Confidentiality is key

Young Woman Sitting Looking at Laptop Screen

There is increasing awareness about the need to support the mental wellness of employees at the workplace.

NEA and CPF were reported to be the “…latest to offer counselling services to staff” (Straits Times, 28 Oct 2013). Their efforts to provide their staff with access to paid-by-company counselling services are to be lauded. But as the author of a letter to the forum points out, the telephone as a platform for counselling is far from ideal (“Limitations of telephone counselling”, Straits Times, 29 Oct 2013).

There is a reason why the best practices guides (e.g., Buyer’s Guide by EAP Association, Buyer’s Guide by EASNA, Buyer’s Guide by the UK EAPA) recommend face-to-face counselling as an integral component of a comprehensive employee assistance programmes (EAP). While workplace telephone counselling provided by masters-level mental health professionals has been shown to have some effectiveness, it is noteworthy that telephone counselling was less helpful than face-to-face counselling for individuals experiencing poor psychological wellbeing (read this APA review for details).

There may be relatively less stigma for employees to access telephone counselling services, but “it has serious limitations as a clinical tool, including the absence of the ability to ‘see’ nonverbal cues from a client” (APA Monitor). Counsellors in a face-to-face session, in contrast, have the opportunity to show interest, concern, respect, receptiveness and support through direct eye contact and open body language. Indeed, research indicates that counsellors need to adjust their strategies for establishing rapport for a televideo conferenced counselling session (e.g., appropriate and careful placement of the videocamera, the use of gestures for taking turns to speak, increased use of nonverbal cues such as nodding and smiling).

Employee assistance programmes (EAPs) are designed to “improve and/or maintain the productivity and healthy functioning of the workplace, through the application of psychological principles, including specialized knowledge and expertise about human behaviour and mental health”. That is to say, EAPs support the mental wellness needs of employees by providing them with access to confidential counselling services, as well as education and awareness activities such as mental wellness talks, all of which are paid for by their employer.

And EAPs can only work if employees know about them. Knowing that one can seek help from a professional mental health professional is essential, if employees are to use EAP and if employers are to benefit from having employees who are more engaged at work.

But there is one thing even more important than telling employees that there is an EAP at work. Knowing that counselling services are completely confidential is the most important aspect of the EAP. Providing employees with assurance about the confidential nature of the counselling service is key to employees using their EAP.

Employees should know that all information shared would only be released with their written consent (see the limits of confidentiality from this APA FAQ). Even the fact that an employee has consulted with EAP should not be disclosed to his or her employer. Responsible employers will want to know how many employees used the service (to ascertain if it is useful) and the employees’ satisfaction with the service (to find out if employees felt counselling was helpful to them), not which employees used the service.


Balancing work and life on a tightrope

Work-life harmony is currently a national priority.

The Singapore Tripartite Forum deems employees able to combine work responsibilities and personal-family needs likely to be more engaged and productive at work. Businesses are being encouraged to provide for work-life balance among employees.

And the policy emphasis on work-life harmony is supported by the MoM Work-Life Grant. This grant, previously known as Work-Life Works! or WoW! (no, not World of Warcraft), supports EAP counselling and hotline services as part of Employee Support Schemes. The 2005 Work Life Harmony Report  provides findings and recommendations for employers on using work-life strategies to optimise business performance, while Tripartite Guidelines on Best Work-Life Practices lists mental wellness talks/workshops and confidential professional counselling among employee support schemes for enhancing work productivity. But what’s like on the ground?

According to a research report by Azzone and colleagues in the Journal of Workplace Behavioral Health, 90% of Fortune 500 companies implemented EAP services for their employees in 2002, while 40% of US employees in the private sector had access to EAP services in subsequent years (Merrick, Volpe-Vartanian, Horgan, & McCann, 2007; U.S. Department of Labor, 2005).

In Singapore, comprehensive EAPs are a relatively new development, even though corporate wellness programmes have been in place since the 1980s. As many as 26% of private companies in Singapore with at least 50 employees had a comprehensive workplace health promotion programme in 1998 (Chew, Cheah, & Koh, 2002). The findings published in the Singapore Medical Journal were based on a survey which had a 49.5% response rate from 4,479 companies. A 2006 National Workplace Health Promotion Survey, cited in a recent book edited by Kirsten and Karch (2012), Global Perspectives in Workplace Health Promotion, puts this number at 58.7%.

With the recent mushrooming of local EAP providers, hopefully it won’t be too long before the untangling of Employee Assistance Programmes (EAPs) and employee assistance payments can begin.

No idea that we had an EAP!

The benefits of corporate wellness programmes range from a return-on-investment or ROI of US$6 to a decrease of up to US$6 in health care costs.

An 2009 EASNA research note by Attridge and colleagues documents an ROI of US$3 to US$10 for every dollar invested in an employee assistance programme. Similarly, analysts in a 2010 Harvard Business Review article report a US$6 savings in healthcare costs for every dollar spent on employee wellness programmes, while recent data from the International Foundation of Employee Benefit Plans for their Wellness and Value-Based Health Care survey revealed a US$1 to US$3 decrease in overall health care costs for every dollar spent on wellness programmes.

However, no organization can possibly reap the benefits of an EAP or corporate wellness programme if employees aren’t aware of the programme in the first place. As Miller asserts in a recent article for the Society for Human Resource Management“communication is the key to wellness success”.

Azzone and colleagues (2009) report that employees use EAP counselling services when their employers actively promote EAP services. Others make the cogent argument that periodic communication with employees to evaluate client satisfaction with EAP services not only demonstrates the value of the programme, but raises employee awareness about EAP services (Moore, 1989; see also Frost, 1990). As noted in a review by Merrick, Volpe-Vartanian, Horgan, and McCann (2007), employee awareness of EAP services and confidence in the confidential nature of EAP counselling are key to EAP utility. This is demonstrated in an empirical study sampling participants from six worksites: Trust and confidence in EAP services reliably predicted EAP utility (French, Dunlap, Roman, & Steele, 1997).

EAPs are only as effective as the efforts that an organization (and its EAP provider) makes to ensure that employees are aware about EAP services and the confidential nature of EAP counselling services.

Getting the most out of your EAP

As detailed in the buyer’s guide to EAPs by the US Employee Assistant Professionals Association (see also this description of EAPs), a quality EAP should provide a 24/7 crisis hotline, confidential assessment and counselling services, referral support, critical incident response service, EAP orientation for all employees, manager training on manager referrals with training support materials, promotion of EAP awareness among employees, annual EAP utilization reports, programme and client satisfaction evaluation.

EAP services should provide access to qualified clinical professionals who adhere to professional ethical standards and guarantee confidential record keeping. Timely responses to manager-referrals and punctual feedback on EAP utility, programme evaluation, and satisfaction further distinguish quality EAPs.

Evident in the EAP pricing per head cited in a UK buyer’s guide to EAP, it’s clear that you get what you pay for. Comprehensive EAPs which offer on-site counselling, critical incident response services, EAP orientation for all employees, and manager/supervisor training, as well as the ubiquitous 24/7 emergency hotline and referral support, will deliver a quality service which promotes awareness and utility of EAP services among employees.

And as we know, accessibility to EAP services, particularly EAPs which focus on preventive measures through mental wellness talks and online resources, is key to helping employees effectively deal with stress in both the professional and personal arena (Azzone, McCann, Merrick, Hiatt, Hodgkin, & Horgan, 2009; Yu, Lin, & Hsu, 2009).

What’s the return on investment for EAPs?

“The typical analysis produces an ROI of between $3 and $10 dollars in return for every $1 dollar invested in the EA program.”

That is what Attridge and colleagues have reported for the Employee Assistance Society of North America (EASNA) in a 2009 research note, first published in their “Selecting and Strengthening Employee Assistance Programs: A Purchaser’s Guide” publication.

In a study of university employees with the majority having access to face-to-face EAP counselling services, Phillips (2004) found improvements in work productivity for 59% and 62% of 704 and 1,206 cases from 2002 and 2003 respectively. The data published in Employee Assistance Quarterly revealed an ROI of 3.5:1 and 4.3:1 in 2002 and 2003 respectively (Phillips, 2005).

Another empirical study sampling employees with access to face-to-face EAP counselling services demonstrated less absenteeism and improved work productivity for 50% of 882 cases (Kirk, 2006).

In a paper presentation at the 2003 APANIOSH Work, Stress and Health Conference, Attridge (2003) reported improved an average 43% gain in work productivity for 57% of 11,909 cases from a national EAP provider supplying counselling services mostly by telephone.

A more recent presentation at the 2007 Employee Assistance Professionals Association Annual Conference, Baker (2007) documented reduced presenteeism: Based on 3,353 cases from an national EAP provider supplying telephone counselling, low-productivity days were reduced from an average of 30 days to as few as 3.4 to 8.0 days, resulting in an average gain of 58% in work productivity.

In addition to recognition that effective EAPs produce greater work productivity, better employee engagement, less absenteeism, less presenteeism, and reduced turnover, it’s gratifying to know that the return on investment for EAPs isn’t different from that reported for corporate wellness programmes: Berry, Mirabito, & Baun reported in a 2010 Harvard Business Review article that “every dollar invested in the intervention yielded US$6 in health care savings”.

EAPs in Singapore

Employee Assistance Programmes (EAP) were initiated in the 1940s as workplace alcohol programmes in the US. By the 1970s, EAPs were extended to provide assistance with a broad range of problems including professional development issues and personal concerns.

EAPs subsequently proliferated across UK and the AsiaPacific region, as noted in a review of the EAP market in UK and Europe by Buon and Taylor (2007). In an overview of newer EAP markets, Hopkins (2005) discerns that with the 1990s, EAPs have been established in Singapore, as well as Hong Kong, Japan, and Scandinavia.

Despite being a recent development in Singapore, EAPs have been a topic of local research. Ho (1997) has examined the effect of corporate wellness programmes have on stress, job satisfaction, and absenteeism in Singapore. Although absence from work did not differ between employees with a corporate wellness programme from those without one, the study did demonstrate that employees with a corporate wellness programme perceived their employer more positively. Specifically, employees with a corporate wellness programme expressed greater satisfaction about their job and their benefits.

Moreover, local funding opportunities lend support to the growing market for EAPs. The MOM Work-Life Grant supports EAP counselling and hotline services as part of Employee Support Schemes. The HPB Workplace Health Promotion Grant supports EAP counselling and mental health talks/workshops.

With work-life balance becoming a priority for employees – a recent survey by Accenture reports work-life balance the top priority for some local employees – employing employee support schemes will be  key for staving off staff turnover. Mental wellness programmes will be here to stay for some time.

What is an EAP?

An Employee Assistance Programme or EAP is a professional psychological service which supports the mental wellness needs of employees and managers/supervisors at the workplace.

As defined by the Employee Assistance Professionals Association, EAPs are designed to “improve and/or maintain the productivity and healthy functioning of the workplace and to address a work organization’s particular business needs, through the application of specialized knowledge and expertise about human behaviour and mental health”.

EAP services typically comprise confidential, professional counselling services, mental wellness talks and online resources, an emergency phone hotline, and on-site critical incident response services, as well as management consultation and coaching. Referral to specialist services, active promotion of EAP services, provision of manager/supervisor training on EAP services, and feedback on utilization rate and satisfaction with EAP services are also viewed as essential components of EAPs. For example, the Buyer’s Guide to EAP by the US Employee Assistance Professionals Association and UK EAPA list these as core components, which employers should look for when shopping around for an EAP.

These services help employers manage a variety of employee problems, which can range from job-related concerns such as work stress and burnout, conflict with colleagues or supervisors, ineffective time management, and communication difficulties, to personal issues such as depression, anxiety, grief and loss, addictions, relationship/marital problems, and parenting difficulties. Importantly, EAPs have been shown to improve work productivity and mitigate individual and organizational risk factors which may impact upon workplace productivity.