Improving Mental Health through Workplace Cultural and Environmental Factors

In this episode of the Pulse, we will explore the powerful connection between an organization’s culture and environment and employee mental health. Beyond traditional EAP services, we’ll discuss how improving workplace culture, physical spaces, and social connections can boost resilience, reduce anxiety and depression, and create a stronger sense of belonging. 

Mental health service usage increased 17% in 2024 and 62% since 2020. Don’t miss this opportunity to discover new ways to support your team and improve employee mental health.

Our Guests:

Andrea Davis, Director of Wellbeing at The Alera Group

Sara Johnson, PhD. Co-President & CEO at Prochange Behavior Solutions and Senior Research Fellow at HERO (Health Enhancement Research Organization)

Joan M. Troester, MBA, CEBS, SPHR, Senior Assistant Vice President, Deputy CHRO at The University of Iowa

Guests will: 

• Explore the influence of resiliency and a sense of belonging on mental health 
• Uncover strategies employers can put in place to improve a sense of belonging  
• Examine the factors that impact resiliency, much like we would focus on improving diet for better cardiovascular health

Transcript

HOST

Welcome to the Pulse, produced by Vital Incite, where we keep pace with what's trending in employee benefits. This series was developed to bring together nationally recognized subject matter experts from the health and pharmacy industry as well as top academic and research institutions. Our goal is to provide unbiased information and offer scalable strategies that give you clarity amid the chaos and provide answers to your most burning questions. I'm your host, Mary Delaney, Managing Partner of Vital Incite an Alera Group Co. In today's episode we will be exploring how implementing a shift in workplace culture and environment can be a realistic and cost-efficient strategy to improve mental health in the workplace. I am very eager to jump into this topic because of how clinically sound, simple, inexpensive and accessible these strategies are.

Since 2020, mental health service usage has increased 62%, which of course we can all blame on the gift of COVID. But in fact, demand for services continues to increase each year, and in just 2024 alone, mental health usage increased a substantial 17%. I think we all realize the impact poor mental health has on our physical health, decision-making and our ability to perform at work. Thankfully, there is an improved acceptance that mental health struggles are a normal part of everyday life, and now we have more people being proactive at getting professional help. We see that in a surge in improved utilization of counseling services. As employers try to solve for this demand through appropriate resources, they also need to remain true to their fiduciary responsibility. Employers need to understand what's influencing the increased demand and utilization. Diagnoses of anxiety disorders have more than doubled since 2020. This may be a signal that more people are willing to accept they need help. But we also realize suicide rates are climbing, which illustrates the advanced stages of some of these conditions, and that drives poor outcomes. How many of us in the world of supporting employers as benefit advisors and HR team members have laughed that we talk about mental health strategies while the demand on us through email, meetings, texts, etc. continues to climb. So in this episode we will discuss how the environment and workplace culture can influence mental health. I think we all realize how critical improving mental health is and how sad it is that we have done such a poor job influencing improved mental health, because, just like physical health, it robs so many of a quality life.

Our three panelists are brilliant and so willing to share their knowledge and resources with all of us to drive change. So with that, let me introduce you to these incredible panelists. Let me go in alphabetical order, starting with Andrea Davis. Andrea is the Director of Wellbeing for Alera Group. She is committed to helping organizations build a strong culture of well-being through innovative strategies and evidence-based practices. Andrea partners with her clients to create tailored well-being programs that are holistic in nature, with the goal of ensuring that employees have the tools, resources and environment needed to feel supported and empowered to achieve their best health. She is a graduate of Cornell University with a BS in Engineering, and is certified as both a health coach and thriving workplace culture consultant. Andrea, thanks so much for joining us today.

ANDREA 

Thanks for having me, Mary.

HOST

Next we are fortunate to have Joan Troester join us. Joan, or Joni, is the Senior Assistant Vice President Deputy CHRO for the University of Iowa. At Iowa, Joni provides leadership for many human resource services, with an emphasis on well-being, talent, total rewards and data analytics. Additionally, Joni leads the university's efforts related to holistic well-being as part of the university's current 5-year strategic plan priorities. Joni brings 30-plus years of experience across higher education and healthcare settings. She is focused on integrating the concepts of total rewards and well-being in support of the people strategy for the organization. Joni is currently a member of the Board of Directors for HERO, which is actually where I met Joni. HERO is a national nonprofit organization focused on employer-based health and well-being. Joni earned her degrees from Iowa with a BS and MA in Exercise Science and an MBA. Joni, thanks for taking the time to be with us today.

JOAN

Yeah, thanks so much, Mary. Delighted to be here with my colleagues.

HOST

And last but not least, we have Sara Johnson. Sara Johnson is the Co-President and CEO of Prochange Behavior Solutions, a behavior change consulting firm and solution provider that empowers people to experience life-changing breakthroughs in well-being. She has been the principal investigator for over $11 million in federally funded research. Sara has been recognized as one of the top 10 Most Influential Women Scholars in Health Promotion by the American Journal of Health Promotion. Among her various accomplishments, Sara has also had more than 40 publications. Sara, I know you will have so much to add to this conversation. Thanks for sharing your expertise with us.

SARA

Really glad to be here. Thanks for inviting me to take part in this important conversation.

HOST

Well now that we have our powerhouse experts lined up, let's dig in. I had to laugh as I start us off. I'm pretty sure that I'm going to ask my first question and you ladies will not need me to say another thing. That's because you're so passionate about this. I really love that. So let me at least start off by setting the stage so that we all are aware of why this conversation is so critical. Andrea, can you kick us off by sharing some statistics so we know why it's worth listening to this discussion as an employer and as a human?

ANDREA

Sure. So while we have certainly seen an increased focus on mental health in the employer space, in our communities and our families, most notably since 2020, the data shows that there's still very much more work to do and opportunities for us to explore. So I'll just refer, as we look at individuals first, to some data from Mental Health America. As we look at adults in 2024, 23% of adults experienced mental illness in that year. And we look back 5 years to 2020, that was 19%. So we've seen an increase from 19 to 23% over the past 5 years. And obviously so much work has gone on in that time. Very concerning, 5% of adults in the past year had serious thoughts of suicide. In fact, 2022 had the highest number of deaths by suicide ever recorded in the U.S. I know we have certainly had more incoming inquiries from clients on this topic. So certainly one to be mindful of. And our colleagues and these employees that are working for us, of course, are also worried about their children. So as we look at youth, 13% of youth experienced serious thoughts of suicide in the past year. 1 in 5 youth had at least one major depressive disorder or episode in the past year. So a lot of things to keep an eye on. And I don't think that undermines the work that's been done, but just again, paints the picture there's more to focus on. And I'd love to just like drop a couple other points on there more from the employer perspective. So as we think about stigma, certainly in our communities and in our workplace, a big factor. This is also Mental Health America: 47% of employees said they know about their company's mental health services, but only 38% feel comfortable using them. So we talk about this a lot with clients. It's great to check the box and have programs and tools and resources. It's great to communicate them. But if people don't feel safe accessing them; if they don't feel comfortable that there won't be repercussions or someone will look at them differently from using them, they won't use them. And it's just prevalent in our society and something we need to kind of really take a concerted effort to address. So that's one, and just two more points. Cost, always a concern with mental health. A recent Gallup survey showed that this cost was the biggest barrier for folks in making sure they got care. 52% of Americans said that cost was their barrier and reason why they didn't access care for those that didn't. And from the same survey looking at access, 42% of adults said that challenges in finding providers is what kept them from seeking care. We've seen a lot of this with clients – and it doesn't necessarily…it may be different in different parts of the country depending on what your geographies are – but certainly it's a big issue. So there's lots more we could go on with in terms of looking at data, but hopefully that just gives a little bit of a backdrop for where we are right now.

HOST

Well, you've definitely made your point, and thank you, Andrea. That's a good way to kick this off. Those are pretty serious stats. Now, Joni, can you explain what happened in Iowa that your employer actually made this a priority?

JOAN

Yeah, so just a little bit about the university. We're a large, complex institution. We have about 32,000 students and about 25,000 faculty and staff. And we also still have our own academic medical center. So we have a large healthcare clinical population. And it became very apparent that our people strategy and supporting people was really the only way that we were going to fulfill our mission around teaching, research, service and patient care. Now we've had a well-being focus for the past 2 decades. We launched a comprehensive initiative in the mid-2000s, but it was really coming into the pandemic and out of the pandemic that mental health came to the forefront for a lot of employers. And then our new president in 2021, President Barbara Wilson, made it her first priority for campus. And so when you talk about leadership support from the top down, that was critical for us. And she actually established a well-being and mental health campus collaborative that I co-chair with a colleague of mine from our student side of the house. And it is focused comprehensively on our campus population – students, faculty and staff. Then fast forward a few months, we launched a strategic plan in ‘22. It was a 5-year strategic plan, so we're starting year 4 soon. And for the first time we had holistic well-being via one of the 5 priorities. And the focus of that was to evaluate what we're doing currently, but more importantly create a cohesive framework of resources along the continuum, improve access that Andrea mentioned. And then what I'll talk a little bit more about going forward is how do you integrate that into the culture? So, when the leadership changes, when the winds change in our organization, it's embedded in the culture and lives on. And so that's really why we made it a priority and why it's still a priority today, even as we come out of the pandemic and into some different environmental constraints that we have.

HOST

It is amazing to have that kind of leadership support. And we all know that leadership support is critical to really being able to create change. So kudos to you and to the University of Iowa for recognizing that. Sara, I bet you have something to add to this conversation.

SARA

I do. I certainly couldn't agree more with the points that Andrea and Joni made. The alarm bells are certainly ringing far and wide. I think one of the most notable examples is that if you're paying attention to the Gallup data around life evaluation, we see that Gallup measures life evaluation regularly among the American population using 2 simple, easy questions that any employer can use within their own employee population about your current life evaluation and how you expect your life to be in about 5 years. Employees or residents are asked to rate that on a 10-point scale. And anyone who says that their current life is a 7 or better on this 10-point ladder and that their future life will be anything better is considered to be thriving. And of course, our goal is to have as many people thriving as possible. And one of the things that Gallup has reported in their most recent data from April of 2025 is that for the time since 2020, for 2 consecutive quarters, we've been below 50% of the US population thriving. In fact, we're at about 48.9% now. And that's alarming because that matches sort of the deepest depths of the pandemic and is only rivaled by the worst point of the financial crisis in 2008. So we're in a real race for the bottom when it comes to overall well-being. And we know that mental health is a very important predictor of overall well-being. In fact, it accounts for 5 times as much of the variance in overall well-being as physical health. Obviously, there's other contributors – a big one being financial well-being and social well-being. We're going to talk lots more about that later. But it's certainly important for us to focus on mental health in that overall well-being picture. And I think another really important subpopulation that we need to be paying very close attention to are the young adults. So while the overall prevalence of mental health conditions among the population is, as Andrea cited earlier, you know, anywhere from 20 to 25%, among individuals in that 18- to 29-year-old category we're looking at rates of anxiety and depression symptoms more in the 40% range. So it's really, really concerning that population in particular. And that's also a population that's disproportionately experiencing the epidemic of loneliness that's striking the nation. So really an important population of interest.

HOST

Wow, that is really sad that between 18 and 29 is when life should be so much easier, you know? In our prep discussions, you talked a little about social media and the influence it has on mental health. Certainly at Vital Incite, we do see in our data there is an increase in dependents having mental health concerns. We know that issue impacts employees’ productivity because as the old adage goes, you're only as happy as your saddest child. So the issue of increased mental health concerns for adolescents does impact employers. Sara, can you share some thoughts around the influences of social media?

SARA

We are concerned about the disproportionate reliance on social media, particularly among young adults, and I think that may be one of the contributors to the disproportionate rates of anxiety and depression among that group, because they're the group that's most reliant on social media, leads to a lot of social comparison and exacerbates some of the struggles that many of us have had socially when we were younger. So we are very concerned about the rates of social media use, particularly because we see that there's a correlation between social media use and some of those mental health symptoms. And this, I think speaks to some of the challenges we're seeing with remote workers as well. Remote workers are more likely to experience higher rates of loneliness. And we'll talk later, I hope, about some of the strategies we can use to help address that. But if we are concerned about a number of factors influencing those symptoms among particularly young adults, social media use, even diet quality, when we think about the gut microbiome and certainly people who are in the remote workforce or in a hybrid workforce and who were onboarded remotely in their new position. So we think there are many, many contributors, and social media is certainly a leading one.

HOST

Wow. All really good points. And of course, the remote workforce, we really have to make an effort to make those connections. With that, let's dive into some strategies. There are still some employers that think that they need to stay outside of the mental health conversation other than providing an EAP. Joni, you shared a little bit about why the university was willing to make this a priority. Sara, can you continue on and explain more from a business perspective why employers should care about this?

SARA

One is that we know from Mindshare and NAMI and a number of other organizations – Gallup, that individuals who feel supported at work have better work outcomes – better performance, less absenteeism, higher productivity, improved team functioning, less burnout, better retention, more likely to recommend their places…their place of employment is a great place to work. So I think with regard to every outcome employers care about – job satisfaction, retention, absenteeism, productivity…improving mental health will contribute to improvements in all of those.

HOST

Thanks. Anyone want to add to that? Joni?

JOAN

We have a very rich population health data at the University of Iowa. And so we actually looked at those individuals that score in the thriving category, along with their engagement index. And you're finding a relationship there just in our own population. So not only is it proven in the science and the research, but we see that as well. We know when people are thriving, when they feel supported at work, when they feel like people actually care, that they do better work, they are willing to come to work and support the organization in a different way. And I think that it makes good business sense because we're really here striving to create student success, create a healthcare environment where clinicians can thrive, and we want to attract and retain the best people, too. And so all of those, while people may say, “Why should I care?” and it's a little bit soft, I would say that we have hard data to really identify that not only is it the right thing to do, it's the, uh, has a good business case behind it for the institution.

HOST

That's wonderful. Now, Andrea, you kind of mentioned the whole concern around stigma. Could you explore that a little more for us?

ANDREA

Yeah, sure. So it's interesting – I was reading a piece from McKinsey not long ago, from early 2025 or late 2024, and they had employers rank their plans for mental health, and stigma came out dead last. It's the last thing, you know, the bottom of the pile of things they would focus on. But yet 75% of them said stigma was a concern in their organization. And I think it's everywhere. You know, as I said earlier, it's, it's just pervasive in our culture, and it's changing slowly. So I think what's so interesting about stigma is, while it's falling on the bottom of the list, it might be one of the lowest-cost things you can really impact. You know, it's something you can work on slowly over time. It's something you can work out without putting in huge investments. So you can think about training. You know, if we're doing mental health-related training for our managers or our colleagues, that has an impact. The use of language that we use, openness of leaders and managers, whether it's making references to a mentally healthy workplace in a, in a talk that you're doing, or putting out a quick video and encouraging people from a senior leader to take advantage of resources, to putting things on your calendar, like time off with family, so people see, you know, there's lots of different ways we can start to bring it more to the forefront and sort of work down that stigma. And even conversations – having managers have it a priority to check in on people when they're having a meeting with one of their staff members, and hey, how is everything going? How are you? Is there anything we can do to support you? So there's lots of little ways, and I think it falls to the bottom of the list because it feels soft, but it really can have a huge impact in terms of creating that safe environment where people will feel more likely and more comfortable accessing resources and being more open about what they need.

HOST

You know, it's funny, I'm older, so I can remember when I first got into business and management training included teaching us not to ask too many personal things because we had to be separated from any decisions about a person's promotions, etc. and how you manage them. The reality is we know that divorces, sick children and all the other life events impact us. I always knew what was happening in people's lives, but was very cautious with conversations. The reality is we all have hurdles in life, and helping people over those hurdles really creates a better workforce. That stat Andrea already provided was that 23% of adults had a mental health concern in 2024 in one year. So every one of us is going to be touched by this at some point. Joni, I'm going to ask you to really go deep into this conversation. The real meat of this podcast is what you have done at the University of Iowa. And if you don't mind just taking time and going through the whole process and explaining it, because I'm pretty fascinated by what you did and how on earth you guys pulled this off.

JOAN 

So, you know, we've had a strong foundation for mental health support, so our health benefit plans, as Andrea alluded to, it's really important to have robust coverage. We have zero copay for all mental health services. We have a very comprehensive, strong internal employee assistance program that we get reasonable engagement with. And I think that speaks to our kind of trust and safety within the organization. And then we have quite a few training programs and delivery modalities to make sure that we can address 24/7 clinical folks, etc. And then most of that is backed up by our population health data. But I think what with the well-being and mental health collaborative in the strategic plan, what we really leaned into is not more programs and services, but how do we integrate it into the culture. So how does it become part of just either learning or working at the University of Iowa? So from the employer perspective, we looked at a couple of…we identified some opportunities, actually. One is we leaned into that local culture drives local support. We're a really large organization. Our colleges and administrative units really focus as kind of separate business units. And it's a complex environment to navigate. We also have our supervisors and managers wanted to be supportive. They're a little overwhelmed themselves, often lacking in time, skills and confidence to offer the support to their staff. And then we heard from folks that it wasn't just the supervisors and managers, it was really colleagues that were just as important to provide that kind of support. So we did a really a large analysis of what do we currently have on campus, and then what could we develop to really focus on integrating things into our culture that can live on beyond any of us that were in leadership positions today.

So we developed 2 things that are really the keynote of this. We developed a standalone well-being and mental health training for our supervisors. This was based on content that was from the World Health Organization, Mental Health in the Workplace, that came out in 2022. And it looked at 3 separate areas. What are perceived barriers to addressing mental health? So how do we get at that stigma? How do we get at that issue of privacy, etc.? It addressed for supervisors what are some warning signs to look for. And then finally there was a section on skill development. So empathy, listening, appreciative inquiry, recognition, some validation and also some self care for the supervisor themselves, because it can be a challenging area to be in. So we developed this online on-demand training – 3 sections, 45 minutes total. And really worked through our key stakeholders and influencers on campus to get supervisors to engage. First round we had about 600-700 supervisors complete it. Second round we had the same, you know, about 400. So we're over about 1100 supervisors out of probably 2500-3000 that we have on total on campus. But we've also integrated it into all of our new supervisor onboarding. And so as a new supervisor comes into their positions on campus, this is now something that they go through. Not mandatory, voluntary, but that they go through and then we build that skill set over time. So I think that was really important. We did go back – we're always curious, did it have the impact we wanted? Went back and actually did a survey with our supervisors and overwhelmingly it increased their skills, but it increased their confidence. And I think that was the biggest thing, because a lot of times supervisors just really aren't sure what to do. So that's a key thing that will be ongoing as part of integrating it into our culture.

Now the second one that's a little bit newer is our peer-to-peer support. This came out of the focus groups that we did, recognizing that we all, every one of us on campus, have a role to play in supporting mental health and well-being. And how do we get comfortable in that and confident in that to have those caring conversations. And so we had a small subgroup of our well-being collaborative take a look at this. And they looked at a number of programs already in existence and landed on a very unique program out of Australia called R U OK? And it was originally developed in Australia as a suicide prevention program. We've worked with the Australian group to be able to have the ability to take their framework and tweak it for the University of Iowa culture. And so we developed this peer-to-peer program called R U OK? We launched in last summer – so summer of ’24 – with a pilot group. So our university HR, about 100 people – friendlies, as I always call them – we piloted it and said how would this work? And so all of our, at about 15 supervisors take this to their staff meetings. You go in one staff meeting, introduce it, the second staff meeting, you follow up. It's all about setting norms, expectations and getting your staff comfortable with asking each other “Are you okay?” If they notice something that doesn't quite, uh, might cause some concern, alarm, etc. That can be as much as someone, you know, being very vocal about what's happening, or maybe you just notice that someone is a little bit distracted, or someone, you know, doesn't quite seem to be themselves. So how do you just confidently ask, “Hey, are you doing okay?” So, tweaked it after we did our pilot, then we went to a number of early adopters. We had some folks on our campus raise their hands. So we went to our College of Business leadership, our Division of Student Life leadership, our Animal Resources, which supports our research operation – a very different group of folks. And overwhelmingly they loved it, because it's so easy. Two staff meetings by the supervisor, agreements by everybody on the team to be able to check in and then follow up. So out of those early adopters, we had over 80% of our supervisors say, easy to implement. And we had about 80% of our staff who went through all of that say, I now am confident and I will follow up with people and ask, “Are you okay?” And so this is not a mental health intervention with trained, licensed counselors. This is really on the front end of the continuum looking at, can you ask, can you listen, can you get people to services that they need it, and can you follow up? And so we're now onto the stage of what we call our innovators. So we got, through our pilot, our early adopters. Now we're going out to a little bit larger group that we’re pegging our innovators. This is our College of Liberal Arts, a very large college on campus, College of Education, College of Engineering. And then most recently, my colleague and I talked to our Finance and Operations unit, which is all of our…anywhere from custodial and groundskeeping to our accountants on campus. And overwhelmingly, people are like, this is easy. This is the right thing to do. And so we're excited because, to Andrea's point, this doesn't really cost us anything. This took some time to develop and some time to get people engaged, but it doesn't really cost anything. And we hope that we can get to a tipping point where this becomes the norm across our campus. And so our next group is to really lean in to our healthcare campus, and we are doing some initial work with our Department of Nursing, which is like 4,000 individuals, to see how we can engage within that group, you know, the very same premise. But I think what had me so excited about this is one, it isn't about a person delivering something; it's about all of us. It's not hard. It's just about being a caring person willing to have a conversation, and it doesn't cost us anything. And when I think of those 3 things, I think, wow, this is something that can live on way past my tenure and anybody else's tenure at the university.

HOST

You know, I'm so impressed when I hear your story, because I'm trying to think of the perspective that the employers are going to have while they're listening to this. Small employers are going to say, I don't have the funding, or, this is a big, large facility university that pulled this off. But when I listen to you, universities have a lot of specialists. Those people always have opinions, and I love them. They're brilliant. But that's always harder to roll out new things. And then you go into the healthcare environment, and again, a group of brilliance and people with a lot of opinions. And you were able to pull this off. Past that then, you went through your list of custodians, accounting… Pretty much you're dealing with every industry, and they've accepted this.

JOAN

You know, what we're finding, Mary, is coming out of the pandemic and kind of the challenges that we face today, and just kind of what our, you know, culture is facing, people want something that they can do to have a positive impact. And that's what I'm hearing as well, is they feel like out of everything that they may not be able to influence, they can influence how they respond to their colleagues. It's not just positive for the person that's on the receiving end. It's really positive for the whole group, because it is something that they can just feel good about.

SARA

And Joni, to the point that Andrea made earlier, they're not using those skills or that approach to those interpersonal relationships only at work. They're taking that home to their families, to their significant others, to their friends, to their relatives, and changing the way they approach all interactions, which hopefully will have a positive impact far beyond the University of Iowa.

HOST

That's a really great point, Sara. And what is so amazing about this is this is just about being a better human and probably getting a little bit more into the reality of what we should be doing anyway, instead of all the distractions of social media and our tasks and our emails and phones and everything else. So this is really wonderful and really so simple. I can't believe that you pulled all of this off. What do you think employers really need to hear in order to be motivated to try to make a change?

JOAN

Every culture is different. So I think that is really, really important. And probably, as I've worked here for a good bit of time, if I look back at where I was at when I first started versus where I'm at now, I'm much better about listening to what people want and need, versus coming in with an intervention of what I think they want and need. And so this was really built out of some focus groups and listening and trying to think about how do we do this in a way that doesn't add extra? Sometimes when we put in a program or an initiative, we're asking people to do more, keep track of, or do X, Y and Z. And this is just embedded into how you do your work. So I think those things for me were really, one, important in the beginning, and then two, what I think makes this sustainable. And I think that's what I'm most excited and passionate about is this can be sustainable, which is really important as we look to the future.

ANDREA

One thing I love, too, it kind of gives people a common language. So, this is not directly relatable, but we use something at Alera Group called The Collaborative Way. And we have different principles and it gives us this common language that people use and speak to as we work. And I think this does the same thing, right? So suddenly if someone's opening a conversation to check in on someone, someone's not going, “Why are they asking me?” You know, this just becomes a common part of how people interact and the culture that people expect. And it just, I don't, I think having that common language really changes the way people work and live on a day-to-day basis at work with each other. So that's really cool.

JOAN

Yeah. To share just a little bit of a personal story. So I actually had early in the year I was, I was struggling a bit with some health issues with my elderly parent, and a colleague of mine actually she, she noticed, and she had said to me, hey, you seem a bit off, a bit…a bit distracted. How are things going? And you know, it gave me the opportunity to just share a little bit. And while we didn't solve anything with that sharing, I definitely walked away one feeling valued and feeling a little bit better. And so I think that's the beauty of it, too, Andrea, to your point, I didn't feel like, oh, am I not producing or am I not performing? It was more like, no, this person does really care and it's helpful in, in the day-to-day.

HOST

So that's really incredible. Just to think about how we can change our relationships can solve this pandemic of mental health concerns. Joni, you shared with me the links to your resources and we're going to put them and share them with everyone on our website. And as we post this recording, our listeners can go through your resources and leverage them in their own efforts. I think it was very generous that you put them in a public space for everyone to share.

JOAN

Yeah, so part of our well-being collaborative, we pulled together just a comprehensive framework of resources for our campus. So it's wellbeing@iowa.edu and Mary will put all of that in there. But we have a whole section on peer support, and I think that's really the emphasis here for us. And we have a program that's dedicated just to students. It's called Together All, and people can take a look at that. It's fascinating because it's available online 24/7, completely anonymous. So it's different than what we use for our faculty and staff because of our population. But then we have our R U OK? program out there. And really what we did was we put together an overview of it, but that’s just a toolkit for our supervisors. So there's a supervisor handout. There are two staff handouts – one for the first staff meeting, one for the second staff meeting. And then probably most important what we heard in our pilot program is people didn't know how to ask, “Are you okay?” To Andrea and Sara's point, they're like, well, will people be, you know, think I'm, you know, odd for asking them this? So we came up with a number of conversation starters that we have as a handout. So people, if they're thinking about, well, how would I do this? How would I go up to someone if I was noticing this? So it's as simple, as, “You seem a bit quieter than usual – how are things going?” “Is there anything on your mind?” Or, “I noticed you've been a bit distant lately.” You know, just a whole host of conversation starters that staff can get comfortable using till it becomes more of the norm for them. And so what we do is we ask our supervisors to take a look at all this material. Then we'll sit down with a supervisor and do like a 10, 15-minute quick consult to say, here's any questions, here's how you might introduce this in your staff meeting. And then, you know, it's up to them. And we've, we've had just so many supervisors embrace this and say it's very easy to use, comprehensive, didn't have to schedule a separate meeting, didn't have to do any follow-up, etc., etc. And then what we do on the back end is, everybody that goes through this gets a Qualtric survey to tell us what they thought about it. So we can continue to kind of tweak around the edges of what would be helpful for our groups.

So yes, it's out there, people can use it, people can take a look at it. We're really happy that we have all of this. And then the other piece that I think is really important is, sometimes people are in really significant distress, right? I mean, sometimes it's not just the, the peer following-up. So, so what do we do then? So, we have other trainings, we have response guides that people can have about getting, you know, our 24/7 crisis line, our EAP, our mental health benefits, all of those things, should people need to refer people to somewhere that gives them, you know, more clinical type intervention if they would need it. So yeah, happy to share. And I think the more that we can do this amongst each other, as Sara said, you know, it isn't just about at work. Then they go back to their families, their community. These are all skills that we can help build.

ANDREA

And the reality is, while in the way that you've done it, it's a light lift, but it sticks with people. These managers or colleagues, they're living this anyway. They're observing things that might be making them have pause and worry about someone. They're having an employee come to them and raise concerns about well-being concern and they don't know what to say. So they're living it anyway, so it's kind of empowering to give them the tools to feel more confident in handling those situations. So doing it as a light lift, it's not one more thing on their plate. It probably takes some things off their minds. So I think it's really, really great.

HOST

It's a great point. And now I would tell you that I am trying to think of how a small employer who may not have all the staff, or actually many employers who are really understaffed in their HR departments are thinking. So even though this is all laid out, somebody has to help support this; someone has to carry it. Now, in the long run, the investment in the staff to support this can really have a positive impact on a business outcome. But the reality, with the economy being so shaky, employers are not going to hire staff to support this effort. Andrea and Sara work with employers all the time. I would like the two of you to talk a little bit about what resources employers should consider and if they need support, how do they take that next step in this?

ANDREA

Sure, I can kick off and then Sara chime in. We've covered a lot of bits and pieces throughout this, but I'll maybe recap kind of just putting them together. So as we work with employers, we'll think about a variety of different levers. So what are the different areas we want to look at? And that doesn't mean that every employer is going to be addressing all of these things at once. But let's look at the different factors and see which areas we need to focus on. So certainly access, cost, timeliness to care are key. And there's, you know, we can be looking at our data, we can be looking at engagement surveys. Joni mentioned focus groups, and just anecdotal information. What are you hearing from people who are coming to HR, to managers and, you know, how it's going for them and seeking care. Culture we've certainly talked about today. I think one of the biggest things that has sat with me recently, and it's so hard to talk about with employers because it's so ominous. But, you know, we can put programs in place, we can…we can communicate them. But again, if people don't feel safe, or alternatively, if the culture we're sitting in at work is part of the problem, those things kind of fall flat. You know, you think of somebody's offering a meditation, but there's no time to actually do it because there's so much going on at work. So it's really hard to put tools and resources in place and have them have the right impact if the culture we're sitting in isn't supportive of that. So I loved hearing what Joni said because I think that feels so overwhelming that it's just like, I can't do this. And I think Joni's given an example of how there are ways to do it that maybe aren't quite so overbearing. Training is a key one. Joni just touched on that. I don't even have any more to add other than I echo everything she's seen. It's been a big item for our clients. We've seen recently a lot of manager training focus how to express care and compassion, how to share the resources, how to know, you know, what to look for. All the things Joni just referenced. Stigma, as we talked about, engagement in community, so we see more employers talking about employee resource groups or peer support networks. Like Joni mentioned policies. So taking a look, do we have policies in place? And so people…do people know what they are? So if people need to take time to care for their mental health, that they're able to do that. And the last piece, I would say, just in terms of levers, is like, how are we doing on communications? Like everything with benefits, there are so many things to communicate, but really communicating, often communicating regularly. And I think it was Joni or Sara, I'm not sure who mentioned this, but really thinking about key points when you communicate. So when you're onboarding someone, great time to let people know what benefits and resources. But what about other times? As we think about people coming back from leave – if someone's been out on leave, it may have been for a new child, it may have been for a medical situation or caring for a loved one. Those are times it might be challenging too. Another great time to think about those resources. So those are kind of the different levers we think about. And again, you may not be tackling all of them at once, but it's kind of a good list to go through and assess how you think you're doing and where the opportunities are. And then as Joni mentioned, putting it together in a framework where you know, okay, these are the areas we want to focus on. What outcomes are we hoping to see, who's accountable, who's our leadership sponsor, what metrics are we going to track? So kind of pulling it all together and we touch on some of these pieces. We launched our Alera Group Mental Health Toolkit awareness toolkit for 2025 recently. So Mary can probably put that in the resources, but we have a guide in there which is kind of like your one-on-one guide on thinking about putting together a mental health strategy. We've got sample communication templates, a planner for communications for a year-long campaign on mental health, and a whole variety of tools. So any employer who's listening to this, whether they're an Alera client or not, can take advantage of that.

HOST

Thank you so much for sharing all of that. Sara, what are your thoughts?

SARA

Well, I agree with everything that Andrea said and I'm just in awe of the program that Joni has put together at the University of Iowa. And we've been thinking a lot, in addition to those types of strategies, what are some of the key drivers of improved mental health? And specifically focused on resilience and belonging in the workplace. And at the core of both of those are strong and meaningful social connections and having a team that you think you can count on. So particularly when we're speaking to organizations who may be smaller and have more constrained resources, we're always mindful of helping them to think of low-cost or no-cost strategies that they could use to shape everyday behaviors they're already engaging in to build a really robust foundation of strong social connections among their team members. And that can be small modifications to the onboarding process. I love the idea of communicating about the resources that are available during the onboarding process. You know, some employers are now considering, if they haven't already, instituting an onboarding buddy, so that someone has a built-in social connection that follows them, maybe for the first year, with regular check-ins. Or one thing that we do at our organization – we're a smaller organization – we instituted a process where people introduce themselves when they're joining the team, but then schedule brief 15-minute check-ins with their extended team members just to get to know each other and connect on a more personal level. Again, a small, low-cost modification to the onboarding process. We also, when we're thinking about training opportunities, then enhance them with structured conversations around the shared content. So maybe we're all watching a TED Talk or reading an article or reading a white paper, then we come together and there's a structured process through which we talk about it and each person has the same amount of time to share and then calls on someone else. So again, you're doing the training anyway, but building in a social connection where everyone has an opportunity to share. Or, at the outset of a meeting or at the close of a meeting, starting with a shared moment of mindfulness, or instituting something that Vivek Murthy calls the Inside Scoop – letting people share. Either having one person a week on a rotating basis, or opening the floor for anyone to share anything that's going on in their life outside of work. So again, all small tweaks to something you're already doing anyway to help foster those meaningful social connections. And to the extent that it's possible, bringing together people who are maybe remote or hybrid for opportunities to engage socially together – even a small tweak, like if you are a hybrid or remote organization, having a cameras-on culture even makes for stronger social connections. So again, all low-cost things that can potentially make a difference with fostering those really strong social connections.

HOST

You know, you ladies are brilliant. As a data person, I sometimes struggle with these concepts. But you have made this so simple and perfectly illustrated why this is important. When you talked about a virtual support system, we have a group that we call the Revitalizers at Vital Incite. They started having these monthly virtual meetings, and last month they did some drawing game, and I have to admit I missed it because I got stuck in a meeting. I don't know what happened, but everyone talked about how hard they laughed and how good it made them feel and the connection they had. As you're speaking, I can't help think about how simple and rewarding that was. We have at least a third of our staff that's completely virtual and then 2/3 that are hybrid. So this little game allowed people to get to know each other. And what I'm hearing is we really do have to be cognizant of those people who are virtual who have started outside the office. So this is a great opportunity to do something like that.

SARA

And Mary, the point you just made is so important. Finding a way to infuse a little bit of fun into a meeting. We recently attended a presentation, Dana Gower at Art and Science of Health Promotion did a presentation on improv and how we can incorporate more improv into our team functions. And she talked about in a breakout session having people play virtual ping pong. Very silly, one minute, but shared fun, shared experience brings some humor into the station. It's a little mood lifter. And again on that note, there's other things organizations can do. Encouraging team members to bring more nature into their space is also another thing that can help improve mental health. And low-cost, free, but very evidence-based approach to improving mental health.

JOAN                                  

Yeah, you know, that's a great thing, Sara. We have a couple of things that we instituted on our campus that have really created a lot of connection. One, we every spring we work with our campus landscaping and we do a tree tour. And so it's a guided tour of campus gardens, trees, etc. And it is absolutely amazing. We've had it for the last two years and it is one of the most highly attended events. Again, no cost. I think they offer like 5 or 6 different times, everything's budding out, etc. And then the other thing we did, and this was something our president really wanted, we launched in university HR called Discover Your University. And so it was about taking really unique entities on our university and creating an opportunity for people to come together and tour and learn about that. So for instance, we have a huge hydraulic center and flood control center that no one knew anything about. It's like nationally known, right? And so you get like 50, 75 people together with interest in that, you know, getting a tour, learning about it. So there's a lot of pride in the organization; there's a lot of connection to each other, connection to the organization. And I think those things are just so incredibly meaningful as we think about connection, belonging and supporting people's mental well-being. And to your both of your points, low-cost, doesn't cost much.

HOST

It's amazing. There's two things I want to make sure we still hit on before we run out of time. One is, Joni mentioned that they make all their counseling services and it sounds like with no cost share with the member. We got more feedback this year from different employers related to their EAP programs that I want to share. A typical EAP offers about 3 visits and no one really uses it. And actually at Alera Group we had progressed a couple of years ago into using a different service where we had, I believe it was about 6 visits. And what we do is, on our data, we don't get why people use an EAP; we just get that they've had these counseling sessions, and we were able to see that people maxed out at 6 and didn't always follow up with someone else. So when trying to assess the impact, it was challenging to know if they would have benefited more from more sessions. Alera, though, prioritized mental health and increased those visits to 10. We see a significant increase in the unique persons using counseling. And our HR team has said that they're getting feedback that people don't want to start counseling if they think they only have 3 sessions and they're going to have to start with someone else. So if they're not going to be able to complete it, they may never start at all. So a large number of sessions actually engage more people. We had another organization, a very large company, and their EAP reported outstanding engagement, and what we did is collected information on who outreached to set up therapy and then how many started counseling. And their system, a member had to do some kind of admin call before they were assigned to a counselor. We did find that the EAP had a lot of people reaching out to get counseling, but 47% of the people who tried to get counseling only got to the admin call because it was too much of an admin burden to get to the counseling session. So it was a complete failure because if you already have stress and anxiety, you finally made that outreach and then you don't make it to counseling, that's a poor outcome. So as employers, you do need to think about setting up the right structure along with the environment. How are these resources set up and are they accessible? Go ahead, Sara.

SARA

Mary, I was just thinking, we have talked to some employers who, because the EAP utilization is so low, have started by default to schedule an EAP appointment for everyone. Just as a frame of, this builds a foundation for you to get to know this resource that's available to you. Because despite efforts to overcommunicate the availability of that resource, in many cases people aren't aware or don't remember it when they need it most, to the point that Andrea made earlier. So some organizations are literally scheduling a default appointment for everyone. If you don't need counseling at this moment, then perhaps you can just build a stronger foundation or reinforce what you're already doing or use it in some other way.

HOST

That's a great point. I do have clients who have done that, and who have established that in order to get their wellness incentive, they do have to participate in one EAP visit. The value of that they realize it's not that hard to set it up, and it's not going to harm them to talk to someone about mental health. That's great. Good point.

Just a couple of minutes left. Resilience. We didn't touch on that quite as much as I wanted to. It's so important in this conversation. So can you quickly share how this connects with resilience and why that's something an employer needs to keep in their mind? Go ahead, Sara. I know you're an expert in this area, so go for it.

SARA

This is a topic near and dear to our heart for sure. So we're defining resilience as the process of adapting well in the face of adversity or stress, or you can think of it as your ability to bounce back or recover easily. And we've really spent a lot of time trying to identify the key drivers of resilience so that we can intervene upon them to help people build their resilience. And certainly, as I mentioned earlier, strong social connection is a very important one. And two others are having a deep sense of meaning and purpose, and having a positive mindset. So some people may struggle to think about what is their sense of purpose, but we have really found, and certainly Vic Strecher and others have driven home the point that helping people tune in to their core values or, you know, what gets them out of bed in the morning, or what's most important to them, or what they want written on their tombstone really helps people tune in to their sense of purpose. And we know that people with a stronger sense of purpose have better outcomes across the board. Longer life, better well-being, less depression. And also helping people tune in to their core values makes them more receptive to health behavior change communications. So it serves sort of double duty. So we're really interested in helping people develop these skills to bolster their resilience over time.

HOST

It's awesome. So as I mentioned when we started this conversation, and I'm sorry that I have to bring it to a close, what is so exciting about what we have shared here is that these suggested strategies are not expensive. This approach is not restricted to large employers, and they don't take a huge budget. These strategies are something we could really apply in our everyday life. I have learned so much from this conversation with you all. Thank you for sharing your expertise and experience with us. It's not often that we can finish a discussion and have tangible things that we can immediately use to drive improved health and health outcomes.

So I wanted to see if I can outline some critical takeaways just to make it easy for our audience to remember this. 23% of adults have experienced mental health concerns in 2024. Andrea provided the information that 5% of adults have serious thoughts of suicide, and that there's a huge challenge with access to care. The cost of care is also critical. The University of Iowa has integrated this into their middle manager training, and their culture promotes real conversations around mental health, which creates an environment that allows people to thrive. On the business side of things, thriving increases productivity, retention and performance. So if I'm a CFO, this matters to me. We need to improve access to care, but that is not just by adjusting member cost share, but it's also by decreasing the stigma having people feel comfortable raising their hands and acknowledging that they need help. And one example of this was just incentivizing an EAP visit. Andrea talked about how to create some culture shifts, how Alera has a toolkit for employers to put in place. Joni brought up that we all have a role to play in supporting health and well-being, and how easy it is if we can just listen. I heard that a lot from Joni. We all talk a lot, but just to really listen and really digest what people are saying is critical.

All right. You guys are incredible. Thanks for joining us today. To our audience, I hope you feel more equipped to take this information to help improve your culture at work or maybe even within your community to help drive change.

Thanks for listening to this episode of The Pulse. If you enjoyed it as much as we did, be sure to subscribe so you always stay up to date on our most recent conversations. Share the link with others so we can start to demand something new, and follow us on LinkedIn. The Pulse is produced by Vital Incite, an Alera Group company. Alera is on a mission to help organizations identify medical spending waste through data driven strategies while helping to improve the health of their employees. If you want to make healthcare easier to understand and manage and improve your organization's bottom line, reach out to us at VitalIncite.com. I'm Mary Delaney. Thanks for listening.