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Assisting Happiness

HR Magazine
Employee assistance programmes provide emotional and practical support for workers and profess to cut absenteeism. But do they actually work?

HR Magazine Article

Would your managers know how to deal with an employee who bursts into tears in the office over an impending divorce, or the death of a parent? Would they be able spot one of their workers buckling under the strain of financial problems and taking it out on colleagues? Would they be able to tell if someone was putting a brave face on a personal trauma?

Not all senior staff have the emotional intelligence – or time – to deal with their employees’ crises, yet companies can ill afford to ignore them. Around 170 million working days are lost every year because of ill health, according to a TUC report released this February. Psychological illness is the main cause of absence in the UK, with an estimated one in four workers experiencing depression, anxiety or stress at any one time – and mental-health issues cost the UK’s GDP around £52 billion a year, according to the Centre for Mental Health. And it’s poor management and long hours that are the two most commonly reported contributors to stress.

“It’s a cliché, but happy employees are productive employ- ees,” says Jayne Billam, director of human resources at the University of Lincoln. A year ago she introduced an employee assistance programme (EAP) – an employer-sponsored information and advice service – for her 1,500-strong staff. “We were aware that seeking help through occupational-health services becomes very formal and public. Often timing is critical. You might have to wait a long time with the NHS – referrals early on are much more beneficial.” Lincoln’s EAP is a top-of-the- market model, offering a range of confiden- tial and flexible services from face-to-face counselling, round-the-clock telephone consultations, and online servic- es for employees and their family members, on a range of areas from mental health to child care and legal and financial advice. In the first year 8-9% of employees used the services, which is about average for EAPs in the UK, though Billam hopes more will make use of it in the future.

First introduced in the 1960s, EAPs used to involve corporate welfare and alcohol treatment programmes, but since then have evolved to focus on mental health, with optional trimmings. And they’re more important now than ever, says Libby Payne, clinical director at EAP provider CiC, what with longer waiting times, cutbacks to NHS services, and increased economic hardship during the downturn. She says public-sector workers, particularly those in public- facing work such as the police, NHS social services, fire-fighter and probation services, tend to make more use of EAPs than the private sector. But EAPs only provide a short-term solution, normally counselling sessions are capped at five or six, although practitioners – usually registered psychologists and counsellors – are adept at referring employees for longer-term care if necessary.

When UK companies first began buying EAPs, they were often stand-alone services at a cost of as much as £25 per head. Now, as their provision has trebled in the UK in the past decade, they come cheap – sometimes at as little as £4.50 a head, or are bolted on for free to a health and safety package. Unsurprisingly, some providers are critical of how EAPs have become commoditised and downgraded, merely paying lip service to meeting a company’s statutory duty of care.

“There’s no such thing as a good EAP that’s cheap,” says Dr Mark Winwood, clinical director for psychological health at AXA PPP healthcare. “I’m bemused how something that costs under a fiver can offer good-quality psychological care – you need experts on hand 24/7 and a minimum of five counselling sessions to have a real impact.” Like many top-of-the range providers, the likes of AXA and ComPsyche offer phone lines staffed around the clock by trained clinicians who give immediate support, and assess and refer as appropriate. A call might be followed by a series of counselling sessions by phone, email or in person. AXA and other larger providers have several hundred affiliated professionals nationwide. At their cheapest, an EAP might offer online resources only – which might be good for information but a poor support in the immediacy of emotional distress. “I can’t see someone who’s bereaved or addicted looking up information online via an EAP,” says Dev Raval, former head of reward at BSkyB. Other cheaper programmes charge an ad hoc fee when used.

But if a company decides to spend £10 or more per capita for a decent programme, is an EAP, to put it bluntly, worth the money in getting employees back at work and truly engaged? Only an estimated 30% of UK companies have an EAP in place, compared to around 75% in the United States – and on average only between five and 10% of employees actually use them. But according to research commissioned by the UK EAP Association, which reviewed around 28,000 EAP interventions, when employees do actually pick up the phone, treatments are successful. Approximately 70% of EAP clients were demonstrably shown to recover or improve after counselling intervention; 92% were treated within nine days; and 80% completed counselling intervention – with 95% attending six sessions. In a separate survey of around 4,000 employees who received counselling through an EAP, 64% said their ability to cope with work was good or very good, compared with just 17% before intervention. ComPsyche’s own research shows that after using an EAP, employers saw a 24% reduction in taking days off work and a 52% reduction in stress levels. And they bring demonstrable return on investment: research collated by Canadian HR outsourcing company Morneau Shepell in 2011 found EAPs provide an estimated ROI of between 2:1 and 4:1.

When it comes to using EAP services, men are more likely to use an EAP than traditional therapeutic counselling, says Winwood, largely due to the confidentiality of the service provided. While employers might receive anonymous feedback on how the service is working, colleagues can consult it without informing their employer. “It’s a lot easier (for a man) to pick up the phone in a private space than it is to walk into a consulting room,” says Winwood.

Implementing an EAP is often HR’s responsibility, and there are a few key questions to ask a provider, says Raval, who’s had 20 years of experience of working with EAPs, and recommends using a broker. “Ask what the pathways are – what happens when someone rings, what the turnaround time is, and how counsellors are sourced, vetted and monitored. If you’re a nationwide company, they may have to bring people in – if you’ve got vulnerable staff, you need to know they will be looked after.” Ask the provider what uptake they expect, how outcomes are measured, and how feedback is managed, adds Winwod. “As an HR manager I’d also want to know what the protocol is for referring an employee who isn’t doing so well.”

Another key consideration is how to publicise the service – employees often switch off at the first mention of counselling and many might not know of an EAP’s existence at all. Good schemes will come complete with promotional material and advice, says Winwood. At the University of Lincoln, Billam organised an ‘in-your-face’ launch day, and backed her campaign up with email reminders, leaflets with payslips, and promotion via the union and staff magazine. “Even a simple poster on the back of a toilet door is effective,” she says. Line managers and employee representatives need to be kept up to speed so they can gently steer staff when appropriate. Using specific aspects of the service as a hook is a valuable way of promoting an EAP without overselling the mental-health support. Now that financial concerns feature highly in the current economic climate, it can pay to advertise an EAP’s financial advisory services, says Raval.

When EAPs are cheap or even free, they may be poorly promoted within the company. “It’s not unheard of to see organisations happy with low utilisation [of EAPs],” says Chris Rofe, vice president of Lockton Benefits UK. “That keeps costs down so provider and employer are happy – a vicious circle.” More enlightened employers celebrate higher uptake as a sign the scheme is working. While the focus on intervention with EAPs is short term, the wider knock-on effects are important, as a spokeswoman from mental-health charity Mind says: “Staff feel valued and are more likely to go the extra mile for the organisation.”

Practical or emotional issue?

Practical concerns can have an emotional component, says Dr Mark Winwood, clinical director for psychological health at AXA PPP healthcare. Debt is often a massive worry and people tend to call with an issue rather than a diagnosis. “There’s often an underlying psychological condition,” he explains. “Our whole raison d’etre is not taking things at face value but giving a thorough assessment and putting lasting skills into place.”

Why do people call EAPs?