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Employee assistance programmes are usually pretty dull affairs. For a few decades now, employers have paid EAP providers to run phone lines their employees can call if they need support with personal problems. The idea is to provide some short-term support — a handful of counselling sessions, say — to help staff deal with mild problems before they get worse.
But this year, EAPs have found themselves facing a swelling wave of complex mental health problems brought to them by people with nowhere else to turn.
“We were never designed to be a crisis line,” says Bertrand Stern-Gillet, who runs Health Assured, the biggest EAP provider in the UK with more than 80,000 clients. But he says “high risk” calls have now become a daily occurrence, ranging from child or adult safeguarding concerns to someone who “might have taken a significant amount of pills, or they might be standing on a bridge”. The company is hiring more staff and managers to try to deal with the rising complexity and emotional intensity of the work.
Andrew Kinder, head of mental health services at Optima Health, another EAP, ran an online seminar about bereavement for the employees of one client. He expected about 40 attendees, but 1,200 logged on. “People were actually sharing quite a lot of experiences about what they’ve gone through,” he says.
Antidepressant usage is also on the rise. In 2021/22, 8.3mn patients received at least one prescription item for antidepressant drugs in England, according to NHS data — 22 per cent more than in 2015/16.
Column chart of Number of patients prescribed with antidepressants (mn) showing Last year more than 8mn received at least one prescription item for antidepressant drugs
What’s going on? On the positive side, people have become more comfortable discussing their mental health and asking for help. That’s an improvement on the past when “we had this undercurrent of need that wasn’t even being talked about,” says Vicki Nash, head of policy at mental health charity Mind.
But it’s clear that’s not the whole story. The loneliness, worry, grief and financial problems caused by Covid-19 and associated lockdowns appear to have damaged the mental health of people all over the world.
In the first year of the pandemic, the global prevalence of anxiety and depression increased by 25 per cent, according to the World Health Organization. In the UK, young people are a particular concern: one in nine children aged 6 to 16 had a probable mental disorder in 2017; by 2021 that was one in six, according to NHS data.
At the same time, mental health services in many countries were disrupted by the pandemic and have struggled with the rise in demand. In the UK, waiting for treatment has become so common that Greater Manchester has created a service called “Waiting Well” to support people while they wait. But the longer people have to wait, the worse they tend to get. Nash says people can be turned away because they are not unwell enough to qualify for treatment, “so they have to wait until they become dangerously sick”.
One study into the experience of people on waiting lists interviewed a woman who said: “I didn’t shower, I didn’t get out of my bed because I thought in my head, I thought maybe if I stay in bed long enough someone will come and section me and then I’ll get help.”
Stern-Gillett of Health Assured says some GPs are telling patients to contact their EAP provider if they have access to one because they’re “more likely to get some kind of support quicker than NHS pathways”.
On top of that, the UK has now been hit by a severe bout of inflation and a likely recession. The people who are most vulnerable to a steep drop in living standards are those on low and insecure incomes. They are also more likely to have poor mental health — problems that often exacerbate each other.
A recent report by the Joseph Rowntree Foundation highlighted the striking link between antidepressant use and deprivation: in 2021/22, more than twice as many patients were prescribed antidepressant drugs from practices in the most deprived areas in England than in the least deprived areas.
Column chart of Number of patients prescribed with antidepressants by IMD* decile showing Antidepressants are more commonly prescribed in poorer areas
The problem with leaning more on employers to provide mental health support during this time is that not everyone has access to such programmes. People on low pay, insecure contracts or no work at all are less likely to have such a safety net.
They will need as much help as the money-constrained state can spare. Some interventions don’t have to be very costly, such as integrating talking therapies with debt advice. Other policies that would help are already on the table but need to be implemented, such as government plans to make life in the rental sector less insecure.
Leaving people to cope on their own will store up more problems, both for them and the economy as a whole. Already, a rising share of people say they are too ill to work. Although the over-50s are the biggest driver of this trend, there is also a worrying rise in inactive young people. For them, the biggest cause of long-term sickness is mental illness, phobias and nervous disorders, up 24 per cent since 2019.
Economic problems are hard for people at the best of times, and these are not the best of times. How well or badly we handle this moment will have ramifications long into the future.
sarah.oconnor@ft.com