No one is untouched, either directly or indirectly, by mental-health issues. Even before the COVID-19 pandemic, one in four Americans over the age of 12 had a mental or substance-use disorder each year, according to the US Substance Abuse and Mental Health Services Administration. Not surprisingly, that figure has risen sharply during the long, stress-inducing COVID-19 health crisis. Our research last year found that employers had major concerns about the behavioral health and productivity of their employees. We observed many kinds of actions by employers to address this concern, and many of them are now navigating the transition back to the workplace.
In a recent webinar, Erica Coe and Kana Enomoto, coleaders of McKinsey’s Center for Societal Benefit through Healthcare (CSBH), sat down with former US Surgeon General Jerome Adams, MD, and with Paul Gionfriddo, former president and CEO of Mental Health America, to discuss the current behavioral-health crisis and the imperative for employers to act on it. These leaders—all of whom have a personal connection to the topic—discuss the importance of addressing the mental health of employees, as well as the particular challenges associated first with the pandemic, and now with the return to work. The following are edited excerpts from their conversation.
Kana Enomoto: I want to start with the massive impact of COVID-19 on mental health, especially for our national workforce, as we begin transitioning back to in-person work. Our recent research on employers shows that nine out of ten say they know that COVID-19 is having an impact on their employees by creating unprecedented anxiety and depression, and 70 percent say they’re taking action. Yet our recent consumer-health survey reveals that almost half of the respondents—49 percent—anticipate that going back will have somewhat or significantly negative impacts. Going beyond the data, how have the two of you seen and thought about the mental-health implications of returning to work?
Jerome Adams: Every challenge brings with it opportunity. There are tremendous opportunities now, because of COVID-19, to rethink the workplace and the flexibility that we afford people. Awareness of mental health is the first step. The existing mental-health issues in this country were exacerbated by the pandemic and will be further amplified, for many, by the transition back to work. Employers need to take actions that make employees feel safe while also enabling them to meet their financial obligations and care for their families—two big stressors that can compound mental-health issues. Another critical step is for employers to step up because you realize not only that it’s the right thing to do for your community and your employees but also that it matters to you and your economic bottom line.
And that’s why I put out the first-ever surgeon general’s report1 written not for a health audience but for a business audience. It points out that we are at a health disadvantage in our country: we spend more for healthcare than any other country, by far, yet get terrible results. And that’s hurting us in terms of healthcare expenses, which are the number-two expense for most companies. It hurts us in terms of worker turnover. It hurts us in terms of absenteeism, decreased productivity, and workplace accidents. And you’re not going to have a healthy workforce, or a healthy community to draw from, if you ignore the importance of mental health.
Paul Gionfriddo: To build on that, we know that some employees’ mental health is disproportionately impacted. For example, going into this pandemic, people believed—and continue to believe—that young people would be the most resilient and older groups would be the most fearful, but the opposite is true. Younger people are feeling the effects more deeply. As Dr. Adams pointed out, we’re talking about trauma being built upon trauma being built upon other traumas. If we fail to address these successive traumas, they will continue to add up. There are countless free resources available online. Millions of people access them every year. You’re not alone in looking for help and information.
Erica Coe: As our country is emerging from the pandemic, what gives you hope about our ability to overcome the challenges of mental illness and substance abuse?
Paul Gionfriddo: I see a transition taking place to something I’ll just refer to as “wellness days”—the flexibility some employers are beginning to give employees to take days off when they need them, whether or not they have a diagnosable physical- or mental-health condition, and not to have those days charged against vacation time or traditional personal time. Similarly, companies have extended three-day holiday weekends to four-day weekends and given people other times off at random. What gives me hope is that employers, in particular, are recognizing that productivity can go up under those circumstances. You do not have to worry about people not working hard enough; in fact, part of the problem is people working too hard and not realizing that their productivity drops off after hour 40, 50, 70, or 80.
Everybody felt things had been so fragile this past year, and that any one of us, almost at any time, could have gotten an illness that could have killed us within a few days. It’s caused people to take a few deep breaths and think about how to create work–life balance for adults and school–life balance for kids.
Jerome Adams: I have hope because, going into the pandemic, we were finally making a dent in the opioid-misuse epidemic. We created some real momentum. We were lowering the stigma of opioid misuse and increasing the availability of naloxone.2 We were helping people recognize the spectrum that starts with adverse childhood experiences, early anxiety, and depression and then turns into substance misuse, which then triggers the need to connect people to treatment and then, ultimately, to long-term recovery. I’m also optimistic because COVID-19 forced a reckoning in terms of the disparate impacts that certain risk factors and diseases have on certain communities. No one can argue against that anymore, because we saw how communities of color were ravaged by COVID-19.
Telehealth visits increased from about 10,000 per week, pre-COVID-19, paid for by the Centers for Medicare & Medicaid Services [CMS], to over a million per week paid for by CMS at the peak of the pandemic.3 A lot of those visits were mental-health visits. We’ve got new tools and a new comfort level with many of those tools, and new realizations about society that I hope will be a catalyst moving forward.
Erica Coe: Stigma around mental health as compared with physical health remains a huge issue. What other perspectives can you share on this topic?
Once we normalize mental health the way we normalize an MRI for your tweaked knee or any other medical treatment, that’s when you start to see stigma come down. When you fight stigma, you can save lives.Jerome Adams
Jerome Adams: Stigma is the biggest killer out there. Stigma kills more people than cigarettes, than heroin, than any other risk factor. Because it keeps people in the shadows, it keeps people from asking for help, it keeps good people from being willing to offer help. And the way we overcome stigma is by sharing our stories as people who have mental-health issues of our own, sharing our stories as people who have overcome mental-health challenges, and sharing our stories as people who have reached out to help and embrace others who had mental-health challenges. Once we normalize mental health the way we normalize an MRI for your tweaked knee or any other medical treatment, that’s when you start to see stigma come down. When you fight stigma, you can save lives.
Kana Enomoto: I want to add that Dr. Adams, as surgeon general, did so much to reduce stigma. When “the nation’s doctor” is talking about mental health and addiction and substance use, it’s not just a fringe issue; it’s everybody’s issue.
Paul Gionfriddo: Yes, when we normalize, then we address and mitigate any effects of stigma. When we leave stigma alone, it transitions quickly to discrimination, and discrimination translates quickly to lack of access and unequal services and support. That’s where we have, unfortunately, too frequently allowed ourselves to go in this country and, really, in the world. And, certainly, Dr. Adams’s work and Kana’s work and the work of others to pull that back and move in the other direction has been essential to addressing, not so much stigma, but the way stigma lies at the heart of the dichotomy, or the dialectic, between normalization and discrimination.
Jerome Adams: There’s also the question of how workplaces can support disabled employees. We know that people with disabilities of all kinds suffer higher rates of mental-health issues because of stigma that then turns into discrimination, that then turns into barriers to the ability to interact in society. Again, COVID-19 has given us an opportunity to engage people with disabilities in new ways through technology and to make the workplace more accessible to them. When we have an inclusive workplace and an inclusive society, we all benefit.
Erica Coe: Any closing thoughts on how to focus on resilience and promoting mental wellness with the goal of prevention?
Jerome Adams: For the employers that have the capacity to do this, I would encourage you to think about appointing a mental-health and wellness champion. Every single company is going to have someone who is their point person for COVID-19. And the reality is that as someone who is running an organization, you are going to be just as likely, if not more likely, to encounter problems with mental-health and wellness issues as people come back into the workplace as you are to encounter problems with COVID-19. That’s just a fact, so you should be thinking proactively about it. And if we are proactive about it at work and if we create an atmosphere where we can talk about “how can we be healthy? how can we build resilience? how can we prevent burnout?”—and not just “what do we do once someone’s burned out?”—then I think we’ll be in a better place.
Paul Gionfriddo: If we understand that rather than one in four, this past year it was probably one in two people that had a diagnosable mental-health condition—so this is everybody’s concern, this is everybody’s matter, this is everybody’s lives—hopefully, we will be able to move as far upstream as we can and recognize that mental health is the goal, just as overall health is the goal. There’s no such thing as overall health without mental health.
There’s no such thing as overall health without mental health.Paul Gionfriddo
And so I’m hopeful that people will not wait till stage IV. We’ve spent too many years, too many generations, waiting till crises have occurred to say, “OK, now we need to address our mental-health challenges and our challenges to mental health.” And I do think we have the opportunity here because we have the attention of the public, we have the attention of the media, we have the attention of policy makers. We need to make use of that and drive change right now because this is our opportunity.