The Stepped Care Approach to Mental Health: How to build digital tools to tackle workplace stigma
Each year, depression and anxiety cost an estimated $1 trillion in productivity losses.1 For employers, these impacts are tangible: employees struggling with mental health have higher rates of absenteeism, presenteeism (the lost productivity when a worker can’t function at full capacity), and turnover. In other words, employees with major depressive disorder cost an average of 33.4% of their annual salary in lost productivity.2
Many employers have responded by expanding access to their mental health benefits. But access isn’t the only obstacle: many employees dealing with mental health concerns are unable to recognize the benefits of support. And some are simply unwilling to seek it.
In our current landscape, employers are challenged to seamlessly embed mental health support into their organizational culture. Digital mental health services could help.
Overcoming the barrier of mental health stigma
To understand why many employees are hesitant to seek help, employers must understand how decisions about mental health are impaired by social stigma.
Identifying oneself, or being identified by others, as ‘mentally-ill’ attaches a host of socially prescribed negative character assumptions that are often incorrect. As a result, many employees choose to not disclose mental health issues – 39% of employees in a 2016 study said they wouldn’t tell a manager if they were struggling.3
Self-stigmatization can prevent reaching out
Employees struggling with mental health are often unable to identify themselves as such due to the negative implications of stigma for their self-image. And if they do identify as mentally-ill, it is not only their decision-making that suffers but their performance as well. Self-stigmatization occurs when individuals internalize their negative beliefs about mental illness, resulting in self-limiting behaviors and attitudes that hamper productivity.
How employers can tackle workplace stigma
- One solution is for employers to explicitly promote awareness and acceptance of mental health, as a way to signal that it’s okay to seek support.
- Another, more subtle, route is treating mental health as an organizational problem, not a personal one. This approach provides more extensive mental health support that is seamlessly integrated into the daily practices of an organization.
Behavioral Science, Democratized
We make 35,000 decisions each day, often in environments that aren’t conducive to making sound choices.
At TDL, we work with organizations in the public and private sectors—from new startups, to governments, to established players like the Gates Foundation—to debias decision-making and create better outcomes for everyone.
How the stepped care approach normalizes mental health support
So, how can employers start to enact these solutions? One promising avenue is adopting digital mental health platforms that use a stepped care model.
Stepped care 101
The goal of stepped care is to ensure the right person receives the right level of support at the right time.
Traditional mental health benefits offered through employee assistance programs (EAPs) follow a one-size-fits-all approach that provides a higher level of support, such as personal therapy. Conversely, stepped care offers a broad range of support suited to the diverse needs and preferences of employees.
Figure data retrieved from: https://campusmentalhealth.ca/toolkits/campus-community-connection/models-frameworks/stepped-care-model/
Stepped care offers a range of mental health support
Levels of support range from tools that monitor mental health risks to sessions with trained specialists. By providing a range of support, platforms with a stepped care model can provide support to each employee. Not everyone needs personal therapy, but nearly everyone can benefit from the offer of a meditation app designed to promote mindfulness.
The stepped care approach acknowledges that mental health issues exist along a spectrum, rather than black-and-white framing that suggests some employees need help and some do not. By expanding the scope of who can benefit from mental health interventions, organizations can create a more inclusive environment that fosters a greater sense of psychological safety.
Another positive knock-on effect of the stepped care model is that it makes decisions to progress to higher levels of support easier. Deciding to undergo cognitive behavioral therapy (CBT) will seem drastic to many people as a first line of treatment. But if someone is first able to learn about CBT through curated resources, they can make an informed decision - and progress to engaging with an AI-driven CBT chatbot or in-person therapy with a professional. By taking smaller ‘steps’, the journey to receiving the right level of support becomes far more seamless.
Using digital management tools to standardize organizational practices
Step 1: Monitoring wellness through digital management tools
A more embedded way to improve employee wellbeing is through digital management tools. Platforms such as OfficeVibe provide managers with KPIs on the wellbeing and engagement of their teams, allowing them to proactively monitor and respond to challenges as they arise. Other AI-based platforms such as Autumn and Mindstrong provide even more direct indicators for employee wellbeing by analyzing how users interact with their computers or smartphones, enabling early detection of mental health symptoms.
An important feature of these tools is that they protect individual privacy - which is a crucial consideration - focusing more on how managers can support their teams as a whole rather than specific individuals within it.
Step 2: The human side of wellness management
Monitoring tools are not an end-all-be-all. To be effective, they need to be integrated alongside human-centered interactions within an organization.
During team meetings, managers can present team engagement and wellbeing metrics, as well as highlight key issues from survey feedback. Managers can use these insights to check in with their teams, discuss any gaps in performance, and involve them in designing creative solutions to better support them (and, implicitly, their mental health).
Anonymous feedback provided by pulse surveys can also be used to frame one-on-one discussions between managers and employees.
Step 3: Taking action
It’s important that survey feedback and wellbeing indicators are backed by actions in the workplace. One solution is to design an if/then procedural framework that determines what action should be taken at what time.
For example, a drop in team engagement below an established threshold could trigger a pulse survey to solicit employee feedback. A manager could then arrange in-person meetings with members of the team to discuss the problems they are encountering and propose solutions to address them. After identifying and implementing the most promising interventions, managers track and monitor the performance of the new interventions by soliciting continuous feedback from their team.
The value of these tools is that they send a clear message to employees that their mental health matters. And when the insights from these tools are tied to concrete actions, improving the mental health of employees becomes an implicit social norm embedded in the culture of an organization.
How you can integrate mental health into your organization
Amidst the ongoing mental health crisis, employers recognize that the success of their business hinges on the mental health of their employees. The social stigma around mental health remains a barrier to accessing support, but innovations in digital mental health offer more subtle interventions for enhancing organizational wellbeing. By providing a broader range of support through stepped care and incorporating mental health support into organizational practices, employers can build a more resilient and productive workforce.
The Decision Lab is a behavioral consultancy that uses behavioral science to advance social good. Digital mental health is one of the fastest growing industries, and it’s one of our specialities. We’ve worked with governments and charities to build useable mental healthcare interfaces and we’re passionate about helping organizations provide effective, behaviorally-informed services. If you'd like to improve workplace mental health together, contact us.
References
- World Health Organization. Mental health in the workplace. Retrieved Mar 4th, 2022 from https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/mental-health-in-the-workplace
- Woo, J. M., Kim, W., Hwang, T. Y., Frick, K. D., Choi, B. H., Seo, Y. J., ... & Park, Y. L. (2011). Impact of depression on work productivity and its improvement after outpatient treatment with antidepressants. Value in Health, 14(4), 475-482.
- Boak et al., (2016). The mental health and well-being of Ontario students, 1991-2015: Detailed OSDUHS findings. CAMH Research Document Series no. 43. Toronto: Centre for Addiction and Mental Health.
About the Authors
Ryan McPhedrain
Ryan is currently pursing his PhD in neuroscience at McGill University, focusing on the molecular and cellular mechanisms of neural plasticity in the developing brain. His main interest is in applying behavioural frameworks to guide interventions that enhance mental health and wellbeing. A staunch advocate for data-driven solutions, he seeks to leverage data science and machine learning tools to improve behavioural outcomes in digital health and finance. He has also participated in McGill-affiliated science outreach campaigns, giving presentations on neuroscience topics for high school students and answering publicly-sourced neuroscience questions. In his spare time, Ryan can be found enjoying a good book, playing various sports like hockey, volleyball and tennis, or simply getting lost in nature.
Marielle Montenegro
Marielle Montenegro has a background in behavioural neuroscience from McGill University. Her prior experience ranges from projects in behavioural finance to health, where she was responsible for designing programs that unlocked barriers to medication adherence, curating behaviourally guided content for financial planners and informing policy to improve access to and perceptions of mental health services in University. Prior to working at The Decision Lab, she was based in Johannesburg working as a Behavioural Policy Analyst, where she designed impact measurement framework to assess the effectiveness of telecommunication policies on access to communications in rural communicates.
