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Mental Health Has Become a Business Imperative

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Of the many issues we have faced throughout the past two years, perhaps the most surprising but important is mental health. Studies now show that nearly 81% of workers face some form of burnout or mental health issue, and 68% of employees say their daily work has been interrupted by these challenges. 1

Health care is one of many industries, along with retail, transportation, and hospitality, that has been especially affected by burnout and stress as a physically and mentally depleted workforce has faced peaks in demand for services.

Large health care providers like Provident and HCA, among others, have told us that their employees are “undergoing trauma, just like our patients.” This, in turn, is leading to sickness, absenteeism, and staff turnover. There’s a domino effect on remaining teams, too, as these employees are overstretched and unsettled and face high levels of stress in order to meet patient needs with fewer people.

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From our regular discussions with HR leaders around the world, it’s clear that the organizations outperforming their peers are those that have cultivated a strong sense of empathy and flexibility, developed new skills to address workforce needs, and extended holistic mental health support to employees.

Like many of the changes that have come out of the pandemic, this new approach to mental health looks set to be a permanent one. As they begin to see the value in the link between mental health and the well-being and overall performance of a business, leading companies are going the extra mile to understand and respond to the way employees feel day to day.

The CEO of Starbucks has stated publicly that he considers the mental and emotional health of the company’s workers to be its biggest challenge coming out of the pandemic. 2 Morgan Stanley, which employs many people who have advanced degrees and are exceptionally high performers, now has a chief medical officer dedicated to maintaining and improving mental health across the organization.

Within human resources departments, we’re seeing a growing trend of companies promoting new roles focused on measuring and improving mental health at work.

Our research (a study of over 1,000 companies) examined which business and people practices have the most impact on business outcomes, people outcomes, and innovation. This analysis points to the importance of transitioning from the traditional focus on employee benefits to one that encompasses job and work design, management, rewards practices, a demonstrated commitment to psychological safety and fairness, and a culture of employee listening.

This research shows that “healthy” organizations outperform their peers in a range of ways. Rates of absenteeism are almost 11 times more likely to be lower, and these employers are more than three times more likely to retain people. Companies that care about staff well-being are at least twice as likely to delight customers, to be identified as a “great place to work,” and to exceed financial targets. These companies also adapt more readily to change and are more effective at innovating . 3

From HR Issue to Management Priority

We’ve found that within organizations, the higher up that mental health is prioritized, the bigger the impact of any interventions. Until recently, mental health was seen as a benefits problem, relegated to the realm of HR. Companies offered employee assistance programs, for instance, or insurance-provided advice networks to help staffers find a counselor. These programs, while widely available, were rarely used in practice, due to employees’ worries about the stigma of asking for help. Plus, benefits managers were continuously concerned about the programs’ cost.

Now, this equation has changed completely. Mental health is scaling the management agenda, and money is being made available to invest in identifying and addressing issues with positive, proactive, and increasingly creative solutions.

Pioneering companies are creating programs for sabbaticals, time off, child care benefits, and far more flexible work arrangements. Tools like real-time pay systems , regular feedback sessions, the four-day workweek , and far more discussions with leadership are all efforts to make work more humane and healthier for workers. Simple policies like allowing dogs in the office can cost so little yet matter so much to employees.

In many cases, technology platforms and targeted apps are providing some of the answers — from meditation apps geared toward mindfulness to tools that improve the employee experience by helping to alleviate administrative strain. But for maximum and lasting impact on mental health, change needs to happen within the context of culture, where conversations about mental health are encouraged and normalized.

Any good, proactive mental health initiative starts with listening. Most companies, and most business leaders, won’t know how much stress there is in the organization unless employees tell them. Sentiment surveys, open town hall meetings, and exit interviews are all crucial inputs for gathering facts and bringing attention to the issues employees are facing.

The real shift here is that many companies are now removing the stigma attached to talking about matters of mental health. People can say, “I’m not feeling well today,” or “I’m tired,” or “I’m having troubles at home”; that type of feedback is critical.

Monitoring in this way will help senior managers pinpoint any particular hot spots in the business for further investigation.

Innovation in Action

During the pandemic, the leadership team at global telecommunications provider Verizon created a series of biweekly conference calls to help senior managers empathize with the high levels of turnover, stress, and employee burnout in its field force and share ideas on how to address these urgent issues.

JPMorgan Chase implemented a well-being application for all of its employees that asks staff members and leaders to check in regularly to tell the system how they feel that day. HR monitors these signals and data inputs to see whether certain groups are experiencing major changes in stress, enabling HR team members to connect managers and challenged teams with support.

Royal Bank of Canada requested that all managers take a course in mental health, developed by the public mental health council of Canada. This course helps leaders develop skills for recognizing various forms of stress or other illnesses, using the language of mental health.

Airline reservation and technology company Sabre surveyed employees regularly to understand their stress and productivity challenges in the move to remote work. Using this input, the company shifted to a new management model, creating a set of focused tools for managers to diagnose, improve, and continuously monitor employee stress and productivity.

Toward the Genuinely Healthy Organization

Creating a robust and consistent process for monitoring employee well-being allows employers to spot issues before they escalate and to provide timely help. Encouragingly, of the 1,000-plus companies we studied, about 15% now think about overall employee well-being as an integrated part of their strategy .

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This has implications for leaders’ skill sets and personal attributes, too, which over time will have a bearing on who is promoted into senior roles. I believe very strongly in human-centered leadership — the idea of putting your people first and prioritizing their health. Managers or team leaders have to keep in mind that people’s sense of safety and security is the most important thing. Once that’s in place, you can talk about everything else. But if that isn’t there, everything else you’re working toward will suffer.

Now more than ever, it’s time to think about the employee experience more holistically. It isn’t just my own work that’s highlighting this. Study after study shows that mental health is the top-rated benefit requested by workers. In response, leaders, managers, and employees at all levels must advocate for a proactive approach to mental health. It’s both the right thing to do and a solid business strategy.

About the Author

Josh Bersin ( @josh_bersin ) is a global industry analyst covering HR, talent, and leadership and is the founder of the Josh Bersin Academy.

1. “ Employer Support Has a Direct Impact on the Health and Resilience of Employees, According to a Mercer Survey ,” Mercer, Sept. 13, 2021, www.mercer.com; “American Worker in Crisis: Understanding Employee Mental Health in Unprecedented Times,” PDF file (Burlingame, California: Lyra Health, July 2020), https://get.lyrahealth.com; and “ Edelman Trust Barometer 2022 ,” PDF file (Chicago: Edelman, January 2022), www.edelman.com.

2. A.R. Sorkin, “ Howard Schultz: Starbucks Is Battling for the ‘Hearts and Minds’ of Workers ,” The New York Times, June 11, 2022, www.nytimes.com.

3. J. Bersin, “ The Healthy Organization: Next Big Thing in Employee Wellbeing ,” Josh Bersin (blog), Oct. 27, 2021, https://joshbersin.com.

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Mental health in the workplace: The coming revolution

On July 7, 2020, Lenny Mendonca, the former chief economic and business advisor to California governor Gavin Newsom, went public with why he had suddenly resigned from that position on April 10. Mendonca, a former McKinsey senior partner, revealed his struggles with debilitating depression in a deeply personal column that also probed the pervasiveness of mental health issues among the general population and the public-policy implications of untreated mental illness.

Three weeks prior to his resignation, suffering severe depression, Mendonca had checked into a hospital for an overnight stay. But, acting in his position of great responsibility, in the middle of the COVID-19 crisis, Mendonca had “told myself and my team that we all have to operate at 120 percent. . . . This meant 80-hour work weeks and barely sleeping.” Reflecting on his diagnosis and months-long process of recovery, Mendonca wrote: “What does it say about me that I have a mental health issue? It says that I am human.”

Mendonca is right: mental health issues are pervasive. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), one in four Americans has a mental or substance use disorder . The National Center for Health Statistics noted a suicide-rate increase of some 35 percent between 1999 and 2018, with the rate growing approximately 2 percent a year since 2006. Suicide is now the tenth-leading cause of death in the United States. Depression increases suicide risk —about 60 percent of people who die by suicide have had a mood disorder. The Health Care Cost Institute’s 2018 report disclosed that per-person spending on mental health admissions increased 33 percent between 2014 and 2018, while outpatient spending on psychiatry grew 43 percent. Between 2007 and 2017, the percentage of medical claims associated with behavioral health (both mental illnesses and addictions) more than doubled.

Preexisting mental health challenges have been exacerbated by the impact of the COVID-19 crisis. Based on analysis by McKinsey , COVID-19 could result in a potential 50 percent increase in the prevalence of behavioral health conditions. A new survey by the Kaiser Family Foundation reported that 45 percent of Americans felt that the COVID-19 crisis is harming their mental health; while 19 percent felt that it is having a “major impact.” In a recent poll from the Pew Research Center , 73 percent of Americans reported feeling anxious at least a few days per week since the onset of the pandemic. Between mid-February and mid-March 2020, prescriptions for antianxiety medications increased 34 percent. During the week of March 15, when stay-at-home orders became pervasive, 78 percent of all antidepressant, antianxiety, and anti-insomnia prescriptions filled were new (versus refills).

Lenny Mendonca had the resources to get as much help in whatever form he needed, and he recognized how rare his situation indeed was. Obtaining treatment for behavioral health issues remains much too difficult. A 2018 survey cosponsored by the National Council for Behavioral Health reported that 42 percent of respondents cited cost and poor insurance coverage as key barriers to accessing mental healthcare, with one in four people reporting having to choose between obtaining mental health treatment and paying for necessities. Because of cost, coverage, and the social stigma still associated with mental and substance use disorders, most people with behavioral health issues do not receive treatment. A study of more than 36,000 people found that this was true of 62 percent of people with mood disorders, 76 percent of people with anxiety disorders, and 81 percent of people with substance use disorders.

Access to mental health resources and attitudes about mental health are almost certainly poised to improve. First, young people are both more likely to have behavioral health issues—young adults between the ages of 18 and 25 had the highest prevalence of any mental illness—and more willing to talk openly about psychological well-being and to seek assistance. Second, companies are recognizing the costs associated with not addressing employees’ mental health issues. Third, the growing emphasis that companies place on controlling their self-insured healthcare costs points directly to investing in mental health interventions. That’s because mental health prospectively predicts the incidence of serious—and expensive—medical conditions such as diabetes, cancer, and coronary artery disease. What has effectively been a “don’t ask, don’t tell” approach to mental health in the workplace is becoming instead “do ask, do tell, let’s talk.” There is a coming revolution in how companies (and public-policy makers) think about, talk about, and cope with all forms of mental health issues.

In this article, we argue that mental and substance use disorders—sometimes referred to as behavioral health conditions—are real, pervasive, and expensive. They cost companies money directly for treatment expenses and indirectly, and more expensively, from increased healthcare expenditures, turnover, and diminished productivity. Employees need, and increasingly demand, resources to help them cope with mental health problems. If companies make mental health services more accessible and intervene in the workplace in ways that improve well-being, they will simultaneously make investments that will provide real improvements in employee outcomes and consequently in company performance. Examples from companies that are taking the lead in addressing mental health illustrate what to do and how to do it.

Employees need, and increasingly demand, resources to help them cope with mental health problems. If companies make mental health services more accessible and intervene in the workplace in ways that improve well-being, they will simultaneously make investments that will provide real improvements in employee outcomes and consequently in company performance.

The economic impact of mental health issues

Even before the COVID-19 crisis, behavioral health problems such as anxiety, stress, and depression were widespread, constituting a leading cause of diminished well-being and exacting an enormous toll in the form of absenteeism, reduced productivity, and increased healthcare costs. In 2019, the World Health Organization labeled employee burnout a medical condition, noting that its cause is chronic workplace stress.

Research shows that workplace stressors such as long hours, economic insecurity, work–family conflict, and high job demands coupled with low job control are as harmful to health as secondhand smoke . Together, they cost the United States approximately $180 billion and 120,000 unnecessary deaths annually.

A 2015 peer-reviewed study estimated the total cost of major depressive disorder in the United States to be $210 billion, a figure that had increased 153 percent since 2000. About half of the economic impact was attributable to costs of treatment, with the rest attributable to absenteeism and presenteeism (being physically at work but not at full productivity) costs incurred in the workplace.

A 2019 Mind Share Partners report noted that almost 60 percent of the 1,500 employed respondents sampled across for-profit, nonprofit, and government sectors reported experiencing symptoms of a mental health condition in the past year, with half saying that the symptoms had persisted for more than a month. Sixty-one percent said that their productivity at work was affected by their mental health. More than a third of the group—50 percent of millennials and 75 percent of Gen Z respondents—reported that they had actually left jobs at least partly because of mental health.

Mental health is also a diversity and inclusion issue. The Mind Share Partners study found that Black and Latinx respondents reported experiencing more symptoms of mental disorders than their white counterparts, and were more likely to have left a previous job for mental health reasons.

The pandemic has only made the situation worse. A McKinsey survey of approximately 1,000 employers found that 90 percent reported  that the COVID-19 crisis was affecting the behavioral health and often the productivity of their workforce. Gallup reported that almost half of US workers were concerned about one or more of four possible job setbacks—reduced hours, reduced benefits, layoffs, or wage cuts.

Even before the COVID-19 crisis, behavioral health problems such as anxiety, stress, and depression were widespread, constituting a leading cause of diminished well-being and exacting an enormous toll in the form of absenteeism, reduced productivity, and increased healthcare costs.

Depression and stress foretell other costly physical illnesses

Companies and countries are appropriately obsessed with bending the curve of healthcare costs. Starbucks paid more for health insurance than for coffee, and the three domestic automakers spent more on healthcare than on steel.

What is less recognized is that stress and depression increase not just the costs associated with treating behavioral health problems but also the incidence of other costly physical diseases. At least two mechanisms help explain this connection between mental and physical health.

First, psychological well-being and social determinants of health can directly affect the likelihood of an individual engaging in healthful behaviors and self-care such as eating and drinking alcohol in moderation, regular exercise, and avoiding smoking and drug use. People with mental and substance use disorders, as well as those who have experienced psychological trauma, are at higher risk for chronic diseases such as diabetes, heart disease, and musculoskeletal problems.

Second, research shows that stress and depression cause physiological changes, such as metabolic, endocrinal, and inflammatory shifts, that are markers and predictors of disease. The idea that the mind affects the body is scarcely new, but the emerging science of psychoneuroimmunology is revealing in detail the pathways that link changes in the brain to effects on the immune system (see sidebar, “The promise of precision psychiatry”). A paper linking stress, depression, the immune system, and cancer noted that “many studies” showed “that psychological stress can down-regulate various parts of the cellular immune response. Communication between the CNS [central nervous system] and the immune system occurs through chemical messengers secreted by nerve cells, endocrine organs, or immune cells, and psychological stressors can disrupt these networks.” 1 Edna Maria Vissoci Reiche et al., “Stress, depression, the immune system, and cancer,” The Lancet Oncology , October 2004, Volume 5, Number 10, pp. 617–25, thelancet.com.

As an example of the effect of depression on other diseases, we used a large longitudinal Optum prescription data set to explore the prospective effects of depression. Receiving an antidepressant prescription was used as a marker for depression, and obtaining prescriptions for drugs used to treat diabetes, cardiovascular disease, and cancer as markers for those diseases. We found that obtaining an antidepressant increased the odds of subsequently receiving a drug for diabetes by 30 percent, cancer by 50 percent, and heart disease by almost 60 percent. People who received antidepressants were more than 300 percent more likely to later use sedatives and 400 percent more likely to obtain an amphetamine prescription.

Simply put, the path to reducing healthcare costs goes through the brain.

The promise of precision psychiatry

One plausible reason for both the stigma and undertreatment of behavioral health problems is the perception that conditions such as depression are less “real” than clearly physical ailments, such as a broken leg or liver disease. Many people even suspect that curing a mental illness is largely under the volitional control of those suffering from it. Moreover, the treatment of mental illness is often perceived as being imprecise and relatively ineffective. Therefore, urging companies to take mental health more seriously requires demonstrating both the physiological reality of mental disorders and the possibility of more effective treatment.

Depression is a heterogeneous disorder that manifests with a variety of symptoms including “sleep disturbance, guilt, loss of energy, impaired concentration, change in appetite . . . and suicidal ideation.” 1 Manpreet K.Singh and Ian H. Gotlib, “The neuroscience of depression: Implications for assessment and intervention,” Behaviour Research and Therapy , November 2014, Volume 62, pp. 60–73, journals.elsevier.com. This heterogeneity has made diagnoses and evaluations of treatments more difficult. However, recently there has been substantial progress in understanding the physiology of mental health issues. To take one example, major depressive disorder (MDD) in fact does have physiological consequences that are evident in neuroimaging studies of the brain. Neuroimaging as a diagnostic tool has the advantage of being “a safe, noninvasive procedure that is ideally suited for simultaneously identifying aberrant behavior, brain structure, and brain function.”

Leanne Williams has outlined a “neural circuit taxonomy” for both depression and anxiety. The fundamental idea is that there are different neurological manifestations—for instance, in which regions of the brain are active and are connected to one another—for different manifestations of depression. Such a taxonomy can be used to link symptoms to underlying neural disorders as revealed through neuroimaging.

Amidst the COVID-19 crisis, many people are facing the impact of sustained and uncontrollable sources of stress that affect brain physiology. Using her taxonomy, Williams and her colleagues have illustrated how stress and isolation related to COVID-19 may affect different neural archetypes for anxiety and stress .

A taxonomy of different forms of depression makes it possible to associate treatment outcomes with different manifestations of the disease. Such an approach would do for psychiatry what has occurred in other medical domains such as cancer treatment and other diseases over the past 20 years: advancing clinical practice by matching treatments more effectively to each version of the underlying disease. Better understanding the physiological etiology of mental illness can also help move practice toward prevention. Instead of waiting till the equivalent of “stage 4” of a mental illness, when a person facing a crisis due to the accumulated burden of disability feels that suicide is the only choice, we might be able to detect the problem early, at something like “stage 1” or before onset of a mental disorder, and treat preemptively.

When treatments are matched to different disease archetypes, doctors can prescribe more robust healthcare interventions. As precision psychiatry becomes a more common standard of care, mental health treatments will become even more effective, giving more confidence to those who fund treatment of employee behavioral health conditions, such as depression, that their investment will pay off for both the company and its people.

Employees’ rising demands for attention to mental health

Today’s workforce expects employers to take mental health issues seriously and provide appropriate support and assistance. Senior executives consistently tell us that discussions of mental health issues have become much more frequent and open in workplaces. The head of mergers and acquisitions for BP noted that in the last 18 months there had been a striking shift in the willingness of people to disclose struggles with behavioral health issues.

Ginger, a company providing an on-demand mental health platform to employers, conducted a 2019 survey using a random sample of US employees. The study found that employees were more likely to seek help with stress, anxiety, and depression now than they were five years ago. More importantly, 91 percent of employees surveyed believed that their employers should care about their emotional health, and 85 percent said that behavioral health benefits were important when evaluating a new job. In fact, the respondents said that when evaluating the benefits of a new job offer, on-demand mental health support came second after corporate wellness initiatives, ahead of financial advising, gym memberships, and free meals.

While the vast majority of employers see mental health as a priority, they struggle to meet increasing employee need and demand for behavioral health services. The Ginger survey found that one-third of respondents had to pay out of pocket for behavioral health services. Twenty percent fear that they’d harm their careers if their employers found out, 20 percent worry that they don’t have time to get help, and 15 percent find that the providers listed in their company’s plan were too limited, not available, or didn’t actually provide services under the plan.

These concerns are not confined to the United States. A Deloitte study conducted in the United Kingdom reported, among other things, that just 22 percent of line managers had received some form of training on mental health at work, even though 49 percent said that even basic training would be useful. In the absence of such training and support, more than a third of employees did not approach anyone the last time they experienced poor mental health, while 86 percent noted that they would think twice before offering help to a colleague whose mental health concerned them.

Current mental health benefits fall short

According to the 2008 Mental Health Parity and Addiction Equity Act, mental health benefits in health plans in the United States should be comparable to physical health benefits. They are not. A 2017 report by Milliman noted that an office visit with a therapist was about five times as likely to be out of network—and therefore more expensive—than an office visit with a primary-care practitioner. The CEO of a company providing mental health benefits to companies noted that in some instances insurance-mandated networks of mental health providers are filled with professionals who are not accepting new clients and do not respond to inquiries. Network adequacy and accessibility of behavioral health services pose serious problems for health insurers, employers, and workers nationwide. Given the economic toll of mental and substance use disorders, employers should be highly motivated to invest in behavioral health else risk increased healthcare costs and employee attrition.

Another constraint on accessing mental healthcare is that for many years mental health providers have been undercompensated for their work, leading, not surprisingly, to a great shortage. One study showed that 60 percent of US counties did not have one psychiatrist. One SAMHSA report noted that 55.2 percent of adults with mental illness received no treatment in the previous year.

It will take years to overcome the underinvestment in mental health. But if employers begin now, they can earn the appreciation and loyalty of their employees.

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Six ways to ensure that mental health benefits serve a company and its people.

Good mental health benefits pay off. An April 2018 article in the peer-reviewed Journal of Occupational and Environmental Medicine found that about 86 percent of employees reported improved work performance and lower rates of absenteeism after receiving treatment for depression. 2 Ron Z. Goetzel PhD et al., “Mental health in the workplace: A call to action proceedings from the Mental Health in the Workplace—Public Health Summit,” Journal of Occupational and Environmental Medicine , April 2018, Volume 60, Number 4, pp. 322–30, journals.lww.com/joem. A Harvard Business Review article noted that “$4 is returned to the economy for every $1 spent caring for people with mental health issues.” 3 Morra Aarons-Mele, “We need to talk more about mental health at work,” Harvard Business Review , November 1, 2018, hbr.org.

Some leading companies understand this payoff and are taking action. A McKinsey study  of about 1,000 employers noted that about 60 percent said they were starting, continuing, or expanding their behavioral health services. Drawing from their examples, we’ve created a list of key actions that every organization can and should take to improve employees’ mental health and benefit from the ensuing economic gains.

Measure behavioral health

Measurement of employee stress and mental well-being is on the rise, but still lacking. A prepandemic (2019) survey of more than 600 firms by benefits consultant Willis Towers Watson reported that the proportion of employers measuring the stress level of their employees was projected to increase from 16 percent to 53 percent by 2021. That increase would still leave a significant fraction of employers with no data on the empirical dimensions of employee behavioral health challenges.

Furthermore, employer surveys and measures of behavioral health often use ad hoc, idiosyncratic questions. To detect current mental health problems, we recommend a 12-item general-health questionnaire first developed in 1970 . The instrument has been translated into 38 languages and extensively validated worldwide, including in Spain, Germany, and Australia. Consistently using validated, reliable measures permits better comparisons across study settings and over time, and gives companies the best chance to measure progress and benchmark their mental health status against other populations.

Given the economic toll of mental and substance use disorders, employers should be highly motivated to invest in behavioral health else risk increased healthcare costs and employee attrition.

Make behavioral health a transparent priority

It’s incumbent on company leaders to drive awareness and action on mental health. By talking about mental health openly and backing up that talk with significant action, leaders can destigmatize mental illness and signal that people can and should access the support the company provides. EY (formerly Ernst and Young) launched a WeCare program to educate its people about mental health, urge them to seek any necessary assistance, and support others who might struggle with mental illness. At SAP, Vivek Bapat, who drives purpose initiatives, which include mental health, commented: “We’ve created a virtual team of representatives across the entire business. We have representation from our product area, customer engagement, HR—including the diversity and inclusion officer—and from our chief medical officer.” This group meets regularly to discuss the company’s mental health initiatives. “It’s a diversity and inclusion conversation,” added Bapat. “It’s a product conversation, it’s a customer conversation, it’s an employee-engagement conversation, it’s a leadership conversation, it’s a brand conversation. It’s all of those conversations. Together.”

A company’s actions will be significant only if senior management and even the board of directors ensure continuity of effort and follow-through. Sometimes, mental health becomes a priority at the company’s highest levels because of personal experience. The head of one intellectual-property practice for a leading international law firm became interested in mental health because of the struggles of his brother. Brian Heyworth, the global head of institutional business at HSBC Global Asset Management, joined HSBC in 2006. Heyworth struggled with anxiety and depression when he was in his 20s and 30s, and in 2006, shortly before joining HSBC, he had “a full-scale psychiatric breakdown, which led to spending two months in a hospital in the United Kingdom called the Priory.” He currently serves as chair of the City Mental Health Alliance in London, a group of some two dozen financial-services companies, banks, law firms, accountancies, and insurance companies that explores how to improve the environment for mental health.

Company values can also play a part in prioritizing mental health. John Flint, the former CEO of HSBC, felt called to provide a duty of care for HSBC’s 240,000 employees and their families. He also believed that improving employee health and well-being was the most important enabler of executing the company’s commercial strategy.

Jonathan McBride, the former head of diversity and inclusion for BlackRock, noted that the company became interested in mental health as part of its effort to advocate for social issues and to create a culture that nurtured diversity. McBride noted three pathways that can encourage a greater focus on mental health. One was to educate people via data-backed awareness campaigns about the empirical realities of mental illnesses. Second, he said, “You ennoble the topic. You talk about overcoming [behavioral health challenges].” The third pathway is a “Be Kind” campaign, where you interrupt the rush to judgment by helping people understand that “it’s entirely possible that people around me are going through something you can’t possibly understand.”

It’s incumbent on company leaders to drive awareness and action on mental health. By talking about mental health openly and backing up that talk with significant action, leaders can destigmatize mental illness and signal that people can and should access the support the company provides.

Hold leaders accountable for making progress on employee mental health

Things that are measured and receive management attention lead to accountability, and mental health is no different. Michael Fenlon, the chief people officer at PwC, told us that the company “asked all of our teams to create well-being plans using the framework of mental, emotional, physical, and spiritual well-being, where spiritual refers to having a sense of purpose. We provided tools and examples and asked everyone on the team to have both a personal goal and a team goal. I think we got about 5,200 team plans. We asked teams to visit progress against those plans on a regular basis. And we asked all of our leaders to lead from the front, to share goals they’re working on, and to serve as role models. Our CEO, for instance, talks openly about vacations and how he plans vacations throughout the year.” The combination of visible plans with accountability for progress ensures that mental health receives the attention it deserves on the company agenda.

Explore a range of new services, including online interventions

A Society for Human Resource Management article noted that a rising number of employers are providing a variety of subsidized or fully covered digital mental health solutions. 4 Stephen Miller, “Employers enhance emotional and mental health benefits for 2020,” Society for Human Resource Management, October 28, 2019, shrm.org. Just as telemedicine visits with doctors for conventional physical ailments are growing, so are various online applications to help deal with behavioral health issues. Many companies now offer Calm and Headspace, apps that help with meditation and sleep. Companies such as Talkspace, BetterHelp, and Ginger work with companies to ensure that employees have easy access to trained therapists. There are even start-ups, such as Toronto-based Animo, that try to apply natural language processing to social-media posts and emails to discern the psychological health of a population, track the effectiveness of interventions, and predict trends in mental well-being.

Given the pace of innovation in the mental health space, companies would be well advised to learn about this ecosystem as part of their efforts to give the best mental healthcare to their employees.

Work closely with your health-benefits administrator to ensure adequate behavioral health coverage

In the United States, most people receive their health insurance through their employer. Most of those employers use health-benefits administrators—health insurance companies—to run their plan, including contracting for access to behavioral health providers. That’s why it’s critical for business leaders to collaborate with their plan administrators to review their company health plans regularly and thoroughly, carefully examining how the plans operate and what they provide. Business leaders can make clear to health-plan administrators that investing in mental health is key to their companies’ organizational success. They can ensure availability of behavioral health services by assessing barriers to access, the breadth of provider networks, reimbursement rates for providers, utilization-management practices, and out-of-pocket costs confronted by employees. Organizations that prioritize access to mental health services and workplace supports have the potential to realize significant return on their investment.

The pandemic has made painfully clear that our collective emotional health is in jeopardy, and many employers are scrambling to meet burgeoning demands.

Consider on-site mental health services

More large employers are providing onsite medical care. Providing care onsite cuts out employee travel time and can save costs. Company-paid doctors are often less expensive than fee-for-service arrangements or care provided in settings with large facility charges.

Now there is a growing movement to make behavioral health services available at the workplace as well. According to the Business Group on Health, one-third of employers with more than 5,000 employees said they would offer behavioral health counseling on-site in 2020, a big increase from the one-fifth that did so in 2018. Presumably, this trend—together with increased access to virtual care—will continue when employees return to traditional office settings post-COVID-19.

The spread of the novel coronavirus has accelerated many shifts that had started in the months and years before the pandemic. Better mental health coverage for employees is one of those. The pandemic has made painfully clear that our collective emotional health is in jeopardy, and many employers are scrambling to meet burgeoning demands. Combine this with the openness of young people toward mental health discussions, and that good mental health coverage for employees translates into success for companies, and you’ve got the foundation of a revolution. The six steps we’ve laid out in the article can give companies a head start on this inevitable, welcome, and profound change.

Jeffrey Pfeffer is the Thomas D. Dee II Professor of Organizational Behavior at the Graduate School of Business, Stanford University. Leanne Williams is a professor in psychiatry and behavioral sciences at Stanford University and the founding director of the Stanford Center for Precision Mental Health and Wellness.

This article was edited by Rick Tetzeli, the editorial director of the McKinsey Quarterly .

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Opening up About Mental Health at Work

Last summer, American gymnast Simon Biles won the admiration of many when she withdrew from several Olympic events for mental health reasons. Biles is one of a growing number of high-profile individuals who have recently shared personal mental health struggles. Olympic swimmer Michael Phelps. Superstar Lady Gaga. Prince Harry. All have used their platforms to bring mental health issues to the fore.

When celebrities voice concern about their mental health, they raise public awareness and help reduce stigma. But how does this heightened attention to mental health affect the workplace?

The numbers are telling Mind Share Partners is a nonprofit organization focused on mental health at work. In the spring of 2021, they conducted a survey of full-time employees in the United States. Their findings, revealed in Mind Share Partners’ 2021 Mental Health at Work Report in Partnership with Qualtrics & ServiceNow , are eye-opening.

Over three-quarters (76%) of respondents indicated that they experienced at least one symptom associated with a mental health condition in the past year. This was up from the already significant percentage (59%) found in a similar 2019 Mind Share Partners survey. The most frequently reported symptoms were burnout, depression, and anxiety, and these challenges aren’t fleeting. For more than one-third (36%) of those surveyed, symptoms persisted from five months to a year. Employees at all levels experienced mental health symptoms, with slightly greater instances reported by executives (82%) and C-level professionals (78%).

Mental health challenges have a profound impact on an organization. One-sixth (17%) of respondents said that they missed more than 10 days of work in the past year because of mental health challenges. Further, 77% experienced a decline in productivity due to mental health. And an astonishing one-half of those surveyed said that, at some point during their career, they left a job due to mental health concerns.

Absenteeism. Productivity. Retention. It’s no wonder that organizations are beginning to pay serious attention to mental health. “Mental health challenges,” as the Mind Share report’s authors wrote, “are [now] the norm.” Other global research confirms the Mind Share Partner findings.

Deloitte conducts an annual survey of millennials (and now, Gen Z as well) to identify trends involving the digital natives who are rapidly coming to dominate the workplace. Deloitte’s 2021 Global Millennial Survey Report noted that nearly one-third of respondents said they’ve taken time off work “due to stress and anxiety caused by the pandemic.” Among those who didn’t take time off, 40% indicated that, even though they chose to go to work, they were “stressed all the time.“

Why now? What’s causing unprecedented levels of mental health issues in the workplace? As Deloitte found, the pandemic is a significant driver. But it’s not the only factor. There are myriad other factors that combine to exert pressures that affect our mental health. Globally, there is political unrest and significant polarization. Environmental concerns including climate change weigh heavily on people’s minds, especially among those in the rising generations. There are heightened concerns over the growing wealth gap, over racism, over diversity and inclusion of populations that have long been marginalized. And, on top of all these issues, they’re also stressed about the need to find purpose and do meaningful work.

Organizations respond to mental health concerns Fortunately, as employees increasingly become more transparent about their mental health challenges, organizations are stepping up to help address them. In many cases, the pandemic gave businesses the immediate need – and the opportunity – to tackle issues around workplace flexibility. Senior leaders, experiencing mental health challenges of their own, are reaching out to employees with greater authenticity. They’re hearing and acting on concerns about diversity, equity, and inclusion, and about purposeful work. And they’re acknowledging that a focus on mental health is no longer a ‘nice to have’ but a necessity in the 21st century workplace.

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Mental Health in the Workplace: A Conversation Bridging Research and Practice

How can we promote mental health in the workplace? 

This is a question that Zhiqing (Albert) Zhou , PhD, and Lawanda Lewis are constantly asking themselves in their work, just from different perspectives. As an associate professor in the Department of Mental Health , Zhou researches how employees’ work-related experiences impact their health, well-being, and safety. As an HR Business Partner who oversees multiple academic departments at the Bloomberg School, Lewis has firsthand experience with assessing the mental health needs of employees and the effectiveness of workplace mental health and wellness programs.

This Mental Health Awareness Month, Zhou and Lewis came together for a wide-ranging conversation about research, practice, program implementation, and what still needs to be learned to help workplaces manage and support the mental health of their employees.

This conversation has been edited and condensed for length and clarity.

Lawanda Lewis: Post-COVID, we’re seeing different work modalities, from fully remote work to hybrid work to a mix. Hybrid work seems to be the way of the world now. What approaches can organizations take to better promote mental wellness in a hybrid workforce?

Albert Zhou:  There is consistent evidence of the benefits of hybrid work, such as more flexibility, more autonomy, reducing commuting time, and better work-life balance. Meanwhile, there are reports of remote or hybrid workers feeling lonely or isolated, dealing with the added stress of shared spaces and family responsibilities, and feeling pressure to always appear available and present. We published a study in 2022 in the International Journal of Human Resource Management that found that workers’ mental health was negatively impacted when they felt too closely monitored by their managers.

One way to deal with this is to make sure managers are trained to prepare, support, and better communicate expectations and guidelines for hybrid and remote workers, while giving workers flexibility and more control over their time. Social and emotional support from coworkers and supervisors is also instrumental to building a healthy work life. People should be able to ask questions, connect with their colleagues, and access resources regardless of when and where they’re working. My collaborators and I are trying to understand how hybrid or remote work can be better managed so that workers can enjoy the benefits and reduce the negative consequences for their mental health.

LL: What has recent research revealed about the mental health benefits of transitioning to a four-day work week with no pay reduction?

AZ: We still need to do more research on the four-day work week, and we don’t yet have consistent solutions, even though this topic has been discussed for over 50 years. But there have been pilots and case studies in several countries that have shown evidence of increased productivity. Workers in these studies reported that they are more satisfied with their work, have better work life balance, and experience less stress and burnout. However, one issue that came up is scheduling problems. For example, I’m working for four days, but my clients are not, so how can we align our work? When we studied weekly work cycles , we found that Monday is already the most stressful day. Since working on Friday is off the table, how do I make sure too much work doesn’t pile up on Monday? 

It’s important to note that these pilot programs were tested with a small number of organizations who voluntarily participated, which means they were already open to the idea of a four-day work week. It's unclear, then, whether their practices can be generalized to other workplaces. The transition to a four-day work week may be easier for office workers, but it would be harder for people in industries where people’s work schedules are less flexible, like blue collar workers or healthcare workers. Again, more research is needed, especially with HR professionals like you, since a lot of these changes will be implemented through HR functions. You are at the front line of making sure that it works as planned, taking feedback, and continuously shaping the practice.

I’m learning a lot about HR practices, and I was wondering if you could give examples of programs you have implemented to promote workplace mental health. 

LL:  One of our most important programs is the Johns Hopkins Employee Assistance Program (JHEAP), which provides confidential counseling, resources, and referrals to employees and their families for personal and work-related issues. And we’ve implemented flexible work arrangements. Hybrid or modified hybrid schedules allow employees to meet the needs of their roles and divisions while still managing their personal and work lives. 

We also provide programs that can help employees manage their physical, emotional, social, and financial well-being, like meditation and yoga classes; premium memberships to tools that reduce stress and improve focus, like the Calm app; and the Healthy at Hopkins Wellness Initiative hub for resources and benefits.

Our leadership trainings raise awareness of mental health and unconscious bias and help supervisors recognize and manage employee stress. To reduce the stigma of talking about mental health, we regularly coach managers on how to create open dialogue with their employees about issues like stress and workloads. Through these kinds of initiatives, we want to help managers create a psychologically safe work environment. 

AZ:  Offering a variety of programs is great for addressing individuals’ different needs and creating psychologically safe relationships, while also caring about the overall work environment. Of all these different programs, what has worked well? 

LL:  Our Employee Assistance Program has evolved over the years. The University has been good at adapting it as work set-ups change and employee needs change, so that flexibility has led to a lot of reinventions over the years. Being flexible with our employees’ work arrangements has also worked really well. Everyone is dealing with day-to-day issues and unpredictable situations, so we want managers to balance knowing what needs to be done with caring for their employees. 

JHU’s supervisor trainings have helped managers lead fairly, create open communication, and provide timely feedback so that employees always know where they stand. We also think it’s important to show employees appreciation and recognition for their hard work.

AZ:  Definitely. We’ve seen in research that lack of recognition negatively affects productivity, performance, and mental well-being. It’s always good to see appreciation and recognition coming from the top down. Are there other workplace mental health topics that HR professionals like you are interested in right now?

LL:  I'm interested in learning more about efforts to reduce stigma and promote open dialogue, especially when it comes to relationships between supervisors and their subordinates. What should organizations look out for when managing that relationship?

AZ:  That's a great question because supervisors play an important role in employee mental health. From the research perspective, we develop specific, reliable, and valid measures to assess supervisor behaviors. The commonly used approach is asking workers to answer questions about the frequency of certain supervisor behaviors, such as rudeness or inattention. Those kinds of behaviors are subtle and sometimes low intensity but can affect people’s well-being if experienced regularly.

It's important to note that sometimes employees’ perceptions might not correspond to the actual behavior of the supervisor. The supervisor might not intentionally be rude, but their behaviors can still be perceived as rudeness or incivility. That's why when we study supervisor behaviors, it's important to calibrate across multiple direct reports of the same supervisor. That's an indication of a pattern of behavior and that action needs to be taken in terms of interventions or training. So, I think it’s important for organizations to continuously gather employees’ perceptions and combine data from multiple sources to get a more accurate reflection of supervisor behaviors. To prevent incivility in the workplace, it's important to build an environment where people are aware of their behavior and are mindful of their impact and talk about mental health.

LL:  Reducing mental health stigma is a major theme. We want to raise awareness of resources and make sure that people get the support they need. But when we start talking about illnesses, we start to trickle into the lines of protected health information and figuring out how to handle that information. We have an office that supports employees who need accommodations, but we are still learning. 

AZ: It’s great that HR is thinking about and prioritizing workplace mental health because that’s not the case everywhere. The research on workplace mental health is also still evolving. I’m doing a review piece with a student about disclosure of mental health conditions and how we can foster more open communication so support can be provided. But there’s still a long way to go. As a researcher, I want to keep providing evidence to help teams like yours who are doing actual implementation and supporting employee health and well-being. 

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White   House Shares Government, Private Sector, Academic, and Non-Profit Actions to Accelerate Progress on Mental Health   Research

The United States is facing an unprecedented mental health crisis impacting Americans of all ages. To tackle this crisis, the Biden-Harris Administration has taken bold steps to transform how mental health is understood, accessed, and treated. Under President Biden’s Unity Agenda, the Biden-Harris Administration released a comprehensive mental health strategy and mental health research priorities . These steps aim to make mental health care more affordable and accessible and improve health outcomes for all Americans.  

As a part of Mental Health Awareness Month, the White House Office of Science and Technology Policy called on government agencies, the private sector, nonprofit organizations, and academia to share the actions they are taking to expand and improve mental health research in the United States. These actions address key research priorities and move us closer to a future where every American has access to the best available care when and where they need it.

Government Actions

• The National Institutes of Health (NIH) Common Fund’s Community Partnerships to Advance Science for Society (ComPASS) Program announced 25 community-led research awards. The ComPASS program provides an unprecedented opportunity for communities to lead innovative intervention projects that study ways to address the underlying structural factors that affect health and health equity. Awards include research focused on addressing stigmatization of behavioral health and services and improving access to behavioral health services in Hispanic, low-income, rural, and LGBTQ+ communities.
• Accelerating Medicines Partnership® Program for Schizophrenia (AMP SCZ) released its first research data set — AMP SCZ 1.0 —through a collaboration of the National Institute of Mental Health (NIMH), the Foundation for NIH, the Food and Drug Administration, and multiple public and private partners. To improve the understanding of schizophrenia and to identify new and better targets for treatment, AMP SCZ established a research network that examines trajectories for people who are at clinical high risk for psychosis. The network also develops psychosis prediction algorithms using biomarkers, clinical data, and existing clinical high risk-related datasets.
• NIMH’s Individually Measured Phenotypes to Advance Computational Translation in Mental Health program is a new initiative focused on using behavioral measures and computational methods to define novel clinical signatures that can be used for individual-level prediction and clinical decision making in treating mental disorders . As one example of research supported through this initiative, researchers at the University of Washington are applying computational modeling strategies to behavioral data collected through a smartphone app, with the goal of predicting and preventing serious negative outcomes for people who experience hallucinations.
• NIMH awarded research grants to develop and test innovative psychosocial interventions to prevent suicide. Researchers at San Diego State, one of the grant recipients, are combining an existing intervention—the Safety Planning Intervention—with patient navigator services, and testing the effectiveness of this novel combined intervention in reducing suicide risk among sexual and gender minority youth and young adults.
• NIMH and the Eunice Kennedy Shriver National Institute of Child Health and Human Development funded 11 new studies focused on understanding bidirectional relationships between social media use and adolescent mental illness, psychiatric symptoms, and risk or resilience for psychopathology . Collectively, this research aims to address important questions about the short-term and long-term interactions between social media behavior and youth mental health, as well as the mechanisms contributing to risk and resilience.

Private Sector, Academic, and Non-Profit Actions

• The University of California, Somos Esenciales, and Zuckerberg San Francisco General Hospital are conducting the Supporting Peer Interactions to Expand Access study, which examines digital mental health solutions in resource-limited settings, emphasizing cultural and linguistic inclusivity. This study examines a cognitive-behavioral therapy intervention for depression or anxiety for Latino patients with limited-English proficiency and tests implementation strategies, including support from community peers, to integrate this intervention into primary care.
• Headspace is launching a participatory research approach to better understand mental health needs. Headspace is partnering with the city of Hartford, Connecticut to provide mental health resources to all Hartford residents including free access to the Headspace app. This public-private partnership is the first of its kind to improve community-wide mental wellness while researching engagement with the Headspace app and the associated mental health outcomes.
• The Association of American Medical Colleges (AAMC) established a Mental and Behavioral Health Awards Program to champion integrated behavioral health (IBH) patient care models. The inaugural funding was awarded to Cincinnati Children’s Hospital Medical Center, Georgetown University Medical Center, Texas A&M School of Medicine, and the University of California Davis School of Medicine for their innovative approaches to IBH team training and patient care, as well as their commitment to accessible and equitable whole person care. AAMC will summarize and disseminate lessons learned from these institutions to advance IBH across the health care delivery system.
• Unity Health Care established the $2.3 million J. Willard and Alice S. Marriott Foundation’s Behavioral Health Development Fund to train the next generation of IBH fellows. This program allows Unity to recruit and train the next generation of mental health providers, with a focus on models of care that expand access, improve outcomes, and drive health equity through IBH. The behavioral health providers work seamlessly with primary care providers to address unmet critical and looming mental health challenges with a culturally congruent approach.
• The American Association of Psychiatric Pharmacists is providing up to $500,000 to study the impact of integrating Board-Certified Psychiatric Pharmacists (BCPPs) into health care teams. BCPPs are advanced practice clinical pharmacists who provide Comprehensive Medication Management within team-based care focusing on medication optimization, evidence-based practices, and patient-centered goals. These research grants fund multiple sites and expand the number and quality of studies involving BCPPs.
• The Healthy Brains Global Initiative (HBGI), the Mental Health Services Oversight and Accountability Commission, and initially three counties in California, are implementing performance-based pilot programs to improve outcomes for people living with serious mental illnesses. These pilots are testing reimbursement for achieving health, housing, and wellbeing outcomes while strengthening the performance management of existing Full Service Partnership (FSP) services. FSP programs intend to be comprehensive services for individuals who are unhoused and who are experiencing severe mental illness.
• The NIH-funded RAND-USC Schaeffer Opioid Policy Tools and Information Center (OPTIC) is building evidence to guide policy responses to the opioid crisis. RAND and the University of Southern California lead OPTIC, a collaboration of eight research institutions, to create national resources to guide policy responses to the opioid crisis. OPTIC develops and disseminates information on policy effectiveness overall and in diverse, structurally disadvantaged communities, improved tools and methods for assessing policy effects, and strategies for addressing the opioid crisis.
• Insight is opening a new medical-psychiatric hospital to serve the community disproportionately burdened by the Flint Water Crisis with a $2.5 million grant from the Michigan Department of Health and Human Services. The hospital and services are being designed to transform how behavioral health is understood, accessed, treated, and integrated with medical and community services. Research at the hospital will focus on advancing equity in access to behavioral health services, developing treatments for serious illnesses, and supporting youth mental health.
• RAND and Active Minds are evaluating how Send Silence Packing®, the country’s largest traveling campus-based mental health literacy and suicide prevention exhibit, affects college students’ knowledge, behaviors, and stigma around mental health. Findings will guide scalability, resource allocation and decision-making on college campuses and efforts to optimize peer-informed actions to support student mental health and well-being.
• The Child Mind Institute (CMI) is leveraging over $150M from partnerships with the Stavros Niarchos Foundation and the State of California to expand mental health care access for youth in marginalized communities worldwide. CMI utilizes evidence-based, culturally adapted educational resources, provider training, and scalable, innovative, open-source digital technologies for mental health assessment and intervention. The Youth Mental Health Academy recruits a diverse workforce by providing educational and internship experiences to 2,500 high school students from under-represented communities. The Healthy Brain Network openly shares diverse brain and behavior data from >7,000 participants for pediatric mental health and learning research.

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Making Mental Health a Campus-Wide Priority

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I n the first year of the pandemic, anxiety and depression increased by 25 percent worldwide . Additional factors, such as racial injustice, economic inequality, and geopolitical tension, have kept mental health at the forefront ever since. This heightened awareness is long overdue—mental health struggles can have far-reaching effects across societies, including significant impacts in the workplace: Globally, an estimated 12 billion working days (at a cost of US $1 trillion) are lost to depression and anxiety every year.

This was a lived experience for one of us (Jen), who currently serves as the Interim CEO and COO of Mind Share Partners. Immediately after completing her MBA about a decade ago, Jen co-founded a nonprofit organization that focused on challenging social issues. She was primed to put her training in negotiations, financial planning, and ethical leadership to good use.

Four years into that effort and pregnant with her first child, Jen experienced symptoms of depression that affected her work. It’s tough to run an organization when you have near-zero motivation. It didn’t occur to Jen to say anything to her team, funders, or board of directors about what she was going through. She came out of her MBA program thinking that the role of a leader is to be strong and steady and to make strategic decisions. So she stayed silent.

“She came out of her MBA program thinking that the role of a leader is to be strong and steady. So she stayed silent [about what she was going through].”

Looking back, she could have been a more effective leader during those challenging times if she had been open and candid about her situation. Relationships and communication weren’t as strong as they could have been. And others on the team, she found out later, were also quietly navigating their own mental health challenges.

Jen’s story demonstrates why business leaders need to integrate principles of mental health management into their leadership approach. Not to provide therapy—the clinical work should be left to the pros—but to make mental well-being a standard, integral consideration for leadership roles. And this shift begins with business schools, both in the the classrooms where students are learning to become the business leaders of the future and in the university workplace for faculty and staff.

Here, we’ll share considerations for educators and university leaders to prioritize mental wellness on their campuses, as well as strategies for infusing mental health awareness into the business school curriculum.

Work by Dr. Nico P. Pronk , a visiting scientist at the Harvard T.H. Chan School of Public Health, states that “Almost 90% of employees surveyed think employers have a responsibility to support mental health. And 40% would like to see their employer provide training for managers and supervisors that addresses mental health issues.”

Yet, in our work at Mind Share Partners, we often see organizations lean heavily on helping individual employees by giving them treatment-focused benefits and mindfulness apps. But new research from Oxford University shows that these resources do not improve workplace well-being effectively on their own.

A meta-analysis conducted by Deloitte demonstrated a greater return on investment with mental health awareness and training programs. Educating employees on mental health management and taking steps to change company culture are proven to be effective and cost efficient. Meanwhile, individual therapy for employees is cost intensive and yields a lower ROI.

Let’s start by considering a university campus environment, where, often, thousands of faculty, staff, and students live and work, be it in person or virtually. Prioritizing employee mental health in a university setting is just as important as it is in a traditional business setting. University staff experience the same types of mental health struggles, however, they often keep these struggles to themselves due to a lack of resources, or a lack of awareness of resources, and a fear of discrimination.

Carrie, a principal at Mind Share Partners, experienced this firsthand. Working on college campuses for over a decade, she became increasingly aware of how mental health challenges were impacting students . There were regular calls to add mental health professionals to campus counseling centers, training to identify students in crisis, and, unfortunately, campus alerts about students who ended their lives.

However, during her time at three different schools, Carrie doesn’t recall ever being told about resources for the staff. The pressure to perform—especially during the busiest periods, around the start or end of a term—to Carrie, at least, meant keeping her concerns and struggles to herself. The time to care about one’s well-being was during the summer, hopefully.

Many efforts around well-being in higher education focus on the students, and rightly so: Many diagnosable mental health conditions present themselves during early adulthood, with 75 percent of challenges presenting by age 24, according to the National Alliance on Mental Illness . And the current social and political unrest globally, especially on US college campuses, is almost certainly affecting anxiety levels among student populations.

“Integrating mental health does not mean lowering standards of excellence. It means questioning when a pressure-filled environment is helpful or hurtful.”

At the same time, faculty and staff need to care for themselves, too—not only for their own well-being, but also to model healthy behaviors for their students. A 2023 survey of faculty found that many in higher education are burned out. “Like many workers who struggle with low pay, lack of advancement opportunities, and feeling disrespected, higher education faculty members struggle to keep it together,” wrote Sean McCandless et al. in Inside Higher Ed .

Another study in the Journal of Clinical Medicine looks at the growing mental health concerns in academia. With mental health at the forefront, it’s no surprise that three out of four faculty and staff say more mental health support would improve their job satisfaction and retention potential.

Creating a mentally healthy workplace for faculty and staff

In our work, we advise companies and train leaders on how to create a mentally healthy workplace. The first step is to look at company culture. Company culture is like air—when air quality is poor, it has negative health effects.

Here are a few of our suggestions for university leaders when it comes to creating a healthy campus culture for faculty and staff.

Ask: Is this actually urgent? Academic settings tend to pressure high performers to meet high standards of excellence. While high-pressure situations can be unavoidable, they sometimes become the default. Integrating mental health does not mean lowering standards of excellence. It means questioning when a pressure-filled environment is helpful or hurtful. For instance, do your school’s project and publishing timelines coincide with other high-pressure time periods, like the start or end of a term, or during midterm exam periods? Could those timelines be shifted?

Provide flexibility. Our research found that poor work-life balance was a top factor negatively impacting US workers’ mental health. Providing greater flexibility and healthy workplace routines can go a long way, even boosting talent retention. In a review of the literature on the mental health of university faculty, the authors of a 2023 paper found that “supporting mid-career faculty through a facilitative and flexible job environment is key to university success.” In an environment that can be heavily bureaucratic and political, it’s even more important to find ways to build in and prioritize greater flexibility. Can remote working considerations for staff be adjusted, for example? Can schedules flex to accommodate caregiving during the workday?

“When we talk to high-achieving professionals who are managing mental health conditions, they often say the burden of hiding their challenges is bigger than the symptoms of the condition.”

Constantly remind employees of available resources. Mental health resources available to support faculty and staff should be noticeably visible and communicated frequently beyond employee orientation. Our research shows that employees don’t have a lot of trust in HR departments. That means university leadership should make sure messages about mental health resources come from multiple sources, including those with positional power and those with cultural influence.

Share personal stories of mental health challenges to reduce stigma. Storytelling is the most effective way to reduce the stigma around anxiety, depression, and other mental health challenges. When a person in power shares their own mental health experience, they give permission for others to do the same. Academics including Dr. Stephen Hinshaw at the University of California, Berkeley, and Dr. Ruth White , formerly at University of Southern California, have spoken about personal mental health experiences. The same goes for C-level leaders from Pinterest, Minnesota Vikings, and Siemens Energy . When we talk to high-achieving professionals who are managing mental health conditions, they often say the burden of hiding their challenges is bigger than the symptoms of the condition.

Open up a dialogue with colleagues. Although intimidating, mental health conversations can be straightforward . Leaders and department heads often worry that by bringing mental health into a conversation, they will violate privacy laws or say the wrong thing. Discussions of mental health, done properly, don’t violate privacy. Our counsel is to express curiosity about the impact, not the cause. A professor, for instance, may notice a colleague has seemed stressed and distracted. The professor could ask, “I’ve noticed you’ve been quieter recently. How have you been doing?” Don’t dive into diagnoses or causes—provide an opening for discussion or just for listening. The point is to offer psychological safety.

As campuses become more mentally healthy workplaces, they can also become more authentic spaces in which future leaders learn why mental health management is a core piece of strong leadership.

Prepare future leaders by integrating mental health into the curriculum

Some years ago, the president of Columbia University, Minouche Shafik, said , “In the past, jobs were about muscles. Now they’re about brains. But in the future, they’ll be about the heart.” Faculty can help develop more connected, emotionally intelligent business leaders by engaging students in discussions about mental health and leadership; they can teach and model why creating mentally healthy workspaces is a critical management skill.

We recommend integrating topics such as the following into the curriculum at business schools:

Discuss the business case for workplace mental health. Companies that integrate mental health into their employee experience see higher trust and engagement from—and retention of—their people. In addition, younger workers in particular expect mental health support .

“Prioritizing mental health awareness will help business schools ensure we’re developing future leaders who can respond to rapid change and lead effective teams.”

Understand mental health as a strategic consideration. Professors can proactively weave questions about mental health into existing case discussions—for example, by exploring how a merger or a layoff might affect employee well-being.

Explore the meaning of leadership. As mental health emerges as a standard for businesses, students can explore what that means for themselves. Business schools hold these types of conversations very effectively around ethics, and this can be expanded to include mental well-being.

Teachers should keep in mind that it is not their job (or any manager’s or colleague’s job) to be a therapist or to try and solve someone’s mental health challenge. Rather, introducing mental health conversations within business school curricula can help students understand that employee mental well-being is a key leadership consideration.

Note: For additional guidance on how to surface and manage mental health conversations within your curriculum, read the Inspiring Minds article “ It’s Time We Talk About Mental Health in Business Classrooms .”

Moving forward

While mental health wasn’t an active part of workplace discussions in 2013, when Jen completed her MBA, it is now. Business schools have an opportunity to help set new industry standards and teach students the practical skills they need to be more successful CEOs, managers, and entrepreneurs and to provide faculty and staff with the support they need for themselves.

We have one more story to tell. During Jen’s second pregnancy, she again had symptoms of depression. But this time, at a new organization, she shared her situation—and not in some grand or dramatic way. She sent a message about what she was experiencing and, as time went on, would mention when she was having a particularly challenging week. By sharing her experience and getting consistent reinforcement from leaders across the organization, she gave permission to others to acknowledge their own experiences and seek support early on, rather than waiting for a crisis. She also gave herself permission to have her experience without the extra burden of hiding it, demonstrating that leadership and business success can happen alongside mental health challenges.

The future of work will require leaders to prioritize mental health—to retain key staff, to attract new talent, and to run productive teams. By modeling what this looks like at universities and incorporating mental health into the student experience, business schools can more effectively prepare future leaders.

Jen Porter is interim CEO and managing director at Mind Share Partners. She advises and trains companies around the world to create mentally healthy workplaces. Her work has been published in Harvard Business Review and Forbes . She holds an MBA from Harvard University. She has been a TEDx speaker and a Forbes 30 Under 30 Social Entrepreneur.

Carrie Grogan is a principal at Mind Share Partners, where she leads impact-focused advising on how to create a mentally healthy workplace. She facilitates workplace training and designs programs to reduce stigma and increase belonging. Her work spans Fortune 50 retailers to local nonprofits. She has spoken at the 2024 Association for Talent Development International Conference, HR Transform, COO Forum, and the MJ Murdock Charitable Trust.

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Integrated Youth Services Network of Networks

From: Canadian Institutes of Health Research

Backgrounder

The Government of Canada is committed to helping youth access the mental health care they need, where and when they need it. That is why it is providing up to $59 million to the Integrated Youth Services Network of Networks, or IYS-Net. This initiative will link together a web of provincial, territorial, and Indigenous networks to create a learning health system, where research evidence, data, and youths’ lived experiences are used to inform processes, policies, and practices to improve services.

June 3, 2024

The funding breaks down this way:

• Close to $9 million for six integrated youth services provincial networks in Québec, Ontario, Manitoba, New Brunswick, Nova Scotia, and Prince Edward Island, and the national Indigenous network.
• More than $21 million to expand IYS-Net to all provinces and territories.
• More than $10 million to enable the Indigenous IYS network to expand across Canada.
• Up to $18 million for an IYS Learning Health System Data Platform supported by the Centre for Addiction and Mental Health to allow the collection, processing and sharing of more timely, accurate, comprehensive, and diverse data sets on youth mental health and substance use.

Further details about the researchers receiving funding today:

This investment is made possible thanks to support from the Canadian Institutes of Health Research, Indigenous Services Canada, and additional support from the Graham Boeckh Foundation , the  Bell-GBF Partnership , RBC , the  McConnell Foundation , the  Hunter Family Foundation  and the  Medavie Foundation .

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Navigating Mental Health at Work: A Reading List

• HBR Editors

Resources for employees, managers, and leaders.

Simone Biles’s withdrawal from Olympics competition has reignited a global conversation about mental health and work. Here’s some resources for those struggling with mental health at work, as well as managers who want to prepare for these these conversations with employees.

As the latest in a series of high-achieving public figures who has taken a step back from work to focus on their mental health, Simone Biles has reignited an ongoing conversation about mental health, disclosure, and stigma.

But public figures are not alone: More and more people are talking to their bosses about their mental health. Surveys show employees want to work at a company whose culture supports mental health ; in fact, it’s becoming one of the most-requested benefits in the wake of the pandemic . This is especially true for young workers: In a recent Deloitte survey of more than 27,000 Millennials and GenZers around the world, nearly half ranked mental health as their first or second priority.

As a manager, how can you prepare yourself for these conversations with your employees? Or better yet, what can you do if you’re the one personally struggling with mental health at work? Here are some resources to help.

For Individuals

We Need to Talk About Mental Health at Work

In the U.S. one in four adults struggle with it. (November 2018)

What Covid-19 Has Done to Our Well-Being in 12 Charts

The pandemic has led to mental health declines, increased work demands, and feelings of loneliness. But the news isn’t all bad. (February 2021)

Make Mental Health Your #1 Priority

In a global survey, 48% of Gen Zs said they feel anxious most of the time. (September 2020)

Your Mental Health and Your Work (podcast)

At a time when we bring so much of ourselves to work, mental health is still something we don’t like talking about at the office. But so many high-achieving people have suffered — or are currently suffering — from anxiety, depression, or other mental and emotional issues. (September 2019)

When You Need to Take Time Off for Mental Health Reasons

And how to get back into the swing of things afterward. (March 2018)

For Managers

Research: People Want Their Employers to Talk About Mental Health

Nearly 60% of employees have never discussed their mental health at work. (October 2019)

When Your Employee Discloses a Mental Health Condition

Best practices for navigating the conversation. (February 2021)

Talking About Mental Health with Your Employees — Without Overstepping

Three tips. (November 2020)

Eight Ways Managers Can Support Employees’ Mental Health

Nearly 42% of employees report a decline in mental health since the pandemic began. (August 2020)

Five Ways Bosses Can Reduce the Stigma of Mental Health at Work

One in four adults struggle with a mental health issue. (February 2019)

• This story is by the staff at Harvard Business Review.

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Hidden recession? Mental illness costs the U.S. a staggering $282 billion annually, shows new study

Mental illness isn’t just a pervasive problem in the U.S.—one in five adults experience it each year, per the nonprofit National Alliance on Mental Illness —it’s also an expensive one, costing the economy $282 billion annually. This, according to a new study by economists at Yale and Columbia universities and the University of Wisconsin-Madison.

The research, published in April as a working paper by the nonpartisan National Bureau of Economic Research , reveals the estimate is equivalent to an average economic recession, or 1.7% of the nation’s aggregate consumption . The $282 billion price tag is also 30% more than costs estimated in previous epidemiological studies, which researchers noted focused on the cost of treatment and income loss due to mental illness .

“In this paper, we develop the first integrated model of macroeconomics and mental health building on classic and modern psychiatric theories,” coauthor Aleh Tsyvinski, PhD , a professor in the Yale Department of Economics , said in a news release . “We show that mental illness alters people’s consumption, savings, portfolio choices, as well as the country’s labor supply, generating enormous annual costs to our economy.”

People with mental illness may consume less, opt for less-demanding jobs, and avoid investing in risky assets such as a house or stocks, Tsyvinski said. His team’s data showed people experiencing mild or severe mental illness consumed 3–7% fewer goods and services and worked 13–23% less than healthy individuals.

“We wanted to get a better understanding of mental illness and quantify its economic costs,” coauthor Job Boerma, PhD , an assistant professor in the Department of Economics at UW-Madison , said in another news release . “Mental illness is something that 20% of the population experiences at any given point in time. The fact that the costs of mental illness amount to a number as large as 1.7% of aggregate consumption for the U.S. population—that’s massive.”

Increasing mental health care access would boost economy

Boerma and Tsyvinski, along with Boaz Abramson, PhD , an assistant professor in the Finance Division at Columbia Business School , applied their research to three policy proposals backed by the Biden administration :

• Expanding availability of mental health services
• Lowering out-of-pocket costs
• Improving mental health of adolescents and young adults

As of April 1, more than 122 million Americans were living in mental health professional shortage areas, according to health policy nonprofit KFF . In these locales, just 27% of mental health care needs are met. Eliminating this deficit would not only reduce mental illness by 3.1% but also bear societal benefits equal to 1.1% of aggregate consumption, or $118 billion , the study found.

Providing care for everyone ages 16–25 experiencing mental illness would be even more beneficial, resulting in estimated gains of 1.7% of aggregate consumption.

However, the researchers found that lowering mental health care costs would result in minimal economic impact. The problem, according to Boerma, is many people with mental illness don’t seek treatment, whether due to a dearth of available services, stigma attached to mental illness, or belief treatment would be ineffective. Cheaper services would be unlikely to surmount the challenges.

“If you don’t affect those other factors, lowering the cost of care itself is not going to increase people’s propensity to take up treatment,” Boerma said.

Next, Boerma plans to make lawmakers aware of his team’s findings, saying in a UW-Madison news release he hopes the continued blending of economic and psychiatric research will fuel science-backed policymaking.

“Very exciting insights are always coming at the edges or the overlaps of different fields,” Boerma said. “It will be good for the field if we do this more.”

If you need immediate mental health support, contact the 988 Suicide & Crisis Lifeline .

For more on mental health:

• Almost 1 in 2 Americans feel they’ve lost time to poor mental health, survey says. It’s worse for people with depression or anxiety
• Americans are increasingly concerned about their mental health, survey says. Here’s how social media plays a role
• 75% of Americans think mental health issues are treated worse than physical illness, new survey says. Here’s why
• These states and cities have the best—and worst—brain health in America

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Why we don't exercise

We know that moving our bodies is good for us. So what keeps us from doing it?

For the better part of a year in 2017, I could barely will myself to leave my house. I was experiencing a prolonged depressive episode with daily, sometimes hourly, panic attacks, and I couldn't see the point in continuing on.

Many things helped me survive. Talking it through in therapy several times a week was like opening a pressure valve in my brain — it kept me functioning just enough to get by. Medication had mixed results — I felt less panicky, but also less joy, excitement, and other essential emotions. Crying to friends provided temporary catharsis. But it wasn't until I discovered Muay Thai, a form of kickboxing , that it felt as if day-to-day life might provide something other than hopelessness.

Every other form of healing I'd tried had focused my mind — its disordered thoughts and supposed chemical imbalances. What I hadn't tried was getting out of it altogether. When firm but well-meaning coaches yelled at me to fix my form, do five more pushups, and kick the bag until my shins were red and nearly bleeding, it jump-started my nervous system. It made me feel human again.

It's a trope to say you should not tell a depressed person to go outside, take a walk, or go for a run. Doing so would dismiss the severity and reality of their illness, like telling someone with a broken arm to go play catch. To some extent, this is true: It's probably not the best idea to tell someone struggling deeply with mental illness to simply suck it up and walk it off. But it's also true that when someone encouraged me to get out there and use my body, it was precisely what I needed at my lowest moment. I ended up at the gym only because my friends repeatedly encouraged me to come with them to a class until one day I finally did. It wasn't a cure-all, but it made me believe that a solution might exist.

Many of our collective crises — depression , anxiety , unhealthiness, and loneliness — are made worse by the same thing: our tendency toward a sedentary, shut-in lifestyle . We live in a society that makes it extremely difficult to find the time and space to be active. An abundance of research shows that exercise is good for depression , and yet most of the time when I hear people talk about the mental-health crisis — on TikTok, on X, and in real life — it is rarely mentioned. In my experience, it's much more common to hear people talk about finding the right diagnosis, the right medication, and the right kind of therapy than it is to see people encouraging their loved ones to get the heck outside.

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Many of us know exercise is good for us. All that's left is getting up off our asses.

The evidence is overwhelming that physical activity is good for both our bodies and our brains. A meta-review of studies that included 128,000 participants found that exercise of any kind significantly reduced symptoms of anxiety and depression . There are several theories as to why this is — exercise could increase the availability of neurotransmitters like dopamine in the brain, or it could help the brain form new neural pathways that are helpful to escaping cycles of depression. Either way, moving is good for our brains.

And the physical consequences of not moving enough are well-documented: heart disease, diabetes, high blood pressure, cancer, and a host of other maladies are linked to low physical activity. It is also bad for our mental health: A 2014 meta-analysis of more than 100,000 people found that increased sedentary time was positively correlated with rates of depression. A study from the beginning of COVID found that it was harder for people to stop being depressed if they spent too much time sitting.

Depression is a vicious cycle; it pits your brain against itself.

Despite the research, Americans have become less active over time. By one estimate, we're getting 27 fewer minutes of physical activity on average each day than we did 200 years ago. And for the past several decades, only about a quarter of American adults have met the recommended guidance of at least 20 minutes of exercise a day, according to the Centers for Disease Control and Prevention. One 2019 study found that we spent 82% of our time sedentary.

For kids, who need even more physical activity, the decline is stark. A 2022 Report Card on Physical Activity for Children and Youth gave the US a D- score, concluding that America, while never sufficiently supportive of physical activity, had become even worse at making the space and time for it. In 2007, an estimated 30% of adolescents completed the recommended 60 minutes of moderate-to-vigorous activity every day. By 2020 that number had fallen below 9%. Far fewer kids participate in team sports or walk or bike to school than did in the past, the report found. In Canada, as one study put it, pediatricians are so concerned about the decline in physical activity that they are encouraging parents to let kids engage in "thrilling and exciting forms of free play that involve uncertainty of outcome and a possibility of physical injury."

Instead of getting enough exercise, we're stuck lounging around on our phones. We've replaced real-world, bodily stimulation with mental stimulation from our screens. Meanwhile, our brains are rotting. In one study, nearly half of Americans ages 18 to 29 reported experiencing depression or anxiety in 2023. And over the past few decades, mental illness for teens and children has been on the rise.

Instead of looking at the situation and concluding that we all need to exercise more, some people are doing the opposite. Certain trends circulating social media emphasize not using your body: " hurkle-durkle ," aka "bed rotting," involves wrapping yourself in comfy clothes and bed linens and staying in bed way past the time you should be waking up. But while there is a time and place for doing nothing and relaxing, Americans aren't actually getting more rest. Much of the country is chronically underslept .

In this trend, I see the logic of depression — the sense that nothing can or will change so there's no point in trying. Much of America, it seems, has given up on trying to be active.

Over time, my year from hell faded from my mind. But eventually, my exercise routine went with it. I didn't need to work out to stay sane, I thought, and so I stopped committing to it. Then I moved away from the Muay Thai gym and completely fell out of the routine. After a few years, the depression caught up to me. It wasn't as catastrophic as before, more of a persistent ennui that was hard to shake. I tried to figure it out in therapy. I tried to intellectualize it. I tried to excuse it: There was no point in trying anything, life was just inherently bad, the political state of the world was scary, the outside world was too expensive. It wasn't working.

I've gotten to the point where exercise — being in my body, sweating — is more important to me than more mind-oriented forms of therapy.

Then one day, early in the pandemic when I was prone to languishing in my room for hours on end, a roommate suggested I come to the tennis court with them for an hour. I was immediately hooked. Playing tennis with friends several times a week wasn't just fun, and it didn't just help get me into shape — it became a main focal point of my life. It provided me with a new relationship to my body and mind. I'd forgotten that exercise, while not a cure for my mental illness, was a necessary precursor to my mental wellness. After years of intellectualizing my sadness and discomfort, I once again had something that got me into my body, got my endorphins going, and, most important, got me to stop thinking about anything other than where to place the ball on the other side of the court.

Depression is a vicious cycle; it pits your brain against itself. When I was at my worst, the usual advice of "don't tell a depressed person what to do" wasn't helpful to me because I needed someone to help me break that cycle by telling me to stop repeating the same patterns. What saved me was friends who helped me get out of the house, suggested I join the gym with them, or encouraged me to do anything to get me out of my head.

I still sometimes get depressed. I still struggle with mental health. But I now feel as if I have a reliable way to help myself out of it. I've gotten to the point where exercise — being in my body, sweating — is more important to me than more mind-oriented forms of therapy . It's not a magic cure, but I now see it as a fundamental baseline. If I'm not moving, nothing will help my sad state.

SSRI prescriptions continue to rise and more people are seeking therapy , but depression and anxiety rates remain sky-high. If you've tried nearly everything else, why not simply get moving?

P.E. Moskowitz runs  Mental Hellth , a newsletter on psychology, psychiatry, and modern society. They are also the author of the forthcoming book Rabbit Hole, a combination of memoir and reportage about the role drugs play in our happiness.

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F.D.A. Panel Rejects MDMA-Aided Therapy for PTSD

An independent group of experts expressed concerns that the data from clinical trials did not outweigh risks for treatment of post-traumatic stress disorder.

By Andrew Jacobs

An independent advisory panel of the Food and Drug Administration rejected the use of MDMA-assisted therapy for post-traumatic stress disorder on Tuesday, highlighting the unparalleled regulatory challenges of a novel therapy using the drug commonly known as Ecstasy.

Before the vote, members of the panel raised concerns about the designs of the two studies submitted by the drug’s sponsor, Lykos Therapeutics. Many questions focused on the fact that study participants were by and large able to correctly guess whether they had been given MDMA, also known by the names of Ecstasy or molly.

The panel voted 9-2 on whether the MDMA-assisted therapy was effective, and voted 10-1 on whether the proposed treatment’s benefits outweighed its risks.

Other panelists expressed concerns over the drug’s potential cardiovascular effects, and possible bias among the therapists and facilitators who guided the sessions and may have positively influenced patient outcomes. A case of misconduct involving a patient and therapist in the study also weighed on some panelists’ minds.

Many of the committee members said they were especially worried about the failure of Lykos to collect detailed data from participants on the potential for abuse of a drug that generates feelings of bliss and well-being.

“I absolutely agree that we need new and better treatments for PTSD,” said Paul Holtzheimer, deputy director for research at the National Center for PTSD, a panelist who voted no on the question of whether the benefits of MDMA-therapy outweighed the risks.

“However, I also note that premature introduction of a treatment can actually stifle development, stifle implementation and lead to premature adoption of treatments that are either not completely known to be safe, not fully effective or not being used at their optimal efficacy,” he added.

While the vote is not binding on the F.D.A., the agency often follows the recommendations of its advisory panels. A final decision by the agency is expected in mid-August.

MDMA, or methylenedioxymethamphetamine, also sometimes referred to as midomafetamine is a synthetic psychoactive drug that fosters self-awareness, feelings of empathy and social connectedness.

The illegal drug is listed as a Schedule I substance, defined as having no accepted medical use and a high potential for abuse. Should it win F.D.A. approval, federal health authorities and Justice Department officials would have to follow certain steps to downgrade the drug’s listing, much like the process now underway with cannabis .

The D.E.A. might also set production quotas for the drug ingredients, as it does with stimulant medications used to treat ADHD.

With the panel’s focus on such topics as “euphoria,” “suicidal ideation” and “expectation bias,” the daylong session on Tuesday demonstrated the nuances and complexities facing regulators as they grapple with the terra incognita of a therapy that only recently entered mainstream psychiatry after the nation’s decades-long war on drugs.

An added wrinkle: the F.D.A. is a regulator of medications. It does not regulate psychotherapy and has not evaluated drugs whose efficacy is tied to talk therapy.

If approved, MDMA-assisted therapy would be the first new treatment for PTSD in nearly 25 years. The condition, which affects some 13 million Americans, has been implicated in the outsized suicide rates among military veterans, whose suffering has galvanized lawmakers from both parties and prompted a sea change in public attitudes about therapies reliant on psychedelic compounds.

According to the studies submitted by Lykos, patients who received MDMA plus psychotherapy reported significant improvements in their mental health. The most recent drug trial found that more than 86 percent of those who took MDMA achieved a measurable reduction in severity of their PTSD symptoms.

About 71 percent of participants improved enough that they no longer met the criteria for a diagnosis. Of those who took the placebo, 69 percent improved and nearly 48 percent no longer qualified for a PTSD diagnosis, according to the submitted data.

The questions, concerns and evident skepticism voiced by the 10-member panel echoed those raised by agency staff members, who last week issued a briefing document aimed at helping the panel evaluate the efficacy and potential adverse health effects of MDMA therapy.

In her opening remarks, Dr. Tiffany Farchione, director of the F.D.A.’s division of psychiatry, noted the regulatory challenges posed by MDMA, saying “we’ve been learning as we go along.” But in her testimony and in staff documents, she and other agency officials repeatedly noted that the overall study results were significant and lasting.

“Although the application presents a number of complex review issues, it does include two positive studies in which participants in the midomafetamine arm experienced statistically significant and clinically meaningful improvement in their PTSD symptoms,” she said. “And that improvement appears to be durable for at least several months after the end of the acute treatment period.”

Much of the criticism about Lykos’s study designs focused on so-called functional unblinding, a problem that affects many studies involving psychoactive compounds. Although the roughly 400 patients who took part in the studies were not told whether they had received MDMA or a placebo, to reduce the odds of bias in the results, the vast majority were acutely aware of any altered state of mind, leading them to correctly guess which study arm they were enrolled in.

The F.D.A., which worked with Lykos to design the trials, has acknowledged shortcomings in the study designs and recently issued new guidance to address the issues facing psychedelic researchers.

A number of other critical voices emerged in recent months. They include the Institute for Clinical and Economic Review, a nonprofit that examines the costs and effectiveness of medications, which issued a report calling the effects of the treatment “inconclusive” and questioning Lykos’s study results.

Other organizations, like the American Psychiatric Association, have not opposed approval outright, but have called on the F.D.A. to mitigate any potential negative consequences by crafting rigorous regulations, strict prescribing and dispensing controls, and close monitoring of patients.

The F.D.A. staff analysis recommended that approval should be contingent on restricted health care settings, monitoring of patients and diligent reporting of adverse events.

Just before they voted on Tuesday, the advisory panel heard from more than 30 speakers who offered starkly divergent views on the application.

Several critics focused on Rick Doblin, a veteran psychedelics advocate who in 1986 founded the Multidisciplinary Association for Psychedelic Studies, the nonprofit organization that filed the original application for MDMA-assisted therapy with the F.DA. The organization later created a for-profit entity that earlier this year became Lykos.

Brian Pace, a lecturer at Ohio State University, described the company applying for approval as a “therapy cult” and criticized Mr. Doblin’s public comments highlighting his zeal for psychedelics, including a belief that legalizing and regulating them would bring about world peace.

But the majority of those who spoke in favor of the application offered deeply personal accounts of how MDMA-therapy had largely quieted the symptoms of their PTSD.

Among them was Cristina Pearse, who said she suffered from PTSD after being sexually assaulted when she was 9. Over the years, she said she had been prescribed a litany of psychiatric medications and at one point she attempted suicide.

MDMA therapy, she said, changed her life. “What used to feel like a tsunami of overwhelming panic was now merely a puddle at my feet,” said Ms. Pearse, who started an organization that helps women recovering from trauma.

She ended her testimony by urging the F.D.A. to approve the application.

“How many more people need to die before we approve an effective therapy?” she asked. “As you weigh the risk, please keep in mind that this therapy can save many lives. I lost most of my life to this disease. I’m grateful to reclaim it now. But I wish this was an approved medication decades ago.”

Andrew Jacobs is a Times reporter focused on how healthcare policy, politics and corporate interests affect people’s lives. More about Andrew Jacobs

Advances in Psychedelic Therapy

Psychedelics — though mostly still illegal — have surged in popularity in recent years as alternative treatments for mental health..

After decades of demonization and criminalization, psychedelic drugs are on the cusp of entering mainstream psychiatry , with U.S. combat veterans leading the lobbying effort .

Psychoactive mushrooms, legal in Oregon  but still illegal under federal law, are gaining popularity as therapy tools .

As psychedelics move from the underground to mainstream medicine, clinicians aspiring to work in the field are inducing altered states with deep breathing .

MDMA-assisted therapy , which seems to be effective in reducing symptoms of post-traumatic stress disorder, is inching closer to approval in the United States .

Ketamine has become increasingly popular as a therapy for treatment-resistant depression . But the misuse of the anesthetic drug has spurred F.D.A. warnings .

Many drugs known for mind-altering trips are being studied to treat depression, substance use and other disorders. This is what researchers have learned so far .

While psychedelics are showing real promise for therapeutic use, they can be dangerous for some. Here’s what to know about who should be cautious .

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Halsey reveals illness, announces new album and shares new song ‘The End’

FILE - Halsey appears at the Vanity Fair Oscar Party in Beverly Hills, Calif., on March 27, 2022. (Photo by Evan Agostini/Invision/AP, File)

FILE - Halsey appears at the amfAR Cinema Against AIDS benefit during the 76th Cannes international film festival, Cap d’Antibes, southern France on May 25, 2023. (Photo by Vianney Le Caer/Invision/AP, File)

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NEW YORK (AP) — Halsey has been privately battling illness, the singer revealed Tuesday.

She shared the news on Instagram in a series of videos that appear to document the singer receiving infusions.

“Long story short, I’m lucky to be alive,” she wrote in the caption. “Short story long, I wrote an album.”

A diagnosis was not immediately clear. Representatives for Halsey did not immediately respond to The Associated Press’ request for comment.

“I feel like an old lady,” Halsey says aloud in the first video, while rubbing her legs in apparent pain. “I told myself I’m giving myself two more years to be sick. At 30, I’m having a rebirth and I’m not gonna be sick and I’m gonna look super hot and have lots of energy and I’m just gonna get to re-do my 20s in my 30s.”

The singer also released a new song on Tuesday, an acoustic guitar ballad titled “The End.”

The new album on the horizon is a follow-up to her fourth studio album, 2021’s ambitious “If I Can’t Have Love, I Want Power,” produced by Nine Inch Nails’ Trent Reznor and Atticus Ross.

According to a press release, Halsey is making a donation to both The Leukemia & Lymphoma Society and the Lupus Research Alliance alongside the release of “The End.”