Employee assistance programs now and into the future
Many organisations rely on independent Employee Assistance Programs (EAP) to address their legislative requirements via the provision of psychological and counselling support. However, over recent years, a range of issues and concerns have repeatedly been raised regarding the EAP sector, as reiterated in a recent report on mental health by the Productivity Commission (2020). There is an urgent need for dialogue and collaboration on the implementation of best practice strategies to ensure healthy, safe and productive Australian workplaces (Productivity Commission, 2020).
There is a growing rate of mental health issues in the workplace and this has serious consequences for employees and organisations alike. Hazards in the workplace can include not only the inherent environmental risks associated with some industries, but psychosocial hazards such as poor and unsafe work conditions, ineffective or insufficient management and leadership, and harrassment and bullying. Psychological effects such as anxiety and depression, substance use and/or problem gambling can occur as a result of workplace stressors, and these effects can be compounded in settings where poor mental health is already present.
Research demonstrates that organisations that actively support psychological health and safety experience financial gain through decreased errors and accidents, increased productivity, worker retention, reduced sick leave and fewer workers’ compensation claims (Richardsen, et al., 2019). One of the key learnings from the field of safety science is the importance of cultivating a work environment that supports employees’ physical and psychological health.
What are EAPs?
EAPs are employer-funded confidential counselling programs made available by government departments, most large companies and many small/medium enterprises to their employees and families, with the aim of helping them to cope with concerns that can adversely impact job performance and general psychological wellbeing (Richardsen, et al., 2019).
EAPs originally started in the 1930s out of a need to manage and mitigate the impact of alcohol use in the workplace and began expanding from the 1970s onwards to address a growing range of employee health and wellness issues such as personal life issues, work performance and psychological health concerns. EAPs now support employees across a range of work-related and personal problems ranging from work-related stress, trauma and interpersonal conflict, through to health issues and personal mental health challenges, crises such as financial difficulties, family violence, grief, loss and addiction issues.
EAPs are considered an essential facet of Human Resources Management and are a significant element of organisational assistance (Productivity Commission, 2020). The current range of services that EAPs are contracted to provide can vary considerably in depth and breadth, and due to the rise of e-counselling, services are no longer restricted by timezones and geography.
Current and emerging concerns
A range of concerns that have been repeatedly been raised over several years have been highlighted in a recent report on mental health by the Productivity Commission. This report scrutinised the range and efficacy of EAP services and made recommendations for service clarity and quality improvement (Productivity Commission, 2020). Determining EAP service efficacy is complicated for a number of reasons. First, there are different models of EAP service delivery. Second, the range and types of services provided vary across EAPs, and thirdly, there are no enforceable standards for EAP delivery. This lack of accountability is primarily responsible for the sparse and often substandard level of research conducted in the EAP sector (Frey, et al., 2018).
Service offerings or ‘packages’ can differ across EAPs, which raises questions regarding the qualifications and experience of EAP practitioners, and whether the interventions they provide reflect evidence-based practice.
Evidence-based outcomes remain largely elusive, with approximately 60% of organisations not evaluating their EAPs and the remaining 40% relying on employee feedback, surveys and feedback from their EAP provider. Additionally, there has been inconsistency amongst EAPs regarding how to self-evaluate or monitor the efficacy of their programs/counselling services; with few external evaluations or benchmarking of best practice to guide employers (Frey, et al., 2018; Productivity Commission, 2020).
There are conflicting findings with respect to the available research on EAP services, which makes it diffult to ascertain and compare the effectiveness of different EAPs. A review of studies between 2011 and 2019 found that EAPs made cost savings of almost 5% in hours lost per month and resulted in an approximate 45% decrease in absenteeism (Csiernik, et al., 2021). However, there have been no studies in the past decade that have investigated the cost-benefit analysis of utilising an EAP. Although utilisation rates are cited as evidence of EAP relevance, Australian EAPs tend to rely on utilisation metrics and satisfaction surveys to demonstrate their effectiveness, rather than outcome measures that measure and track change from pre- to post-intervention. Further, some findings have revealed negative mental health outcomes following EAP counselling; reporting increased emotional and cognitive dysfunction, and deterioration of clients resulting in a referral to other qualified treatment providers (Csiernik, et al., 2021).
Further considerations and issues
In addition to a lack of valid and reliable research, another key obstacle to best practice standards and evidence-based clinical practice in the EAP sector continues to be the lack of licensing and regulatory requirements for the provision of EAP services (Productivity Commission, 2020). EAPs have been shown to compete for industry superiority with respect to product cost and range. A main criticism is that their expansion and services offered are largely driven by business priorities and profit-generation rather than evidence-based or clinical best practice standards, which at times, can make them a jack of all trades, master of none.
The Employee Assistance Professionals Association of Australasia (EAPAA) is the peak body for EAPs in Australasia and requires its members to adhere to service standards and a code of ethics; requiring providers to employ a designated and registered psychologist or mental health social worker to overview the professional
activities of employees and consultants to the EAPAA. However, there is no requirement to be a member in order to deliver EAP services to organsations, and consumer demand seems to be the main driver for change. Thus, EAPs are increasingly commercial and shaped by economic and profit factors (Productivity Commission, 2020). As it stands, EAPAA does require each member EAP to have a minimum of three years experience in delivering EAPs before their membership application will be approved. However, it does not request evidence of efficacy of service delivery over these three years.
The challenges of the COVID-19 pandemic have created a need for EAPs to be delivered flexibly and distally, through information and communication technologies. Online platforms have the capacity to deliver evidence-based mental health care to the diverse Australian workforce landscape; to employees unwilling or unable to access services due to lack of service availability, time constraints, difficulty with access and accessibility, or preferences for anonymity (Marcelle et al., 2019).
Addressing the challenges
There is growing interest and support from senior mental health leaders for improvements in the delivery of evidence-based, client-centric mental health support in workplaces. Incorporating the core elements of a traditional EAP in conjunction with leveraging advances in psychology, program design and technology to better engage both employees and improve overall organsiational psychological safety needs to be emphasised (Productivity Commission, 2020).
With respect to research and evaluation, there has been an increase in the use of a variety of standardised outcome measurement tools, single group pre-post studies, and quasi-experimental pre-post test with control group designs over the past decade (Cisernik, et al., 2021). There is also promising research being conducted on The Workplace Outcome Suite© – a psychometrically validated self-report survey tool designed to collect EAP specific outcome data both at start of counselling and at a follow-up (usually at two or three months) after the last clinical session (Csiernik et al., 2021).
There is support from the Productivity Commission (2020), the EAPAA and a growing number of technology savvy client-centric EAPs regarding initiatives for improving the sector and meeting the mental health needs of employees (Productivity Commission, 2020). Much of this can be achieved by consulting with EAPs which currently work within a client-centric, evidence-based framework across all modes of service delivery and regularly conduct rigorous evaluations both of client outcomes and service delivery performance indicators.
Recommendations
Although there are wide-ranging recommendations for supporting mental wellness and preventing and treating mental health issues in the workplace, the recommendations in this paper are specific to EAP service improvements and how psychologists can best support these improvements.
- Develop nationally endorsed information and education on EAP services and industry standards that support a client-centric approach to service delivery, consultation and organsiation analytics to oversee the sector (Productivity Commission, 2020; Frey, et al., 2018).
- Promote rigour in research, evaluation and adherence to evidence-based and/or clinical best practice standards for service development and delivery which includes an increased focus in the area of e-counselling. (The EAPAA is currently supporting Comcare and the National Workplace Initiative in researching and developing new workplace mental health processes.)
- Develop policies to ensure that suitably qualified and experienced mental health practitioners are recruited, trained and peer-supported to work with the indivudual EAP providers offerings (Productivity Commission, 2020).
- Ensure resources on improving workplace mental health service access and accessibility issues are available for culturally and linguistically diverse people and people working in remote areas. This may be achieved through advancing EAPs offerings in the e-counselling space (Productivity Commission, 2020).
Member EAPs of the EAPAA are required to have the professional activities of their employees and consultants overseen by a designated psychologist or social worker whose registration numbers must be supplied to the EAPAA. Their current presence in the sector notwithstanding, there are some specific roles which psychologists can fulfill which would enhance service provision (Productivity Commission, 2020).
- Targeted recruitment of registered psychologists and well-supported placements in EAPs for postgraduate provisionally registered psychologists would enhance service provision and capacity.
- Mentoring of EAP counselling staff is an important function which psychologists can fulfill.
- Collaboration between universities and other research organisations and EAPs to conduct high quality quantitative and qualitative research in client-centric EAP efficacy and their delivery platforms will highlight best practice, develop effective prevention and intervention measures for a diverse set of industries, and will assist in addressing the gap regarding industry standards.
Shaping the future
EAPs are in an ideal position to deliver evidence-based, multi-modal mental health care to the diverse Australian workforce landscape. Given the current increasing demand for mental health services in the workplace and the magnitude of the effect that EAPs can have on the organisations who utilise their services, creating best-practicxe strategies for optimal mental health outcomes is required to achieve maximal benefit for all parties.
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