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By Taylor Knopf

As more Americans have struggled with their mental health during the pandemic, businesses are figuring out how to support their employees. During a virtual event last month with the North Carolina Chamber of Commerce, local health and business leaders highlighted ways to address employees’ mental health needs and talked about how to encourage their workforce to get the COVID-19 vaccine.

In the past year, the NC Chamber, the professional organization that advocates on behalf of the state’s business community, has been increasingly vocal on mental health issues. And for good reason: rates of depression and anxiety have been at an all-time high over the course of the COVID-19 pandemic. 

During the 2020 winter holidays, nearly 43 percent of American adults reported feelings of depression or anxiety, according to data reported by the Kaiser Family Foundation. That percentage dropped to 30 percent over the summer, coinciding with warmer weather and more people receiving the vaccine. 

However, these numbers greatly exceed the baseline of 11 percent of adults reporting symptoms of depression and anxiety in 2019 in a similar survey. 

Rates of depression and anxiety during the pandemic have been even higher among communities of color and for essential workers, such as health care workers and grocery store employees, according to the KFF report

“Many essential workers continue to face a number of challenges, including greater risk of contracting the coronavirus than other workers,” the KFF report states. “Compared to nonessential workers, essential workers are more likely to report symptoms of anxiety or depressive disorder (42% vs. 30%), starting or increasing substance use (25% vs. 11%), and suicidal thoughts (22% vs. 8%) during the pandemic.”

To put it simply: the American workforce is stressed out and struggling, some more than others.

Percentage of adults who reported symptoms of anxiety and depression during the summer of 2021. Graph courtesy of the Kaiser Family Foundation

Mental health emergency

This summer, the NC Chamber signed on to a letter to North Carolina leaders begging them to join with the health and business communities to address the pandemic-induced mental health crisis as emergency rooms have been overwhelmed with mental health patients.

Additionally, supporting employees’ mental and emotional well-being was a key focus during the NC Chamber’s health care conference in September. The Chamber’s CEO Gary Salamido was a highlighted panelist during the NC Health Care Association’s mental health virtual town hall on Oct. 7.

“The health of people is a top priority for employers, and a chief focus of that has become mental health,” Salamido said in a press release for the NCHA event.

Despite the increased health care conversations, Salamido reiterated during the NCHA event that the NC Chamber does not have an official position on expanding Medicaid coverage in the state, a policy move that would sweep some half-million low-income workers into the program.  Experts say adopting the policy, which has been approved by 38 other states and the District of Columbia, could bring relief to patients, providers and hospitals. 

However, Salamido and the business community have dedicated a lot of time over the past few months talking about mental health.

“Increases in employee stress, anxiety and burnout from the pandemic are concerns we’ve heard repeatedly from members,” he said. “Work-life balance, job security, caregiving responsibilities and financial well-being have been denoted as additional stressors, all of which can play into someone’s mental health well-being.”

Keep talking about mental health

Businesses need to be talking about mental health “all the time,” said Lynne Fiscus, president and CEO of UNC Physicians Network, during NC Chamber’s the same conference.

Fiscus referenced the KFF report showing heightened levels of anxiety and depression, saying “this is something we can’t ignore. It’s horrific to hear about and read about, but we got to believe the data and we got to figure out what we’re gonna do about it.”

Historically, Fiscus said, people didn’t talk about personal challenges, anxiety, depression, substance use or other mental illness at work. 

“Normalizing talking about it as business leaders, talking about it with your leaders, in your teams makes such a difference because there has been so much traditional shame associated with behavioral health issues,” she said. 

Fiscus encouraged business leaders to review their health benefit policies to eliminate barriers for employees to access mental health services. Because when people don’t get the interventions they need early on, they often end up in the emergency room. 

Jacob Parrish, vice president of systems and procedures at Vidant Health, told the business leaders gathered over Zoom that half the patients at Vidant Beaufort hospital in Little Washington were there primarily because of a behavioral health issue that day.

“They’re there because there’s nowhere else for them to go,” Parrish said.

This graph compares the rate of adult patients with a behavioral health diagnosis discharged from emergency rooms across North Carolina between 2019 and 2020, showing an increase in people going to the emergency room for mental health issues during the pandemic. Data and graph courtesy of the NC Health Care Association

A Vidant spokesperson said that the eastern North Carolina hospital has seen an uptick in behavioral health patients throughout this year and that the overall volume of behavioral patients in the emergency rooms across Vidant’s network has “remained consistently high, but stable, over the past couple of years.”

As hospitals have found themselves inundated with behavioral health patients, there’s been an increased interest in funding mobile crisis teams who can respond to people in mental health distress in the community. Last month, the federal Centers for Medicare & Medicaid Services awarded $15 million in grants to 20 states, including North Carolina, to expand these types of mobile crisis services for Medicaid beneficiaries.

Transitioning back to the office

The transition from remote to in-person work could be challenging to navigate as well, as many employees are burnt out from juggling work and caregiving responsibilities over the past year and a half. 

Palmer Edwards, immediate past-president of the NC Medical Society, encouraged business leaders attending the NC Chamber’s conference to consult the “Returning to the Workplace Guide” by the American Psychiatric Association Foundation’s Center for Workplace Mental Health. The guide includes signs to recognize and address pandemic fatigue and ways to stay flexible while transitioning people back to the workplace.

The transition plan could look different across a company, said Becky Malone, development solutions communications lead at UCB Inc. Employers should “assume that every employee is an individual and one solution is not going to fit all,” she said. “You have to have a suite of solutions to ensure that you’ve got a little bit for everyone.”

For example, she said a universal “no-meeting Friday” might be great for some, but not practical for others. 

During the pandemic, Malone said her company set up management seminars led by mental health professionals to teach those in leadership positions how to recognize the signs and symptoms of different mental health conditions. Managers were taught how to have one-on-one conversations with employees in response to signs of burnout or depression and direct them to help, including telehealth services, she said.

Several health and business leaders attending the conference noted an increase in use of telehealth services among their employees during the pandemic. 

Vaccinate mandates, incentives

Fiscus, head of UNC Physicians Network, said community members and businesses are always asking how they can support health care workers still fighting on the front lines of this pandemic. 

“A year ago, support looked like sidewalk chalk and restaurants sending lunches to the ICUs and midnight pizzas to the folks in the emergency room,” she said. 


Lynne Fiscus, president and CEO of UNC Physicians Network. Photo courtesy of UNC Health

Then the vaccines came, and community members and businesses rallied to help run mass vaccination sites and pop-up clinics. 

“Now we are at this point in the pandemic where [health care workers] are stressed again,” she said. “Hospitals are full and more than 90 percent of the folks they are taking care of are unvaccinated.”

Right now, Fiscus said the business community can help the medical community by getting their employees vaccinated against COVID-19.

“How do we help you have conversations about vaccinations with your team members? We are all in organizations with vaccine requirements, that’s one avenue,” she said of the other health care system representatives on the call.

Health systems across North Carolina implemented vaccinate mandates for employees and the vast majority of employees complied by the deadline. Other companies, including Triangle-based tech companies SAS and Red Hat, have followed suit and implemented vaccine mandates. 

Fiscus said that some employers in Robeson County, which has a low vaccination rate, have been offering $1,000 to employees who get their COVID vaccine. 

“They did the math and were losing more than that for people out sick and being hospitalized, who were unvaccinated,” Fiscus said. “And I’ll tell you, our doctors in Lumberton and Southeastern [Health] felt supported by that act. The people who are at their wit’s end taking care of patients felt supported by the business community, who they saw were trying very hard to get their folks vaccinated.”

As the time approaches for open enrollment, Fiscus said that some employers are raising insurance costs for employees who choose not to get vaccinated. 

“No one wants to have increases in health insurance premiums, but we’ve done it for the choice to smoke for a really long time,” she said. 

Fiscus said that people who aren’t vaccinated against COVID right now generally are not all “staunchly in the anti-vaxx corner. 

“They are waiting for something, the right conversation, the right information, a nudge. As the business community, you have the ability to provide some of those nudges to help people along.”

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...