Good afternoon everyone. Welcome to Session 419. This is Emerging Research from the National Safety Council on COVID's Impact on Substance Use and Mental Health. Today's speaker will be joining us from Wisconsin, Ms. Rebecca Martin. Ms. Martin, I will turn the presentation over to you. Thank you. Hi, thanks for having me and welcome. Thanks for having me virtually. I appreciate it. I'm coming to you live from Wisconsin where it's finally sunny but still pretty cold. So our learning objectives for today are describing COVID's impact on organizations, identifying changes to substance use and mental health brought on by the pandemic, and identifying emerging best practices employers implemented in response to the pandemic. So this was also the goal of this research that we did at the National Safety Council. So the National Safety Council is a nonprofit. We have been working in the safety advocacy space for over a hundred years. It's a mission-based organization and we focus on eliminating the least leading causes of preventable death so people can live their fullest lives. So our mission is saving lives from the workplace to any place. So we focus our work on three areas, workplace, roadway, and impairment. And I am on the impairment team. And so one of the things that we were working on is looking at substance use and mental health in the pandemic and its impact on workplaces. So when we think about substance use and mental health, it's a pretty broad topic and it's absolutely impacting sort of every facet of American life and probably the world at this point. So some fun facts and figures for us. One in 12 Americans has a substance use disorder. 90% of suicides are carried out by someone with depression, struggling with substance misuse, or a combination of both. 18% of employees go home to addiction as reported by a recent Gallup poll. So that could be the employee themselves or a family member. 46% of Americans have a meaningful relationship with someone struggling with addiction or have struggled with it personally. And five times is the loved ones of people struggling with addiction are five times more likely to use emergency services. And the latest information is about 10% of the workforce has a substance use disorder. So a lot of times when we think about people with substance use disorder, we do not think about them in terms of being in the workplace, the people next to us, the people around us. So that's definitely an interesting statistics, I think that brings it home for a lot of us. Just recently in December, they published the quarterly report for worker mental health index. And they found that one in four of America's workforce is screening positive for PTSD, which is an astronomical percentage higher than pre pandemic, which was 130% higher. The other thing we found is that depression is 63% higher than before COVID-19. And in particular, they've also found that male workers are having a higher percentage of difficulty with substance use than female workers. I think perhaps the most striking statistic that we have so far about substance use and mental health and their impact is that we have the highest number of people who have died from a drug overdose from May to 2020 to April 2021 is more than 100,000 people. I think that number breaks down to about 12 people per hour. So in for the course of this presentation, 12 people will die from a drug overdose. So we really wanted to know more about how sort of this twin pandemic as people have been calling it of COVID and then substance use and mental health was impacting our workplaces. So NSC received funding from SAMHSA to survey our members. And we collaborated with the National Opinion Research Center at the University of Chicago for some of our research support. And our final total of survey respondents was 154. So that's our end for the rest of the data. So who were the people who filled out our survey? So we used our members, NSC is a member organization, we have over 15,000 organization members, and then many thousand individual members. And so the majority of the people who filled out our survey were environmental health and safety professionals, followed by human resources and managers or directors. We were serving employers, not employees. So when we think about sort of our respondents, we are really targeting people who had supervisory in a supervisory capacity. So our primary industries that were represented in our survey respondents, the overwhelming majority were manufacturing and construction. So these guys represented half of all of our respondents, which should make it a little bit more difficult to do any kind of drill down analyses across industry, just because the overwhelming majority were manufacturing and construction. But those are also the two industries most impacted by substance use that construction workers have some of the highest rates of mental health and substance use across workforces. So size of the organizations, most of the respondents were in what we're kind of calling a small category of 101 to 500 employees. And that's also where most of the construction manufacturing respondents fell into as well, which also made it difficult for us to do any sort of drill down across organization size, because we couldn't really tease apart the construction manufacturing from the size of the organization. Geographic location, predominantly south and Midwest. So we asked respondents where their main headquarters were located. We do have some respondents who had who lived in one area, but their organization was housed in another. So we did ask the question that way. So one of the first things we wanted to know about was what was impacting the organizations and then what was impacting the employees. And so when we asked the organizations what issues are having a greater extreme impact on them, this was sort of the breakdown. So well over half were indicating that supplying chain issues were having a great or extreme impact on their organization, followed by PPE provision. So face masks, that sort of thing. And then loss of revenue and change in work locations of change in work location was, you know, going from in person to virtual or virtual to in person to hybrid. We had the pandemic considered from the very beginning of March, all the way up to when they filled out the survey, which was February of this of this year. So it's kind of a big span time period. So one of the things that we were kind of trying to figure out was whether or not that impacted which issues were being talked about in terms of having a greater extreme impact on the organization. And then we asked similar questions around whether or not different issues were having an impact on their essential and non essential employees. Most of our respondents did not have a distinction between essential and non essential employees. And the non essential essential employees breakdown or distribution of responses was the same. So we will only really be talking about essential employees or grouped together of employees. So the top issue that our respondents indicated was impacting their employees was quarantining, followed by masking, and staying homesick. So one of the things that's sort of interesting is that we have of the top issues that that they were indicating, most of them have an impact on their ability to be at work. So if you're quarantining, because you had a positive or your family member had a positive, if you have, you know, signs or symptoms, even if you didn't have a positive, you have more people, people are more likely to stay home during the pandemic. And then for those of us who are working in parenting, disruptions in childcare and school were were obviously huge during the pandemic. So then we asked what the organization's greatest concerns were for their essential employees. And COVID-19 itself ended up being one of the top concerns, followed by stress levels, and then keeping employees. But what was interesting to us is that a lot of the top issues all related to mental health as being a concern, but substance use was not. So there are very few people who responded that substance use was a concern for their employees. So despite the fact that all of this other research was coming out in terms of increases in substance use during the pandemic, it didn't get sort of played out in our responses to our survey. So we also had an opportunity for them to put out information in their other responses. And they naturally fell into kind of these different categories. So COVID specific, again, people were concerned about absences, general disillusionment due to COVID-19 rules and restrictions, skeptical team members, testing and vaccine shots. And then under mental health, people were talking about the fact that they were concerned about issues along depression, anxiety, more mental health issues. And then a huge red flag is observations made of increased presence of employee personal firearms in the workplace. Obviously, that is a huge impact on safety and mental health and public health. You know, there wasn't any other details provided other than that, but it's just one of those huge red flags. People being tired of the pandemic, personal stress, tiredness, not doing their jobs, changes to work logistics, so just distractions, remote learning meetings. And then homework changes, so kids staying home and parents having to figure out what to do. And then this one was interesting, too, because increased attendance as employees took less vacation since they had nowhere to go, definitely impacts sort of when we think about that mental health part is that people were not getting a break. So throughout this pandemic, people were not getting a break. And that absolutely ties into that mental health piece, safety and substance use. So we asked the respondents whether or not they were observing different changes in their employees during the pandemic. The overwhelming majority mentioned absenteeism, which sort of matches up with some of their greatest concerns being things that were impacting their ability to go to their job, followed by distractions from home, turnover, and then presenteeism. So you might be at work, but mentally or physically distracted from your job. And then more than half of our respondents selected more than one of those as being observed in employees. So when it came to questions about substance use and mental health, one of the things we asked was whether there were perceived increases in incidents and injuries due to either substance use or mental health since the pandemic started. So 35% of our respondents felt that there was an increase in incidents because of mental health concerns. And 21% felt that there was an increase in injuries due to mental health concerns. But the same is not true for substance use. There was only 4% of our respondents who felt that substance use was impacting increases in incidents and injuries in their workplaces. So we also wanted to figure out what their perception was around substance use changes since the pandemic started. So very few of our respondents felt that substance use had decreased or greatly decreased. Another handful of them felt like it had not changed at all. And then a smaller percentage felt that it increased or greatly increased except for cannabis and alcohol. So those are more culturally and legally acceptable compared to others. So there was definitely more confidence in our respondents in feeling that alcohol and cannabis use had increased, whereas they were less likely to indicate that some of the other substance uses had increased. But I think of some concern, especially in thinking of impairment and safety, most of the respondents were unsure whether or not substance use had changed since the pandemic started. So then we wanted to know what was the employer's response to all of these issues in the pandemic. So the first thing we were looking at was EAPs or employee assistance programs. And about a quarter of our respondents offered an EAP in some form to at least some people. So we had sort of a breakdown. And these are not, these might be the same organization who offered it to multiple levels of staff. There's only about 20% who did not offer one. And there were a couple who did not offer one themselves, but their union offered it to employees. So we asked sort of what were the common reasons for EAP usage. And the biggest thing is that people really didn't know. So when we were looking at who could fill out our survey, we were trying to find, target our survey respondents to people who had knowledge of EAP and HR and knowledge of some of the COVID precautions. And what we learned was that very few people know much about how their EAPs are used. So in fact, some organizations, when you purchase an EAP, you have to purchase at the get-go, the ability to get reports. So it's not like a HIPAA issue, it's you haven't purchased it when you purchase your EAP. So for example, my organization, NSC, did not purchase the ability to run reports when they purchased their assistance program. We are now. So it's very difficult to get information about whether or not employees are actually using it if you don't purchase reports upfront. The other thing we learned was that they're not unduplicated counts. So for example, they might be able to say, we had a certain number of encounters around mental health, but it doesn't mean that there were an unduplicated count of people who talked to the EAP about mental health. It could be 12 encounters, but only two people. So that was some of the issues that came out in trying to distinguish EAP usage across organizations. But of those who did feel comfortable answering these questions or had access to that information, the number one issue was employment to health followed by work life balance. And substance use is way down here at 11% for themselves and 3% for a family member. So NSC also has another initiative called safer that is funded with the CDC and NIOSH. And so we work together to include some EAP questions in their surveys that they've been doing of employers. And so they sent out a survey for employers and then employees every other month. And so we asked similar questions to our survey that we were doing in the impairment practice with some of the questions that they were doing with SAFER. And so they found that they were also finding changes in EAPs since the pandemic started. So 7% of their respondents were implementing an EAP for the first time. 31% expanded offerings and 16% expanded coverage. So when they asked those who had made changes, why they made those changes, 60% said there was an increase in number of employees requesting them. 53% said there was an increase in mental health or impairment related absences, incidents, or injuries. And they also had a 47% increase in concerns of supervisors about mental health or substance use on their direct reports. So we did not separate out mental health and substance use in these questions. We had them kind of lumped together. So even among the organizations that didn't make changes to their EAP offerings, they were still reporting an increase in employees asking for them at 19%, an increase in mental health or impairment related absences, incidents, or injuries at 30%, and an increase in concerns of supervisors at 24%. So when they asked employees, these were not one-to-one ratio of employers and employees at the same organization. It was just a different survey targeting employees non-supervisory capacity. So they asked employees whether or not they had ever used EAP benefits at their current or previous position. 18% said they had, 66% said they haven't, and 16% didn't know what an EAP is or what it's for. When asked if their current workplace offered one, half of people said yes and a quarter said no and others didn't. So of those who knew that their employer had an EAP, not very many people were familiar with what an EAP is and what it offers. So 11% said they had no idea at all, 36% said they were slightly familiar with it, 27% said moderately, 16% said very, and only 10% said experienced. So even as we're talking about sort of solutions or offerings to address mental health and substance use, we need to know more about EAPs and we need to know more about employees' understanding of EAPs. So we asked our survey respondents what their organizations did to address substance use in particular. And so the majority of respondents said they communicated the importance of mental health, followed by promoting the EAP to employees. And a lot more employees than I was anticipating, so 23% began or expanded EAP benefits in response to the pandemic. So like I said, that use of EAP has really come up sort of across the board. We also asked them separately what their response was to mental health. And similar to the previous response about substance use, promoting their EAP was the top thing that they did, followed by communicating the importance of mental well-being. So one thing that we would like to know a little bit more about is what sort of communication were they doing and what kind of classes and techniques were they promoting. So many of the respondents felt that they had been providing training and education and classes and that sort of thing. But we're not detailing specifics around what they did. Of note is that there are a small percentage of organizations that increased health care coverage for mental health and a small percentage that increased health care coverage for substance use. So I think it was 3% said they increased coverage in response to substance use and 5% said in response to mental health. So they had another opportunity to tell us some other reasons why that they were doing in response to the pandemic for substance use and mental health. And it was interesting because this was the first time some of these more negative issues came out. So we had two people who answered that there were no issues with substance use and mental health, that employee health and well-being were not affected by the pandemic, there were no changes. And then you had another one who said they hired a full-time mental health and well-being coach. So sort of this discrepancy in perception around the pandemic's impact on employees. And while we did not ask anything about testing, two of the respondents brought up the fact that they were doing different types of drug testing. So the other thing that we were really wanting to know more about was whether or not there were additional or innovative or sort of emerging responses to the pandemic. So the overwhelming majority of our respondents felt that their organization was implementing above and beyond normal responses to the pandemic. So 95 of our respondents were able to provide additional details of what they did during the pandemic. And so I took their free responses and categorized them out. And so these are not unduplicated numbers. So most respondents had an answer that involved multiple kind of areas where they were addressing issues related to the pandemic. The overwhelming majority talked about workplace or workflow changes. So physical distancing, adding in plexiglass, changing in shifts. So having a group of workers come in always together. So kind of cohorting their staff. A lot of other people talked about PPE. Face mask mandates was brought up a couple of times. And then there was a lot of organizations that were providing training, education, communication, particularly about COVID. I think the thing that was interesting to us is that while the organizations that provided additional mental health promotion or well-being, this was 15%, provided a lot of detailed information about what they were doing, it wasn't very many of them who brought it up. And in fact, no one mentioned substance use or impairment at all. So are there emerging best practices? Yes and no. We don't have enough to conclusively identify them as such yet, but we definitely have some issues that are starting to emerge, but we need more longitudinal data. So we classified sort of the emerging responses into three areas. So EAPs, so respondents indicating that they began, expanded, or promoted EAPs. On-site and community services. So respondents indicating they offered on-site medical staff, testing, vaccines, PPE, something sort of above and beyond what was required. And then holistic responses. So organizations that were indicating they made changes that potentially have a broader impact, either on their organization, the community, public health, that sort of thing. So EAPs came up a lot. So one of the organizations said that they increased access to their EAP program through remote options. They worked with EAP providers to increase talks and presentations on stress management. They offered EAP services, were encouraged every day as they had a number of employees that were having difficulties with loneliness, depression, and isolation. Increased promotion of their EAP, offered group webinars on mental health, dealing with stress, promoting the importance of self-care and offering suggested behaviors and ways to seek help if needed. 23% of our respondents expanded or began offering EAPs, and 54% of respondents in SAFER survey expanded or began offering EAPs. So this was definitely a huge area that people were utilizing as a response to the pandemic. So when it comes to on-site and community services, access to supplies, in-house doctors, testing, and labs, several organizations said that they actually had PCR testing available on-site. They gave out free COVID tests to employees and business partners, face masks for work and personal use, including for family members, providing toiletries for personal use to address the retail shortages. I really liked that one. If you think back to the beginning of the pandemic where there was a run on toilet paper, this organization provided things for their employees to address those issues. PCR testing on-site, on-site vaccine clinics, COVID-19 trainings. One of the things that I think was really interesting is that a lot of them offered these beyond just their own employees, but they opened it up to the community as well. And then holistic responses. Expansion of child care benefits and resources for all employees, comfort kits sent to homes of those impacted by COVID, expansion of child and elder care benefits, the idea of expanding child and elder care benefits is huge and can have far-reaching impacts just beyond and beyond the pandemic itself. One organization eliminated smoking from their casino and increased ventilation. The public health benefits of that alone cannot be understated. A lot of employees, organizations rather, provided additional emergency leave, additional pay, additional supports for family members who are either dealing with COVID or child care issues. One of the organizations offered bonuses and did video messaging and a thank you campaign. This one I think has been, is really important. So they had company-wide teams call to check in with employees. It was required that they have their cameras on so they could see people. When it was determined that someone was having a difficult time, we had various people reach out to them. The office shut down, but not our construction site. So we had a small group of people that worked in the office and were considered essential for the construction workers. So they knew they had support and assistance if they needed it as they continued working in groups. One of the things we found was that the most difficult for people was wearing masks. So many people became depressed just for the fact they couldn't see others' expressions, smiles, or understand conversations. Side note, hearing checks and access to hearing aids could help that too. Telehealth benefits increased, co-pays waived during COVID. Extensive education provided on vaccines to their staff, employees, residents, resident family members, financial support, access to a community navigator was provided on-site and is ongoing beyond the pandemic. Cash incentives to get vaccinated, additional leave if sick from vaccination or COVID infection. And then 20% of our respondents addressed substance use mental health by having flexible schedules or providing mental health days. And over 50% of our respondents provided education or information about the importance of mental health and well-being. So key takeaways. There was definitely a disconnect between observations of employer behavior like absenteeism, presenteeism, turnover, and what might be causing this, like substance use and mental health versus just the COVID restrictions. Response variation seemed to be reflective of sort of the country's attitudes in general. Some respondents said that it had no impact at all. Other respondents talked about deaths in their work community from COVID. Respondents were intentionally HR and EHS professionals. So what responses would employees provide? Mental health issues were highlighted during the pandemic nationally and our survey responses seemed to reflect that. The same was not true for substance use. Our emerging best practices are still emerging. We need more information, longitudinal data, and outcomes. And organizations have the capacity, ability to respond to the pandemic and support employees. And they play a critical role. Workplaces are where the employees spend the majority of the time. And so really trying to dig in whether or not some of the innovative responses that employers are having can be carried over beyond that to impact overall safety and well-being. So some of the lessons learned. Our survey was a survey perception. So we were not asking for actual numbers of incidents or injuries and that sort of thing. It was a convenient sample of our members. We did have some difficulty getting responses. The pandemic is ongoing. At the time that we put our survey out, it was sort of the end of Omicron and some of the mandates were being lifted. And the vaccine mandate was going through the courts. So there was a lot going on for people. We had a hard time finding respondents who knew about AIP and HR information and COVID response. Our surveys were not anonymous. So that might impact the willingness to discuss substance use. And it confirmed there was a definite need for impairment recognition and response training. So some of our next steps. We're looking at surveying employees. Doing some additional research into substance use and mental health at the workplace around the pandemic. Additional research into EAP usage in particular because that's been such a response to the issues in the pandemic and we need more information. And then, you know, what are some things that you would like to see? We do have a lot of resources out there for workplaces around substance use and mental health. So we were really wanting to start incorporating some of the things that we're learning from the pandemic into the resources that we already offer. And we have time for questions. All right. Thank you very much. I'll ask if anybody in the room has any questions, please come down and use the mic. And while we're waiting, I will be looking in the chat to see if we have questions. So I'm looking in the chat. I don't see any questions. And I also don't see any questions coming from the room. So we'll say thank you very much. We very much appreciated your presentation today. And just for folks' awareness, if you're interested in slides, if they're not already available in the app, we will make every effort to make slides updated into the app so you can download them at some future date. Ms. Martin, thank you very much for presenting at American Occupational Health Conference. Have a good afternoon.

Rebecca Martin

National Safety Council

COVID-19

substance use

mental health

survey

workplaces