Health care

[SCREEN TEXT] Behavioral Health & Workplace the Changing Workplace: What we must do next

[Fara Palumbo] Thank you all for joining us today. We are so thrilled to be here to discuss an incredibly important topic that many of us are faced with every day.

Stress in the workplace is nothing new. However, the pandemic has created a new level of fatigue and burnout for many of our employees. At whatever point we get through that quickly or on their own. This webinar continues our work to bring experts together to tackle the important behavioral health challenges facing employers and their workforce.

Earlier in the year, we hosted a round table and today we are joined by a panel of experts and practitioners for a very timely discussion on workplace changes that have seen both, that we've seen throughout the pandemic and they are now seeing now that the vaccine is rolling out. They'll provide insight on how these changes could impact pandemic amplified conditions, such as burnout and caregiving, as well as discuss the best strategies for addressing them while creating a culture of health that will support employees now and into the future.

So let me introduce our panelists for today. First, Dr. Ken Duckworth, chief medical officer National Alliance on Mental Illness. Dr Sonja Boone, executive director of medical policy services, Blue Cross Blue Shield Association. Dylan Landers-Nelson, who's the director at Business Group on Health. And finally, Amanda Smith, chief engagement officer at Morgan Lewis.

[SCREEN TEXT] Behavioral Health Challenges

28 of 38 employers in BCBSA's online research community see behavioral health as a priority for the next 12 months. 

"I predict we will continue to see increased utilization of behavioral health resources. It's sad that it took a pandemic to drive employees to these resources, but I'm glad that mental health is being spotlighted more overall in society. Get rid of the mental health stigma!"

Before we get into questions, let me take a minute to share some data that we've gathered. In a recent post study that Blue Cross Blue Shield Association conducted with 38 participating employers, we saw some interesting insights surface as to what they're facing and thinking about right now. 28 of 38 employers see behavioral health as a priority for the next 12 months.

[SCREEN TEXT] Behavioral Health Challenges: 36 of 38 employers have been affected by behavioral health challenges

36 of the 38 employers have been affected by behavioral health challenges, and as you can see by this chart, there was a range of indicators they identified, including reduced productivity, increased absenteeism and pto usage, and higher utilization of behavioral health resources.

[SCREEN TEXT] Behavioral Health Challenges

• Employers have observed employees are challenged with work-life balance (30), feeling connected (27), and burnout (25)
• Employers see lack of resource awareness (20), stigma (16), and remote work (16) as barriers to addressing behavioral health

Overall, employers have seen that employees are wrestling with work-life balance, feeling disconnected and burnout. Remarkable changes in a relatively short period of time.

So now let's turn to our panelists. Let's start with you, Dylan. What are your thoughts on what I shared related to workplace changes and the behavioral health impacts on the workforce?

[Dylan] Yes, Absolutely. Thank you so much for having me and for the excellent question. I work at Business Group on Health, which is a non-profit member association, and we have about 430 members, the vast majority of, majority of which are large, self-insured employers. We do a number of surveys throughout the year on several different topics, but our most comprehensive comes out once a year, and I realize, actually, this is coming out in a couple weeks, so keep an eye out for it.

And every year we ask what employers are planning to do for the following year. Last year was the first time we were asking these questions in the context of a pandemic, which we all knew would continue to be a challenge in 2021. And the data that you shared very much resonates and aligns with much of what we've heard from our members. We ask what an uh an employer's top area of focus is for the coming year, and the number one for 2021 was implementing virtual care access, but then number two was a focus on mental health, uh with 43 percent of our members saying that that was their top area of focus.

You know, the only thing that I think stuck out is maybe a little bit different, and some of this is anecdotal and members that we speak with, is that many of them actually saw increased productivity with folks who went uh home, who are working from home now. And, you know, I think traditionally there's been a concern that people are less productive when they're working at home, but when the barrier, or not necessarily the barrier, the line between work and home was blurred or in some cases totally erased, turns out that people used extra time that they may have spent commuting previously or living their lives, they've got their work computer right in front of them and that productivity has increased in some cases. And I think this is why you see some employers deciding that they're not necessarily going to bring white-collar workers back to the office in the future in the same way that they had previously. But absolutely, mental health is a a massive challenge and we're hearing from our employer members regularly that this is a challenge. I will say, also, just briefly on a personal level, this very much resonates. My daughter is currently in treatment for leukemia right now, and working from home, I get to be a part of the good and bad of her treatment. And it's been a really rough week with for her and so um for everyone in the audience, if I disappear at some point in the future, it's because our family needs help and this is not a position I’ve been in previously before now and I don't think it would be if I were in the office because I would be totally focused on work. Uh so uh, this topic resonates and uh you know I just appreciate being a part of it. Thanks.

[Fara] Thanks so much, Dylan. And we know you're not gonna disappear forever. You might have to step away from this call for a few minutes. Um you know, I I agree with you. I hear so much um from our own employees about that blurred line between work and home now that everyone's working remotely, so totally can relate to that. Um Amanda, in your experience, especially as a large employer, what are some of the greatest challenges employees are facing, as well as potential opportunities for employers? And then what's your role in helping address those?

[Amanda] Sure, yeah. Thank you for that. So the uh the law firm that I work for, Morgan Lewis, is one of the very biggest law firms in the world. We have 2,100 lawyers and about 5,500 total employees, so we see these issues playing out sort of in real time and I could not agree more with Dylan that um we're just beginning to sort of grasp all of the implications of what for for many of us in many parts of um in different sectors of the economy is going to be sort of a permanent hybrid of work from home and work in the office. And um in addition to the background, obviously the stressors of the pandemic itself. We are certainly seeing that sort of concerns about dissolution of the boundaries between personal and professional life. I had a colleague who who said, you know, "I’m working from my bedroom and living in my office." And and that's sort of perfectly encapsulates, I think, what um the pandemic experience has been.

And so, for us, we have really felt like we needed to make behavioral health and mental health in particular, front, you know we need to put that front and center. We had uh the benefit of having built out a pretty sophisticated well-being platform prior to the pandemic, and I’m so grateful that we did. It really focuses um not only on sort of how to help people who are already unwell and who need clinical intervention, but also giving people very concrete, very proactive, very easy-to-implement um interventions themselves that they can they can take on themselves. Um and that's very grounded in sort of empirical, positive psychology, and I can give some examples of that. But I really think that that's what employers can be doing right now, is um communicating. Communicating with empathy. Communicating with transparency about just the existence of the issues and then giving their employees the tools that they can use. Um those things together, I think, creates a culture of well-being, creates sort of a baseline understanding of the different um the different aspects of well-being and how it's not a fixed thing. It's something that we can all influence ourselves.

[Fara] That's so fantastic when you think about how uh well-being has always been thought about as sort of this soft focus area, and yet companies have been so much more productive if they paid attention to this all along, so great great job in what your organization is doing. 2020 created the perfect storm for burnout. Add to that the increase in unpaid caregivers, um really who are susceptible to burnout as well as a host of other pressures. And then 2021 is trending to be another tough year for the workforce. There's definitely a tendency to lean too heavily towards self-care as a solution to employee burnout, yet the real causes of burnout are often organizational. So let's talk about what employers can do to better address burnout culturally by embracing it at the organizational and individual levels more equally. Sonya, describe a little bit for us what employee burnout really is. And talk about solutions requiring more than just self-care, and then, as well as the need for addressing burnout at the organizational level. Sonja, we hope you're not on mute.

[Sonja] And I was on mute. Thank you. Sorry that was a great question. Thank you for having me today. And one of the things that I want to point out is that Blue Cross Blue Shield Association is dedicated to providing services to all of the 34 plans. As you can imagine, there are different employer sizes, etc. When we talk about burnout, I agree wholeheartedly with what Dylan and Amanda have said thus far. When you blur those lines between work and private life, people can feel overwhelmed very quickly.

So some of the signs of burnout that managers and senior managers, senior leaders look for are people in their organization that are feeling overwhelmed, expressing emotional exhaustion, feeling burdened more than usual, and one of the results of that is depersonalization. So whereas they may have been dedicated to what they're doing before, now it's just a number or just a project. And you then see decreased motivation and decreased productivity. So those are some of the signs of burnout. Yes, I think that with most mental health, behavioral health issues that we deal with in this country and in the world, we tend to focus on what a person can do themselves. But, as you mentioned, a lot of these stressors are organizational and are driven by the organization.

So some of the things that senior leaders can do, I think amanda touched on this, was communicate. First acknowledge that there could be a problem with burnout or there could be a problem with anxiety, especially all the stressors everyone is dealing with. And then really communicate with their um employees what they're doing about that, um, that they are teaching and and training their front-line managers to recognize burnout. And then to make take action and do something about that burnout for those particular employees who are experiencing that. So, changing some of the um you know organizational culture that has set up for burnout, for example, uh overwhelming number of meetings. How do we make more efficient meetings? Less meetings? And also senior leaders modeling those behaviors, modeling, you know work-life balance. I like to call it work-life harmony, as opposed to balance. It feels like something's going to fall. But I think those are some of the things that we need to think about as we talk to the senior leaders of different organizations. 

[Fara] Ken, anything you wanted to add?

[Soja] Yeah, you may want to add to that.

[Sonja] Yeah, I’m ken duckworth. I’m the chief medical officer for NAMI. Thank you for having me. NAMI's decided to give the staff a week off. And that was just a decision the organization made, never did that before. Our leader of human resources suggested it, given that mental health has been quite an intense journey. And working in a non-profit helping other people and doing media and helpline calls, I will say I was worried, well received. it's going to happen right after our convention. So the whole staff will be off. So even though you are off, you will also not be receiving emails from anyone else because everyone's off.

When I worked at Blue Cross Blue Shield of Massachusetts, the CEO, Andrew Dreyfus, decided to make all sick days into wellness days during the context of the pandemic. It just made a decision that you could take your time acknowledging, both of these moves are major structural acknowledgement that it's been a hard time for people. And I think the third thing is to consider, uh having a health plan that covers things like phone sessions, which addresses both convenience and equity for people who don't have privacy or may not have adequate internet.

[Fara] Great, great ideas. I love that week off idea. I may need to steal that one. Um amanda, Morgan Lewis,

[Ken] Take it. it's a good idea. You know, there's no, we did not copyright it. Let's go.

[Fara] Uh, thanks, Ken. Um Morgan, Amanda, Morgan Lewis, you mentioned before, a very, very large low uh global law firm. Talk about facing burnout in an entire profession. Um you know, there has been research among lawyers. I know you're going to be talking about there. Share some examples of how Morgan Lewis is addressing this and um including what more you specifically hope to be doing.

[Amanda] Yeah, um thank you. And you're you're absolutely right, you know, I I came I come from a field where uh you know the research is really strong, very strong. Recent research um as recently as 2018, 2019 um the ABA produced a very a very important sort of seminal study on legal professionals that showed sort of off-the-charts uh behavioral health concerns: depression, anxiety, substance misuse. And so, we as a law firm were facing, over the last several years, a situation where we had a sort of a population, both the lawyers and the other professionals in our firm, that were sort of predisposed, right, to have these issues, as as lawyers do. It's quite clear, um, and also the pandemic and then also these sort of follow-on effects that we've all been talking about, that you know, we have all of these sort of burnout issues that are exacerbated by the the the dissolution of this boundary between personal and professional life. And so, um, you know fortunately, we had the um the platform built out, but what we really felt like we needed to do was tweak it and evolve it, um, and really recognize that there, we had to walk a middle road and address, not only both the clinical and the proactive aspects of well-being, but we really had to make sure that our managers were informed, our senior managers were informed, and also that we gave people, as I said earlier, the tools to sort of try to influence their own well-being.

So, um for example, we um focus really quite a lot over the last year on the mind-body connection. You know people were trapped inside, um physical activity dropped really significantly, so we launched what we called, not a step challenge, but a movement challenge, sort of inspired by all of those stories that we saw during the pandemic of people running a marathon on their balcony, you know, in Europe or in Asia. It sort of became a thing, right? And so we tried to sort of piggyback on that but make it a very positive thing that was also a team-building activity where we could sort of share experience with each other and create a sense of having lived through this experience together.

And so, you know, I think all of those things, that sort of comprehensive and holistic approach, um which you know entails giving people the tools, creating sort of a set of first responders that, as Sonja said, can sort of be aware and identify um people who might be in crisis or at risk of being in crisis, and then also trying to create a a culture, a culture that um it's very intentional um, and we communicated about it a lot. We communicated about it, you know every time our chair, Jamie McKeon, talks, she says, you know something about ML Well. We have a senior partner who um is very active in in and vocal about his own recovery, and he he talks. Um and so all of those things together, I think, hopefully will put us in a position to work with our quite at-risk population and move things forward in a flexible way as we head into the, I don't even want to call it the new normal, I guess it's just the next new normal because things seem to be changing at a at an ever-increasing rate.

[Fara] That's fantastic, Amanda. We, you know, we all know that culture often gets created by the storytelling that occurs, so you want those stories to be the ones that really bring this message home to to the workforce. Um thank you for that.

So, you know we know that balancing positive employee health outcomes with the drive for excellent business outcomes is difficult, right? Especially given that the drive to focus on results often leads to increasing workloads that then results in behavioral health challenges, like burnout and additional pressure on caregivers. So it's like a vicious circle. So Sonja, let me go to you. How should senior leadership, and you started to touch on this a minute ago, how should senior leadership be thinking about this and then effectively setting the tone at the top?

[Sonja] That's a great question, Farah, and um I did touch on it a little bit, and I think Amanda just touched on it as well. Not just thinking about it, but actually doing the research and making them a commitment to their employees, that they will focus on this, that they will have, implement various initiatives that are concrete ways to change the culture and, again modeling it themselves. One thing I’ll say that I’ve seen in the literature over again over and over again around interventions that work, and one is when uh the front-line managers are able to not just model behaviors around work-life balance, but also share their stories. And amanda touched on that with one of mentioning one of her senior leaders who is sharing a story that they're working through. So being able to share, that humanizes what's happening with them and so it takes away the stigma of sharing that you may be having some problems with burnout or feeling overwhelmed, because people want to be high achievers in their organization. So I think that the lead the leaders can think about this differently. They can also start to model those behaviors differently. And again, again, communicate. Over communicate, as Amanda said. I think that's key to be able to have a touch-base or you know organization-wide, uh one of the things that we do in in at Blue Cross Blue Shield Association is our CEO, Kim Keck, makes announcements, um you know that people pay attention to. So we see a newsletter, um post from uh Kim Keck and everybody's paying attention because she's paying attention to what's happening in our organization and cares about every single employee. So I think that's another thing. Communication is key. Um, yeah, I hope that really gets to the core of what's going on and that's what senior leaders should do.

[Fara] Exactly. You know, um we often talk about, as I asked, you know setting the tone at the top and senior leadership messages and so forth. But those messages at the top take some time and take a lot of energy to actually trickle down throughout the entire organization. So what role should then frontline managers be playing in creating a healthy workplace culture? So, Dylan, let me switch to you. Tell us or share some examples of leaders that really set the tone for culture and the impact that that can have, and talk to us about the need for training managers to spot signs of issues, supporting employees and leading empathetically.

[Dylan] So uh yes I’m happy to do that I was just thinking I wanted to add one thing to the previous conversation, too. The, uh, you know, there's some good data coming out recently about a very high level of turnover across industries, um particularly domestically in the US right now as we think about whatever that new normal is with people being able to work virtually with, you know there's been a zillion different news articles about, you know restaurants and other retail areas having a hard time hiring people right now. The pandemic has really changed a lot of things, including, you know people's kind of relationship with their jobs and trying to figure out what they want in life and how they keep themselves, you know, healthy um, you know, physically and mentally. And I think that the, um you know, the tension between keeping people healthy and happy at work and and supporting employee well-being is is more and more aligned with productivity because if you've got people who are getting overly burned out and they're stressed out, a lot of them are leaving. They're going to different organizations. They don't have to move to another city to work for way more employers now. There's a lot of opportunity um for workers. And so it really behooves employers to be really focused on having a workplace that is um, you know, healthy, including supporting people's mental well-being. I think we see that um in employers that have some of the highest levels of utilization of mental health services, particularly through their employee assistance programs, that you've got uh, you know, onboarding for people who are uh new to an organization, there'll be a strong focus on what their EAP is, what kind of well-being programs they have in place. And also making it clear that it's okay to share, um you know, if you're having issues, it's okay to use those programs and not feel like it's going to impact your trajectory in an organization. I will say, again, personally I had been at Business Group on Health for a few years when, um, you know we can see each other's calendars as we're scheduling meetings and and you know figuring out when we can connect with people. And everybody's got a, you know dentist appointment, you know, no scheduling here, doctor appointment. There's no stigma against getting your teeth cleaned. Well, when I would go see my therapist that I would always say "private appointment" because there was some level of, I don't want people to know that I’m going to a therapist. I don't want there be a question of if I can, you know, get my work done. And no one would care if I had a broken ankle or dirty teeth or something like that. There would be no question. And I kind of made the decision like, okay if I get gruff about this, uh I I’m going to consider maybe this isn't the place that I want to work. And I just started saying, you know, "therapy appointment," you know. Let me tell you about how I think this is a great idea. It's sort of just the snarky joke of like, I hope that someone sees this and feels more comfortable.

So, I think it doesn't even have to be necessarily the senior leadership, but kind of just a general culture policy early on so that people understand that this is not going to reflect poorly, you know, that you can be a high-performing, um career-advancing uh person, whether it's white-collar, blue-collar, um, while also seeking supports for for mental health. And we see that, you know, those types of peer and manager trainings, um you know over 50 of our large employer members are doing those now. That was absolutely not the case just two years ago. So, I think that there's some, you know, deep recognition on the part of large employers, that this is something that they have to be supportive of and help their frontline folks be able to do it.

[Fara] Right. Thank you.

[Sonja] Can I comment on something that Dylan just said? Just bring up really quickly, um one of the things that the American Medical Association has just launched, not too long ago, is called a stress first aid toolkit. And it actually focuses on peers because you're more likely to talk to a peer about some of the stress, stressors that you're having. So, um it helps them identify what to look out in in their peers and what they say, just triggers, and then what to do, and then how to proceed from there in terms of engaging with managers, etc. So it's an it's just a peer um toolkit. It's called AMA First Aid, Stress First Aid Toolkit. Just wanted to give that to everyone as a toolkit.

[Fara] That's a great, uh great piece of feedback. I I will definitely go check that one out myself. I’m going to pivot to another topic here. With vaccines rolling out and the new workplace models that we're all talking about and exploring, a lot of employees are stressed out about the idea of going back to the office, even part-time. So let's talk about what employers should be doing to address and support their employees, many of whom have real concerns about their reluctance to return. So, Sonja, talk us a little bit about flexibility, including how to build flexibility, and how people should transition back to the office, their work schedules, and the very important use of time off, as well as some inclusive access to care.

[Sonja] Right. Thank you. That's a great question and and again, Fara, this is where communication is key. So being able to set expectations at the senior management level, but also at the manager level who's dealing directly on the front line with the employees. Letting them know, sending messages that it's okay to have a flexible schedule. It's okay to not come back, you know five days a week, but come back slowly, two days a week. And then remotely three days a week. And they have to be sensitive to the fact that people are juggling the care of an elder or the care of a child, as every uh solution does not fit all. And so being flexible in the solution that fits that particular employee is important. What does that mean, Fara? It means that the managers have to be empowered. They have to be, you know, educated, but also empowered to make decisions that fit, you know, each employee that they're working with. So, it's not just about flexibility, but it's also about communication and how though the organization wants to provide that flexibility to the employees that's going to be really key in this time that we're trying to figure out the flexibility for everybody coming back into the office.

[Fara] Yeah, no doubt about that. Um, Amanda, how is Morgan Lewis approaching return to office with workforce behavioral health in mind?

[Amanda] Yeah, I mean it's it's for us it's such a front and center question. Thank you for asking. Um you know we've, I think like every employer large and small out there, you know there's obvious anxiety about returning to work. And so we've done a lot of education. We've done a lot of, we did a whole set of sessions on vaccine safety, which we thought was really important to just make, give people all of the information from very reputable sources. Um we did a whole separate set of sessions on other anxieties where we almost, we we had a panel of psychologists who came in and, um, we did what amounted to almost like role-playing of, you know, how do you have that awkward first conversation? I mean those of us who've sort of re-entered society, you know after this long period, I think we've all had that that um that sense of uh of social awkwardness, um so we really tried to give people, um more than anything, just a recognition that it might be weird for a little while, right? But the other thing that I think is really important and and really, um, I think many many regardless of size of of the employer, um we have people that are are, even if they feel um anxious, are really excited to get back and to see people, right? Um you know, if we we have um uh made such a investment in employee engagement, that's what is in my title, I I’m essentially our talent person, but that's that that that's the lens through which we see all um the entire relationship of our firm and the people who work at our firm. And so um we've really tried to lean into that, to sort of emphasize that there are great things about being back even. And not to not to um dismiss the anxiety and the real fears that come from public transportation and all of those things, um we've really tried to sort of lean into the positive, too, because there's um, you know, even prior to the pandemic, you know, there, the way that we live in in the US at least is is very tied up, and many of us, our identities are tied up in our work and our friends are at work, and and um and that's really positive. That's a good thing, you know, and so we've really tried to emphasize that in our communications.

Um on a more practical, on a more practical um uh basis, we gave um days off for vaccination, we gave vaccination days off. We've sort of had a very very individualized approach to talking to people about hesitancy rather than blast emails. Um and I think all of that is, it pays off. It's um, you know, some of what we spoke of earlier, my fellow panelists spoke of earlier, of sort of over-communicating, um showing vulnerability, transparency, acknowledging that these are unprecedented times and we're all in these unprecedented times together. There's no one, no matter how many different crises you've led your organization through, this is different than all of them. And um that goes a long way to sort of creating those um feelings of trust and empathy and engagement um that I think will ultimately alleviate the anxiety about returning to work. Um and it will be weird for a while. I think it's just important to recognize that for all of us.

[Fara] Yeah, there's no doubt it'll be weird for a while, and it may get even more weird when we have to start using our masks again. So that's another thing we're all faced with. You know, on this whole notion of um stigma and and worrying about this, uh Dylan, you've done, Business Group on Health has done a lot of important research in this space, especially related to employers seeing stigma and accesses the issues, yet employees pointing to not having the time and not being able to afford care. Talk to us a little bit about that.

[Dylan] Yeah, absolutely so um you know we have been doing a lot of work and with our employer members, and then I also reflect on, you know, what our own organization of about 30 employees has done um with this exact conversation and anxieties that um, you know, me and you know my co-workers and I have um uh about returning to the office. And certainly there are folks like myself with an immunocompromised family member for whom, uh you know, it's a different sort of calculus on on, you know, the level of um risk of illness that that you know I’m willing to take versus other co-workers and um what that means when, you know, some people are very excited to get back and others are a little bit worried. So you know on that question, I think it's really important to listen to your employees, frankly, whether that's giving people forums to speak publicly about what they're worried about or what they're focused on, good and bad. Anonymous surveys, as well, that you know you can be a small employer doing this as well, just give people an opportunity to say what they're excited or worry about and that can really help you know guide your strategy and how you address some of that. And then, yeah, I want to just recognize the tremendous privilege that we all have clearly sitting at home um when, you know, I go to the grocery store and there's plenty of people working there interacting with people that you know they have no idea if they're healthy or vaccinated or whatever else. So, you know we need to make sure that this is something that, when we have these conversations about return to work, we're not forgetting that uh there's, you know, half of the country, maybe not half of the country, I shouldn't I shouldn't say percentages when I don't know the exact one, but you know a lot of people have been continuing to work, um interacting with a lot of other people. So, just wanted to throw that out there.

You know, in terms of, yeah, access to services, so I I think um you know, previously we've had conversations with um, you know the HR uh folks at large employers that we work with every day where they often cite, you know, stigma as a major reason why people don't access services, which is absolutely true, but I want to make sure, and we've seen this in our our data when we've done some studies alongside other organizations where you interview workers and ask, you know, "What are some of their greatest challenges to accessing services?" And it's often the case that it's getting time off of work to get them, um and that it costs too much, uh, both of which are absolutely true. And this is why it's important to listen to your workers so that you can address them. You know, the worst thing that an employer could do, in my book, is put in anti-stigma campaigns and then have programs and policies that make it very hard to get services. Because you don't want people to get to a point where they say, "All right. I’m finally ready to seek care," and then hit, you know 17 different roadblocks to getting it. So you really have to think holistically, you know, and this isn't a shocking revelation, but just make sure that once someone has gotten to a point where they're ready to seek, you know, mental health um supports, that that they can do that. And it is a big challenge, but you just want to make sure that you're working on both of those alongside each other.

[Fara] Oh, that is so true. Um really a tough thing to sort of balance as a as an employee. Um before we move on, I just want to say that we will have a few minutes for audience Q and A. So if you have any questions, send those in through the Q and A chat box and we'll get to your questions as quickly as we can.

So, in the meantime, employers in our recent study identified low resource awareness, stigma, remote working as some of the top barriers to addressing behavioral health. But behavioral health inequities present another really important key barrier. So let's talk about how those inequities have been amplified and how employers can and should be addressing them. So, Ken, let me start with you. There are so many challenges. Can you give us your insights in this space?

[Ken] When I worked at Blue Cross Blue Shield of Massachusetts, we were the first plan to cover phone sessions, and that was directly because of equity. So it's well established that video-enabled teletherapy is as good as in-person, if you look at the evidence, the data that's well established. Phone has not really been studied, uh but it was an equity act of faith, uh to just make a statement that those sessions would be covered the same as in-person. The Massachusetts legislature then got behind that and mandated that for all health plans going forward after the pandemic emergency has stopped. So this is a substantive equity moment because not everybody has the internet. It doesn't solve the core supply demand mismatch. That is to say for people's concern about stigma, demand is overwhelming supply.

And so, I would encourage people to be honest about that and to provide ways to solve for that problem. There are individuals at health plans who try to make appointments. There are telehealth companies that are separate and additional to the network, and then there are customized networks. Those are all solutions that you can put into play because if you give people the ways to find help through equity, like phone sessions, you're going to need to back that up with ways to execute it.

[Fara] Really, really critical to provide the right benefits to the organization. And, you know, as we speak to the need for not just the right benefits, Sonja, let's also talk about the right communication, um you know, ongoing outreach to reduce stigma and privacy to make the care experience more inviting.

[Sonja] Right. One of the things that we, and and I’ve worked on this in the past, is cultural competency, you know in medicine and in health care. It's very important. But what it involves is actually talking to the person, asking them questions, not assuming, not making broad, sweeping assumptions or stereotypical assumptions around what a person may be going through.

So I think it will be really important, again with that frontline manager, who's, you know, working with employees directly, to be trained and talk in asking questions that are not illegal, but asking questions that are important to uh help them understand employees and what barriers they may have to seeking help if they're feeling burned out or if they're feeling anxious about, you know, return to office. All of those things. Again, it sort of creeps back up to the senior leaders to show acceptance, create those opportunities to communicate that it's acknowledged burnout is in the organization and then to allow those managers to be empowered to talk with their employees in a way that takes takes a stigma out of the conversation and creates a new normal, better organizational acceptance of initiatives that can make a difference. Um I think that the other part of this is that manager being able to feel comfortable in sharing and having testimonials um that they can humanize the whole process with their employees. It makes a big difference. And so, understanding cultural competency can also, not it's not just for medicine. It's it's for the entire, you know, workforce, I think, um not just in the US but in the world, in having those managers be um empathetic and compassionate in how they deal with their employees and the unique barriers they may be facing.

[Fara] Thank you so much, Sonja. You know we've talked a lot about communication sort of in general. Amanda, as an employer, you know, we're all trying to be very aware of how we communicate to the various employee segments within the company. So how critical is it to do that in ways that get through that are helpful and relevant rather than even more stressful?

[Amanda] Yeah, I mean I think this is such an important topic. It might be, for for an employer, I think it might even be the most important topic because um we work really hard to have an inclusive a diverse and equitable and inclusive workplace. And in my mind, you can't have inclusion if you don't have well-being and you can't have well-being if you don't have inclusion. And so those are in, I think, we think of those things as two sides of the same coin and something that should be thought about together and um analyzed together from the perspective of developing programs. Um so you know communications are critical. I think what Sonja just said about cultural competence about that being sort of a um a requirement for managers now um in the US. Should have been always. But certainly is now especially given um, you know, what Dylan said earlier, which I I want to endorse completely, about how employers who don't sort of try to understand and be culturally competent are gonna lose workers, right? Um you know the the great resignation is happening. The important thing is understanding that different people within your organization are gonna have different concerns. Um one example, I think that I just wanted to offer is we did a program this year that was focused on our Black employees that was um uh really developed in um cooperation with and collaboration with with our Black Lawyer Employee Resource Group, which is an an incredible resource. Your ERGs, if you have them, if you're big enough to have them, um can help you with this. And if you're not big enough or quite big enough to have them, consider starting them. Um and we developed a program um to talk about Black mental health and invited a very renowned psychologist, Rita Walker, to come in and talk to us about um, you know, the the the sort of dual pandemic that has been um been happening in um in many communities of color in in the US and how, you know, not only do we hopefully have a inflection point with respect to racial justice issues but we also have communities of color who are disproportionately affected by COVID. And and we really just wanted to acknowledge that and provide some resources. And so we've tried to be very targeted in that way. But again, through ERGs I would encourage everyone listening to to look to those groups of interested and committed employees in order to sort of help you navigate this.

[Fara] I 100 percent agree with you, Amanda. I think, we call them employee networks, are critical to uh sort of be your conduit to the various employee segments. You know, I’ll just say one thing for those of you who may not be aware, Several Blue Cross and Blue Shield companies recently launched a behavioral health employee communications toolkit to their employer customers. And this is just a free suite of internal communications materials that were designed to help employers foster more open dialogue around this topic and drive employee awareness. It tackles a number of different areas. So that is available to you through your Blue Cross Blue Shield Association and and through your um local Blue Cross Blue Shield plan. Uh most of them anyway.

So with that um, let's talk about where we go from here. So given the conversation today, we're gonna do a very quick-fire um "What are the top three actions employers should focus on now?" And remember to go off mute when I call your name. So, let's start with you, Ken. Top three actions.

[Ken] Uh the number one thing is to remember that employees are experiencing mental health vulnerabilities, or their family members, and to prioritize that. The number two thing, in my opinion, is select a health plan that has benefits that cover things. That's not universally true. And the third is to create a culture where the managers feel that they can be open when a conversation happens and the people being managed feel that they can go to their managers. So those are my three things. Thank you.

[Fara] Thank you. Sonja.

Oh, great. Thank you, Fara. One is for the organization leaders of the organization to recognize factors that contribute to burnout and anxiety. Second, to develop, once they recognize, develop solutions that can be concrete solutions that their employees can benefit from. And I echo what Ken just said about actually having benefits that support that. And then third, empower your uh frontline workers, your managers, to take the step, and also the peer employee, empower all of your employees to take the steps to really help someone who's in need who is experiencing burnout or depression or anxiety. So thank you.

[Fara] Thank you. Amanda.

[Amanda] Um, this is going to be repetitive, but um communicate, communicate, communicate. Over communicate. Communicate with intention and empathy and transparency. Um, develop a culture. That's not something that you could do overnight, of course. I think we all wish it would be, but um start now to develop a culture that is, creates sort of a baseline knowledge of behavioral health issues. And then finally work on the protective and proactive side of things, as well as the um, you know, sort of reactive, interventionist, clinical side of things. There's things that you can do and tools that you can give your employees, no matter how small of a company you are, that will let them grapple with these issues more effectively.

[Fara] Thank you so much, Amanda. And let's wrap it up with Dylan.

[Dylan] I would say listen to your employees. If you're going to be intentional about your communication, your benefits programs, how you return people to work, how you support people who have been in the workplace for the last year and a half, give people anonymous ways to give feedback about what they're feeling and what they would benefit from. Would say secondly, um let's see, uh, you know just continue to push, you know, on mental health going forward whether it's now or in the future. Employers have had a tremendous challenge previously putting in programs, putting in strategies and communicating them to people who could benefit them in a time of need. So you've got, you know, one clinical area and you need people to get it at the exact time that they need it. Maybe they don't know that they need it. Benefits programs or benefits fairs are only once a year. Right now, every single person in this country, you know, you could argue on the planet, even if they think COVID is a total hoax, they've probably got other mental health issues that they could benefit from. Uh but you know everybody is going through something right now, and so, you know it is such a slam dunk major focus for people to be communicating to their employees about. And then I would say finally, just make sure that you're covering Medicaid-assisted therapies for substance use disorder. We haven't really talked about substance use disorder specifically this year, but opioid-related overdose deaths were up 30 percent in this past year. And it's um you know something, I think hits a lot of us personally, and our families, and I just think it's so important to make sure that employers are continuing to focus on that. Sorry, that was kind of long. That's mine.

[Fara] That was fantastic. I will just say ditto to everything you all said. Such a great conversation that we've had so far. Um let us turn now to the audience questions. And I am going to start with Amanda, um, trying to read these here. Let's talk about frontline managers needing to be educated and supporting their teams. But it's also important to acknowledge that they and senior leaders are also personally sometimes affected by behavioral health challenges. How do they get supported?

[Amanda] Such a great question. I love that. I think this is such an important question because, um, like Dylan just said, there is no one who's not impacted. And I think somebody in the chat also said something about, you know, "What about HR? HR are the people that have been managing us through the this." And so there's always, and not to mention the people who have been, as Dylan said, frontline workers, right, um, you know, who have been, you know, who have not stopped working in the office and we all have no matter, I think, virtually all of us, have essential personnel where that's been true. So um I think that that there's no easy answer to that question. Um I think you have to first understand that that's something you need you need to solve for as an employer, that you can't you can't have everything trickle up so that then the people at the top of the pyramid are um, you know, left um, you know, sort of trying to solve the problems of everybody else in the organization. But you also can't um ignore the fact that there are some people in different segments of your employee population who need more or different kinds of help. So I think the answer is to, in that sort of creation of the culture, and um just the acknowledgement that um some of the peer-to-peer um um supports can be just as important as supports within the managerial structure itself, or in as, you know, the formal managerial structure. Um, you know, I think one of the amazing things about creating sort of an engaged and and workforce that that understands basic concepts of well-being is that um you know it could be anybody, it could be a receptionist who is identifying a partner who might be having a mental health issue and it could be um somebody who works in my position who could be seeing that our HR person is really struggling. And um if if we've done it correctly, then it should be sort of a web of supports instead of something that just works in the strict managerial roles. Um so that's, again, you know, that's something that has to be worked towards and is a continuous process that you have to sort of strive towards over time as an employer. But that's that's the idea. And I think I think um, you know we heard that and what Ken said and and that that's that's really the goal.

[Fara] Yeah, I totally agree. Um and so true about some of the HR people, as well. I think we're we're seeing a lot of that. Sonja, how can we, this is another question from the audience, how can we help our frontline managers spot indications of burnout within their teams?

[Sonja] Again, I think it's uh really about education, but there's, it's very easy to communicate to the managers what to look out for. Those symptoms of burnout are classic. Um studies show those symptoms over and over again. And so uh being able to recognize them and then having initiatives that and interventions that they can deploy right away, be empowered to deploy them, is really important. And then I mentioned, you know, there are other toolkits but the AMA Stress First Aid, giving first aid under stress to, you know, your peer, and then taking other steps, is one tool that's really helpful. But there are others out there, and I think that organizations can really do a great job for all of their employees to implement some of these toolkits.

[Fara] That's great. Um Ken, you talked before about um virtual resources and we've had a lot of conversation with you about that. So an audience question, "Other than virtual resources, what are other tactics that employers can use to address behavioral health inequities?"

[Ken] Um well again, I think the phone sessions are the linchpin to an equity strategy. Therapists across America made the quickest pivot in mental health history doing video sessions within three days of the pandemic. Virtually no one was doing phone sessions because it wasn't being paid for. So across the country, a lot of health plans, including a lot of the Blue Cross plans, are paying for video and phone sessions. That's one example. You can't make the workforce more diverse overnight, right? You have the workforce that you have, the people that are in the networks, so to me that's the best example of how to get uh more culturally competent services to more people. I think telehealth with video has helped with that. I think there's some evidence for that because people are no longer relegated to the people they can drive to. And so phone sessions are, again, very good on an equity perspective for all the people who neither have privacy nor the internet. So those are two important examples and I think the EAP you select, the online resources you select, these are all decisions that employers are making. They should be approaching them from an equity perspective.

[Fara] Great. Thank you so much. Um here's a question um I’m going to throw it out to um Dylan. Suggestions, any suggestions for how and what smaller employers can do?

[Dylan] Yeah, so you know Business Group on Health uh pretty much solely works with larger self-insured employers. So, you know, the data that we have on, you know in terms of trends for the employers that we work with, are generally, you know, employers that have several thousand up to hundreds of thousands employees. That being said, I think a lot of these things, you know, that we've been talking about apply even in a smaller workplace. So, for example, making it clear when you're onboarding someone that um it is okay, maybe not, you know, you can say it's okay to talk about these types of things or make it clear that um you've got um services in place if someone um is, you know, struggling with burnout or other mental health challenges. You can listen to employees. Give them anonymous opportunities to give you feedback on what they could benefit from. You know, depending on what kind of industry you're in, you can do things like give people a mental health day off. A week is a lot for most employers, and and if you're a grocery store, you definitely can't do that. But, you know, a lot of other places you can you can look at flexibility in terms of where people are working. I saw another question about, you know, people's physical space, you know, proximity to each other. Some of that, particularly when you're a smaller employer, you can't flex on that really easily. But if you've got people who can work from home and don't need to be in an office, I would say don't reflexively bring people back because you think that's going to be the most productive way to run your business. Because the past year and a half has suggested that maybe it's not. So um, you know, those are those are some things to to consider.

[Fara] Um thank you so much, Dylan. I think we have just time for one more, so I’m gonna throw this one out to Amanda. If you are a frontline manager and you want to approach your senior management about some of these ideas, especially when they are the opposite of how things have been handled so far, what would you suggest?

[Amanda] I was hoping we would get to this this one because I think this is really important. So there is, what I think of in my head, as the business case for doing all of this, right? And it relates to something that Dylan said earlier, which I would I would go out and assemble data, because some of some of the people that we report to only really listen to data, and and present on um what's coming out about what what I what I refer to as "the great resignation," what many people are starting to refer to as "the great resignation." There is this enormous portability now where you have, and you don't, you're not necessarily limited to work in the um the the community in which you live, and that is going to change everything. And I think it's going to change every almost every aspect of our economy, right? So um the the evidence shows, and this is a separate set of data, but it is certainly available in multiple places, including Gallup does, it has a lot of information on this, there's a lot of if you search for um information on well-being positive psychology and productivity, you'll find a lot of information about how well-being and productivity are interdependent. And so if you want your employees to be more productive, have fewer days off, um sick days, rather, we should have more days off but fewer sick days, and to ultimately be more goal-focused, more task-oriented and more productive, it is a business imperative um that you invest in this kind of well-being. And that includes, um you know, talking about it on onboarding, it, talk it extends to benefit selection, you know, go out and get the Blue Cross Blue Shield toolkit on talking to different populations within your organization and uh put together a strategy for your manager that says "We will be more successful as a business if we attend to these things now. People will stay longer and they will be more productive and ultimately will benefit us. It is an investment in human capital."

[Fara] Thank you, so much.

[Amanda] That's an important one.

[Fara] So well said. Um this was fantastic. Many, many thanks to our panelists for their fantastic insights. And thanks to each of you for joining us today. If you are interested in more information, we have a full suite of behavioral health resources, including an ebook, white papers, infographics, videos and more. And you can find it all at smarterbetterhealthcare.com. Have a wonderful afternoon.

[SCREEN TEXT] For more Behavioral Health resources and other important healthcare topics, please visit: www.smarterbetterhealthcare.com

[Dylan] Thanks, everyone.

[Ken] Thank you.

[Amanda] Thank you.

[Sonja] Thanks, everybody. Take care. Be safe.