Why EAPs go unused despite growing mental health awareness

The employee assistance program, or EAP, is a model upon which many employers rely to help workers address mental health concerns. But EAPs are underused, according to analysts, a fact that has not gone unnoticed as reports of depression, anxiety, substance abuse disorders and other conditions increase.

A July report published by Amwell, a telemedicine company, found that 85% of U.S. employee respondents had not used employer-provided mental health benefits. One study by Centers for Disease Control and Prevention researchers found that, during the COVID-19 pandemic, most public health workers who did not use EAPs reported difficulty accessing the programs. Others used separate external services or reported a lack of awareness or motivation to use EAPs.

EAPs have long been “wildly underutilized” by employees, said Erin Terkoski Young, senior director for health, equity and well-being at WTW. But the programs are still important in the mental health context, she added, because not all employees elect to enroll in employer-sponsored health benefits that could address mental health issues.

Alternatively, employees may enroll in high-deductible health plans where they are responsible for higher out-of-pocket costs that present a financial barrier to seeking care.

“The EAP is often the only touchpoint for employees to access legitimate and qualified mental health services,” Young said.

Employers have good reason to discern how to improve EAPs, especially in the near term. Mental health placed as the top healthcare-related issue for large employers in 2023, according to a recent Business Group on Health survey, with 80% of respondents saying that access to mental healthcare was their most important focus for the year.

Issues affecting EAP utilization

Aside from plan participation and cost concerns, Young identified two other reasons why EAPs struggle with utilization.

The first of these, Young said, is workplace “stigma” toward mental health issues or even toward EAPs specifically. Stigma itself is a word that requires some unpacking — the American Psychiatric Association notes that the term encompasses stereotypes, prejudices and discrimination toward people who have a mental illness — and it may take several forms.

For example, an employee who has a substance abuse disorder may feel shame or fear the perceptions that colleagues might have of them if they attempt to seek help via an EAP, Young said.

The second reason Young pointed to is a lack of employee understanding about the value that the programs can provide. EAPs can assist with conditions that are traditionally included under the umbrella of mental health, such as depression or anxiety, but they also may be structured in order to help workers deal with other life problems that contribute to these conditions.

An EAP could, for instance, help employees find child care support in the event that a provider is unavailable.

“If an employee has stress around child care or daycare service, some of that can bleed over into things like burnout and presenteeism,” Young said. “Through seeking services of that nature, it might help to alleviate some of the mental health struggles that I’m having with my life.”

Other employees simply lack the time to contact their EAP due to a busy schedule or personal commitments. A 2023 report by primary care service One Medical found that 45% of employees who did not seek mental healthcare said they were too busy.

What employers can do

At the most basic level, employers should not treat EAPs as a “check-the-box benefit,” Young said, adding that the programs’ value as an entry point to obtaining mental healthcare means employers must be intentional when operating EAPs.

If employees report having difficulty finding time to contact an EAP or attend appointments, for example, that may signal a need for greater flexibility and managerial training. Employers could also consider offering access to in-house healthcare providers who are immediately accessible to employees and can direct them to treatment, said Erica Johnson, associate at law firm FordHarrison.

“Communication and knowing your employees is key,” Johnson said. “When a company takes individual mental health seriously, I feel that increases employee morale.”

Improving accessibility can begin as early as the onboarding process, during which employers can provide information about their EAPs, when access to each EAP begins and how employees access them — including the name and contact information of any specific staff members who are appointed to operate the EAP, Johnson said. Moving forward, HR teams can disseminate info through email, internal communication platforms and special programming such as health fairs.

Employers also need to keep in mind that EAPs should integrate holistically with other components of their well-being benefits programs, Young said. That aspect may go unnoticed by some employers.

“It is important to see how all of the pieces of an EAP fit together,” Young said. When an employee contacts an EAP, the person conducting the intake assessment should ask questions that provide insight into the different areas of an employee’s life so that the employee can be referred to all appropriate supports that the employer offers, either internally or externally, she explained.

Young gave the example of an employee who calls the EAP to discuss a fertility issue. The EAP could refer the employee to a health provider as well as a family-building benefit program, if the employer offers it. This kind of integrated approach is “becoming more of the expectation and the table stakes” among employers, Young said.

Meanwhile, employers may address discomfort around mental health by working with managers and supervisors to allow employees time to take care of mental health concerns when they arise, Young added. This includes adjusting to employee needs in real time; if an employee needs time out of the workday to contact the EAP privately, managers and supervisors should understand the importance of letting employees do so.

“Even though many people think that they know and understand, they still feel like it’s very distant from them,” Young said. “It’s a physical health condition, and we need to treat it in the same way that we do diabetes and asthma.”