“I am not okay. But I know I have to be. And I will be. But I’m not okay.”
I (Andrea) shared these conflicted yet honest sentiments with a colleague after the murder of Ahmaud Arbery began to receive increased media attention in April. The feeling I called “not okay” was actually psychological distress. I was nervous, mentally fatigued, and continually distracted by the pain of another racially motivated murder and the fear that this could happen to someone I loved. While I was not directly connected to Ahmaud Arbery, the tragedy felt personal due to a psychological phenomenon called shared racial fate.
Managing my distress was further complicated by the burden I felt at work of having to maintain exemplary performance, a burden made even heavier by the realization that my family’s finances and my professional reputation hinged on my ability to compartmentalize and suppress my emotions while working.
Even with my background in mental health, I didn’t accurately label what I was experiencing — race-based traumatic stress — until I spoke with a therapist. Fortunately, my mental health care benefits allowed me to reach out to a professional who helped me process my reactions and develop strategies to manage my emotions and take care of myself.
Unfortunately, many Black Americans don’t have access to these same types of resources. Nor are Black Americans the only ones who experience race-related stress. Millions of people from racial minority groups carry the psychological weight of racism throughout their lives, including at work, and very few are able to reach out to culturally responsive mental health providers through their employee benefits.
Over the past several months, many companies have pledged to better support their Black, Indigenous, and/or People of Color (BIPOC) employees, particularly when it comes to mental health. To do this well, they must offer services that meet the unique mental health needs of those employees.
At Lyra Health, I (Joe), consult regularly with employer benefits teams that are increasingly recognizing the shortcomings of a one-size-fits-all mental health program. So what do more effective programs look like? We believe they need to do two key things: Offer culturally appropriate benefits, and ensure employees who need those benefits are using them.
Offer Mental Health Benefits that Work
Most large employers offer mental health benefits via an employee assistance program (EAP), but these programs are often ill-suited to BIPOC communities’ specific needs. While rates of mental illness among Black Americans are comparable to other racial groups, this community faces higher prevalence of severe symptoms that result in disability. The data are particularly troubling when coupled with the fact that BIPOC individuals are often less likely to seek treatment than other groups because of stigma, understandable cultural mistrust toward health care providers, and a lack of access to culturally responsive care. Many of these barriers are rooted in a history of maltreatment by the mental health profession.
Studies show that even when people identifying as BIPOC do obtain services, they often prematurely discontinue care and are less likely to receive a full course of treatment as recommended by clinical guidelines. Traditional EAPs exacerbate this issue by often offering six or fewer sessions to address an identified problem. Thus, treatment coverage often ends well before many evidence-based treatment protocols can be completed.
To make sure that your mental health benefits address these barriers look at the following dimensions of your benefits solution.
- Access: Is it quick and easy to find and schedule an appointment with a provider? Do you offer online booking and matching of employees to available providers who fit their care needs? A mental health benefits solution should be able to demonstrate an average wait time for an appointment of less than one week, with the ability to obtain a next-day appointment for urgent or severe issues.
- Cultural responsiveness: Are providers in the network vetted for their use of culturally responsive approaches to care, such as an ability to assess cultural factors that impact clients’ lives, experience and training related to race-based stress, and competence in adapting treatment to cultural needs? Further, what continuing education does the vendor offer to ensure that their providers have easy access to high quality, culturally-informed training? Trainings should address issues related to race and ethnicity, but also promote culturally sensitive care related to other social identities, such as best practices for evaluating and treating clients who identify as transgender.
- Provider diversity: Does your mental health solution recruit and engage racially diverse providers? Ask about their initiatives to promote diversity within their provider network and whether they continually assess the balance of racial representation among their providers.
- Effectiveness: Are providers assessed for use of evidence-based therapies that are shown to be effective for diverse populations? Does your benefits solution track clinical outcomes specific to your employee population? An EAP should have data to show that most employees’ mental health symptoms reliably improve.
- Flexibility: Are employees able to engage in care on their terms? That can mean being able to receive care in-person, by phone, or by video call.
- Specialty coverage: Can your employees easily find providers who are trained to treat specific issues, such as post-traumatic stress disorder, or specific populations, such as children and adolescents?
Enhance Utilization Through Education and Partnership
Offering the right mental health benefits is the first step, but even the best benefits won’t be effective if they’re not utilized. Many EAPs have incredibly low usage rates, including among employees who identify as BIPOC, which some experts believe is due to the stigma mentioned above as well as a lack of awareness; many employees simply don’t know that the EAP is available to them. Employers need to promote their mental health benefits using both data and storytelling to normalize mental health, challenge stigma, and explain how evidence-based therapy can effectively treat a wide spectrum of mental health conditions, from mild anxiety and insomnia to substance use and trauma.
Employers should also consider partnering with their BIPOC employee resource groups (ERGs) or affinity groups. These groups can provide safe spaces for discussion around employees’ race-based traumatic stress and the intersection of mental health and cultural diversity. Ask the leaders of these groups if they’d be willing to have an HR representative and possibly a clinician from your mental health benefit provider join a meeting to discuss barriers that are holding BIPOC employees back from seeking help and how to overcome them. If your program effectively covers the dimensions above, you can use this meeting to highlight features such as the ability to be matched with a provider who is culturally responsive.
We also find that outreach efforts are much more effective if BIPOC leaders champion them. When an executive who identifies as a BIPOC shares a personal story about mental health, it can help to destigmatize and encourage access to these benefits.
As companies seek to build and support a more diverse and inclusive workforce, leaders need to understand that race-based stress can be a unique, pervasive burden for many of the employees they want to champion. Offering and promoting mental health benefits that are evidence-based, culturally responsive, and supported by company leaders can lead to meaningful progress in prioritizing the mind, body, and soul of BIPOC employees.
