How to develop an inclusive mental health program

Key takeaways:

• Tracking common stressful life events gives employers a chance to serve up benefits and programs to employees just in time to reduce the risk of mental health decline.

• Understanding who copes well under stressors and how it’s done will provide the foundational components of any mental health program or strategy.

• Those who successfully cope with life’s setbacks tend to use a trifecta of personal, interpersonal, and organizational resources, including building emotional resilience, connecting with others, and using employer-sponsored benefits.

• Listening to those with the most experience navigating life’s challenges (e.g., older adults, underrepresented ethnic groups) helps identify valuable resources while also creating an inclusive and equitable suite of mental health solutions.

Employers have become increasingly focused on benefits and programs that support mental health in the workplace. Not only can employers differentiate themselves by doing the right thing, they understand that cultivating a workplace culture of mental health has a direct, positive impact on their organization’sbottom line. Employees who are mentally healthy are more likely to be physically healthy, financially secure, and motivated at work. Fidelity takes an inclusive approach to our research to better understand how employers can help and build a successful mental health program for all employees.

What is mental health?

We refer to mental health as feeling more good than bad, being satisfied with life, and being connected with loved ones, all of which matter across diverse groups. Without access to preventive resources, like workplace benefits, poor mental health can deteriorate into mental illness (a clinical disorder) and require treatment beyond the scope of what workplaces can offer.

HEALTH SOLUTIONS THOUGHT LEADERSHIP

Setbacks are inevitable, but some cope better or worse than others

Many employers are increasing their focus on mental health and developing strategies to support employees through stressful times. Dealing with health and financial setbacks during the pandemic has put people at even greater risk of mental health issues than any other large-scale event in recent history.

Across a diverse sample of American adults we found sharp mental health decline just within the first six weeks of the first U.S. shutdown. While all groups felt worse, younger adults struggled the most spanning concerns about short-term finances, health, personal wellness and social connections—pointing to strategies that deepen support efforts for young employees.

While there is no playbook on how to handle a global pandemic and life in quarantine, we can

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look back at life events we know are particularly stressful for employees and are increasingly likely given the current climate. We find that the top three harmful life events are 1) a re-organization at work, 2) caring for a sick loved one, and 3) any setback leading people to take on debt. Among those dealing with such events, at least one in three people report being highly stressed. Even before 2020, younger adults dealing with these life events are most likely to feel highly stressed than any other age group. Quite possibly, anyone facing hardship without having accumulated lessons in how to cope with major life stressors could be among the most vulnerable.

With both financial and health challenges increasing and costs of health care showing no signs of tapering off, we can expect medical debt to be even more problematic than other kinds of debt. In 2017, struggling with health and finances simultaneously left nearly one in five people in medical debt and related to a 30% increased rate of high stress levels compared to those dealing with a re-org or a caregiving situation. To make matters worse, medical debt is by far the worst for well-being even compared to other kinds of debt, such as student loans or credit cards. Not only are stress levels highest for people with medical debt compared to other debt, they also report poorer health behaviors, fewer social connections, and lower life satisfaction, all critical to maintaining mental health.

Not all employees deal with stressful events in the same way. For instance, white employees with medical debt are more likely to be highly stressed than their Black and Latino/a counterparts.

42%

36%

23%

38%

45%

Boomer

Gen X

Millennial

Black+Latino/a

White

% stressed by medical debt

Generation

Race/ethnicity

Emotional resilience. Being resilient when dealing with a re-org was the only factor that mitigated the high stress experienced by most. When focusing on why non-white employees have lower rates of stress when saddled with medical debt, resilience also stands out. Feeling less stressed despite a higher likelihood of having medical debt is suggestive of the value of experience as people learn how to pay off medical bills and bounce back, stay calm under stress, and remain optimistic—in other words, be resilient. Resilience was lower among white employees with medical debt compared to white employees without medical debt. In contrast, Black and Latino/aemployees maintained the same level of

resilience when carrying medical debt compared to those who were not.

It may be that white employees have a more challenging experience with medical debt, making it harder to stay resilient. Yet, when we look at the effect of the global pandemic, we find a similar pattern among Black Americans, who were 56% more likely to feel hopeful than white Americans during the first weeks of quarantine. Consistent with research on overcoming adversity, people acquire and build resources to help them more readily tackle future setbacks. Those capable of seeing the good in a bad situation are more apt to accept their circumstances and persevere.

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Powerful resources for employees: emotional resilience, social connection, and employer benefits

The power of hopeThose who are emotionally resilient take more effective steps to meet needs and maintain mental health,

even when they have suffered a health or financial setback

38%

28%

48% 49%

66%

50% 50%

22%

70%

41%

59%

19%

High hope Low hope High hope Low hope

Take steps Needs met Good mental health

NO SETBACKS PANDEMIC SETBACKS

their risk of a bad outcome. When bad outcomes are inevitable, they often feel as bad as younger people, but they recover a lot quicker. In part, this is because older people are highly selective about the company they keep. This may be why older adults are less likely to be stressed across all three life events.

Even as the pandemic unfolded, Boomers’ concerns were lower than Millennials. While most Millennials and Boomers reported learning information from health and financial resources they trusted, Millennials were less likely to translate use of social resources into helpful action. Boomers’ use of social resources aligned with their rate of taking actionable steps (e.g., wearing masks, social distancing, tracking their budget to avoid debt, and protecting their savings), helping them get their needs met better than Millennials. Millennials’ concerns were much higher as they spun their wheels trying to prepare for possible financial and health setbacks.

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Being hopeful was key to mental health (i.e., low levels of depression, anxiety, loneliness, and high satisfaction). When dealing with a financial or health setback (e.g., loss of job, having a loved one get COVID), regardless of hopefulness, people were more likely to take steps to manage their health and finances and were less likely to be in good mental health. Yet, the steps taken among those feeling hopeful appear to better meet their needs and offset the negative impact on mental health considerably. Looking at those feeling lesshopeful, the steps taken while experiencing setbacks don’t support good mental health, in contrast to the hopeful group. Nearly 60% of people with hope had good mental health even in the face of setbacks compared to just under 20% of those who were not hopeful.

Social connection: Having a resilient attitude is powerful, but it may not always be enough. As people age, they tend to be better off emotionally than younger people largely because they avoid situations that increase

Boomers taking actionBoomers' use of resources aligns with higher rate of needs met, lower concern than Millennials

84%

75%

38%

36%

75%

73%

63%

23%

Using social resources

Taking steps

Needs met

Highly concerned

Boomer MillennialMillennials Boomers

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Social connections offer both informational support and validation of decisions. When making tough choices about employer-sponsored health benefits, for example, Latino/a employees feel most confident and satisfied after choosing an HSA-eligible health plan compared to non-Latino/as. Sure enough, feeling confident and satisfied was a direct result of how much people rely on trusted family and friends to help them make health care decisions. Although we observed older adults and Latino/a employees benefiting from social connections when making health and financial decisions, social support is key for every aspect of well-being around the globe. Helping employees build social connections should be prioritized in any mental health support program—especially when striving for inclusion.

Employer benefits: When deciding on a mental health strategy or choosing a vendor, an approach focused on fostering resilience and social connection are must haves. What else can employers do to help besides relying solely on a mental health provider? Promoting the use of mental health programs may seem like an obvious step, but it may benefit your organization more than you realize.

38%

34%

38%

70%

67%

61%

56%

Non-white women

White women

Non-white men

White men

Non-white women

White women

Non-white men

White men

Mental health benefits

Utilization

Value

In a study of over 9,000 Fidelity plan participants, we find that even among those who don’t use it, simply knowing a mental health program is available is associated with higher well-being. Connecting people with mental health programs is still a challenge given utilization rates are below 40%. Despite low use rates, the majority of employees value mental health programs. Perhaps because of persistent stigma or other beliefs about getting mental health support, women place more value on this benefit than men, with white men least likely to see its value.

What else can employers do to help besides relying solely on a mental health provider? Offering a full, diversified suite of health and wellness benefits is a great start. The more health and wellness benefits offered up by employers, the better off the employee in terms of taking a job, staying at a job, feeling good about work, and experiencing higher well-being overall.

When mental health programs are offered, non-white men and non-white women are 12% more likely to at least try the benefit.

As with resilience and social connection, health and wellness benefits are a key resource to managing setbacks. Finding out who is already making the most use of these benefits and why can help formal and informal communications to engage all employees with wellness offerings. For example, Black and Latino/a employees are much more likely to use emerging health and wellness benefits, especially those geared toward family wellness, like elder/dependent care. Black and Latino/a employees are also more likely to see the value

Key drivers of good mental healthPeople with good mental health tend to have lower stress, higher engagement, and make better decisions. They also tend to have these three components in common:

Emotional resilience

Finding good in the bad and bouncing back from adversity

Social support

Helping others and accepting help when times are tough

Health/wellness benefits

Protection, prevention, and guidance to navigate issues

Boomers and Black and Latino/a show more ability to bounce back in stressful times

Latino/a tend to rely more on loved ones

Non-whites are most likely to use workplace benefits

in many of these benefits than white employees We also see that women are more likely to use and value benefits more directly tied to mental health including counseling and employee assistance programs. One reason is that economically disadvantaged groups may have a greater need for these kinds of supports. Another possibility may be that there’s a greater appreciation for workplace amenities among those who have been historically denied access.

ABOUT OUR APPROACH

At Fidelity, we think broadly about how to support and promote diverse perspectives at our firm, across the financial services industry, and beyond. We’re committed to listening and exploring within this space, and to sharing the best practices we’ve learned along the way.

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Conclusion

Know how to intervene

Across a diverse workforce, a key first step for employers and their mental health providers is to work together to decipher who might be vulnerable and when (see #3). Both employers and mental health providers should work on reaching out to promote and explain the mental health program, the goals of the program, and how those goals will be reached. Being vague with promises of feeling better might not resonate as much as describing how employees will be helped. Emphasize how both the organization and the mental health provider will work to:

• Strengthen emotional resilience muscles as a stressful situation is on the horizon can help prevent things from getting worse or out of control.

• Facilitate building connections with others at work and for the mental health provider, going beyond work to foster meaningful and supportive relationships.

• Teaching employees the ins and outs of the workplace benefits at their disposal to either prevent stressful life events like medical debt by focusing on a financial wellness program, manage a stressful event like using elder care or family leave to deal with a sick loved one, or professional development opportunities to feel more confident before the next workplace re-org comes along.

Know who needs support and who best exemplifies successful coping

Across multiple life events and demographic subgroups, we used an inclusive strategy to find who was most vulnerable and who was adeptly resourceful at maintaining mental health. We saw younger employees may benefit from the wisdom of older adults and white employees may learn from the strategies non-white employees use to cope with adversity. Listening to resourceful employees is a great way to build a mentally healthy culture at work. Over-indexing on underrepresented groups can foster inclusion and increase the likelihood of learning innovative and effective coping strategies.

Know which situations (or life events) trigger high stress

Often, employers can’t prevent stressors from happening in the first place. What employers can do is track which events are most stressful to employees, when a stressor is likely to happen, or if it has already. Once these entry points are identified, arm employees with available resources that have been vetted for effectiveness, inclusiveness, and seen as valuable among fellow employees (either through scientific, market, or internal research). Make sure that there are multiple entry points (or communication tactics) for employees to access these too.

There are lots of challenges in today’s world that cause employees stress. The COVID-19 pandemic is certainly not helping. As talking about mental health becomes more of a social norm, it’s important for employers to be open in communicating their solutions, but also making sure that their solutions are derived from the success stories of diverse workforces. Some key considerations to improve your mental health benefit offerings are:

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Fidelity Investments 2020 Health and Financial Preparation During a Crisis, a nationwide online survey of ~1,000 people using a nationally representative sample. This survey was fielded by Ipsos, once on April 2 (with 1,004 respondents) and again on May 11 (with 1,002 respondents). Ipsos and Fidelity Investments are not legally affiliated.

Fidelity Investments Life Events survey of 9,000 DC participants record-kept by Fidelity. October 2016. Greenwald & Associates, an independent third-party research firm. Fidelity also worked in collaboration with the Stanford Center on Longevity.

Poor mental health was calculated as % of people scoring below sample average in ratings of depression, anxiety, loneliness, low life satisfaction. Fidelity Investments 2020 Health and Financial Preparation During a Crisis, a nationwide online survey of ~1,000 people using a nationally representative sample. This survey was fielded by Ipsos, once on April 2 (with 1,004 respondents) and again on May 11 (with 1,002 respondents). Ipsos and Fidelity Investments are not legally affiliated.

For plan sponsor and investment professional use. Approved for use in Advisor and 401(k) markets. Firm review may apply.

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© 2021 FMR LLC. All rights reserved.

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Additional resources

• Millennials and Gen Z in a time of crisis: The generations known for placing a high value on experiences was put on pause by the coronavirus pandemic. Of course, this has been difficult across all generations, but the youngest among us appear to be most at risk. For employers, knowing what concerns them most can help you offer them the support they need.

• Uncovering the real value of the benefits you offer: Explore our research that shows a select set of health and wellness benefits that appear to generate the biggest impact on employees’ overall well-being beyond work to encompass financial, health, workplace, and well-being in life.

• Raising the grade on your benefits: Explore how 35 benefits score across four important measures of value from your employees’ perspectives—awareness, utilization, value to health, and value to work-life. These scores offer insights in how you can boost the worth of benefits for your employees in myriad ways.