Front-line resources for workplace mental health
Reprinted from the "Workplaces" issue of Visions Journal, 2009, 5 (3), p. 21
Workplace depression is a term used to describe the clinical impact, costs and disability associated with depression (and anxiety) as it relates to working people and workplace settings. Many symptoms of clinical depression, such as low energy, poor motivation, impaired memory and lack of concentration, can greatly affect work function. So, it is not surprising that depression causes loss of productivity and leads to more absences from work.
Clinical depression (also called major depression) is most commonly found in the working-age population. Seven out of 10 people with clinical depression in Canada are still working while depressed.1 In fact, the economic costs of depression in Canada are estimated to be $4.5 billion a year in lost productivity alone.2
Because of these troubling statistics, many businesses and employers now recognize the importance of optimizing the mental health of their employees. Unfortunately, not all businesses have the resources needed to provide services within the company that meet the mental health needs of their workers. One solution for employers is an Employee Assistance Program (EAP)—sometimes called an Employee and Family Assistance Program (EFAP). EAPs are usually outside agencies that contract with employers. EAPs provide confidential counselling and referral services for employees who are dealing with stress, family or work conflict, or other mental health issues.
Depression in the workplace—a study
For many workers suffering from clinical depression, EAP service providers are often their first contact with mental health professionals. There has been little research, however, about how well EAPs help with clinical depression. I am currently heading a workplace depression research program at the University of British Columbia Mood Disorders Centre, which will provide more information in this important field. My colleagues and I have collaborated with Paula Cayley, president and CEO of Interlock EAP, to develop and evaluate programs for improving outcomes in clients with depression. Interlock (www.interlockeap.com) provides short-term counselling services, delivered by experienced clinical counsellors with master’s or doctoral qualifications. Its services are provided to more than 350 organizations within BC and across Canada.
In our first study, we examined the clinical records (anonymously) of over 1,400 clients attending Interlock services.3 After EAP counselling, most clients improved in both their symptoms and function. However, the 27% of clients identified as having depression were still not as well as those without depression. These results show that clients with depression may need more intensive treatment than what is usually offered by EAPs. Consequently, we are now looking at ways to improve treatment for these clients.
We know that evidence-based therapies such as cognitive-behavioural therapy (CBT) are very effective short-term treatments for depression and anxiety. It’s very difficult for people to access CBT in our health care system, however, because there are still not enough practitioners that offer this service, and it is not paid for by medical services. So, EAPs may be an important resource to provide CBT and other brief counselling to working people. But EAPs don’t always offer CBT, or they may have only a limited number of counselling staff trained in CBT. There are other barriers that make it difficult for working people to access counselling. Having to take time off work, the cost of transportation and, particularly in rural areas, having to travel long distances to counsellors’ offices can all cause problems.
We are now looking at a new idea that may overcome many of these barriers: counselling delivered by telephone. Studies done in the United States have shown that telephone-delivered CBT is helpful for people with clinical depression who are being treated by family doctors.4
Counselling over the phone has promise for workers with depression
Interlock recently ran a pilot project on telephone counselling with BC’s Interior Health Authority (IHA). IHA employees with depressive symptoms, who were attending the Interlock EAP, were offered telephone-delivered counselling. Interlock counsellors were trained to use a telephone-delivered CBT program that proved useful in the US studies.4 Fifty clients agreed to participate in phone counselling sessions, and 31 completed the eight-session telephone CBT program. The telephone sessions were scheduled at the client’s convenience, including lunch time, evenings and weekends.
There was high client satisfaction with the program, especially because of its convenience and not having to take time off work to go to a counsellor’s office. Clinician and client ratings showed a lot of improvement in depression scores, overall function and work productivity. These results suggest that telephone counselling may become an important service offered by EAPs to clients with depression. Further studies are underway to more closely look at the clinical and economic impact of telephone counselling.
EAP services needed for all workers
EAPs are a front-line resource for employees with mental health concerns. EAPs can also be considered “primary care settings” for identifying and treating people with mental health conditions. There is great potential for EAPs to develop, apply and evaluate early intervention strategies. Early intervention improves personal and work outcomes for clients with clinical depression and anxiety.
The mental health services provided by EAPs should be available to all workers.
About the authorDr. Lam is a Professor of Psychiatry at the University of British Columbia, and Director of the Mood Disorders Centre at UBC Hospital. His clinical research includes study of biological factors in clinical depression and new treatments
Statistics Canada. (2006). Statistics Canada Health Statistics Division. 2006; Health Reports, 17(4):1-88.
Government of Canada. (2006). The human face of mental health and mental illness in Canada 2006. www.phac-aspc.gc.ca/publicat/human-humain06/pdf/human_face_e.pdf
Preece, M., Cayley, P.M., Scheuchl, U. & Lam, R.W. (2005). The relevance of an Employee Assistance Program to the treatment of workplace depression. Journal of Workplace Behavioral Health, 21(1), 67-77.4.
Simon, G.E., Ludman, E.J., Tutty, S. et al. (2004). Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: A randomized controlled trial. Journal of the American Medical Association, 292(8), 935-942.