Access to therapy isn't enough — 5 things you can do

For those in the workforce suffering from serious mental illnesses and chronic disorders, access alone may not be enough. Help means also reducing barriers and engaging employees who might not reach out on their own.

Company leaders say it frequently now, “it’s okay to not be okay.” Yet we know that around 5% of the workforce (according to research conducted pre-pandemic) are experiencing serious mental illnesses and chronic disorders. They are far from okay. We can’t overlook the need to help the people suffering at the acute end of the mental health spectrum.  

Companies provide EAPs. Good insurance plans offer mental health benefits. Master’s programs around the country are graduating licensed therapists, counselors, and social workers. 

And yet.

We keep hearing about a mental health crisis. We hear stories — on the news and whispered among families and friends — of people who need professional help and support. People suffering, but not seeking or getting access to effective treatment. 

The barriers to seeking or following through with treatment are manifold. Logistics and overwhelming complexity on one hand. On the other, attitudes and perceptions of the individual, both about their own condition and the potential for improvement. In a global study, of those who didn’t access treatment, 63.8% reported wanting to handle the problem on their own and 15.7% didn’t believe their condition could be effectively treated. Fewer, 7.7%, cited stigma as the reason for not seeking care.

So providing coverage for therapy is not enough. We have to think about reducing or eliminating barriers to help get those who are suffering connected to the help they need.

That means bolstering motivation and engagement, reducing friction, and meeting people where they are with the relevant support and resources they need.

For someone with an acute mental condition, whether they have been struggling with it for years or it is newly affecting them, they are not at their best. Depression, anxiety, PTSD, and substance abuse issues can take up a lot of mental, emotional, and physical energy. 

No one size fits all. For some, an onslaught of information or offering services might be overwhelming. Others might not be in a position to self-serve from a long list of resources.

What can you do?

1. Engage through alternative, lower-stakes ways into the conversation. For example, a short well-being assessment might offer a new way to think about the dimensions of their life while also providing insight into one area, like nutrition or movement, they might take a small action on. A simple breathing exercise can deliver an immediate benefit. 
   
   This type of engagement can help to create awareness of the support structure available. It can also build trust and a willingness and desire to engage with support. Additionally, to the extent that an individual can engage in well-being practices and develop some core psychological resources, research has shown these resources can be protective and valuable to someone struggling with more serious, chronic mental health conditions (Keyes). 
   
   The goal is to motivate and encourage an individual to become an active participant in their own mental health. Changes occur as being the result of one’s own will: “My own decision, but with help from others.” Positive experiences with these alternative touchpoints can make it easier for the person to reach out for help. 
2. Make it easier to reach out. Once they do reach out, it is critical that they have someone they can readily turn to in a trusted environment. They are likely afraid — of the illness itself, which might be interfering with their ability to think clearly or take action, and of its effect on their work and relationships. They may also fear stigma or actual job-related consequences and discrimination of admitting to mental illness in the workplace. 
   
   On top of these fears, the condition itself may cause confusion and interfere with a person’s ability to think clearly, sustain focus, or take action (and follow-through). For example, research has shown that anxiety disengages critical neurons in the prefrontal cortex that aid in decision-making. Intrinsic motivation is also lower, making it harder to seek help if it isn’t readily available.  
3. Provide an empathetic and sensitive landing place. Having resources and people in place to help supports the person in making sense of their situation. A person suffering from a serious condition or experiencing a mental health crisis can’t always communicate their own thoughts and feelings clearly or understand what others are saying. They need someone who can stay calm, empathize, and connect with their feelings. This support does not initially need to be comprehensive or clinical, either. Studies show that even seemingly small interactions such as small talk, eye contact, or conversations unrelated to the illness can be helpful. 
   
   Once a person feels heard and understood and is validated in their suffering, they can begin to find the courage and strength to participate in their own treatment. A balance between professional care through a formal relationship and smaller gestures of kindness, connection, and being seen can help build trust and sustain motivation to continue. 
4. Offer person-to-person guidance. An objective, trusted person “by their side” can provide encouragement and practical guidance to help an individual in need overcome the barriers for accessing support. For example, many people in this situation, whether it is a new or ongoing condition, don’t have the knowledge to identify the features of their condition. They might not be fully aware of the extent to which it is impacting their life. Equally, they do not know what aspects of mental illness are treatable, what options are available for treatment, or how to access the relevant services. It is a new, unfamiliar language for many. A trusted guide can help them translate their needs and options, giving them more confidence, and words, to regain some control.  
   
   The guide also provides a layer of compassionate accountability, adding some extrinsic motivation to follow through at each step of the way. Research has shown that having human support from a trusted guide increases adherence to (eHealth) interventions.  Having a trustworthy person with mental health expertise to check in and follow up increases the likelihood of moving these individuals out of suffering. 
5. Encourage the use of a range of mental health tools. Awareness and understanding of the resources and benefits available are low among many employees. This gap ranges from not knowing even where to find a list of options to not understanding what they are or how they are relevant to what the individual is experiencing. Mental health needs are often specific to a moment in time that is a combination of both the mental condition, their personal preferences, and the external constraints (time, geography, responsibilities) on them. Getting the right help requires individuals to become aware of what benefits are offered, understand which benefits are most appropriate to their needs and how to access them, and finally, believe that the benefits will be effective and valuable for them.

James was relieved when he heard about the Care Coach. He really wanted to work on himself. On paper, he was successful enough, but he often felt frustrated that he didn’t achieve quite what he’d expected. He knew that he got in his own way. Mental fitness, building a “psychological six-pack” of core skills, sounded like a good answer. But, to be honest, he was looking forward to talking to a coach because he wasn’t feeling right and it worried him. A few years before he’d had a tough time, including suicidal ideation. He’d done therapy and was in a much better place now. But he was starting to notice worrying signs. He wasn’t sure it was a big deal, and work was so busy that he couldn’t see finding time to track down a new therapist. It would be a relief to talk to someone.

In his first session with the coach, James decided to mention his history and concerns. The coach praised James for catching the early signals and having the courage to bring it up. The coach discussed the differences between therapy and coaching. Together they talked through what he was experiencing and the coach recommended therapy to proactively address what was coming up. She helped direct James to the Member homepage where he could connect to the EAP and access therapy. He didn’t schedule coaching for a while. But recently, he started booking coaching sessions again — he was back. James had successfully resolved his bout of depression by doing therapy proactively. Today, he is once again engaged in coaching and moving forward with personal and professional development goals.

Today many organizations are starting to rethink how they address both serious mental illness and overall mental health in the workforce. Fortunately, there are several factors they can influence to reduce suffering while also fostering greater well-being overall. Addressable factors range from making mental health support and resources more available and improving access and awareness to focusing on preventative measures such as improving well-being and developing the core psychological resources that sustain and improve mental health.  These shifts can, and are, making a difference.