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How early mental health diagnoses can improve employees’ wellbeing

Many organizations have risen to the challenge when it comes to mental health. They understand the importance of focusing their efforts on providing employees with the mental health support they need, enabling them to manage their symptoms and optimize their functioning at work and at home. That’s great news, given that at least 500,000 Canadians miss work due to mental illness every week.

But all too often, employees who visit their family doctor or nurse practitioner for mental health symptoms aren’t diagnosed accurately: more than half of initial psychiatric diagnoses aren’t accurate, says Dr. Diane McIntosh, Psychiatrist and Chief Neuroscience Officer at TELUS.

For example, “More than ninety per cent of bipolar is missed,” she says, adding the mental illness, which is characterized by extreme highs and lows in mood, takes 10 years, on average, to diagnose. “The greater the time to diagnosis, the greater the impact on your brain and on your functioning and quality of life,” she says.

And when serious diagnoses such as bipolar are missed, this can lead to years of struggle, numerous failed treatments and many workplace absences. For employers, this results in lowered productivity due to absenteeism and presenteeism (present but unable to perform optimally), increased rates of short-term (STD) and long-term disability (LTD) and ever-increasing benefits costs.

Mental illnesses cost the Canadian economy $51 billion per year, $20 billion of which is work-related, according to Statistics Canada. And Canadian companies lose an estimated $16.6 billion in productivity per year due to workers calling in sick as a result of mental health issues.

The end result is employees who are unable to function (or can’t function optimally) – and employers who struggle to help them, while bearing the costs of under-treatment, often for months or years.

“All are impacted,” says Dr. McIntosh.

Mental health a top priority

Over the last decade, there’s been a lot of progress when it comes to how Canadian firms support the mental health of their employees. According to the 2022 Benefits Canada Healthcare Survey, 46 per cent of Canadian benefits plan sponsors intend to focus their investments on emotional or mental health over the next three years and 19 per cent recently increased their maximum coverage level for psychological counseling services.

Many organizations recognized the pandemic’s severe impact on mental health. Employees’ reported feeling isolated, were less productive and many faced serious family stress. Rates of depression and anxiety soared over the past three years. According to the Benefits Canada report, depression or anxiety were the most commonly diagnosed chronic conditions in the workplace, reported by 22 per cent of plan members.

In turn, this has in turn led to heightened absenteeism, as workers with mental illness are more likely to be absent from work due to health reasons, according to the Centre for Addiction and Mental Health. It also contributed to presenteeism, as employees struggling with mental illness often stay at work but are unable to perform optimally.  

This new reality led many organizations to partner with insurers and allocate more funds to mental health services. Many now offer their employees access to guided digital therapy, meditation programs to manage stress and access to online cognitive behavioural therapy (CBT). Other offerings include yoga, professional coaching, dietician services, sleep hygiene education and mindfulness/meditation programs.

“Employers are leading the way in terms of mental healthcare,” says McIntosh.

And employees welcome these initiatives. According to the TELUS Health Mental Health Index from October 2022, benefits and services offered for health and well-being, as well as flexibility and type of work, are the most important factors for Canadian workers when selecting an employer. Fully 77 per cent of employees said they would consider changing employers for better health and wellness benefits, according to the Mental Health Index.

Early diagnosis still missing

But mental health success stories are dependent on early diagnosis, says Dr. McIntosh. Unfortunately, there continues to be significant barriers to access psychiatric care. She says despite all of the progress being made in corporate Canada to support mental health, stigma still exists. Dr. McIntosh says that many employees are still fearful of potential negative repercussions if they disclose a psychiatric diagnosis to colleagues or their managers. That fear means that too often they choose to suffer in silence, rather than asking for help.

Dr. McIntosh says that stigmatization of mental illness also happens in medicine. She adds, “This is an education issue. If healthcare providers who are there to help are not well educated or lack compassion, those who might urgently need help will lose hope, leading to a delayed diagnosis, self-medication with alcohol or drugs, and worsening functioning, at work and at home. 

“Stigma lives everywhere,” she says.

Thus, she says, it’s the job of employers to continue to break down the barriers to care by fostering cultures in which discussions about mental health are normalized and encouraged. She says that this needs to start at the top. Leaders who are able to be vulnerable about their own mental health challenges have an incredibly powerful influence on their team’s culture. In addition, managerial training focused on identifying mental health issues in others should be provided by organizations.

“Having leaders that own the fact that they’ve struggled helps in building a compassionate culture,” says Dr. McIntosh. “And it’s critical to steer employees to appropriate supports.”

Earlier diagnosis is more likely if employers work with insurers to provide employees with access to specialized care, in an environment that supports healing, along with a concerted effort to remove stigma, says McIntosh. That means providing access to physicians who can accurately diagnose and treat mental illnesses.

The payoff: a healthy workforce and lower benefits costs

Getting employees help as early as possible will also lead to reduced cost of benefits. This means utilizing Employee Assistance Programs (EAP) to ensure employees are able to remain productive in their roles and reduce presenteeism and absenteeism. In a 2022 study of 830 employee users of EAP counseling services significant reductions in risk were achieved for all outcomes (such as changes in anxiety, depression, health status, life satisfaction, and work productivity). Improvements in health were correlated (positively) with improvements in work productivity, and results were used to estimate an ROI of $4.26:$1 for the EAP from the avoided overall health treatment costs for depression ($611/case) and avoided lost work productivity ($1,433/case).

Ensuring employees get an earlier diagnosis can also reduce their reliance on STD and LTD leaves. McIntosh says she sees many employees in their 20s—many of whom are misdiagnosed—remaining on LTD for months and years. “It’s really unfortunate,” she says. The vast majority do not want to leave their workplace—but feel they don’t have any other choice. As a result, they take leave hoping to resolve their mental health issues—don’t receive the care they need and then struggle to get back to full employment. Once you’re away from the workplace for a year, the likelihood of returning is less than 10 per cent.

The solution: partnerships between employers and insurers to provide the earliest possible access to the optimal mental health solutions.

“These people need access to high quality care,” she says. “We need to support them to get well and stay well. Everyone has a role in creating a healthy, safe, compassionate workplace.”