Employee Assistance Programs (EAPs) have been the dominant model of employee mental health care since the 1970s. Today, however, employers aspiring to support their workforce’s mental well-being are questioning whether the EAP model has kept up with the times. If not, what’s the alternative?

EAP Defined

The Society for Human Resource Management (SHRM) defines EAP as:

“A work-based intervention program designed to identify and assist employees in resolving personal problems that may be adversely affecting their performance at work, such as marital, financial or emotional problems; family issues; or substance or alcohol abuse.”

In 2019, SHRM reported, more than 79% of employers offer an EAP.

The Evolution of EAPs

Systematic support for well-being started taking shape after World War II as Occupational Alcoholism Programs (OAPs). These cropped up largely in response to an influx of employees with alcohol use disorders. OAPs typically were operated by an employer’s internal staff. In 1970, the U.S. government created the National Institute on Alcohol Abuse and Alcoholism and charged it with promoting OAPs (or EAPs, as they were coming to be known). This sparked a burgeoning market for third-party EAPs and the proliferation of a new model offering broader mental health services. By the turn of the 21st century, EAPs started augmenting counseling services with work-life, legal, financial, and wellness offerings, as well as critical incident stress management.

External, Internal, and Hybrid EAPs 

A typical EAP benefit provides eight or fewer counseling sessions per mental health “issue.” Depending on the program, these may be delivered by phone or in-person. Recently, EAPs introduced video counseling, but their success with this model hasn’t been fully evaluated. Most employers now work with external EAPs—solution providers that contract with independent licensed clinicians (including social workers, psychologists, and therapists, depending on the program and state regulations).Some large employers use internal EAPs, in which clinicians are employed by the same organization as the care seekers. Internal EAPs are increasingly rare, operated mostly by employers like healthcare systems and universities that already employ behavioral health counselors. Other organizations offer a hybrid model with both internal and external clinicians.

EAPs Today

Fundamentals of EAPs have remained stagnant over the last 30 years—even in the dynamic mental health landscape brought on by the novel coronavirus COVID-19 pandemic.

Their in-person counseling model is essentially unchanged: The care seeker calls the EAP, a quick screening may be completed, and the caller is provided with one, two, or three clinicians they can contact to schedule a few sessions. Few EAPs have adopted their industry’s preferred measurement tool, the Workplace Outcomes Suite, and quality control is limited or non-existent. The work-life benefits EAPs considered innovative in the early 2000s—typically including referral services for childcare, eldercare, and travel and event planning—fulfilled a need at the time, but may be perceived as superfluous in an age when instant access to search engines and travel websites is nearly ubiquitous. Additionally, large employers are now likely to offer dedicated financial well-being and legal advice programs, diminishing the value of these EAP add-ons. A 2020 paper by the Employee Assistance Research Foundation acknowledged that “sociocultural issues in the EAP field have been scarce at best.” It added:

“Cultural diversity, sexual orientation and sexism are examples which are rarely addressed by EAPs in writing or presentation at conferences or in leading EAP journals and publications. Vendors will claim that they match the client’s specific request for counselors, including gender, sexual orientation, cultural heritage, etc.; however, they do not ask for this specific information from their counselors or affiliates, so is [sic] an inconsistent and inaccurate assertion.” 

Low utilization is an inevitable consequence of EAP complacency. Forbes recently cited EAP utilization rates as low as 1.8%. Aside from the aforementioned lack of cultural competency, EAP members still face a number of practical obstacles in engaging with their mental health services — difficulty reaching a provider, inconvenient appointment times, and sometimes a several-month wait between requesting services and the first appointment. 

EAPs know they’ve fallen behind. The recent cover story in their trade journal, The Journal of Employee Assistance, which is dedicated to promoting potential strengths of the EAP industry, admitted, “The EAP marketplace is faltering.” It lamented the advance of “tech disruptors…sold as a sleek, new solution for the EAP purchaser —transformational in how mental healthcare is delivered.”

Technology Facilitates New Mental Health Solutions

In contrast to EAPs, tech-enabled mental health solutions are evolving rapidly. The Northeast Business Group on Health (NEBGH), in its 2020 publication Digital Tools and Solutions for Mental Health, heralded the emergence of interventions ranging from self-guided care to blended treatment that includes face-to-face therapy and online modules: “The growing number of digital interventions available offer promising ways to tailor programs for different types of employees that are scalable at a relatively more affordable price per employee than other types of interventions.”A comparison of Modern Health to legacy EAP offerings reveals many advantages of teaming up with an innovator. The first, and most dramatic, is how EAPs only target those in dire need of mental health services without considering how preventive services for the entire population can help keep employees out of dire straights in the first place.  

While Modern Health, like many EAPs, offers one-on-one clinical therapy globally when needed, a 24/7 phone line, onsite crisis support, and work-life services, it sets the bar higher with:

• User-friendly mobile and web applications that drive 20% average utilization

• Outcomes measurement using a well-being assessment that incorporates the clinically validated WHO-5, PHQ, and GAD-7

• Personalized care based on the care seeker’s preferred modalities for intervention, the topic of focus, and level of need

• One-on-one specialized coaching, using ICF-certified coaches available globally to support mental health, work performance, financial well-being, and more

• Digital programs with reminders and content refreshed daily to help employees build self-care habits

• Rigorous provider vetting and training, and quality control that features user feedback collected after each session (average satisfaction level: 4.8 out of 5)

• Provider chat, available globally in more than 50+ languages

• “Circles,” safe spaces for employees, managers, and diverse communities to share, connect, and grow

• Patient-centered care that understands the vital role of diversity, equity, inclusion, and belonging and trains providers in cultural humility

• Comprehensive self-service reporting that can be segmented by areas of focus, well-being score, and care modalities

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