EAPs can be an important part of broader preventative occupational health activity, according to IRS research, but need to be promoted to employees and operated effectively by managers.

KEY POINTS

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  There is a strong business case for operating an EAP.
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  The belief that EAPs could protect employers against liability for work-related stress, however, has been shown to be erroneous.
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  Internal promotion of EAPs is necessary to encourage take-up.
  

A recent survey by Employment Review1 suggested that, although many employers provide confidential information and counselling support to their staff through an employee assistance programme (EAP), relatively few employees take advantage of such services. It was also found that few organisations ask their EAP provider to deliver detailed management reports on the operation of the service. Such reports could be a source of important information, for example on the numbers of staff using an EAP over a period, or the type of issues raised in telephone conversations or during counselling. But even where reports are provided, it seems, most managements make little use of them.

This article reports on how these issues are dealt with in three very different organisations making use of EAPs.

Hatton v Sutherland: a motivating factor?

The recent Court of Appeal decision in Daw v Intel Corporation (UK) Ltd2 has underlined that EAPs do not constitute protection for employers against claims for work-related stress. In this case, the defendant employer argued that because it had provided occupational health services it had discharged its duty to the plaintiff, despite the fact that she suffered a breakdown as a result of her excessive workload.The Court of Appeal rejected the argument, agreeing with the original trial judge's findings that the company had been negligent, making clear in its judgment that a counselling service is a tool not a panacea.

The suggestion that the provision of an EAP, in itself, might offer employers legal protection arose out of the earlier work-related stress case of Sutherland v Hatton3, in 2002, when a Court of Appeal judgment laid down principles for dealing with work-related stress cases. These Sutherland or Hatton principles were intended as a guide for judges in future stress compensation claims; but they were exploited in the marketing of some EAPs because they included the statement: "An employer that offers a confidential advice service, with referral to appropriate counselling or treatment services, is unlikely to be found in breach of duty."

Three case studies

The Hatton principles were not a factor in the introduction of an EAP at British Arab Commercial Bank (BACB), an associate of HSBC with 130 employees in the UK. David Crew, BACB's head of HR, joined the organisation in 2000. Crew had identified a "gap in provision" and made the introduction of an EAP one of his first priorities, having seen the benefit of an EAP in supporting staff in his previous job at HSBC. "The availability of an EAP means staff are less likely to take time off sick or to be distracted at work by issues outside it," Crew says. The Hatton case reinforced his belief that introducing an EAP was "the right thing".

The main driver behind the introduction of an EAP at the Treloar Trust - an organisation providing education and care for disabled children and young adults - was a desire to offer as much support as possible to the 750 staff. The substantial care needs of the trust's students place huge demands on employees' physical, mental and emotional wellbeing, according to Caroline Blanchette, a member of the HR team. Two years ago, the Treloar Trust introduced a 24-hour confidential support helpline, provided by Capita, as part of a wider occupational health initiative. The EAP was originally only going to be offered to employees taking up a health insurance cash plan, but the organisation felt it was important that all staff had access to it. The trust also retains the services of two counsellors, to which employees can either self-refer or be referred by the HR or OH team, or through the EAP helpline. Counsellors have been in place for more than 10 years, and offer up to six sessions of face-to-face counselling per referral. Although the principal reason for introducing the helpline was to offer support to staff, Blanchette does accept that the Hatton principles were also a factor: "We wanted to tick all the right boxes," she says.

The UK commercial division of the eye health firm, Bausch and Lomb, has operated a Bupa-provided EAP for several years. Liza Sutherland, an HR consultant at the company, says that proactive organisations increasingly view an EAP as "a business partner". She explains: "When employees talk about personal issues, in-house HR people are aware that we often don't have the skills to give the answers they need, so we offer a signposting to the EAP."

Needs assessments

The BACB carefully examined what it wanted from a service before selecting an EAP provider, says Crew. It concluded that the primary need was for a support mechanism for all staff to reduce distractions and enable staff to make a productive contribution. Crew's HR team considered two providers, before selecting the EAP provided by Ceridian LifeWorks. This was provided as a core benefit for all staff, rather than as part of the employer's flexible benefit scheme.

In many cases, employers will take into accountparticular characteristics of the workforce when they decide what type of EAP to introduce - for example, the languages spoken or shifts worked. Although BACB is a very diverse organisation - its 130 staff in the UK speak a total of 21 different languages - all speak English, so this was not an issue in deciding on the type of EAP contract, according to Crew.

The Treloar Trust also undertook a needs assessment before drawing up contract specifications. Blanchette reviewed "what wasn't going so well" - primarily figures on sickness absence - and examined recent trends in HR practice. Staff were also asking for a service. "There was both a business and an emotional case for an EAP," Blanchette says. She looked at what the organisation wanted from an employee support service, and talked to the local NHS Plus provider and other local organisations.

EAPs need marketing

Liza Sutherland at Bausch and Lomb believes the EAP at the UK commercial division of her organisation is a valuable tool, but is not well publicised, resulting in relatively low usage. She has been in post for less than a year, and is spending time increasing awareness of the EAP amongst line managers and employees and working with the provider on developing innovative ways to market it. Current marketing drives include: posters describing the referral routes into the service; presentations from the provider, which are also available online; and quarterly newsletters. Softer marketing techniques focus on constantly reminding line managers to mention the EAP to team members, and raising issues and problems that might benefit from the EAP. She also believes there is potential for the employee, manager and HR to act in partnership with the EAP, for example in cases where the employee does not want to act alone - although she adds that, for ethical reasons, the service will always require the employee to make the initial approach to the EAP.

Usage rates for the EAP at the BACB are "fine; not too low, or too high to suggest real problems", says Crew. According to the latest activity report, in the 12 months to the end of September 2006 there were 54 contacts, 24 by telephone and 30 over the internet. Eleven of the telephone contacts requested detailed help and guidance, and one resulted in face-to-face counselling. The EAP provider sends out regular flyers to market the service, with the aim of keeping it at the front of peoples' minds. The HR department also circulates annual figures on usage, and includes a question on the EAP in its regular employee attitude surveys. Details of the EAP are a permanent fixture on the company intranet and staff noticeboards.

Management information

Most EAP providers will give regular activity reports covering information such as the numbers of employees using the service, the types of issues raised and the support offered. Some providers are seeking to extend this management information into new areas as a way of adding value to the EAP - for example, by providing commentary on the kinds of pressures and problems facing the workforce, or anonymised case studies of how individuals have been helped to remain productive and at work during a personal crisis.

At BACB, Crew says he does not ask the EAP provider for any information over and above that given in the annual activity report; he believes that his senior management is already convinced of the business case for the service, so does not need further evidence of its worth. Neither the Treloar Trust nor Bausch and Lomb has been offered more in-depth management information as part of the EAP contract, although Sutherland agrees that such data could be quite useful. Her HR department, however, does keep an eye out for any signs or trends emerging from activity reports, and would certainly investigate matters if issues like bullying or harassment started to cluster in a particular department. Bausch and Lomb now receive activity reports quarterly. The most recent concluded that the highest numbers of calls concerned advice on legal issues, although there were also three referrals for counselling.

Emerging elements

The function of an EAP, as underlined by Linda Hoskinson of People Resolutions Group in her recent article in this journal4, should be to act proactively and provide help and advice at an early stage, rather than just reacting retrospectively in the event of a crisis. Indeed, the most proactive EAP providers and employers seek to move support services into new areas of management. This might include, for example, conducting stress audits, coaching line managers in handling sensitive issues and post-incident contingency planning. US-based providers, in particular, are developing a range of "employee threat assessment" services, particularly in the light of the multiple shootings at the Virginia Tech campus in the US.

Line managers at Bausch and Lomb are encouraged to contact the EAP for advice and guidance on how to handle a particular situation, for example before a difficult conversation or meeting with a team member. Sutherland hopes to see an increase in managers' use of the EAP for this purpose in the next few activity reports - a major merger has just been announced, and she expects EAP usage levels to rise generally, reflecting the marketing effort and employees' comfort about using the service in a time of transition.

Crew will sometimes encourage BACB line managers to contact the EAP for advice or guidance on how to manage a particular issue in their team, especially if it is a situation they have not encountered previously. BACB does not use the EAP provider to carry out stress audits, as employee surveys do not suggest that the organisation currently has a big issue with stress. However, the bank's EAP contract includes a provision covering counselling following traumatic events, such as terrorist incidents or threats of terrorism.

The Treloar Trust is considering a health check survey of employees to explore work-related stress and identify areas for improvement, including how managers might be supported to manage wellbeing issues better. This could result in the trust asking its EAP to act in a more proactive way in future - for example, training and coaching line managers. Blanchette adds that the current tendency is for managers to express relief once a case is brought to the attention of the OH team, and to pass on responsibility rather than recognise that they also have a role in managing it.

Referral routes

A good EAP should work proactively, providing help to individuals at an early stage, and certainly before a crisis point is reached. This means that employers need to offer a mix of referral routes into the service. Although this includes self-referral, it is recognised that the tendency is for individuals to self-refer late into a crisis. The employers we spoke to all operate a range of referral routes including, in some cases, the option for line managers, HR professionals and individual employees to work in partnership with the EAP provider on a referral.

In order to prevent late referrals, the HR team at the BACB always reminds employees about the EAP and encourages them to use the service because, Crew notes, "It's not necessarily the first thing they think of if they're in a bit of a state." He also stresses to employees that the EAP should not be contacted as a last resort, or "something to do when you fail", but is a useful source of preventative advice and guidance. The HR team will follow up sensitively their suggestions to individuals to contact the EAP, for example by asking employees whether they were able to get through on the telephone line, or checking "that they're generally OK". Crew believes this informal approach works best for his organisation.

The HR department at Treloar Trust coordinates all employee support activities, although employees can self-refer to the OH team, which will then refer them for counselling if appropriate. The OH team will prepare a report giving advice, for example, on the need for modifications to jobs or working patterns, or the need for specialist support, such as face-to-face counselling. Employees book counselling directly with a counsellor, and the HR function never sees details of who is using this service. To protect anonymity, the HR department will receive anonymised invoices for counselling - "it's a closed circle", Blanchette points out. The Treloar Trust support services receive many self-referrals, "because of the type of organisation we are", according to Blanchette. She adds: "The trust is a very open, supportive environment, so it is incredibly easy to encourage people to seek help."

Employees dialling the Bausch and Lomb (UK commercial division) EAP are assessed on the telephone and, if appropriate, are directed to a counsellor in their local area. Employees must contact the EAP directly - the HR department or a line manager cannot contact the service and ask it to get in touch with the employee - which does mean the EAP is forced to be reactive in some cases. For example, the company became aware of a woman employee believed to be at risk of self-harm. The woman was happy for the EAP or a counsellor to contact her, but would not make the first move, making it difficult for the employer to help.

Demonstrating return on investment

"The cost of the EAP is modest and the benefit is self evident," according to Crew at BACB, who never has to fight for the service to continue. Many senior people at the bank use the EAP, he says, and are well aware of what it does and how it benefits the organisation.

At the Treloar Trust, the governing body did want to see hard evidence on the usage and cost of the telephone advice line and counsellors in the first two years of their operation, which Blanchette was able to provide using hard metrics to demonstrate the business case. In 2004/05, overtime costs (to cover absent staff) fell as a proportion of the salary bill by 0.6 percentage points, to 2.31%. The total number of days lost to sickness in the same period fell by 900, to 5,208 days, including significant reductions in days lost due to stress and depression. The trust now reviews the telephone advice line and the counselling service on an annual basis, and the governing body accepts that employee support is "part of our organisational culture", according to Blanchette.

Conclusion

The vast majority of employers operating an EAP believe it is a valuable way of providing confidential support to help employees and their immediate family with personal or work-related problems that might otherwise affect productivity, performance and attendance. Most programmes offer a 24-hour helpline, staffed by professionals with the skills to offer advice and help with, for example, a personal crisis, addiction problem or mental health issues. More practical support is also offered on legal, financial and taxation issues.

Yet IRS research indicates that take-up of EAPs is often lower than hoped for or predicted by employers, suggesting that they may need to be more effectively "marketed" to staff or incorporated into broader health promotion activities.

It is also clear that the emerging elements of EAPs offered by a growing number of providers have, in general, yet to be appreciated or used by employers: few purchasers of EAPs use them as a resource to assist managers in handling difficult situations, for example. Nor do many employers exploit EAPs as a means of providing management information - for example, to highlight hotspots for work-related stress or clusters of harassment and bullying cases - despite the moves in that direction by the companies mentioned here.

1. Employment Review 874, 4 June 2007, www.xperthr.co.uk.

2. "Counselling not a panacea for dealing with stress at work", OHR 127, May/June 2007, p.8. In fact, this decision only reiterated what had been stated by the Law Lords in Barber v Somerset County Council (see OHR 110, July/August 2004, p.10), ie that the guidelines had "no statutory significance".

3. [2002] IRLR 263 CA.

4. "An introduction to EAPs and counselling services", Linda Hoskinson, OHR 127, May/June 2007, pp.26-28.

HSE stress management standards and EAPs

The "support" standard in the HSE's package of desired states for organisations to strive towards1 in the management of work-related stress is that "employees indicate that they receive adequate information and support from their colleagues and superiors; and systems are in place locally to respond to any individual concerns".

In order to achieve this standard, organisations need to have systems in place to enable and encourage employees to support colleagues, and for employees to know what support is available and how to access it.

Step 3 of the HSE's approved approach to the management of work-related stress states that stress surveys and focus groups held as part of implementing the stress management standards may identify that individuals are experiencing particular problems. It is essential, the HSE urges, to create the means for employees to raise their concerns, which could include providing employee assistance or counselling services.

The HSE recommends that employers talk with staff about ways the organisation could provide support if someone is experiencing problems outside work, and emphasises the need for employers to regularly disseminate information on other areas of support, including from the HR department, OH professionals, trained counsellors and external charities.

1. See www.hse.gov.uk/stress/standards