Eugene Farrell: Reflections on the past three decades of change in wellbeing

Eugene Farrell, the immediate past chairman of the EAP Association UK stepped off the treadmill in the autumn of this year after nearly 30 years at the forefront for wellbeing. He reflects here on the changes in wellbeing and EAP services and what might happen next.

I quit my full-time job at the end September after 28 years working for a large medical insurance company and an employee assistance provider.

The time seemed right to reflect on the mental health and well-being of my family members.

I was introduced to an EAP by ICAS, Milton Keynes in 1996. This encounter changed my professional life. At that time the concept of EAPs wasn’t well understood, and only a few providers had set up a UK Chapter of the US-based EAP Association.

The EAPs in the USA were heavily rooted in alcohol and drug abuse.

Multinationals such as BP, Johnson & Johnson and others have driven the need for UK-based suppliers.

The fee was usually around PS40 per person, and funding was based on pre-payments of blocks of sessions of counselling or payment for wellbeing sessions ‘as needed’.

I worked on building an EAP. As a new provider entering the market, it became clear that pricing was a challenge and not well received.

In the UK, EAPs have tended to focus more on non-work related issues rather than work related issues. Personal stress is a common reason for contacting an EAP.

The EAP was most often contacted by people who were having problems with their relationships. At that time there was little openness about mental health. Work stress was the main employer theme. Wellbeing was not even a thing.

However, <a href="https://www.lawgazette.co.uk/news/pressure-of-work-as-a-result-of-the-walker-case-duty-of-case-has-been-broadened-to-include-mental-inquiry-/19896.article#:~:text=However%2C%20the%20landmark%20decision%20of,care%20for%20the%20employees'%20safety. The 1994 case of Walker against Northumberland County Council established that employers had a duty to care for mental injuries. Work pressure and stress were the main discussion points.

Even with the case law, EAPs still had to be explained, especially to employees, to buyers.

Changes to delivery model

Many employers were reluctant to support their employees. There was a lot of’man up’. Many employers were afraid that admitting they are stressed would negatively affect their employment prospects. One employer told me that people who are stressed out were “just weak”!

In a few short years, the number of EAP providers grew and delivery models changed. The internet was not widespread, smartphones were yet to be invented and telephone mental health assessments were still relatively new.

Some providers offered a second assessment level, where clinical psychologists conducted assessments over the phone or in person. This model was too costly to maintain.

All providers used the same short-term counselling models that we see today, using a network independent counsellors in the UK.

EAPs developed training on stress management for managers and employees. At that time, we had to explain stress, its symptoms, and encourage people seeking help. In passing, anxiety and depression were discussed. This would change in the next few years.

In the beginning, outcomes were not regularly measured and positive outcomes were rarely discussed. In 1998, the ‘CORE” outcome measure launched and was adopted as a way to demonstrate that EAP counselling works.

Some providers use the pre-post measurement for each counselling case. Others use a sampling technique.

This clearly showed that EAP counseling short-term models were effective. McCleod’s 2001 Counselling at Work: The Facts. A Systematic Study of the Research Evidence set the tone for providers and encouraged them to start discussing outcomes more.

We now see the use of WOS GAD7 PHQ-9. We still see positive results from counselling.

Health and Safety Executive promoted the management of workplace stress by publishing its Management Standards and introducing stress risk assessment in 2004.

However, there was no mention made of the impact of an employee’s current life or non-work experiences on their job. EAPs argue that support for the entire person should be offered.

I would attend HSE launch events to promote EAPs and the importance of non-work related issues. I think they thought of me as a nuisance.

In 2007, the Sainsbury Centre for Mental Health, then published the report Mental Health At Work: Developing The Business Case. It stated that the costs to the business of absenteeism due to mental illness were twice as high as the presenteeism.

It was a very convincing business case for the need to provide more mental health support in the workplace. Business now considers performance as a cost.

Slowly, mental health terminology began to be used. Anxiety and depression became more openly discussed, seen in some cases as a more complex version of stress. Employees with stress issues would label themselves depressed. This was useful in opening up minds to other issues than stress, even if it wasn’t always clinically accurate.

Increasing volume of conversation

The work of mental-health charities like Mind, EAPs and occupational health providers, as well as a few celebrities, has increased the conversation about mental health.

Fruit bowls and Indian Head Massages were just the beginning of the wellbeing at work. Stephen Bevan, Peter Kelly and Nick Pahl were some of the key influencers in changing mental health attitudes. Steve Boorman and Dame Carol Black are also among the list.

I’d like to believe that I also played a part in articles, conference presentations and award judging for Personnel Today as well as OHW+. Over the years, I have covered a wide range of topics, including stress, resilience, crisis, trauma, counseling, technology, and apps.

Mental health was becoming a more prominent topic in conferences. The Health and Wellbeing at Work Conference for example had supported the EAPA very well in the UK by allowing the EAPA’s AGM to be held at the conference and including EAPA board members like myself as speakers.

Employers wanted to know more about the EAPs and what they could do. They also wanted to talk openly about mental health. The result was the rise of mental health conferences.

Martin Seligman published in 2002, and Richard Layard published in 2005. Seligman went on to promote the idea of being able ‘flourish later in his 2011 book.

This opened up a discussion about mental health in a different way. In 2017, the Stevenson/Farmer Report provided an analysis of workplace mental health and a template that organizations could follow.

Initially, the EAP market included both large corporations and small privately-owned providers. Unfortunately, pricing pressure forced many smaller providers to leave the market, with mergers and takeovers.

Today, providers are unable to charge more than PS10 for each employee.

It was impossible for smaller service providers to survive. Today, the market is dominated mainly by large providers. It’s interesting to see new tech-based providers emerge who are not hindered by the past.

Covid-19 shifts in a’seismic’ way

The Covid-19 has created a seismic change in mental health attitudes; it became apparent that mental health is really, really important. It affects us all at work and home.

Shame and stigma have significantly decreased and a new sense of openness has begun. It is a relief to me to see that EAPs are rarely explained anymore.

According to the UK EAPA the market has grown from PS32.2m (£32.22m) in 2003, to PS118m (£118.22m), and is now a standard support for the workplace.

EAPs in Britain have always included nonclinical services, such as legal advice, debt advice and healthcare information. Incorporating such services has been a trend in the US and Europe.

Europe has always been behind the UK when it comes to mental health at work. The EAPA was never able to gain a foothold and only Ireland, Greece, and Cyprus were established. Both have failed since.

EAEF, the Employee Assistance European Forum, has grown in importance in Europe. It sets standards for employee assistance, a field in which I was involved in its development 10 years ago.

I am happy to report that mental health and stigma reduction have progressed in a significant way. Members of the Royal Family, along with mainstream media, are now involved and this is a positive development.

It is important to note the additions that surround workplace mental health, and the work of EAPs. As an example, coaching is emerging as a trend that provides a less stigmatised form of support, especially for less clinical cases.

The neurodifference is now part of the conversation, along with ethnicity, gender and identity and the “me too” movement in relation to domestic violence and other forms of violence. These issues are all now part of the work environment.

Digital support is the future, in my opinion, of EAPs. Apps and the internet are replacing traditional phone assessment and in-person counselling and support.

EAPs have always evolved and adapted to the market. They will do this, I’m sure. Mental health is something that has always existed and will continue to exist.