employees that may be struggling. Thus, EAPs and mental health support fall to the wayside and are treated as a last resort.

What can be done?

With the first two obstacles—cost of care and timely access to care—to be overcome, EAPs are bound to leave issues unresolved, which will likely resurface in the future. These hurdles limit EAPs to making an assessment and offering recommendations.

Simply put, that’s not enough.

EAPs need to do more to achieve better outcomes. Let’s not forget, EAPs are intended to help resolve problems and issues that could have a negative impact on the employee’s job performance.

Addressing the cost of care issue requires a multi-pronged approach, and includes—but is not limited to—the following:

 
• Employers and patients need to put pressure on health plans to increase the number of in-network mental health providers.
 
• Check your state’s licensing backlogs, and if necessary, contact your representative(s) to find ways to facilitate reducing the backlogs.
 
• Employees should be sure they are maximizing HSAs or FSAs to help with out-of-network expenses.
 
• Patients should be willing to ask out-of-network providers to negotiate their fees.

To help address timely access to care, we can develop a plan provision that ensures continuity of care. EAP vendors and employers should look to modify programs:

 
• Change EAP structure to include “transition of care” visits
 
• The “transition of care” visits will continue until care is successfully handed off to the mental health professional who will be managing follow-up services.

Removing or minimizing the impact of obstacles that would prevent employees from participating in recommended follow-up mental health services is the best way to ensure the problems and issues are resolved.

Lastly, there is the challenge of transforming company culture to focus more on supporting employee mental health. This is best addressed when company leaders, managers, and licensed therapists work together to develop programs that support employee mental health.  A few ideas that can be implemented to create a supportive culture include:

 
• Taking steps to maximize EAP usage
 
• Offer Mental Health First Aid training (MHFA training) to all employees
 
• Encouraging employees to unplug

For a more comprehensive mental health solution, employers can pair their EAP with a mental health program. Mental health programs like Nivati allow employees to set an appointment with a counselor within 48 hours, and access other educational mental health resources on-demand. Mental health programs also tend to support company leaders and managers talk about mental health within their own organizations. This helps bridge the gap between education, to receiving emergency care, to receiving long-term care.

For more information on mental health programs, check out this article.

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