Accessing mental healthcare services in the Granite State can be a significant hurdle for individuals and families who need it.
One in five U.S. adults experience mental illness each year and 221,000 adults in NH have a mental health condition, according to the National Alliance on Mental Illness in NH (NAMI NH), and 15,000 Granite Staters age 12 to 17 have depression. And while 55.9% of Granite State residents have health care coverage through work, according to the Kaiser Family Foundation, and the vast majority of those plans include mental health coverage, finding providers
can be a challenge.
This is why many employers offer Employee Assistance Plans (EAP). These voluntary, work-based programs offer free and confidential assessments, short-term counseling, referrals, and follow-up services to employees. In 2024, 82% of employees had access to an EAP for a variety of issues including stress, work-life balance, substance abuse, mental health concerns, and financial difficulty, according to the Society for Human Resource Management.
Susan Stearns, executive director of NAMI NH, says employers can be strong advocates for their employees’ mental healthcare needs. “This starts by listening to those needs and also promoting an EAP if there is one,” she says. “Many of us have had to struggle through systems access, particularly with insurance companies and frequently this happens during work hours. Providing that opportunity for employees to navigate these systems is key.”
Employers have become a major source of support for their employees’ mental health and well-being over the past decade, says Robin Antonellis, executive director of the New England Employee Benefits Council. “There’s a new truth. We spend most of our waking hours working for some organization. It makes sense that we should be looking to employers for assistance,” she says.
Finding a High-Quality EAP
KGA, an EAP that serves 370 clients and has more than 75 accounts in NH, provides counseling, support, and resources for employees and their families. President Seth Moeler says companies looking for a quality EAP need to think beyond just checking the box. “A high-end EAP is going to offer 24/7 access directly to counselors because we are regularly contacted by people who are in a crisis,” says Moeler. “People have learned that if they call a very skilled person, we’ll help talk them down, help find perspective, maybe give them a few immediate things that they can do and they may or may not come back.”
Moeler says the EAP industry started in the 1980s and has evolved significantly over the years. “EAPs are very nuanced now around the full spectrum of mental health,” he says. “And like anything in our field, you can buy the jalopy, and you can buy the Maserati.”
A good EAP, Moeler says, not only provides direct access to counselors but makes sure it is set up to help an employee take advantage of their health plan. “We’re going to give you a list of providers that we know who take your insurance,” he says.
Use of EAPs Remains Low
Antonellis says the best way employers go about improving access to mental health services is through an EAP, but the trick is getting people to use those services. According to Uprise Health, a provider of employee assistance programs and mental health services, the national utilization average is between 3% to 5%. “Utilization can be as low as 3% of an employee population,”Antonellis says, explaining that a variety of tech-driven point solutions—such as mental health awareness apps—are on the market and sometimes lead to “point solution fatigue” for employers by providing too many options, which can be overwhelming.
Moeler says employee use of an EAP comes down to whether employers actively promote the EAP at in-person meetings. KGA’s rates of utilization are above 8%, Moeler says. “This is because there are people coming into a conference room or wherever and talking about programs and services. And Zoom works great as well,” he says, adding that managers need to have buy in. “They sit at the crossroads and largely have their finger on the pulse of who’s doing well and who’s not, but they’re not equipped to do everything. You may have one manager who ignores people, saying it’s ‘not my business,’ and another manager who’s way over involved in something.”
During KGA’s promotion events, Moeler says he tells clients, “If you want this to work well, if you want to be an employer that’s not only getting good value out of the program, but frankly has employees saying ‘thank you,’ live promotion is key.”
Part of the problem is the omnipresent stigma around mental health. Ryan King, vice president of human resources at Northeast Delta Dental, a dental insurance provider based in Concord that employs around 225 people, says this is something his company pushes back on. “We promote that it’s ok not to be ok and to have a voice,” he says, adding that Delta Dental heavily promotes the company’s EAP. “They speak at our orientation for new hires and their services are available for employees’ families as well. Our mantra here is mind, body and soul. It’s about physical, emotional and financial health, which are all tied together.”
King says communicating to employees about available benefits is a constant part of his job. He believes this is a big reason why Delta Dental’s utilization rates are high. “Your colleagues have to know what’s available to them. It’s not something you can do once and forget about it,” he says. “Because when they have that moment of need, the last thing we want is for them to panic and wonder what they can do. It’s not just checking a box off.”
Prioritizing Usage
Some employers excel in marketing EAPs and getting employees to use them. The University System of NH (USNH), which employs over 4,000 full-time people, has been using Spring Health services since January. “We found a new EAP last year because we were looking for one that was more dynamic,” says Jim McGrail, chief human resources officer for USNH. “They’re much more available to our employees. At eight months in we’ve had over 8% of employees accessing the program, which is well above benchmarks.”
USNH has also enlisted Hinge Health, an app that provides virtual personalized musculoskeletal care. The company offers a combination of physical therapy, coaching, and wearable devices to help individuals manage chronic conditions like back pain, joint pain, and osteoarthritis. “We’re connecting those two resources—Spring Health and Hinge—so that if you’re using Hinge Health you are automatically notified of the EAP and all of the benefits that are available,” McGrail says, adding that chronic pain and mental health are tied together. “When you have chronic pain, you often have mental health needs. We want people to know about the resources that are available to them.”
USNH won New England Employee Benefits Council’s Best in Practice Award in September for demonstrating excellence in the field of employee benefits. Among its best practices is conducting a mental health first aid class across the institution through the human resources department and various managers, McGrail says. “That was a daylong event where we looked at things that people might say that could be signs of a serious problem,” he says. “Once these things are identified you can then direct people to resources whether that’s through Cigna or the EAP.”
Katrina Decato, USNH’s human resources communications and program director, says USNH has a robust communication plan around mental health and wellbeing. “We’re reaching out to people year round,” she says. “We also introduced a mental health and wellbeing guide recently. We’re not just saying, ‘We have an EAP,’ but explaining the resources and talking about things like debt consolidation through your EAP. We really hit on all the topics that people are worried about. Also, I think ‘EAP’ has become an outdated term. It’s more than what people think it is.”
Solutions for a Variety of Needs
There are a variety of ways employers can influence positive mental health outcomes for employees, beyond, but including, EAPs, Antonellis says. One way is through paid time off (PTO). “It’s not ok for someone to have just three days of PTO for their grief when their spouse dies or you’re in your 20s and your parent dies,” she says.
As physical and mental health are connected, Antonellis says the Benefits Council promotes businesses that could be helpful to employees. One of these is GRAIL, a company that offers an early detection test for cancer. GRAIL services can be purchased by employers on an employee’s behalf. Other benefits, like pet insurance and fertility benefits, are also available, Antonellis says. “These are all things that can help people with mental health,” she says. “We can’t forget that physical health and family are connected to an individual’s mental health.”
Antonellis says employers who want to invest in mental health can do so without adding formal programs or benefits to their workplaces. As vice president of human resources at Dana-Farber Cancer Institute, where she worked for nearly a decade prior to arriving at NEEBC, Antonellis says her team addressed mental health and well-being with a low-cost informal program. “We chose to do something that couldn’t have been more bare bones,” she says. “We created a rolling cart with three shelves that had chotchkes of all kinds. Fidget toys, stress balls, candy, plants, boardgames. We called it the Wellness on Wheels ‘WOW’ cart.”
Northeast Delta Dental has its own informal and formal ways of addressing mental health, King says. The company holds many lunch-and-learn workshops on mental health topics and offers access to walking challenges, road races, and an onsite gym. The company, he adds, “is well above the average utilization for its EAP.”
“We also tackle big topics like neurodiversity. We want to make sure managers understand how a neurodivergent mind works,” King says. “It’s never just one topic. We look at this through a 365-degree lens and work with our EAP on what topics we aren’t covering.”
These wellness supports are sometimes offered at the association level. The NH Lawyers Assistance Program provides confidential support to lawyers, judges, and law students struggling with substance misuse, depression, stress, and other crises, says Jill O’Neill, executive director, adding much of the work she does involves customizing plans of support and then working with the individual based on what they need. She describes the program as a meld between an EAP, a doorway, and a peer support gateway that also does programming. “Not everybody is interested in getting connected to a therapist,” she says. “But there may be other things like apps or books or connecting people to a mentor that can be beneficial.”
Stearns says many people find telehealth beneficial because it allows people flexibility. Many EAPs offer a set number of telehealth visits for employees and the number of visits varies depending on the type of plan. “Given the tightness of our workforce, it can be a real struggle to find [in-person] appointments that work around someone’s work schedule,” she says.
Telehealth and other online recovery supports can benefit those served by the Lawyers Assistance Program, O’Neill says, especially given the need for confidentiality some lawyers and judges need. “It’s not just a stigma issue, it’s also about being sensitive to the nature of their work,” she says, explaining that the organization hosts the Lawyers Concerned for Lawyers Peer Support group, which provides a pathway for people battling substance misuse to enter traditional 12-step programs.
“People are not feeling like they have work-life balance and they’re not always accessing the benefits being put before them,” O’Neill says. “That’s why measuring the effectiveness of what’s offered is important. And sometimes when it comes to implementing a well-being or mental health program people just want to check it off. But that’s not going to move the needle or align with the cultural changes that are taking place.”