It is unsurprising that demand for mental health services has rocketed over the past couple of years.
A global pandemic followed by a cost of living crisis has inevitably taken its toll on the nation’s mental health with younger people particularly affected.
While Prime Minister Rishi Sunak has committed to changes that would see responsibility for issuing fit notes taken away from overstretched GPs and handed over to unspecified specialist work and health professionals, sector professionals are divided over the effectiveness of this plan.
But the good news is that insurers are alive to the country’s mental health crisis and have adapted their services accordingly, with preventative solutions increasingly coming to the fore.
And what still rings true is that those employers who invest in their workforce’s mental health can steal a march on their competitors amid an intensifying war for talent.
Demand skyrocketing
“We’ve seen first-hand the impact the cost-of-living crisis has had on mental health,” Matt Liggins, head of wellbeing at Health Shield, tells Health & Protection.
“In our recent survey with full and part-time employees, almost half of respondents stated that this was impacting on their ability to do their job effectively.
“Access to healthcare is a serious concern for many – 72% of respondents said they had had difficulty booking a doctor’s appointment and half were self-treating due to this lack of access.
“This suggests many people aren’t getting the health support they need, which will only increase levels of stress and anxiety.”
And this upward trend in demand has equally been felt among insurance providers.
Michelle West-Wiggins, director of customer experience at Cirencester Friendly, says: “Demand for Friendly Voice, our confidential telephone service staffed by trained nurses, has increased significantly over the past 12 months and many of these calls relate to mental health.
“In Q1 this year, 51% of our Friendly Voice referrals were for mental health support.”
Canada Life echoes those sentiments. Protection sales manager, Rus Waygood, adds: “If we look at the hard numbers for example, we have had over 175K registrations for our WeCare service, with 25% usage being attributed to mental health support since launch.
“Our dedicated mental health support service, MyStrength, has had almost 12,000 registrations across around 2000 employers in the past year since its inception.”
And it is a similar story for Aviva as Sophie Mairs, insights and wellbeing manager at Aviva Group Protection, tells Health & Protection. “In health, we estimate that usage of the mental health pathway went up by around 20% last year and half of the cases requiring early intervention support via our group income protection were for mental health.
“We’ve also seen an uplift in engagement with added value benefits such as the EAP services and stress counselling helplines.
“Over 10,000 people booked mental health consultations via the Aviva DigiCare+ and Aviva DigiCare+ Workplace apps in 2023.”
Younger groups disproportionately affected
In terms of groups bearing the brunt of this mental crisis, it appears younger people and children are being disproportionately affected.
Data from RedArc released last week showed 30% of its new child referrals were for mental health in 2023 alone, and the number of referrals for mental health in children had increased by 42% over the period.
Keith Klintworth, managing director of VitalityHealth, points to a similar trend among under 40s. He tells Health & Protection: “85% of our mental health claims are for Talking Therapies, of which 76% are in those under 40, and almost half (46%) of those were for women under the age of 40.
“This isn’t surprising given our research found while all ages are affected by mental health, younger people have significantly more mental health concerns.
“Those under 30 showed higher levels of burnout (17%), depression (14.6%) and fatigue (55.6%) compared to other age groups, and they are also 224% more likely than older employees (over 50) to suffer from depression.”
But while the impact on younger people is clear, Julie Denning, managing director of Working To Wellbeing, tells Health & Protection there is another age demographic she also worries about.
“There are two groups that worry me the most at the moment,” Denning says. “Those between 18-24 where we are seeing the greatest rise in mental ill health in generations.
“The second is those over 50 who have an increased likelihood of having a long term condition and where mental ill health may be a factor.
“The insurance industry must be mindful of not providing blanket mental health support and ensure that interventions that are designed have the relevant needs targeted in order to secure better health and work outcomes.
“The two groups I am concerned about may have commonalities in presentation but require very different types of support.
“Deep diving into their needs and partnering with the right provider will be key.”
But Denning adds the sector also needs to guard against taking a one size fits all approach.
“For example, I’ve worked with many an employee that doesn’t actually need CBT [cognitive behavioural therapy], rather they have required emotional support,” she continues.
“Mental health is on a continuum and we need to ensure that relevant support maps along that continuum.”
PM’s fitnote plans
Over the past year, the country’s mental health crisis has risen up the agenda for the country’s policy makers.
Last month, Prime Minister Rishi Sunak announced that should the Conservatives win the next general election, those who were still out of work after 12 months of support from a work coach will have their benefits taken away completely.
The PM’s speech was met with disappointment from certain groups – particularly mental health charity Mind.
Its CEO, Dr Sarah Hughes, said at the time that they were “deeply disappointed” that the PM’s speech continued a “trend in recent rhetoric which conjures up the image of a ‘mental health culture’ that had ‘gone too far’.
And online private clinical therapist HelloSelf tells Health & Protection many individuals already find it challenging to seek help for their mental health due to various barriers and stigma associated with accessing care and that making it more difficult to obtain fit notes could further exacerbate these issues.
“Effective communication of any changes to the current way in which people request fit notes is essential,” the company said. “We must continue to educate the public on early warning signs as well as when and where to access support that will be effective for them.
“Routine access to personalised, high-quality mental health support ensures prompt and accurate identification of issues, enabling individuals to maintain their outcomes and strengthen resilience against relapse.”
But the PM also used his speech to commit to changes that would see more “objective assessment” by unspecified “specialist work and health professionals” rather than GPs.
Touching on the PM’s plan for fitnotes, Steve Ellis, associate director at Prosperis, describes it as “pure headline grabbing”.
“It shows that no clear thinking lies behind this announcement. Where will people go? How will they be assessed?
Will the assessor have their records? The GP for many is the one and only solution, to take this away may have a disastrous outcome and a serious underlying condition may be missed,” Ellis says.
But Niall Scott, director at Clarity Health Insurance, says the PM’s proposal may prove workable.
“Provided that the path to obtaining fit notes is clear (I understand this is part of the PM’s plan) then there should be no issue,” Scott says.
“I understand that a worker suffering from a mental health problem who doesn’t know the route to obtaining a fit note could add additional and undue pressure to an already stressful situation; this is why transparency for the new process is so important.”
Brian Hall, chairman of Santé Group, tells Health & Protection he can see some merit in employers engaging more with their employees on mental health.
“Employers should not be relying on the intervention of GPs, employers need independent employment-based advice,” Hall says.
“Everyone blames the job for their stress, even if it’s not the job that’s the problem.
“We hear this from time to time from employers – so if the ‘job’ is where a difficulty surfaces, well at least it has surfaced. This gives the opportunity to address the issues and offer meaningful support.
“Whether the job is the cause or not, poor mental health is almost always accompanied by poorer performance at work, so it is in the employer’s own interest to engage with and support the employee.”
Forward thinking insurers
But insurers are adapting their approach to the mental health crisis as Justin Harper chief marketing officer at Lifesearch, tells Health & Protection.
“We are already seeing a more flexible and inclusive approach to mental health from forward-thinking insurers,” Harper says.
“Intelligent use of temporary exclusions no longer means those who have suffered more severe mental health issues are completely uninsurable (as was the case) and there is a growing maturity in how mental health is talked about and considered at the application stage.
“The ABI Mental Health standards have helped provide a common foundation benchmark for fairer treatment.”
According to Klintworth, Vitality’s data also underlines the importance of early intervention.
“The rise in demand is significant for us as an insurer, as too is the data showing how impactful early intervention is,” Klintworth maintains.
“Between 2015 and 2022, the use of Talking Therapies increased by over 500%, yet at the same time the number of out-patient, in-patient and day-patient claims actually reduced, indicating treatments such as Talking Therapies, are playing a key role in treating our members’ mental health conditions when they arise.
“Prevention is also important as we find those living healthy lifestyles – those active for more than two days a week – are less likely to make a severe mental health claim.”
And there is clearly a key role for employers to play in spotting the signs of mental ill-health early on, Mairs maintains.
“We recognise that employers play a crucial role when it comes to spotting the signs of mental ill-health and managing mental health concerns in the workplace,” Mairs says.
“Employers have a real appetite to improve their understanding of mental health and their confidence when supporting employees.
“We’ve responded to this need by increasing the support we offer employers through our Line Manager Toolkit – mental health, webinars and training sessions.
“Our mental health training for employers and employees went from strength to strength in 2023, with record numbers attending and engagement with the content in our Line Manager Toolkit continues to be strong.”
And for Waygood, the key to success in this area is visibility and a move away from the old stereotype of an employee assistance programme (EAP) poster on the staff room notice board with a telephone number at the bottom.
“Depending on the service, members can interact with Canada Life support services via phone, video call, app, and portal; with regular updates to our intermediaries and clients on online seminar and website-based content,” Waygood says.
“Furthermore, usage and utilisation statistics helps to drive our content for our Wellbeing calendar and online seminar or toolkit content released throughout the year, which can build into employers EDI learning support and resources.”
Winning the war for talent
And ultimately, as the war for talent intensifies amid a mental health crisis and all the productivity problems that brings, it remains true that paternalistic employers are more likely to emerge victorious.
“Talent is increasingly hard to find and retain,” Hall says. “Employers who care about employees and their families, on top of decent terms and conditions will win the race for the best people.
“Ultimately, having a strong mental health support offering, easily accessible, delivered without consequence and promoted as a plus, will become the required standard for employers who do not want to be constantly replacing staff.”