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Creative Wellness Benefits Solutions for Today, Strong Policy for Tomorrow

AnEmployersGuidetoWorkplace
EmotionalWellness

June2011

AnEmployersGuidetoWorkplace
EmotionalWellness
Acknowledgements.....................................................................................................................................
1

ExecutiveSummary.................................................................................................................................
1.1

PurposeoftheGuide ......................................................................................................................

1.2

Approach.........................................................................................................................................

1.3

SummaryofKeyEmployerRecommendations...............................................................................

1.4

FutureOpportunities ......................................................................................................................

DefiningEmotionalWellness ..................................................................................................................
2.1

WorkplaceEmotionalWellness ......................................................................................................

BusinessCaseforWorkplaceEmotionalWellness .................................................................................
3.1

GoalsforWorkplaceEmotionalWellness.......................................................................................

3.2

BusinessImpactforWorkplaceEmotionalWellness......................................................................

3.3

BenefitsandRisksofWorkplaceEmotionalWellness ....................................................................

PrimaryFactorsInfluencingWorkplaceEmotionalWellness .................................................................
4.1

Leadership.......................................................................................................................................

4.2

OrganizationCulture .......................................................................................................................

4.3

OrganizationalStructure.................................................................................................................

4.4

ChangeCapacity..............................................................................................................................

EmployerSolutionsforWorkplaceEmotionalWellness ........................................................................
5.1

WorkplaceEmotionalWellnessStrategiesandRecommendations ...............................................

5.2

WorkplaceEmotionalWellnessPrograms,Services,andCultureRecommendations...................

5.3

WorkplaceEmotionalWellnessPoliciesandMetrics .....................................................................

Bibliography ............................................................................................................................................

References ..............................................................................................................................................

Acknowledgements
ThisGuideistheresultofcollaborationbetweentheNationalBusinessGroupon
HealthandtheCenterforMentalHealthServices,SubstanceAbuseandMental
HealthServicesAdministration.

Manyindividualsandorganizationscontributedtothedevelopment,authorship,
andreviewofthistoolkit.Withoutthiscommitmentanddedicationofthese
individualsandorganizations,theimplementationtoolkitwouldnothavebeen
completed.

ContributingStafffromtheNationalBusinessGrouponHealth
KrissyKraczkowsky,MPH,MBA
Author
DemianKendall
Analyst
ElisabethMeinert
Analyst
RonaldA.Finch,EdD
PrincipalInvestigator

ContributingConsultants
ScottRothermel,Principal
Rothermel&Associates,Inc
Author

ContributingStafffromtheCenterforMentalHealthServices
BillHudock,MA,SpecialExpertFinancingPolicy
CenterforMentalHealthServices,SubstanceAbuseandMentalHealth
Administration

AdvisoryBoardMembers
GeneBaker
OptumHealth

GreggGittus
HealthMedia,Inc.

DavidBallard
AmericanPsychologicalAssociation

AllanKennedy
AT&T

RichardBedrosian,Ph.D.
HealthMedia,Inc.

JaniceLenehan
Johnson&Johnson

AllisonLondonBrown
Healthways

LyleMiller,Ph.D.
BiobehavioralInstitute

AmbyrBrooks
UniversityofMichigan

PamelaGreenberg
AssociationforBehavioralHealthand
Wellness

DanielJ.Conti,Ph.D.
JPMorgan/Chase
DeeEdington,Ph.D.
UniversityofMichigan
JackGroppel
HPIInstitute
BillHudock
CenterforMentalHealthServices
SubstanceAbuseandMentalHealth
Administration

ScottRothermel
Rothermel&AssociatesInc.
RobertRosen,Ph.D.
HealthyCompanies,International
StevenSauter,Ph.D.
NationalInstituteforOccupational,Safety,
andHealth
MarkSmith
HealthyCompanies,International

AnnKuhnen,MD
GlaxoSmithKline

DonWeber
PricewaterhouseCoopers

DanPrewitt
Healthways

SteveXenakis,Retired
U.S.DepartmentofDefense

SusanHagen
UniversityofMichigan

DuanePutnam
Pfizer

CitationandReproduction
AnEmployer'sGuidetoWorkplaceEmotionalWellnesswasgenerouslyfundedby
agrantfromtheU.S.DepartmentofHealthandHumanServices,Substance
AbuseandMentalHealthAdministration,CenterforMentalHealthServices.All
materialsareinthepublicdomain.Whenreferencingtheimplementationtoolkit,
pleaseusethefollowingcitation:
Finch,RAandKraczkowsky,K,editors.AnEmployersGuidetoWorkplace
EmotionalWellness.Washington,DC:CenterforPreventionandHealthServices,
NationalBusinessGrouponHealth;2010.
Allmaterialsinthistoolkitareavailableonlineat:www.businessgrouphealth.org.

1 ExecutiveSummary
Business executives know the longterm success of a company depends heavily upon the
sustainedproductivityofitspeople.Whatnotenoughexecutivesfullyvalue,orhaveyettoact
upon,isthatthestrategicdefinitionoforganizationalassetsshouldextendtohumans,notjust
capital. More importantly, actively investing in a companys human assets, including its
employeesphysical,mentalandemotionalhealth,isjustasvitalasmaintainingitsmachinery,
supplychainandcustomerrelationships.Someargueemployeeemotionalhealthistoosoft
for employers to directly support; this Guide is intended to address these business concerns
andwillproviderecommendationstohelpemployersstrategicallyaddressemployeeemotional
health.
Executives and senior management are seeing the impact of this oversight or neglect as the
cost of health care continues spiral out of control. Total U.S. health care expenditures are
approaching$2.2trillion,whichrepresentsnearly16%ofthecountrysgrossdomesticproduct.
A2008HealthCareCostSurvey,showedcompaniesarepayinganaverageofover$9,000per
employee for health care. In 2006, corporate health care costs represented 44.1% of total
benefitcostscomparedto8.8%oftotalbenefitcostsin1950.i
Inadditiontoaddressingthecostofhealthcare,thecurrenteconomiccrisishasintensifiedthe
focus on productivity, with organizational leaders understanding that increasing and
maintaining employee productivity will be essential to meeting shareholder expectations.
Additionally, the aging of the workforce and employees, who are choosing to remain in the
workplacepasttraditionalretirementage,willrequireeveryoneinmanagementtoseekanew
understandingandcreativeapproachestoachievingorganizationalproductivityobjectives.
Some employers are exploring new concepts that focus on the total value of health, and
culture of health to help achieve corporate objectives. These companies are beginning to
realize that success includes improving and maintaining employee and dependent health
status.Thesesuccessfactorsinclude:

Improving the health status of the workforce. The issue is not what it costs to keep
peoplehealthyandproductive,ratherwhatitcoststoletthemremainunhealthy.

Providingfinancialandotherincentivesthatencouragetheuseofhighvalueandproven
preventive practices and interventions, and discouraging use of wasteful or unproven
services.

Aligning economic and behavioral incentives for health care providers, employers,
suppliersandconsumerstoincreasethevalueandsustainableimpactoftheseservices.
7

Empowering employers, purchasers, intermediaries, providers, and individuals with

shared, clear roles of responsibility and accountability for health and resulting
productivity.

Using broad metrics that go beyond medical costs and focusing on improving health
status.

Measuringthefullreturnoninvestmentfromincreasedproductivityaswellasmedical
costsandsavingsfromcontinuallyimprovingthehealthstatusoftheworkforce.

Toachievetheirstrategicbusinessobjectives,employersmustcreateanenvironmentthat
encourages employees to maintain their total health: physical, mental, emotional and
spiritual. Dee Edington, writing in Zero Trends, has outlined five strategies of change that
will help organizations develop a culture of health and achieving health and productivity
goals.Thesestrategiesincludechanging:
1. Fromhealthastheabsenceofdiseasetohealthasvitalityandenergy;
2. Fromonlycaringforthesicktoenablinghealthpeopletostayhealthy;
3. Fromthecostofhealthcaretothetotalvalueofhealth;
4. Fromindividualparticipationtopopulationengagement;and
ii

5. Frombehaviorchangetoacultureofhealth.

In order to control costs and promote health, employers are offering expanded benefits,
including employee assistance, health promotion and disease management programs. Of
these, health promotion programs are the only programs designed primarily to prevent
poor health. These programs target common risk factors of chronic diseases including
tobacco use, physical activity and diet. Rarely do these programs extend beyond physical
health and target behavioral health or emotional health issues, even though these issues
contributesignificantlytothehealthandproductivityofemployees.
To achieve a meaningful culture of health, company policies, business practices, and
communication methods must support positive emotional health and not contribute to
poor health. Achieving emotionally healthy employees requires organizational leadership
andacorporateculturethatvaluesemotionalhealth.

1.1 PurposeoftheGuide
Thepurposeofthisguideistoeducateemployersaboutthebusinessassociationbetween
organizationalpractices,personalresilienceandtheemotionalhealthofitsemployeesand
8

dependents.Theguideincludesactionablestrategiesandrecommendationsthatwillenable
employers to create a work environment and related programs that promote emotional
health. This purpose will be accomplished by exploring organizational practices that
contribute to individual stress, depression, and anxiety. The guide will also explore
preventive mental health services that can be offered through the health benefits plan,
disability management, and employee assistance as well as health promotion/wellness
programs.
The Business Group believes that by identifying common organizational stressors,
implementing effective programs and using targeted communication practices, employers
can be more proactive at improving the emotional health of their employees and
dependents.

1.2 Approach
TheBusinessGroupconvenedtheNationalCommitteeonWorkplaceEmotionalWellness
(NCWEW)todeveloprecommendationsforthedesign,qualityassurance,structure,and
integrationofprogramsandservicesofworkplaceemotionalwellness.TheCommittee
consistedof25healthandwellnessbenefitsexperts,healthandproductivityprofessionals,
andrepresentativesfrommanagedcareandmanagedbehavioralhealthorganizations,
pharmacologyexperts,academicresearchers,healthcareconsultants,andbenefit
managersandmedicaldirectors.
ThisCommitteemetinMarch,2010inWashingtonDCandparticipatedinseveral
conferencecallsin2010.Thepurposeofthesemeetingswastoidentifyandsetcorporate
policyandcommunicationrecommendationsthataddressedworkplaceemotionalwellness.
ThiseffortwasalsosupportedbyBusinessGroupstaffaswellasexternalconsultants,who
performedresearchinsupportofthisprojectanddevelopedtheGuide.

1.3 SummaryofKeyEmployerRecommendations
Thefollowingcommunication,programandpolicyrecommendationswere
developedforemployersbytheNCWEH:
1.3.1 WorkplaceEmotionalWellnessStrategiesandRecommendations
Recommendation#1:Examinecommunicationaroundemotionalwellnessina
multidimensionalmanner.
Recommendation#2:Clearlydefinethebusinessvaluepropositionofemotional
wellnessforeachstakeholdergroup.

Recommendation#3:Adoptlanguagethateachidentifiedstakeholdergroup
understandsanddescribehowemotionalhealthrelatestooraffectsitsstrategic
interestsandoperationalrequirements.
Recommendation#4:Clearlydefineandcommunicatetheexpectedrole(s)foreach
identifiedstakeholdergroup.
Recommendation#5:Identifyandadoptthemosteffectivecommunication
methodsforeachidentifiedstakeholdergroup.
Recommendation#6:Maintaintransparency.
1.3.2 WorkplaceEmotionalWellnessPrograms,Services,andCulture
Recommendations
Recommendation#1:Helpemployeesbuildandusepersonalskillstotake
responsibilityfortheiremotionalwellness.
Recommendation#2:Integrateemotionalwellnesswithgeneralmedicaland
wellnessprograms.
Recommendation#3:Alignthecorporateculturetoincorporateworkplace
emotionalwellness.
Recommendation#4:Facilitatetransparency,communicationandsupportfora
corporatecultureofemotionalwellnessfromexecutivesandmanagers.
Recommendation #5: Remove actual and perceived barriers to emotional
wellnessprogramsandservice.
1.3.3 WorkplaceEmotionalWellnessPoliciesandMetrics
Recommendation#1:Createbalancebetweenworkandpersonallife.
Recommendation#2:Incorporateemotionalwellnessassessmentsintoshort
andlongtermdisability,FMLA,etc.
Recommendation #3: Create a dashboard with metrics that gauge employee
emotionalwellnessandthecorporatecultureofhealth.

1.4 FutureOpportunities
Thefollowingideasandconsiderationswereidentifiedduringthedevelopmentofthis
Guide,andshouldbeevaluatedaspartofanyfutureeffortsthataddressworkplace
emotionalwellness.
10

Develop a workplace emotional wellness metadata structure and supporting

assessment tools that employers can use to quantify workplace emotional
wellness and related business impact for individual employees, dependents /
families,andemployeepopulations.
Establishbenefitplanningandimplementationresourcesthatemployerscanuse
tosupporttherecommendationscontainedinthisGuide.
Defineattributesofstressincludingthesourcesandsymptoms.
Identify criteria that would facilitate an understanding between workplace
emotionalwellnessandjobfitforspecifictypesofjobsorjobclasses.
Define the individual and populationlevel variables that are statistically
correlatedwithemotionalwellness.

11

2 DefiningEmotionalWellness
2.1 WorkplaceEmotionalWellness
In March 2010, the National Committee on Workplace Emotional Wellness (NCWEW)
was charged with defining emotional health for the purpose of this Guide. Given the
abstractness of the emotional health concept and the lack of a common language or
nomenclature,developinganoperationaldefinitionforworkplaceemotionalhealthwas
a significant challenge. The Committee reviewed existing research on the topic and
workedwithcontentexpertstodevelopasetofkeyattributesandaworkingdefinition
forworkplaceemotionalhealth.
First,workplaceemotionalhealthisamultivariableconcept,whichmeansthatseveral
factors are influencing and being influenced by each other in varying amounts at
different times. When applied to employee or employee groups within a workplace,
thesevariablesinclude:

Degreeofengagementwithonesjob
Energyandvigor
Flexibilityandadaptability
Levelofmotivationandengagement
Personalandworkrelatedcontrol
Resiliency
Toleranceforambiguity

These factors provided the foundation for what are perhaps the most fundamental
conceptsofworkplaceemotionalhealth:functionalityandengagement.Inotherwords,
the bottom line is about being able to sustain a desirable level of functioning in the
workplace,andremainfullyengagedinworkinthemidstofvariouspressures,stressors
andchanges.
Second,emotionalhealthisnotablackandwhiteconcept,butinsteadexistsalonga
continuum (See Table 1). At one end of this continuum employees can sustain high
levelsoffunctioningandareemotionallyhealthy.Theoppositeendofthecontinuumis
characterized by lowfunctioning and emotionally unhealthy individuals. Furthermore,
individuals who experience diagnosable physical or behavioral health problems (e.g.,
major depressive disorder or anxiety disorders) may also function on this low
functioning end of the continuum. Between these end points lie individuals showing
moderate symptoms, as well as those employees who may be atrisk for becoming
emotionallyunhealthyinthefuture.
12


Table1FunctioningContinuum

Organizational Functioning
ADAPTIVE CAPACITY
Structure
OrganizationalKnowhow
Culture
Leadership
ChangeCapacity
HealthStatus

ACUTE FACTORS
Environmentalfactors
OrganizationalFactors
EmployeeEngagement
Structure
Risk

Low

EMPLOYEEPRODUCTIVITY

High

JobPerformance
Attendance,Accidents,Grievances
Disabilities,WorkersComp,BenefitUsage

A third, and related, attribute of workplace emotional health focuses on population

health management, which should not be confused with disease or condition
management. Traditionally, disease management targets those employees who are
experiencing the most severe or chronic health difficulties. Population health
management, on the other hand, has a much broader focus. Population health
management reaches across the span of the emotional health continuum, addressing
problemsatallacuitylevelsimprovingtheseverelyemotionallyunhealthy,preventing
the atrisk groups becoming emotionally unhealthy and maintaining or enhancing the
emotionalhealthforthosewhoareemotionallyhealthyandhighfunctioning.
2.1.1 WHOdefinition
ForthepurposeofthisGuide,anemployeesemotionalhealthcouldbethoughtofas
part of an employees overall health status. One of the more commonly referenced
definitions of overall health has been developed by the World Health Organization
(WHO).WHOstatesthathealthisastateofcompletephysical,mentalandsocialwell
beingandnotmerelytheabsenceofdiseaseorinfirmity.iii
2.1.2 Workgroupdefinition
Expanding on the WHOs definition of health, the NCWEW collectively believes that
health is a state in which an individual understands his capabilities, manages optimal
13

levelsofstressandenergyinhislife,maximizesengagement,andexperiencesasenseof
controlofhisenvironment.Itisinthisstatethatanindividualemployeeiscapableof
functioningatfulloroptimalcapacityintheworkplace.
Theemotionallyhealthyindividualisresilientheorsheisabletocopewithoptimal
levelsofstressandconflict.
Theemotionallyhealthypersonmaintainsapositiveapproachtolifethatisrootedin
his/hersenseofpersonalresponsibilityfor,andabilitytomanage,his/herlifein
personallyfulfillingways.
Anemotionallyhealthyindividual:

Iscapableofadaptingtochangingsituationsandexhibitingresiliencyinstressful
situations

Feelsthathisbasicneedsarebeingmetbothathomeandintheworkplace.

Isselfawareandacceptsawiderangeoffeelingsinselfandothers

Istolerantofambiguity,flexibilityandisadaptabletochange

Canfunctionautonomouslywhileremainingcognizantofselflimitations

Acceptschallengesandrisksandacknowledgesconflictandoptimallevelsof
stressasbeingpotentiallyhealth

Effectivelymanagestoarriveatpersonaldecisionsbasedupontheintegrationof
feelings,cognitionandbehavior

Formsinterdependentrelationshipsbaseduponmutualcommitment,trustand
respect

AttributesofWorkplaceEmotionalWellness

Highfunctionalityinallaspectsoflife

Meaningfulpsychologicalcontactbetweenemployeeandemployer

Sustainedengagementandmindfulness

Intellectualcuriosityanddesire,cognitiveflexibility

Strongcollaborationandmotivationtowork

Humility,generosity,recognitionofthegreatercontextandsenseofpurpose

Senseofinterconnectednesswithonesorganizationalcultureandclimate,
inter/intrapersonalalignment
14

Senseofcontroloverselfandmasteryandcontrolofenvironment

Toleranceofambiguity

Feelingthatbasicphysical,social,financial,mentalandemotionalneedsare
beingmet

Wellnessacrossthecontinuum,asanongoingprocess

Emphasisonorganizationaldiversity

Mutualrespectandloyaltywithintheworkforce

15

3 BusinessCaseforWorkplaceEmotionalWellness
Moreandmorecompaniesarerecognizingthatemotionalhealthisanimportantsuccess
factor. According to the Conference Boards CEO Challenge 2010 report, CEOs identified
excellence in execution, speed, flexibility, adaptability to change, and stimulating
innovation / creativity / enabling entrepreneurship as one of their most important
challenges.ivThesethreechallengesaredirectlyimpactedbythewayinwhichemotional
healthisaddressedbycorporateleaders.Inotherwords,theabilityofacompanytoexcel
inthemarketplace,toquicklyadapttochange,ortobeinnovativerequireitspeopletobe
physically,mentallyandemotionallyhealthy.

Table2ConferenceBoardCEOChallenge:GlobalTopTen(N=144)
Relative ranking
Oct.-Nov
2008

Oct.-Dec
2009

5
6
3
15

3
4
5
6

16

9
7
26

8
9
10

Cite challenge as being of greatest

concern in the coming year

Challenge

Oct.-Dec. 2009

Excellence in execution
Consistent execution of strategy by top
management
Sustained and steady top-line growth
Customer loyalty/retention
Speed, flexibility, adaptability to change
Corporate reputation for quality products/services
Stimulating innovation/creativity/enabling
entrepreneurship
Profit growth
Improving productivity
Government regulation

Oct.-Nov.2008

42.3%

55.4%

39.9

47.0

38.8
33.5
29.0
24.1

42.3
40.1
46.6
20.2

23.0

18.2

22.7
19.9
18.9

34.6
36.9
12.6

Note: Respondents were allowed to rate multiple challenges as being greatest concern(s) in the coming year. The matched set of
challenges between the 2008 and 2009 survey questions is created by removing all of the challenges asked in one year and not the other. An
accurate year-on-year analysis of the relative shifts in ranking of the exact same challenges is completed by calculating rankings independent
of new additions and deletions to the survey questions. The global CEO Challenge rankings are weighted to correct for regional
representation. Each CEOs responses are weighted by his or her respective regions representation in global GDP (Asia, 21.7 percent;
Europe, 36.4 percent; the United States, 23.7 percent; and other, 18.2 percent), according to the GDP data from the International Monetary
Fund World Economic Outlook Database (as of September 2009).

3.1 GoalsforWorkplaceEmotionalWellness
Whenconsideringworkplaceemotionalhealth,thegoalofacompanyisto:

Achieveahigherpurpose;
Delightandbalancetheneedsofitsstakeholders;
Growprofitably;and
Createlongtermenduringvalue.

Toachievethisgoal,companiesneedemotionallyhealthy,mature,engagedandproductive
people.Thegoalofacompanyisnotsolelytobuildacadreofpersonallyfulfilledpeople,
16

butrathertoseepersonalfulfillmentasameanstoanendandtodevelopaworkforceof
fulfilledpeoplewhoaremorelikelytobeengagedandcommittedtotheorganization.By
doingso,thepersonalmissionofemployeesconnectswiththemissionofthecompany.v
One way to visualize these goals is to consider a companys human capital value chain
(SeeFigure1).

Figure1:HumanCapital"ValueChain"

Historically,employersprimarilyfocusedontherelationshipbetweenworkandemployee
physical health. Workflow processes were examined and methods were developed to
addresstheergonomicimpactonemployees.Inadditiontofocusingonemployeephysical
health, employers have recognized over the last few decades that an employees mental
healthhasanimpactonperformance,andemployershavedevelopedanarrayofprograms
andbenefitsthataddressmentalhealth.Morerecently,withthefocusofworkshiftingtoa
knowledgebased economy and social networking becoming a standard part of the work
environment,employersareexploringtheideaofemployeeemotionalhealthanditsrole
andimpactonproductivity.

3.2 BusinessImpactforWorkplaceEmotionalWellness
3.2.1 Howdoesemotionalhealthimpacttheworkplace?
Theaverageemployedadultspends7.5hoursatworkperday.viFormanypeople,work
representsmorethanaplacetopursueintellectualandeconomicgoals.Theworkplace
17

is also an important source of social support. Work can be a source of meaning,

membership, and mutual support through which employees create close friendships
and even life partners. Furthermore, with population trends changing the structure of
nuclear families, religious communities, and tightknit neighborhoods, the workplace
has, for many, become a primary place of communication, social development, and
relationshipforming.Aseriesofsurveysconductedinthe1980sfoundthatnearlyhalf
ofemployedAmericanshadatleastoneclosefriendfromwork.Inaddition,nearlyone
infivesaidthatatleasthalfoftheirclosestfriendswerecoworkers,andnineoutoften
peoplefeltapartofcommunityatworkandlookedforwardtobeingwithcoworkers
eachday.vii
This marriage of identity and the workplace is even more prominent in corporate
culture.Theorganizationalcultureofcorporationstendstodefinethecontextinwhich
people behave and how the organization will be structured. A corporate culture is
formed through the development of assumptions, values, and beliefs that are learned
and adopted by employees. This formal and informal code of conduct becomes
entrenched as a culture as new employees join the organization, link the values and
beliefs to success within the company, and adopt them into their own particular
behaviorsandworkstyles.viii
However, success at work also requires employees to also manage and balance their
emotional health. One could consider the workplace as the playing field of peoples
lives,inwhichemployeesaregrantedopportunitiestosucceedandfindfulfillment,but
employeesmustalsoconfrontsignificantchallenges,stress,andthethreatoffailure,as
wellasthepsychologicaltollstheseentail.Modernworkersmayhavetodealwithlong
hours, long commutes,and deprived time from family andfriends. In fact, in a recent
study,twothirdsofAmericanemployeessaidthattheywantedtoworkanaverageof
twofewerhoursadayifpossible.ix
3.2.1.1

Psychologicalhealth

American workers tend to maintain a psychological attachment to their job. Some

argue that a healthy psychological attachment to work is positive and enhances
humanperformanceatwork.Ontheotherhand,thisinvestmentcanhaveanegative
on emotionally unhealthy individuals who lose their jobs. It is not uncommon for
individualswhounexpectedlylosetheirjobtostrugglewithmentalhealthproblems
such as depression, substance abuse, and anxiety. On a larger scale, widespread
unemploymentinageographicareahasbeenassociatedwithdeclineinthequality
ofneighborhoodsandfamilyrelationships,aswellasanincreaseincrime.

18

1. Depression and other behavioral health problems are very common in the
population,andmaybeevenmorecommonthanformalepidemiologicalstudies
suggest. This prevalence is particularly significant if one includes individuals
experiencinglowerlevelsofdistress(SeeFigure2).x

Figure2:DepressionandSubThresholdSymptoms

2. Even subthreshold symptoms can exert an influence in the workplace. For

example,individualswhoreportbeingdepressedjustoneortwodaysaweek,
whomightneverqualifyforaformaldiagnosisofdepression,nonethelessshow
significantlyhigherratesofabsenteeismandproductivityimpairmentcompared
tothosewhoreportrarelyfeelingdepressed(SeeFigure3andFigure4).xi

19

Figure3:DepressionandAbsenteeism

Figure4:DepressionandProductivity

20

3. The productivity data on subthreshold depression suggest that for some

individuals with mental health problems, difficulties at work may appear early
on,oftenbeforeothersymptomsandrelatedhealthproblemsbegintosurface.
Consequently, the employer may begin to pay a price from the very first
indications of a mental health problem, long before the distressed employee
seekshelpfromahealthcareprovider.
4. Research shows that treatment for mental health disorders, including both
medication and psychotherapy, typically works. If treatment is effective, then
oneoftheproblemsmaybeaccess.Thefollowingfactorslimitbothaccessto,
andefficacyof,treatment:
a. While both psychotherapy and medication have been shown effective,
nearlytwothirdsofpeoplewithmentalhealthproblemswillneverseek
treatmentofanykind.
b. Less than 10% of people with a mental health problem will obtain
specialty care (e.g., medication consultation with a psychiatrist,
psychotherapywithamentalhealthprofessional).
c. Thebulkofpeoplewithamentalhealthproblemwhocomeforwardfor
treatment will be seen by a primary care physician, where they are
typicallyprescribedmedication.
d. Primarycareprovidersarealreadybeingaskedtodotoomuch.Saddling
them with the responsibility for medicating large numbers of patients
withmentalhealthissuesonlyaddstotheirburden,andmightnotbethe
best course of action. Indeed, research indicates that medication in
primary care seldom proceeds according to established clinical
guidelines, with an estimated 80% of cases failing to meet standards of
care.
e. Stigmaisalegitimateissueforaccessingcare,asevidencedbyresearch

thatcontinuestoindicateamajorityofemployeesbelievethattheirwork
statuswouldbedamagedbyseekingtreatmentfordepressionandother
mentalhealthproblems.xii
5. If it works as intended, mental health parity should help remove gaps in
insurancecoverageandimproveaccesstotreatmentforthosewhomostneed
it. These regulations should offer an additional safety net for those who suffer
fromseverementalillness,andfortheirfamilies.However,mentalhealthparity
willnotsolvemanyoftheproblemswithtreatmentaccessandqualitydescribed
above. While mental health parity may go a long way toward reducing
21

disparitiesincoveragebetweenphysicaldisordersandmentalhealthproblems,
it will not affect the millions of employees who suffer these problems silently
and never come forward for any form of treatment. Likewise, it is unlikely to
haveanimpactonthoseemployeesatthelowerendoftheseveritycontinuum,
specificallythosewhohavesubthresholdsymptomsorthosewhoarenotyet
symptomaticbutareatriskfordevelopingproblemsinthefuture.
3.2.1.2

Physicalhealth

1. Extensivedataexistsontherelationshipbetweenchronichealthconditionsand
productivityimpairment.
2. Even in the absence of more serious conditions, variables like sleep loss and
weightgainresultinhigherratesofproductivityimpairment.
3. The relationship between physical health and psychological health is complex
andbidirectional,witheachfactorexertinginfluenceontheother.
4. The prevalence of depression (and other behavioral health problems)
significantly increases among those with chronic health conditions, as well as
those who are obese. For example, while the prevalence of mood disorders in
the general population has been estimated at around 9.5%, depression affects
about25%ofadultonsetdiabeticpatients.xiii
5. Whendepressionandotherbehavioralhealthproblemsarecomorbid(i.e.,co
occurring) with other health problems, productivity impairment increases
exponentially (See Figure 5).xiv When mental health problems are comorbid
withothermedicalconditionstheyincreasetheriskofalltheelementsthatraise
healthcare costs including complications, hospitalization, disability, and
mortality. Conversely, successful treatment of mental health disorders is
associated with improved patient outcomes and lower costs. Among patients
with chronic conditions, those with behavioral health issues stand out as the
mostcostlyandcomplicated.Justtwoexamplesamongmany:

22

Figure5:DepressionComorbidity

Aboutoneinfourdiabeticpatientsexperiencesdepression(SeeFigure6).xvDiabetic
patients with major depression are significantly less likelyto adhere to medication
treatment.Theyalsoshowpoordietaryhabits,aremuchlesslikelytoexercise,and
aremorethantwiceaslikelytosmokeasotherdiabeticpatients.xvi

23

Figure6:DiabetesandDepression

Binge eating, the most common eating disorder, is far more prevalent among the
obese: 25% of severely obese patients are binge eaters, and are at significantly
greaterriskformedicalandpsychologicalproblemsthanobesepatientswhodonot
bingeeat(SeeFigure6).xviiTheyalsohavehigherratesofobesityrelatedfunctional
disability,andshowagreaterdegreeofpsychologicaldistressevidencedbyhigher
rates of depression and anxiety, and more frequent suicide attempts. They report
earlier onsets of obesity and dieting behavior, and experience greater weight
fluctuations, and, not surprisingly, show poorer outcomes from weight loss
treatment and weight loss surgery. At all weight levels, binge eaters show
significantlyhigherproductivityimpairmentthanthosewhodonotbingeeat.xviii

24

Figure7:BMIandProductivityImpairment

3.3 BenefitsandRisksofWorkplaceEmotionalWellness
3.3.1 TheMeaningofWorkandtheComplexityoftheWorkPlace
While the economic downturn of the last few years seems be nearing the bottom, its
effectsonbusinesseshaveyettoberesolved.Thelonglastingimpacttheeconomyhas
hadonbusinesses,theiroperations,andtheiremployeeshasforcedmanycompaniesto
rethink their business strategy and make significant adjustments to their business
priorities.Thechangingeconomyhasledtoneworemphasizedexistingpressuresin
theworkplace,including:

Increasedstress;
Moreanxiety;
Lessjobsecurity;and
Increasedjobdemands.

In the reset economy these factors will become major priorities for businesses to
address.Thesepressuresintheworkplaceandnewexpectationshaveforcedemployers
to think beyond their traditional models and approaches to ensuring a healthy,
productive and functional workforce. These priorities, all of which have significant
bearing on the human capital of a business, will change business operations and
25

repositionhowemployeesconnectandadapttothechangingworkenvironment.
The2009TowersWatsonsGlobalWorkforceStudypointstoseveralfindingsthatshow
theimportanceofaddressingemotionalhealthasemployerscontinuestofacethemost
challengingeconomysincetheGreatDepression.xix

The desire for the most basic needs in the workplace security and stability has
become a significant concern among employees in these trying economic times.
Thinningjobsecurityandstabilityhascausedemployeestofeelmoreanxiousand
lesssecureintheirwork.Atthesametime,manyemployeesarereluctantlytrading
in professional growth for increased security and stability in their jobs as their
organizationweatherstheeconomicstorm.

Employees understand that ultimately they are accountable for their health and
wellbeing, productivity in the workplace and career growth. However, employees
havedoubtsabouttheirabilitiestotakeonthisaccountabilitywithoutappropriate
guidanceorsupportfromtheiremployers.

Evenwithjobsecurityandstabilityatstake,employeeswantflexibilityandbalance
betweentheirworkandpersonallives.Insuchstrugglingeconomictimes,however,
employees may be reluctant to ask for the guidance, resources and support to
achievesuchflexibilityandbalance.

Confidence in organizational leadership is low. Employees have low confidence in

their leaderships ability to keep the organization functional and at the same time
inspireandengagetheworkforce.

The findings from the Towers Watson Global Workforce Study demonstrates
implicationsforemployersandthedecisionstheyneedtomakeaboutthemagnitude,
nature and timing of their workforce investments. While some of the changes in
employee attitudes may not endure, we are nonetheless at the earliest stages of a
significantworkplacetransformation.

26

4 PrimaryFactorsInfluencingWorkplaceEmotionalWellness
Asdescribedearlier,NCWEHconceptualizedworkplaceemotionalhealthasamultivariable
concept,notingthevariousattributesareinfluencingandbeinginfluencedbyeachother.
At the organizational level, these attributes are also impacting and being impacted by
severaldomainsthatareseenascriticaltoacompanyslongtermsuccess:
1. Leadership
2. Culture
3. OrganizationalStructure
4. ChangeCapacity

4.1 Leadership
OrganizationalLeadership,inthecontextofworkplaceemotionalhealth,isprimarily
concernedwiththeemotionalhealthofexecutivesandmanagementandtheirability
to shape a culture of health within the organization. Mature leaders also possess
significant leadership courage and are willing to take responsible risks to build a
culture of health within the company and engage employees to support this culture
andtherelatedpoliciesandprograms.
Leadership courage is expressed in how engaged company leaders are in relation to
the longterm vision and direction of the company. This type of leader clearly
articulates the relationship between the culture of health and strategic direction of
thecompanyaswellastheactionsthatarerequiredtoachievethecompanysstated
goals. Furthermore, effective leadership is expressed in how well the senior
managementteamcanengageemployeesandimplementthisstrategy.

4.2 OrganizationCulture
Organization culture represents the values and social norms that are specific to a
particularorganization.Adoptingacultureofhealthisbeginningtoberecognizedasa
strategicfactorinanorganizationslongtermsuccess.Someemployersacknowledge
thatemotionalhealthshouldbeconsideredwhenexaminingtheoverallhealthstatus
oftheiremployeepopulation,andareacknowledgingthatemotionalhealthispartof
theorganizationsoverallvalueofhealth.Whenemotionalhealthisacknowledgedas
part of the organizations values, it can then be leveraged to support specific social
normswithintheorganization.

27

Creating an effective culture of health requires the adoption of five components or

pillars,asdescribedbelow:
1.
2.
3.
4.

Leadershipandcommitmentatalllevelsoftheorganization;
Creativeenterprisewideprogrammingtofosteremotionalandphysicalhealth;
Policiesandproceduresthatfacilitateandrewardhealthpromotingbehaviors;
Marketing and communications to ensure high rates of participation among
employees;
5. Accurateorganizationassessmentleadingtoclearlydefinedobjectivesandvalid
measurementofoutcomes,demonstratingefficacyandreturnoninvestment.

Other recommendations employers can consider when developing a culture of health

include:
Initiatingorincreasingscreeningandearlyinterventionforemotional/behavioral
health problems among employee populations, including subthreshold
symptoms,beforetheybecomemoreserious
Encouraging employees to participate in Health Risk Appraisal (HRA) and
wellness/prevention programs. Consider using incentives (carrot and/or
stick)tomaximizeparticipation
Referencing behavioral health in all health promotion efforts. Insist that all
HealthRiskAppraisalincludereferencestoit.
UseHRAandclaimsdatatoidentifypopulationsatriskandincorporateculture
ofhealthreferencesinrecruitmentstrategies.
Offerconfidential,scalablealternativestomedicationandhightouchservices,
includingdigitalcoaching,toreachthosewhomaynevercomeforwardforany
otherhelp.
Doeverythingreasonablypossibletoeducateemployeesaboutemotionalhealth
andbehavioralhealthproblemswithafocusonreducingstigma.Rememberthat
realliferolemodelsarethemostpowerfulteachers.

4.3 OrganizationalStructure
The structure of the organization is another important factor to examine when
considering the workplace emotional health. Structure, for the purpose of this
discussion,refersto
a)
b)
c)
d)
e)
f)

Typesofpeople
Numberofpeople
Reportingstructure
Deploymentofpeople(rightpeopleintherightplaces)
Jobdesign
Workprocessdesign
28

g) Infrastructuresupport
h) Informationflow
i) Authority/Responsibilitymatch
Organizational practices have changed dramatically in this new economy, and will
continue to evolve in the reset economy. To compete more effectively, many large
companies have restructured themselves by downsizing their workforces and
outsourcing all but core functions. At the same time, nontraditional employment
practices that depend on temporary workers and contract labor have grown steadily.
Organizations are also adopting new and flatter management structures that result in
downward transfer of management responsibility and decentralized control, and they
are implementing more flexible and lean production technologies such as justintime
manufacturing.Therubrichighperformanceworksystemshasbeenusedtodescribe
andjustifymanyoftheseorganizationalpractices.

For many workers, these reorganizing trends have resulted in a variety of potentially
stressful or hazardous circumstances, such as reduced job stability and increased
workload.Datasuggest,forexample,thattheaverageworkyearforprimeageworking
coupleshasincreasedbynearly700hoursinthelasttwodecadesandthathighlevelsof
emotional exhaustion at the end of the workday are the norm for 25% to 30% of the
workforce.Alternatively,increasedflexibility,responsibility,andlearningopportunityin
todays workplace may offer workers greater potential for selfdirection, skill
development and career growth, leading to reduced stress and increased satisfaction
andwellbeing.
Further, employee productivity is currently very high, perhaps historically high.
Employershavefocusedonincreasedemployeeproductivityasaresultoftheeconomic
crisis, including paying of overtime. Employers are uncertain about increased business
costsassociatedwiththesepractices(i.e.,theimpactofhealthcarereform,regulatory
reform, etc), and have not hired new employees for fear they would face new
downsizings with rising costs. Unfortunately, these continuing changes in the
organizationofworkhavefaroutpacedourunderstandingoftheirimplicationsforwork
life quality and safety and health on the job. However, making sure that workplace
emotional health is included in organizational change discussions is highly
recommended.

29

4.4 ChangeCapacity
Theabilityoftheorganizationtorecognizeandadjusttochangingmarketandrelated
conditions is considered a strategic attribute of mature companies. These conditions
originate from numerous factors and can be quite volatile, such as supply chain
variability, changes in technology, environmental factors, regulatory changes, etc.
Furthermore, mature companies have developed policies and programs that support
and build resilience in employees who have to confront individual or personal
challenges.
Below is a list of themes to consider when assessing workplace emotional health and
thechangecapacityofanorganization:
(1) Individuals with good emotional health can adapt to stressful situations and
changingpressures(SeeTable3)xx
(2) Emotional health is affected by individual factors, experiences, social
interactions,theworkenvironmentandculturalnorms
(3) One of the key components of workplace emotional health is the ability of
individualstofulfillaroleinsociety(i.e.,thecapacitytowork)
(4) Workcontributestopersonalandsocialgrowth,benefitsoneshealth

Table3StressandPsychologicallyHealthWorkplaces

74%ofemployeessayworkisasignificantsourceofstressandoneinfivehas
missedworkasaresultofstress.
55%ofemployeessaytheywerelessproductiveatworkasaresultofstress.
52%ofemployeesreporttheyhaveconsideredormadeadecisionabouttheir
career,suchaslookingforanewjob,decliningapromotionorleavingajob,based
onworkplacestress.
52%ofemployeessayjobdemandsinterferewithfamilyorhomeresponsibilities,
while43%sayhomeandfamilyresponsibilitiesinterferewithjobperformance.
31%ofadultsexperiencestressasaresultofmanagingworkandfamily
responsibilitiesand35%citejobsinterferingwiththeirfamilyorpersonaltimeasa
significantsourceofstress.

30

5 EmployerSolutionsforWorkplaceEmotionalWellness
This Guide includes both communication and policy recommendations that employers can use to
improvetheemotionalhealthstatusoftheirorganizations.

5.1 WorkplaceEmotionalWellnessStrategiesandRecommendations
ThecommunicationrecommendationsinthisGuidedescribetwoapproaches.Thefirstset
of recommendations describes emotional health communication strategies for human
resources professionals, benefits managers and corporate medical directors. The second
partprovidesamatrixofrecommendationsthatoutlinesthelanguage,objectivesandcall
toactionforthreestakeholdergroups:businessexecutives,managersandsupervisors,and
employees.

Recommendation#1:Communicationaroundemotionalhealthshouldbe
examinedinamultidimensionalmanner.
In terms of communication, benefits managers and corporate medical directors will typically
have responsibility for translating the concept of emotional health for all levels within an
organization.Therefore,thesegroupswillneedtocommunicatetoseveralkeytargetgroups:

UPtotheexecutiveteam;
ACROSStocompanymanagersandsupervisors;and
DOWNtoemployees.
ExecutiveTeam

COMMUNICATION

(EX:ChiefExecutiveOfficer,
ChiefFinancialOfficer)

Managers/
Supervisors

Human
Resources
(Benefits
Managers,
Medical
Directors)

Beneficiaries
(EX:Employees,Retirees,
Dependents)
Figure8:MultidimensionalCommunicationsFramework

31

Executiveteam.Executiveteamsupportforworkplaceemotionalhealthpoliciesand
initiativesiscritical.Strongandeffectivecommunicationtotheexecutiveteamneeds
toaddresssupportforacorporatecultureofhealthandemphasizetheimportanceof
emotional health. Impetus for broad change within companies typically leverages a
topdown approach. If executives understand and support the value proposition of
investing in policies and programs that support emotional health, these policies and
programs will have a greater chance of receiving financial support, implementation and
viability.
Managers and supervisors. Managers and supervisors are a key
communication channel to employees. Communication to managers and
supervisors should include resources and training on policies and programs
available to employees to support their emotional health. Communication
efforts to this target group should also include training supervisors to recognize signs of
emotionalinstabilityandhowtoaddressemployeeneedswithcompanyprogramssuchas
theemployeeassistanceprogram.
Employees and dependents. When communicating to employees and their
dependents about emotional health, employers should first consider how they
communicate to employees about other human resourcesrelated information.
Employersshouldleveragebestpracticesandlessonslearnedfromsuccessfulhuman
resources communication strategies (such as openenrollment communication or
wellnessprogramcommunication)toreachouttoemployeesanddependents.Inaddition,
providing opportunities for employee and dependent feedback is also crucial. Twoway
communication between employees and human resources allows employees to inquire
about and feel supported by the company, which will reinforce a culture of emotional
health.

Recommendation#2:Clearlydefinethebusinessvaluepropositionof
emotionalhealthforeachstakeholdergroup.
Since roles and responsibilities vary within different levels of an organization, the
communication will need to address the specific needs of each group. To ensure that
emotional health is on the radar of each key stakeholder group, employers need to
understand the value proposition of emotional health. Table 4 outlines ways in which
emotional health affects each stakeholder group. Benefits managers or medical directors
can use this chart to guide them in understanding the value of emotional health to each
stakeholdergroup.

32


Table4:ValuePropositiontoKeyTargetGroups

VALUEPROPOSITION

TARGET
GROUP

EXECUTIVES

MANAGERS/SUPERVISORS

Emotionallyhealthy
Emotionallyhealthy
organizations:
organizations:
leadtobetter
facilitateimproved
engagement.Better
employeeperformance
engagementleadsto
improvedbusiness
increaseemployee
outcomes(productivity,
attentiontothe
decreasedturnover,
relationshipbetween
betterperformance,
safetyandperformance
bettercustomerservice,
enhanceloyaltytoa
profitability).
companyandleadtoless
establishaclear
unwantedturnover.
connectionbetweenthe
organizationsmission,
enhancesupervisor/
visionandvalues,and
managementrelationship
businesspractices.
withemployees
arecompellingplacesto
increaseemployeejob
attractandretaintop
satisfaction
talent
createacompetitive
reduceunscheduled
advantageinthe
absenteeism
marketplace.
maintainandcanincrease
increaseshareholder
individual,unit,and
value.
corporateproductivity
Emotionallyhealthy,
engaged,andproductive
supportjobsatisfaction
peopleareabusinessasset
andnotaliability.
Anxiety,whichistypically
viewedasunhealthy,canbe
reframedasapositiveand
powerfulforceforchange
andperformance.
Emotionalhealthisthe
foundationforpresentand
futureperformanceand
growth.

EMPLOYEES
Emotionallyhealthy
organizations:
promoteshigherquality
ofemployeeandfamily
health
increasesthehappiness
quotientforemployee
andtheirfamilies
helpsemployeesto
modelhealthybehavior
forchildrenandothers
facilitateamore
supportivework
environment
enhancesjob/life
satisfactionandpersonal
fulfillment
improvesjob
performance
feelinggenuinely
supportedbythe
organization

Recommendation#3:Adoptlanguagethateachidentifiedstakeholdergroup
understandsanddescribehowemotionalhealthrelatestoorimpactstheir
strategicinterestsandoperationalrequirements.
The concept of emotional health itself is extremely broad and complex. Therefore, it is
critical,whendescribingemotionalhealthpoliciesandinitiatives,touselanguagethateach
key stakeholder group will understand. Bob Rosen Ph.D, President of Healthy Companies
33

International,hasfoundthataCEOhashisownorganizingmetaphorthatcaptureshisway
of thinking about his organization. The same could be said for managers and employees.
Whendescribingemotionalhealthprogramsandpolicies,employersneedtouselanguage
the metaphors that has value to each key stakeholder group. Like communication
methods,languagethatspeakstoonestakeholdergroupmaynotbeaseffectiveinevoking
actionforothers.Thus,thelanguageusedtocommunicateaboutemotionalhealthneeds
tobecarefullythoughtout.Tablefouroutlinessomekeylanguagethemestoconsiderfor
eachofthestakeholdergroups.
Table5:KeywordsforTargetGroups

LanguageSamplekeywordsorthemesfor
communicatingemotionalhealth.

TARGET
GROUP

EXECUTIVES

MANAGERS/SUPERVISORS

Uselanguagethateasilytranslates
intobusinessoutcomes:

Uselanguagethatfocuseson
performance:

Authenticengagement
Costsaving
Flourishing
Functionality
Productive
Promotesapositivecorporate
brand
Readiness(emotionally,
physically,mentally)
Resilience
Supportsorganizational
mission
Wellbeing

Employeeengagement
Enhancedproductivity
Improvedperformance
Increasehealthyemotions
(beinggenuinelyvaluedand
challenged).
Reduceunhealthyemotions
(e.g.,anger,frustration)

EMPLOYEES
Uselanguagethatfocuses
managingstressandachieving
balanceinpersonalandwork
relatedlife:
Abilitytobalancestress&
anxiety
Emphasizethriving
Focusonbuildingorenhancing
emotionalhealth
Genuinelyvaluedand
challenged
Managingeverydaylife
challenges
Personalresponsibility
Selforiented
Supportfromtheorganization
Supportspersonaldevelopment

Recommendation#4:Clearlydefineandcommunicatetheexpectedrole(s)
foreachidentifiedstakeholdergroup.
Employers should establish a call to action for each key stakeholder groups. It is up to
employers to clearly define and communicate the expected roles of each key stakeholder
group in order to develop and sustain a corporate culture of health and to improve the
overallemotionalhealthwithinanorganization.
CalltoActionTheExecutiveTeam

LeadershipcommitmentandresourcesInvestmentoftangibleresourcesshowsthat
executive management actively supports organizational policies and initiatives that
improveemotionalwellbeingandengagement.Inorderforpoliciesandprogramstobe
sustainable,theyneedtohavethecommitmentandsupportofthekeydecisionmakers
withintheorganization.
34

Partnerwithhumanresourcestobuildahumancapitalstrategythatcreatesaculture
of health The executive team and human resources department should partner to
developshortandlongtermstrategiestocreateasustainablecultureofhealth,which
includesafocusonemotionalhealth.Thisstrategyshouldincludesettingaclearpolicy
direction, action steps, an environmental scan of the organizations readiness, specific
resourceallocationtosupportthestrategies,andmeasurableoutcomes.

Include measurable goals and action steps relating to emotional health in

performance planning and evaluation The executive team should establish specific
goals and action steps for improving the organizational emotional health. Goals and
action steps should focus on developing a culture of health within an organization,
developing corporate policies for emotional health and implementing programs that
improveemployeeanddependentemotionalhealth.

Clearly frame and communicate the human capital value chain to all stakeholders
Employeehealthandwellbeing EmployeeengagementWorkforceeffectiveness
HumanperformanceBusinessProductivityMarketplaceSuccess

Masterthethreedimensionsofleadership.
o Cognitivestrategy/plans/methods/metrics
o Physicalwellness/hardiness/agility/courage
o Emotionalrelationships/commitments

CalltoActionManagers/Supervisors

Beawareofandknowledgeableofthecompany'spoliciesandprogramsonemotional
healthManagersareusuallythefirstlineofcommunicationtoemployees.Managers
whoarefamiliarwithcompanyprogramsandpoliciesthatsupportemotionalhealth
suchasstressmanagementprogramsorprofessionaldevelopmentopportunitiescan
beavaluablereferralresourceforemployees.

Incorporate emotional health driven metrics into corporate key performance

indicatorsWhenusingkeyperformanceindicatorstoassessthesuccessofadivision,
unit or team, include emotional healthrelated indicators. These indicators might
address unscheduled absenteeism, employee grievances, workers compensation
claims, and job satisfaction. Including these indicators provides additional data,
identifies trends, and helps managers recognize areas in which there could be an
opportunityforimprovementintheemotionalhealthoftheiremployees.

BeawareofpressingemployeehealthandemotionalissuesAkeyroleofmanagers
and supervisors is to understand his or her staffs work productivity patterns. When
35

emotional health impedes employee productivity, the manager needs to consider

emotionalhealthissueswhenlookingatthefactorsinfluencingproductivity.Therefore,
managers and supervisors should regularly assess the emotional health of their
employees. When appropriate, managers should communicate to their employees
aboutresourcesavailabletosupporttheiremotionalhealth.
CalltoActionEmployees

Learn to identify triggers and early intervention methods to enhance their own
emotional health, their coworkers, and family members Employees should be
cognizantofthetriggerswork/lifeimbalance,lackofresourcestocompleteonesjob
task, personal financial troubles that push them beyond their optimal level of
functioning. Identifying these triggers and intervention methods such as a flexible
work schedules or financial management courses can help prevent the reductions in
functioningandoverallhealthstatus.

Access employer resources and programs that support employee or dependent

emotional health Employers set the stage for emotional health in the workplace.
However, it is up to employees to seek out and utilize programs that address key
emotional health issues such as stress management programs, employee assistance
programs,andwork/lifebalancebenefits.

BelieveintheauthenticityoftheinitiativesMostemployersarenotinthebusinessof
creatingathrivingemployeepopulation.However,inmostemployersmission,visionor
values, valuing the employee and integrity are common themes that shape
company culture and guide the way the company runs its business. While creating a
thrivingemployeemaynotbeacompanysprimarylineofbusiness,itshumancapitalis
the companys most important asset. Investing in resources that promote employee
emotionalhealthallowsthismostimportantassettoflourish.

Recommendation#5:Identifyandadoptthemosteffectivecommunication
methodsforeachidentifiedstakeholdergroup.
Interpreting,processingandunderstandinginformationparticularlyabroadconceptlike
emotionalhealthvariesamongthekeystakeholdergroups.Methodsofcommunication,
such as written materials or online information, must be tailored to each specific
stakeholdergroupandperhapsevenmorespecificallytosubgroupswithinthem.
Fortheexecutiveteam,suchasCEOs,communicationmethodsshouldinclude:

Facetofacepresentationsthataddressthebusinesscaseforemotionalhealth;and
36

Presentations with relevant benchmarks, data and outcomes related to employee

emotional health and business outcomes (i.e., engagement, productivity, turnover,
customerservice).

Forsupervisorsandmanagers,communicationmethodsshouldinclude:

Trainingsessionswithbenefitsmanagersandcorporatemedicaldirectors;
Supportforpeertopeernetworksbetweenmanagers;and
Presentations with relevant benchmarks, data and outcomes related to employee
emotionalhealthandoutcomesrelatedtotheirareaofresponsibility(i.e.,engagement,
absenteeism,customerservice,andproductivity).

Foremployees,communicationmethodsshouldinclude:

Educational materials (written, online, etc) that clearly outline policies and programs
relatedtoworkplaceemotionalhealth;
Lunch and Learn sessions where human resource managers can have informal
discussions with employee about programs and policies that support employee
emotionalhealth;
Social marketing campaigns that promote workplace emotional health and relevant
programsandservices;
Development of an employee taskforce to identify emotional health champions
within the employee population. An employee champion is a valuable way to
communicatethecompaniespoliciesandprogramsforworkplaceemotionalhealth;and
Convenientaccesstoworkplaceemotionalhealthresourcessuchashealthcoaching
andongoingsupportthroughvarioustechnologymediums(i.e.,Intranetandemail).

Recommendation#6:Maintaintransparency.
In these economic times, executives, managers and employees all feel the stress of the
economyontheirworkandpersonallives.Moretransparencyfromcompanyleadersand
key decision makers is needed to keep employers informed of the companys business
direction and related challenges. In turn, keeping employees informed of a companys
businessdirectionsuchasfinancialviabilityandmajororganizationalchangesleavesless
roomforuncertainty.Formanyemployees,itisthisuncertaintythatcanleadtosignificant
stress (for example, by creating a feeling of job insecurity), which in turn can negatively
affecttheirproductivity.

37

5.2 WorkplaceEmotionalWellnessPrograms,Services,andCulture
Recommendations
The following objectives and recommendations summarize actionable steps in helping
employers to develop workplace emotional health programs and to support a broader
cultureofhealthwithintheorganization.

Recommendation #1: Help employees build and use personal skills to take
responsibilityfortheiremotionalhealth.
Action(s): When contracting with employee assistance programs (EAPs), employers
should ensure the EAP provides access to specific counseling and resources for stress
managementandresiliencebuildingskills.Stressmanagementresourcescaninclude:

Individual or group therapy sessions focused on identifying sources of stress and

managingthecorrespondingsymptomsofstress;
Counseling for work and familyrelated problems (such as parenting, legal and
financialadvice,andalcoholism);and
Skillbuildingand/orbehaviormodificationcourses,suchastimemanagementand
stresscopingstrategies.

Action(s):Providecounselingandeducationservicesforemployeesinfinancialdistress.
Approximately,oneinfourAmericanworkerscitesthathispersonalfinancialsituationis
a significant source of stress in his daily life. The workplace implications of financial
distress for employers can be dramatic. Financial distress is associated with poorer
overall health physical, psychological and emotional as well as decreased
productivity.xxi
Early research suggests that workplace or employersponsored financial counseling
helps employees build skills to make better financial decisions.xxii One study found
employees who were referred to financial education services through their EAP,
utilization of financial management resources referred through an EAP When
consideringfinancialeducationservicesforemployees,employersshouldconsider:
1. Offeringaccesstofinancialeducationandrelatedresourcethatextendsbeyondthe
educationassociatedwithbasicretirementor401Kplanssponsoredbyemployers.
Financialeducationshouldincludepersonalbudgeting,financialmanagement,credit
managementandtaxplanning.
2. Offeringcounselingandeducationservicesregularly.Financialsituationschangeand
inordertobemosteffectiveandutilizedshouldbeavailableattimesofneedrather
thanannuallyduringopenenrollment.
38

Research also suggests that financial education services offered by employers are
effective and have a positive return on investment. Financial education is relatively
inexpensive to employers and can be offered as part of other financial services or an
EAP. On average, the cost of financial education to an employer ranges from $10 per
employeeperyearto$3,000foranalldayseminar.xxiii

Recommendation #2: Integrate emotional health with general medical and

wellnessprograms.
Researchsuggeststhatunmanagedsymptomsofstressandtheinabilityofemployees
tocopewiththesourcesofstressareassociatedwithphysicalhealthriskfactorsand/or
increasedprevalenceofillness.Employeeswithsignificantsourcesofstressalsotendto
neglecttheirownhealthbynottakingappropriatepreventivemeasures.Thefollowing
recommendationsoutlinehowemployerscanworktointegrateemotionalhealthinto
theirgeneralmedicalplanorwellnessprograms.
Action(s):Whenworkingwithahealthplan,employersshouldensurethatemployees
will have access to health coaches or other health professionals who specialize in
emotional health issues such as stress management. These professionals should be
available via telephone, electronically (email or electronic chat) or inperson. These
professionals should be available at nonwork hours (evenings or weekends) to
encourage use among employees. Health professionals should have the appropriate
qualificationsorcertificationstoassistemployersinmanagingsourcesandsymptomsof
stress, developing coping strategies and building resilience skills to improve their
emotionalhealth.
Action(s): Employers should attempt to link wellness programs with other workplace
emotionalhealthinitiatives.Wellnessprogramsaredesignedtopreventillnessandthe
need for health care services. While the evidence is insufficient to conclude whether
wellness programs actually cut healthcare costs, they have been shown to improve
overall employee health. Corporate wellness programs such as tobacco cessation or
weight loss programs should incorporate an emotional health component. For
example, participants in tobacco cessation programs should be prescreened for
significantsourcesandsymptomsofstress,andreferredtoadditionalresourcessuchas
anEAPorstressmanagementprogramasappropriate.
Action(s): Employers should consider incentives that support preventive care and
rewardemployeeswhoreceiverecommendedpreventiveservicesfortheirage,gender
and risk factors. Incentives and rewards can help increase the utilization of these
preventiveservices.Employeeswhoareemotionallyunhealthytendtobelesslikelyto
receive appropriate preventive care based on recommended guidelines. At the same
39

time, emotionally healthy employees may invest time and resources, such as taking
leave from work for a preventive care visit, to ensure their health and wellness.
Employers need to provide incentives to help those employees who are not getting
appropriate and recommended care, but also acknowledge and reward those
employeeswhoarereceivingthesupportandcaresothattheycontinuetodoso.

Recommendation #3: Align the corporate culture to incorporate workplace

emotionalhealth.
Action(s): Employers should adopt a business strategy that creates and supports a
cultureofhealth.Establishinganorganizationalculturetakesatopdownapproach,and
theimplementationofaculturethatsupportsworkplaceemotionalhealthwillrequirea
directlinktoexecutivesandmanagers.
The executive and manager teamsshould work with human resources develop both a
short and longterm strategy for their organization to create a sustainable culture of
health.
Thisstrategyshouldinclude:
1. AnenvironmentalscanoftheorganizationUnderstandingthecurrentculture
ofhealthorlackthereofofanorganizationandidentifyinggapsbetweenthe
currentcultureandtheproposedfutureculture.
2. Setting a direction Assessing where your organizations current culture of
healthandthecultureitwantstodevelop.
3. Action planning Carefully planning the key steps, targets and milestones
requiredtodevelopacorporatecultureofhealth.
4. Resource allocation Identifying where both financial and human capital
resources will be most efficiently and effectively used in creating a culture of
health.
5. Evaluation of the strategy Develop and measuring key indicators that help
evaluatetheculturessuccessanditssustainabilityovertime.
Action(s): Employers should consider opportunities for enhancing employee and
dependentsocialsupportnetworks.Theaverageemployedpersonspendsonethirdof
their day at work. For many employees, the workplace is a community, much like a
neighborhood or school that provides a valuable social support net for employees. In
addition,socialsupportsuchashavingaclosefriendatworkcanbeadeterminant
ofjobsatisfaction.
Havingastrongsocialsupportnetworkatworkallowspeopletofeelsupportedintheir
dailytasks.Atthesametime,itgivespeopleanopportunitytodeveloptheirempathetic
40

andinterpersonalskills,whichcanbeofvaluetoboththeirphysicalandmentalhealth,
aswellasworkproductivity.

Recommendation #4: Transparency, communication and support for a

corporatecultureofemotionalhealthfromexecutivesandmanagers.
Theexecutiveleadershipofanorganizationiscriticalinestablishingacultureofhealth
withinanorganization.However,aTowersWatsonstudyfoundthatin2008,employee
confidenceincorporateleadersandmanagerswasextraordinarilylow.
Action(s): Employers should incorporate workplace emotional health issues into their

executive and manager leadership training. Nearly all companies have onboarding
training for newly appointed executives or managers. The structure of these training
programs naturally varies between companies based on factors such as industry,
geographical location and the like. However, all executives and managers should have
someformontrainingthataddressesproblemsolvingandcommunicationskillsabout
employeeandorganizationalemotionalhealth.
Action(s): Executives and senior managers should provide regular, timely and
transparent communications to employees. Previous workplace studies by Watson
Wyatt and Mercer have shown that communication from executives and managers to
employees had a positive effect on employee satisfaction, work commitment and
turnover. These studies suggest that employees who feel valued are more engaged,
productiveandhaveastrongerloyaltytheorganization.xxiv

Recommendation #5: Remove actual and perceived barriers to emotional

healthprogramsandservice.
Action(s): Programs and services that support emotional health should be flexible.
ProgramsandservicestosupportemotionalhealthsuchasEAPsshouldbeavailable
duringnonworkhours,weekendsandthroughvariousmediumssuchasinpersonor
via phone. Employers should ensure that when contracting with an EAP, the vendor
offersflexibilitytomeettheneedsofadiverseemployeepopulationwishingtoobtain
theseservices.
Action(s): Make programs and services that support emotional health accessible.
Barriers to programs and services that support emotional health may be financial or
geographicalinnature.Employersshouldremovesignificantfinancialbarrierssuchas
shiftingmostofthecostsontotheemployee.Removalofbarriersmaynotincreaseuse
of these services, but it helps clear a path for employees in need of emotional health
support services. Additionally, when contracting with vendors or developing inhouse
41

programs, employers should ensure that these programs and services are easily
accessible geographically. Locations in a variety of geographical areas, or onsite, will
encourageemployeestoutilizeprogramsandservices.
Action(s): Ensure that programs and services that support emotional health are
culturallyandethnicallysensitive.Notallculturesandethnicitiesunderstandemotional
healthinthesameway.Employersshouldconsidertheirownemployeediversitywhen
assessingthediversityofprovidersandresourcesavailabletosupportemotionalhealth,
suchaslanguagebarriers,raceandethnicity.Employersshouldrequestthisinformation
fromanyvendorsthattheyworkwithonemotionalhealthinitiatives.Employersshould
alsoensurethatanyonsiteinitiativesarealsosensitivetodifferentethnicandcultural
needs.

5.3 WorkplaceEmotionalWellnessPoliciesandMetrics
Thefollowingpolicyandquantitativerecommendationshelptocodifyworkplaceemotional
healthprogramsandfacilitateanintegratedapproachtosupporttheseprograms.

Recommendation#1:Createabalancebetweenworkandpersonallife.
Balancing work commitments with personal commitments is a key challenge for the
employee. Providing a work environment that supports both a productive work
environmentandawork/lifebalanceisakeychallengeforemployers.Workplacepolicies
should balance the business needs of the company with the emotional health needs of
employeesandtheirdependents.

Action(s): Ensure that employees understand telecommuting and flexible scheduling

policies. Many companies already offer telecommuting, flexible scheduling and paid
timeoffbenefitstotheiremployees.

Recommendation #2: Incorporating emotional health assessments into

shortandlongtermdisability,FMLA,etc.
Action(s):Employersmayconsiderprovidingdesignatedcasemanagerstoemployees
whoareonshortorlongtermdisability,caregiversandthosewhoscreenpositivefor
depressionortakefamilymedicalleavetoensurecoordinationofcare.Casemanagers
can be employed through the EAP or the contracted health plan and should consider
developing communication plans for providers, including routine updates to other
caregivers.

42

Recommendation#3:Createadashboardwithmetricsthatgaugeemployee
emotionalhealthandthecorporatecultureofhealth.
Action(s):Incorporateemotionalhealthdrivenmetricsintocorporatekeyperformance
indicators. When using key performance indicators to assess the success of a division,
unit or team, add indicators for emotional health. Such indicators might include
absenteeism,grievances,workerscompensationclaims,andjobsatisfaction.Including
these indicators provides additional data, identifies trends, and helps managers
recognize areas in which there could be an opportunity for improvement in the
emotionalhealthoftheiremployees,engagementandproductivity.

43

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