No 'Easy' Button for Mental Health Care Waiting Lists, But HR Can Help

​Mental health issues are unquestionably a big problem in the workplace—rates of depression, anxiety, stress and burnout have all soared in recent years—but adding to that problem is another one: People are having trouble getting professional help to address mental health concerns.

Almost 1 in 3 Americans who need mental health care report they are unable to receive it, according to the latest data from Mental Health America. State by state, those percentages range from 18 percent in West Virginia to nearly 39 percent in Indiana.

According to Kevin Wang, M.D., chief medical officer of apree health, client companies report their employees and families wait more than six weeks for mental health care prior to becoming apree customers. And CVS Health executives said waiting times for in-person appointments with a mental health provider average 48 days, double what they cite as waiting time for primary care visits.

Benefits managers are trying to get employees the mental health care they need, though there can be significant headwinds, according to Greg Harris, M.D., senior medical director for behavioral health at Blue Cross Blue Shield of Massachusetts.

"I had one [employer] say they just wanted an 'easy' button—and I say there's no such thing," said Harris, a practicing psychiatrist.

There are steps benefits managers can take to help employees and their families manage wait lists or start receiving care faster, though. Virtual care options such as telehealth visits, self-guided assessments on apps, and more emphasis on integrating mental health care and primary care are just some of the options available. And, according to Harris' colleague Erin Lenox, head of commercial and national markets for the Boston-based insurer, thinking about a bridge between "waiting" and getting care should be replaced with a holistic frame of mind.

"I wouldn't say that it's a matter of saying 'While you're waiting, go do this,' because we don't think of it that way," she said. "It's finding a person the care they need. It's not a Band-Aid to get them to the care they need."

As one might expect, consistent communication between health plans, providers and those seeking care is crucial—and HR is instrumental in keeping those lines of communication open. Cara McNulty, president of behavioral health and mental well-being for CVS Health, said benefits managers must make mental health benefits part of everyday communications.

"Most companies don't have large HR teams. They only have so many avenues to get messages out," McNulty said. "In any communications where you're talking about change, driving growth, productivity, your benefits, always put in what your mental health resources are. Because then we normalize that it impacts everything—and I mean everything."

[SHRM members-only toolkit: Creating a Mental-Health-Friendly Workplace]

It can be tricky to adequately assess what your employees and their families' mental health care needs are. Given persistent societal attitudes that still create some sense of stigma around mental health challenges, preserving confidentiality is important. But there are practical steps HR and benefits managers can take to ensure their carrier partners are doing their best to get people the care they need when they need it and communicate regularly with employees. There are a number of things to remember. They include:

Primary care integration: Wang said it's common for people to automatically associate mental health needs with high-acuity psychiatric issues rather than lower-acuity conditions such as anxiety disorders, eating disorders and ADHD. Many of these issues can be addressed through primary care clinicians without waiting for overbooked specialists, a fact that HR can be sure to remind employees about.

For instance, at apree, formed by the merger of advanced primary care group Vera Whole Health and navigation vendor Castlight, mental health care is integrated into the same primary care practice: "We have noticed that six of the top eight mental health conditions have co-morbidities related to primary care," Wang said. "So we capture a good percentage—we like to say we get close to covering 60 percent of the common conditions within primary care and can often see patients the same day or next day."

Convenient community-based care: HR can also point employees in the direction of convenient care that's readily available. CVS Health has in-store MinuteClinics where people can be assessed for mental health conditions; McNulty said nurse practitioners in MinuteClinics can assess a patient for depression or anxiety, and in 14 states, the clinics are also staffed with licensed clinical social workers who can either resolve the patient's issues themselves or refer to specialists if the need is more acute.

The average patient sees the therapist three to six times and then they resolve the issue, McNulty said, citing that 82 percent of people who came in to seek depression treatment said their symptoms were reduced. "So it's not only easy to get into care, it's really effective care," she said.

Survey says: Wang said surveying employees about their perception on the adequacy of mental health resources is a good place to begin strategizing ways to craft an adequate care infrastructure. A survey maintains confidentiality while giving a high-level look at fundamental needs.

"You will often see where specific pain points come up," Wang said, an observation confirmed by Lenox: When Blue Cross conducted a survey among its employer customers, it found 39 percent of respondents said they wish they had more paid time off or flexible hours to deal with mental health issues.

Call me, maybe: As the effects of the COVID-19 pandemic put extra stress on mental health resources, health plans have stepped up their efforts to increase the number of available providers. They are also serving as navigators, and communicating that health plans are increasing the number of available providers is a vital step benefits managers can take.

Lenox said even a phone call can be an effective way to get the care process moving: "It's unique, unlike other types of service. If a member calls us, we can help connect them to the diverse access points."

Harris added that using the plan navigators from the start can alleviate the scattershot results of having people contacting providers on their own, perhaps to find they are fully booked: "People with mental health conditions tend to struggle with hopelessness and demoralization as part of the illness more. And then we face them with this decentralized ecosystem," he said. "So telling them 'Contact Blue Cross, and Blue Cross will help activate the network on your behalf' is a simpler message."

Specifically, asking about resolution rates and processes helps benefits managers know what to advocate: Lenox said 73.8 percent of callers looking for mental health assistance from the carrier in 2022 said the call center had helped resolve their issue in the first call; typically, for low-acuity requests for providers, a call center representative will offer to follow up to make sure the member could make an appointment. More complex cases are assigned to mental health care case managers, who help connect users with the right clinician and services for their needs. After the member is matched with a provider, the case manager follows up directly to ensure the match is working and see if further assistance is needed.

Assess the digital experience: Another thing HR and benefits managers can do is point employees to digital apps, which can streamline the process of finding available doctors and resources. The first step many people seeking information on mental health care take is to check out their carrier's app on their mobile phone. Just as trying to call providers with no guidance can lead to frustration, so, too, can fumbling through multiple pages on an app that don't provide quick access to the information employees need.

Harris said Blue Cross uses an agile design process with regular updates: "Over the past year we have been trying to do more active navigation in the design, learn from what's working and not working, and improve it constantly."

Create a sharing climate, Part 1: Employee resource groups (ERGs) are a popular way to create communities of people with similar backgrounds and interests, and mental health ERGs are no exception.

At CVS, where the groups are called colleague resource groups, McNulty said the mental well-being group is the fastest growing in the company and can serve as a valuable resource to those who are looking for help: "We take that a step further and use that group as our mental well-being ambassadors," she said, "to talk about the importance of mental health and about the resources we have for our colleagues, to share tools and assets. And many companies can easily set that up." There are numerous resources for setting up a mental health ERG online, such as this article in Harvard Business Review from Mind Share Partners.

Create a sharing climate, Part 2: Despite the drive to create a more formal approach to finding any kind of care, many people still rely on friends and colleagues for referrals and advice. By making mental health an everyday topic, those who need help may not only feel more comfortable sharing requests about getting care; those with experience can serve as unofficial guides.

"Share stories," McNulty said. "Most of us have a story. I had postpartum anxiety—I share it openly. It doesn't mean I'm broken; it doesn't mean I'm less-than. It means I needed help and support, and here is what that looks like. The more we talk about it, the more we normalize it, the less people wait to be in crisis and the better we are solving access issues."