Even before COVID-19, the US was facing a mental health crisis: upwards of 20% of the country's adult population met criteria for poor mental health and the majority of people (55%-70%) did not receive care. This was due, in equal parts, to an overburdened system and to stigmatized beliefs.

The coronavirus and its accompanying stressors have put many strains on benefits leaders and their populations. The immediate response has been to transition to remote care, but are telehealth and virtual EAPs enough to combat the growing need for psychological support?

We connected with Dr. Jennifer Kanady, Ph.D., the Clinical Innovation Lead for Sleep at Big Health, to get her take. Dr. Kanady received her Ph.D. in Clinical Science from the University of California, Berkeley, and specializes in the research and treatment of sleep and sleep disorders.

BenefitsPRO: We have heard from benefits leaders that the first thing they did to combat the growing mental health concern was to increase the capacity of virtual EAPs and waive co-pays for telehealth. Was this the right first step for employers?

Dr. Kanady: Yes! It's really commendable that employers quickly adapted to the current mental health crisis by moving to virtual platforms and waiving copays for certain services. These rapid moves provided continuity of care for those already receiving it, and easier access for those struggling for the first time. However, telehealth services have several limitations.

BenefitsPRO: What are those limitations of telehealth and/or EAP?

Dr. Kanady: First, rapid adoption of telehealth has likely been challenging due to a lack of infrastructure and knowledge. To quickly meet expanding demands, some providers had to transition to providing care on less secure platforms, creating privacy concerns. Second, telehealth unfortunately doesn't address pre-existing barriers to mental health care. For example, there was already a shortage of qualified providers before the pandemic; that doesn't change by going online.

Third is the enduring challenge of stigma: people may be uncomfortable starting their exploration of mental health treatment during a period of high stress with a live, 1:1 interaction with a health care professional.

Finally, during Covid-19, engaging with telehealth services may be especially challenging. While we know that stressors have increased during the pandemic, we've heard that EAP usage has been unchanged and, in some cases, even lower than prior to Covid-19. Possible reasons may include privacy concerns or time constraints. For example, due to the added burden of social distancing at home (childcare and helping kids with schooling), people may find it especially difficult to find the time for a private mental health session.

BenefitsPRO: What else can benefits leaders offer to people in this crisis?

Dr. Kanady: Both telehealth and digital mental health solutions provide "virtual" services, thereby addressing some key capacity limitations of traditional EAP and the specific quarantine challenges of Covid-19. But telehealth still relies on human providers with limited availability. Unfortunately, there continues to be a dearth of qualified providers and not everybody is able to have a mental health session between the typical work hours of 9AM – 6PM. Telehealth also doesn't address common barriers to care, such as stigma and the desire for self-help. For example, some people may worry that their boss will discover they're using mental health resources and that it will reflect poorly on their work evaluation.

On the other hand, digital therapeutics are fully automated, and therefore have the capacity to reach millions of individuals. What's more: they can be accessed confidentially and privately, whenever, wherever and however peoples' needs arise.

BenefitsPRO: What kinds of mental health apps are available and how can benefits leaders decide which ones are right for their employees?

Dr. Kanady: There are many different options – myStrength, Ginger, Happify, and of course Big Health's Daylight and Sleepio. But not all digital solutions are identical. One important way that they differ is based on clinical evidence. We suggest that benefits leaders ask mental health vendors the following questions, to find out which ones are best for their employee population:

Has the solution been tested in a randomized-controlled trial (RCT)? Since RCTs are the 'gold standard' of clinical evidence, this question is the fastest way to determine the rigor with which a program or product has been tested.

Has research on the solution been published in independent, peer-reviewed journals? Being published in a peer-reviewed journal helps to mitigate bias, since clinical and scientific third parties review the research scope and design, the validity and reliability of measures being used, follow-up and drop-out rates. But since not all journals are created equally, check the journal rankings here (or check the journal impact factor).

What percent of individuals remitted in their symptoms? This will prompt vendors to explain the results of their study in terms of how many individuals' symptoms improved, and whether the improvement was lasting.

What was the effect size of the outcome and was it between groups or within groups? The vendor will have to explain whether the intervention in question had a small, medium, or large effect size (impact) on the outcomes. Remember if there is a small effect size, it means the intervention had a negligible impact on symptoms.

In what types of populations has the solution been tested? It is important to determine how the studied populations are similar to your employee demographics and if the results will be applicable.

Are there other studies planned or in the pre-publication phase? This serves as an indicator of the vendor's ongoing commitment to expanding their evidence base. Replication is the cornerstone of clinical research.

While the ensuing mental health crisis resulting from COVID-19 is alarming, it provides an opportunity to rethink our mental health system and embrace new, integrated forms of evidence-based care – especially solutions that can meet the potentially long-term needs of this "new normal."

Benefits teams can expand coverage to their populations by investing in not only telehealth, but also in affordable, scalable digital mental health solutions that enable people to get help without stigma. By asking the right questions, benefits leaders can pick the solutions that best meet the needs of their employees. The future may be uncertain, but what is certain is that now is the time to continue prioritizing mental health to alleviate suffering.

Instant Insights /

Beyond telehealth and virtual EAPs: The need for more mental health assistance during COVID-19

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