The US Surgeon General’s recent framework for workplace wellbeing marked a sea change in the way mental health at work is discussed. “For a long time, employers thought, ‘Let's push people to self-care and [employee assistance programs] when there's mental-health concerns,’” says clinical psychologist Joe Grasso, the senior director of workplace transformation at the workforce mental-health platform Lyra Health. “Now I think employers are recognizing the workplace itself shapes mental health.”
We spoke with Grasso about what it means for employers to take a broader view of employee mental-health support. Here is a transcript of our conversation, lightly edited for length and clarity:
Can you share a bit about what your role entails?
We know that mental health is this big crisis in America. It's especially problematic with poor coverage, poor access to care, really highly variable quality of care. So employers have an opportunity to be a big part of the solution by offering benefits that can enhance access to mental-health care.
One of the very few bright spots with Covid was this overdue spotlight on mental health and stigma, with more people now being willing to acknowledge that mental health is this universal issue. It doesn't need to be stigmatized. This is something we should be talking about at work.
I’m a clinical psychologist by training. My role grew organically in supporting customers with developing live workshops and small-group discussions around mental health at work, and then that grew into on-demand content. We also heard along the way that employers are needing to address these issues that are more specifically intersecting work and mental health, like employees facing a lot of burnout. Unparalleled stress outside of work—that can't help but affect your work experience. And so we were continuing to build our learning programs and quickly realizing that burnout is a systemic issue. It's not an individual issue. So if someone is burned out at work, it's usually because there's something happening in the workplace itself that's causing that burnout to be prominent.
So increasingly we've shifted our focus to not just include support for the individual, but support for the organization. We’re trying to help organizations diagnose their organizational problems that lead to burnout, and then equipping them and their managers with tools to solve the work design problems that lead to burnout. Essentially the mantra for us is, ‘Let's fix the work, not just intervene on the worker.’ That dovetails nicely with some recent reports from the US Surgeon General and the World Health Organization for Workplace Mental Health saying we have to intervene at the organization level, not just give individuals more downstream solutions like care.
What are the components of an effective workplace mental-health strategy?
It’s learning and development around mental health at work. So that means addressing not only how to destigmatize mental health and recognize when a colleague is in distress and make sure you know how to support them, but also more on the prevention side, how to lead teams in ways that reduce risk of workplace mental-health distress. Things like how to promote psychological safety on teams, how to lead with emotional intelligence as a people leader, how to make sure that we're designing work in ways that reduce the risk of burnout.
The second component is expert mental-health support for leaders of internal peer-led programs like employee resource groups or affinity groups. For example, in 2020, we saw Black [employee resource groups] really wanting to address racial stress and trauma given the tragedy of racial injustice that was especially prominent. So making sure that an employer's mental-health vendor or partner is supporting these internal programs with how to address the unique mental health needs in your communities, how to talk about mental health in a way that's productive and not going to trigger folks or lead to more stress than before. And making sure that they have best practices for how to promote mental health and their individual communities.
A third component that's often overlooked is measurement, making sure that employers are making data-driven decisions about their mental-health strategies. That means first understanding the state of the workforce: What does their mental wellbeing look like? Not just what is the symptom profile of people seeking care, but how is work shaping the mental wellbeing of the entire workforce? Where are there potential risks or hazards in the workplace to employee mental health? So let's make sure we understand, with data, the ways in which work may be contributing to distress, and then also using measurement to assess the impact of programs rolled out to support employees. You'll hear employers say, ‘Oh, we rolled out yoga or meditation Mondays, or some kind of workplace wellness program,’ but making sure that they're actually measuring the impact of these programs on employee mental wellbeing, and not just assuming through anecdotes that they're effective.
The fourth piece is making sure employers are addressing the ways in which [diversity, equity, inclusion, and belonging] and mental health intersect. When employers are thinking about a DEIB strategy, are they also considering the ways in which racial stress in the workplace might need to be addressed? We need to make sure to talk about mental health inclusively, but also recognize that different groups within the company are gonna have different mental-health needs and different mental-health attitudes, and also different mental-health journeys potentially.
The fifth one is making sure that employers are responding to timely events that are happening in the world by addressing the mental-health fallout, whether that's a mass shooting or the war in Ukraine or political turmoil. The employer is responding by acknowledging what's happening, by acknowledging that there's a mental-health toll and by providing just-in-time resources so that the whole workforce has access to tools to help empower them around mental health.
Of course, in the background of all of that is the need for robust individual care support, so that when you do break down stigma and get people talking about mental health, you're pointing them in the direction of care that's going to be easy to access and effective.
As many organizations tighten their budgets, how should they prioritize workplace-wide mental-health supports versus making sure employees have access to individual resources?
The nice thing about organizational supports is that they don't have to be costly. These can start on a smaller level, like leveraging your existing mental-health benefits vendor to provide trainings that are likely in contract anyway, or just giving greater visibility to them. Or having testimonials from leadership around the importance of prioritizing mental health and following that up with some no-cost initiatives. Like, ‘Let's encourage everyone to shave five minutes off their meeting length so that people have a little time between meetings,’ or making sure to build in a little time to check in on how people are doing in one-on-ones and team meetings. So the nice thing about those interventions is that you can start small and grow them organically at low to no cost.
But that individual care piece really is essential. That's one where I don't think employers can afford, frankly, to take shortcuts. Because we know that when people are struggling with mental illness, you're going to see higher rates of turnover, decreased productivity, increased rates of people taking leave of absence for mental health. And so there is a financial cost to those care benefits, but it pays back in the form of reduction of some of those problems that are intersecting between the business and individual wellbeing.
The majority of employees who have access to mental-health benefits don't use them. What can HR leaders do to bridge that gap?
We always recommend starting with a needs assessment. The main questions to ask are, is there a lack of awareness? Is there a mismatch between what the benefit offers and covers and what people's needs are? Is it that the program itself is too hard to access or ineffective, so when people try it's a bad experience and through word of mouth they discourage others? Or is it about stigma, that people fear lack of confidentiality, or think there's something shameful about reaching out for support so they avoid it? Usually poor utilization falls into one of those five categories, and that helps the employer solve for the driver.
Sometimes if it's an awareness issue, that's an easier solve, because then you can do some things in collaboration with your vendor to promote the benefit. Make sure people know what's free, that it's confidential. Make it a normalized part of conversation in town hall meetings and manager meetings. Managers are trained at how to refer employees. The awareness issue has a lot of tools in your toolkit, but if it's a problematic program because of poor access or poor care quality, then that requires a reconsideration of the benefit itself.
What sort of data should organizational leaders be collecting to diagnose some of these problems you mentioned, and how should they go about doing so?
The first step to collecting the data is to have clear objectives. What does the employer hope to achieve? Is it to increase utilization? Is it to drive down stigma? Is it to make sure that there's a better understanding of the needs of employees? So oftentimes what we'll do in collaboration with employers is sketch out, what is your mental health strategy? And if you don't have one, let's talk about your objectives, what you want to achieve. And we'll pair the different assessment tools to the different needs or objectives of the employer.
A lot of times employers simply know that there's a problem with employees not getting access to care, and they want to fix that. But what we typically encourage them to do is take a step back and understand, in what ways might this problem be showing up that you don't even know about or recognize yet? Usually a benefits consultant can help with this, so sometimes employers will work with a benefits consultant to assess the workforce or do an audit of the mental-health strategy. Sometimes an employer will do that with their existing vendor. The vendor will help them do a workforce assessment or at least a self-audit on different components of their strategy and figure out where they can plug and play some solutions. But usually there's a need to consult with an expert.
To go back to what you were saying about merging mental-health strategy and DEI strategy, who should lead those efforts?
We really try to reinforce this notion that DEIB has to be woven into all aspects of work. The team that's owning that could be a DEIB team, or could be the HR department in collaboration with the DEIB team. But the goal should be that every aspect of the work experience has DEIB infused into it: the job-posting process, the hiring process, the onboarding process. Certainly around performance-review time. And then in terms of people's individual relationships with their managers and how they're managed, and work design—all of those touchpoints between an employee and work are through the lens of what is equitable, what's inclusive, and there's also a recognition that when there isn't proper alignment, it takes a toll on employee mental health.
That's where we come in to round out the DEIB piece by helping employers think about, what aspects of your DEIB programming, or your work design and DEIB, might be affecting employee mental health, and how can we help you with those pieces? If you are not seeing good utilization of mental-health benefits in certain diverse populations, how can we help you make sure that you’re messaging about mental health in ways that resonate with particular communities or groups within the company? Lastly, there's that piece around partnering with ERGs to make sure that when they're talking about mental health or they're facing mental-health concerns in their communities, the employer is addressing the mental-health piece in a culturally responsive way.
You mentioned burnout. It feels like one challenge in solving it is that people can be too burned out to take on the extra work of addressing the issue. How do you break that cycle?
It's tricky. One of the first things that we do when we talk to employers about solving for burnout is empathize and validate: ‘This is hard. You have good intentions and you're probably already exhausted yourselves.’ But I think where we get people more motivated and re-energized is around showing them that this doesn't have to be a black-box problem. It doesn't have to be this source of overwhelm. We can help you, with data, to pinpoint the problem, so it doesn't have to feel nebulous. And then targeted interventions so that you don't have to wonder, what do I do with this data? You're going to have tools and support for how to intervene at the team, individual, and organizational levels, because it really has to be all three.
I think what most employers are looking for is ‘Tell me what to do.’ And that's really what Lyra's trying to do, is step in and say, ‘You know you have a problem, you know you want to do something about it. Let us help you take action and tell you what to do.’ When you get the right group of people in place who know how to deploy these types of tools—usually it's organizational development, occupational health and safety, and HR—you can share responsibility so that there's not this sense of having to own this initiative alone. You can share it with other experts in your company and get guidance from an external expert like Lyra so that everyone knows their role and knows what they should be doing. And that really helps to take away a lot of the anxiety about what to do.
At what altitude is learning around mental health most impactful? Would it be best to focus it on team managers, on organizational leadership?
The messaging around the importance of mental-health education needs to come from leadership, and then the actual execution is primarily targeted with managers, making sure that they are leading their teams in ways that are mentally healthy, that they're responding to signs of distress on their teams. Managers should be the focal point for formal training, but then mental-health literacy training should be for individuals and all levels of the organization. Everyone needs to understand what it looks like to struggle with mental health, and when to know for yourself that it's time to reach out for support and to have some basic tools in your toolbox about how to better manage your stress or promote your own resilience. Those are tools that everyone benefits from.
Let's say I'm a manager, and I've cultivated enough psychological safety on my team that I have an employee come to me and say, ‘I'm really struggling with my mental health.’ Ideally, what happens from that moment?
That really is an ideal scenario. That's what we hope would happen, and that a manager would respond first with some empathy and validation. Then learn just enough about what's going on for this employee to understand, is this a personal issue or is it a workplace issue that's driving the employee's struggle? If it's a personal issue, their role is to point to the mental-health benefit. Your job isn't to diagnose and treat. Your job is to say, ‘Mental health distress, yes or no? If yes and personal, use our mental-health benefit,’ and to frame it in a way that normalizes it, makes it more likely that they want to reach out.
If it's a workplace issue that's driving the distress, that's where the manager, has a lot of latitude and can look at what's within their power to help alleviate the problem, and what might need to be explored in collaboration with HR if it's something related to performance or a company policy that's bigger than me and my employee.
Develop clear objectives around employee mental health.
Partner with employee resource groups to ensure diversity, equity, and inclusion efforts align with mental-health efforts.
When most employees aren’t using a mental-health benefit, it’s usually for one of five reasons: lack of awareness, needs mismatch, access issues, stigma, or fear of lack of confidentiality. Assess which one applies to your organization to solve accordingly.