What mental health issues are common among your organization? Is substance abuse prominent? How are these issues impacting your workplace? What barriers are you facing? Where do you start? The world of workplace mental health and substance use disorder offerings is littered with uncertainty and questions—but why?

These sentiments have been echoed in recent International Foundation mental health survey reports. Large proportions of ‘not sure’ responses have a been common in this survey since 2016. However, in the 2021 iteration of this study, there were significant increases in several key areas. What would lead to a rise in uncertainty of these measures? I took a closer look at the data and tried to identify some trends and solutions behind this uncertainty.

Prevalence of Mental Health/Substance Use Disorder Benefits

Benefits practitioners in the U.S. are having a more difficult time determining which mental health/substance use disorders are common within their organizations.

  • Alcohol addiction – There was an increase in the proportions of respondents ‘not sure’ about the prevalence of alcohol addiction in their organizations between 2018 (31%) and 2021 (40%), with noted increases across all employment sectors.
  • Anxiety disorders – This trend continued with anxiety disorders, in which the number of organizations that were unsure of its prevalence increasing between 2018 (29%) and 2021 (34%). A case could be made that this is a condition where a remote work environment would make detection more difficult for conditions such as panic disorders and phobias.
  • Bipolar Disorder – There was a slight increase in the number of organizations unsure of the prevalence of bipolar disorder over this three-year period (50% in 2018 to 57% in 2021).
  • Depression – There was a substantial increase in the number of ‘unsure’ organizations regarding the prevalence of depression between 2018 (24%) and 2021 (33%).

There were also substantial increases in the number of responding organizations ‘unsure’ of the levels of substance use disorder within their workforces.

  • Prescription Drug Addiction/Substance Use Disorder – The proportion of ‘not sure’ responses increased for prescription drug addiction between2018 (42%) and 2021 (54%).
  • Nonprescription Drug Addiction/Substance Abuse – This theme was echoed with the increase in uncertainty around nonprescription drug abuse. The proportion of ‘not sure’ responses grew from 42% in 2018 to 49% in 2021. These ‘hidden’ issues may becoming more secretive in the face of the remote environment brought on by the COVID-19 pandemic.

Impact of Mental Health/Substance Use Disorder on Performance Measures

There is also substantial (and growing) uncertainty around the impact that these issues have on a number of workforce performance measures.

  • Overall job performance – Increasing percentages of responding organizations are unsure of the impact that mental health and substance use disorder issues have on overall job performance. This figure has grown from 22% in 2018 to 30% in 2021.
  • Absenteeism/tardiness – Almost one in three respondents (32%) are unsure of the impact that these issues have on absenteeism/tardiness in their workforce, up from 23% in 2018.
  • Morale There was a notable increase in the number of ‘unsure’ respondents regarding the impact of mental health/substance use disorder issues on worker morale. This figure increased from 24% in 2018 to 30% in 2021. Recent Foundation data has noted that the COVID-19 pandemic has had a substantial impact on this metric.
  • Presenteeism – Presenteeism refers to the presence of an employee at work if he or she is too sick or too engaged in work/life issues to be productive. The proportion of ‘unsure’ responses to this metric increased from 24% to 31% between 2018 and 2021. This measure would be particularly difficult to track in a remote work environment.
  • Worker safety/accidents – There was also a notable increase in the number of respondents unsure about the impact of mental health and substance use disorder issues on workforce safety/accidents. This measure increased from 28% to 35% over this three-year period.


What factors would lead to an increasing level of uncertainty around workplace mental health and substance use disorder issues? Perhaps, it’s the remote work environments that have been common since March 2020. A recent Foundation report found that approximately 12% of employees worked remotely pre-pandemic, with that figure hitting 55% during the spring of 2021.

It would be increasingly difficult to analyze the prevalence of anxiety disorders, depression and alcohol addiction among workforces in a remote work environment. It would be even more difficult to measure how these issues impact measures such as morale and job performance.

Another culprit could be the recent spike in workforce turnover. A recent report suggested that 52% of workers may be looking for new jobs in 2021. With rapidly changing workforces, it will be increasingly difficult to capture the prevalence, and impact of these conditions.

I anticipate that this uncertainty will continue to be a significant barrier to workforce mental health initiatives in the future. By tuning into mental health crisis warning signs, communicating resources and benefits in place and continuing to destigmatize mental health and substance use disorders, organizations can support employees facing these issues with the hopes of preventing an even greater crisis from occurring.

Justin Held, CEBS
Senior Research Analyst at the International Foundation 

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Justin Held, CEBS

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