Extended Mental Health Benefits in Canadian Workplaces: Employee and Employer Perspectives

Mental health problems in Canada are both common and costly (and have only increased during the COVID-19 pandemic). Yet the lack of mental health resources means that many workers’ needs are not being met. While research and policy has put more focus on promoting timely and equitable access to resources in the public system, two-thirds of adult workers have access to extended health benefits (EHBs) through their employer that include varying degrees of mental health care coverage. Given the unmet needs for mental health services across the public and private sectors, such benefits are an important resource for Canada’s workers. Still, little is known, either about the ways employees use these benefits or the breadth of extended coverage employers provide.

To begin addressing these gaps, the online (French and English[1]) survey described in this report sought to better understand the role of EHBs from the perspective of employers and employees.

Key findings

Employee survey respondents (239 in total) were primarily Caucasian, female, well educated, and had stable well-paying jobs. Even though respondents were required to have access to EHBs to complete the survey, only 39 per cent had made use of such benefits for psychological services over the past year. Whether or not they had used them, both groups (80%) felt that the coverage was inadequate. The most common reasons for accessing psychological services through EHBs were anxiety (23%); depression (17%); and issues related to family (12%), work (11%), and COVID-19 stress (8%). A large percentage had timely access to a psychologist (72% saw a psychologist in the past month), with the same number (72%) reporting improvement in their problem as a result of such services. While respondents also reported accessing other workplace mental health services, a smaller percentage (33%) reported improvements in their problem as a result, compared to psychological services.

Employer respondents (175 in total) were primarily from Ontario, represented small to medium-sized organizations, and were located in urban areas. They were from varied sectors with the largest percentages from the sectors of “health care and social assistance,” “finance and insurance” and “other”. Roughly one-third increased their coverage for psychological services during the pandemic, most commonly due to employee needs and concern about COVID-19’s impact. About half did not increase their coverage, with the most cited reasons being financial or a belief that their coverage was adequate. Increases in coverage differed between small and medium-sized (versus large) organizations. Only 13 per cent with fewer than 50 employees increased their psychological services coverage, whereas 50 per cent with over 1,000 employees did so. About a third (36%) of employers indicated that they had full flexibility in negotiating their EHB plan. This relatively small percentage raises the question of how employers might respond to emerging employee needs (or an issue like the pandemic) should they not have such flexibility.

While a majority of employer respondents (60%) said they were confident that the coverage of psychological services provided a good return on investment (ROI), less than half (42%) reported that their senior decision makers were “familiar” or “very familiar” with the evidence on ROI for such coverage. This result suggests either that respondents were not senior decision makers or there is room to improve their understanding of ROI in this area. The percentage of mental health-related sick days as well as mental health-related claims for workers’ compensation benefits (WCB), short-term-disability (STD), and long-term-disability (LTD) differed by sector and organization size. For small and medium-sized organizations, the average claim was much smaller (0% WCB, 3% STD, 1% LTD) compared to larger organizations (19% WCB, 23% STD, 17% LTD). Provincial governments had the highest number of such sick days (37 days) across the public and private sectors.

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[1] Note: Because respondents to the surveys were not a representative sample of Canada’s general population or workforce, generalizing the results should be undertaken with caution.