At one time, employee assistance programs were considered punishment, and mental health therapy equated to long hours spent analyzing childhood memories while lying on Freud's couch. In today's transparent and wellness friendly world, however, employers are getting better at shedding the stigmas associated with seeking mental health resources. Now more than ever, EAP providers offer convenient service delivery options to get plan participants the help they need. Managers, meanwhile, also benefit from EAPs through access to expert advice to help develop employee policies, diffuse real-time problems and keep the workplace safe.

"In the older days, the EAP was sometimes looked at punitively; people were sent to the EAP if the employee did something wrong. So effective programs [now] promote the employee assistance program as exactly that: Something the employee uses as their own tool to help improve the quality of their life," says Dr. Joseph Hullett, MD, the national medical director for Optum's behavioral health business in the employer market. "The focus should be on wellness, not just illness. ... and on the notion that you don't have to be sick to get better."

He emphasizes that an employee - whether they participate in the health plan or not - and their family should be able to easily access all the EAP services.

Companion Benefit Alternatives, Inc., a subsidiary of Blue Cross, introduced a new method of delivering cognitive behavioral therapy through the Internet. "Beating the Blues" is an online program that offers employees clinically proven treatment for depression and anxiety. It offers a viable alternative for individuals who might not have time to take off from work for face-to-face cognitive behavior therapy or who fear a perceived stigma associated with in-person treatment.

"Lots of people go to therapy now for what we would call short-term, problem-focused therapy," says Missy Lewis, manager of case and disease management at Companion Benefit Alternatives, Inc.


Portable format

In her experience as the managing RN for the "Beating the Blues" program, participants often improved their issue within three to five sessions, and their treatment didn't necessarily require multiple years of commitment to therapy.

The program's portable format allows individuals to access cognitive behavioral therapy in eight online sessions, which members can complete at their own pace in their home, library or office, even late at night. The 60-minute tutorials include graphics, audio and video vignettes of people from all walks of life with whom they can identify. Participants can also record thoughts in an online or printed diary and fill out assessments after every module that report the participant's anxiety and depression levels as well as the program's efficacy. Their distress signals are graphed online so the participant and managing clinician can see if they are improving or worsening.

Portal materials are confidential, but registered nurses or social workers monitor the portal for higher distress scores and can reach out to the member if they express severe distress.

So far, 300,000 people across the globe have participated in the "Beating the Blues" program, and Companion Benefit Alternatives currently has 100 members enrolled in the U.S. plan. Among the published studies supporting the program's effectiveness, typical results show that approximately 60% of participants achieve a reliable change and those individuals who do need face-to-face treatment require less than half of the typical sessions to reach recovery.

"There may be people who use [this program] as a jumping-off point, a way to get comfortable with and explore what it is to do therapy in a private environment and may go on to do additional in-person therapy," says Lewis.

Hullett adds that when people don't think they have a problem, educational resources can raise their level of consciousness. "If you have online or self-help resources, at least you can begin the process of getting that person assistance," he says, adding that "an online methodology has demonstrable success, and it's legitimate cognitive behavioral therapy."

In a routine situation, telephonic or online therapy can be valuable; however, Hullett cautions that to help someone who is out of control, angry or potentially violent, seeing a clinician in person might be best. In addition, in-person counseling allows the counselor to read the patient's body language, determine if they're taking care of their hygiene, see or smell whether they've been drinking, and make other observations that can't be done over the phone. On the other hand, virtual therapy gives patients living in remote areas or disabled people who are unable to travel easy access to help.


Multiple methods

Hullett recommends offering multiple methods of treatment so that employees have options. "Some people won't use your preferred methodology so, in some cases, doing something is better than doing nothing," he says.

Another burgeoning therapy method, telepsychiatry, provides participants immediate contact with a licensed professional through a sophisticated video conferencing system, which employers can provide at onsite health clinics.

An employer's first responsibility is to the safety of its workers, which they can ensure through a transparent and supportive culture, says Dr. Ewa Antonowicz, clinical director of ComPsych, an EAP provider. "Employers need to have an open work environment where the employee feels safe to come to their manager or HR and tell them if they are struggling," she explains.

She suggests employers also draft robust workplace policies that explain the organization's position on violence or respect in the workplace and potential consequences. They should also assemble a threat assessment team - consisting of representatives from HR, security, legal, the EAP and medical, if they have occupational medicine in the workplace - that can take immediate action if there is a violent incident.


Preventing violence

"The major sign [of violence] is any change in an employee's behavior," says Antonowicz. An employee who isolates herself, neglects his personal hygiene, has missed a lot of work or whose work production has slumped, for example, may be at risk, and managers should direct that employee to the EAP. Additional warning signs include expressing a sense of unfairness, making unreasonable demands, becoming threatening, litigious or aggressive. Frequently, violence spills into the workplace from domestic abuse or workplace bullying, which a manager can also address with the EAP.

If a manager notices a significant change in a person's behavior, temperament or attitude, they should take the following steps:

1. Take immediate action. "I always strongly advise employers to talk to their employees immediately when some type of inappropriate behavior happens in the workplace," says Antonowicz. "Employers have a responsibility to provide a safe environment for their employees."

2. Listen. Often when a person acts out it's because they don't feel heard. In order to avoid escalating a tense situation, Hullett tells employers to listen to the individual and avoid direct confrontation and commands, such as "calm down."

3. Address the public facts. When a manager approaches an employee about an issue, they should share their concern as they witnessed it and suggest the EAP as a resource. They should not accuse the employee, try to diagnose them or ask for personal reasons driving their behavior.

4. Offer options. Suggest a solution for how to fix the situation, such as bringing in a mediator to discuss the issue or writing a letter to HR.

5. Involve the EAP. The manager can suggest the employee reach out to the EAP or, under certain circumstances, insist on a mandatory referral that reports - without revealing any personal details - on whether the employee participates in a program and completes it. Depending on the employer's policy, they may have a forensic psychologist determine whether the employee can return to work once treatment is completed.

6. Have clear policies. Employers must have policies in place around bullying, harassment, violence and ethnicity sensitivity to show they will not tolerate hate or violence. Follow the written policy without exceptions.



Train managers, staff

To ensure these policies are state of the art, in line with privacy laws and consistent with others in the industry, have your EAP management consultant evaluate them, suggests Hullett. EAPs can also offer management and employee training for diverse issues, including violence and suicide awareness for managers.

"The EAP is a wonderful benefit for any employer because it not only provides counseling for employees, it provides a lot of support to managers," says Antonowicz. She adds that a company is "not a family, and there is still a boundary between employee and employer. It's a professional relationship but still, there should be an environment where an employee feels safe to share [if they need assistance]."

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