Good morning, welcome. Thank you for the presentation, very great presentation, and we'll keep up with the high level of sophistication of this morning. I am Philippe Guibert, I'm Medical Director of International SOS, but I'm not here in this capacity. I'm representing the International Corporate Health Leadership Council with a few fellow members in this room and with Dr. Robert Quigley with me today to present you this topic. So a few words about the council itself. It's a non-profit organization that was created 12 years ago here in the U.S. We are regrouping a vast array of international corporations, not only U.S.-based, but also European. I'm here today before you as a representative of the European chapter of the council. And this is a place where experts would share insights on corporate health and medical health care for employees in organizations that primarily have the responsibility to take care of their employees. Initially, there was a focus on international mobility and overseas and business travel. But now, the responsibility of organizations has broadened and definitely we want to take care of everyone, starting with domestic employees. So what we do is by sharing insights and information, we want to drive further this topic of corporate health and medical care of employees for organizations and issue reports and drive and promote health in the most responsible fashion for organizations, starting with duty of care. So what we do as a council, we do write, we do issue reports and publications, very topical for organizations, such as white papers on very sophisticated topics, but also publications. We do issue trend reports every three years, sort of understanding of the challenges organizations are confronted with for the next years or so, best practices and recommendations for corporations. And definitely, as I'm here today with my colleague Rob, we are presenting at conferences on topics that are meaningful for organizations and today very much about employee health, emotional health, mental health, and the value of digital health solutions. So to get into the topic, definitely we understand that emotional health is a key component, a key element of our life at home and at work. And we all understand as well, as was presented in the previous presentation, that it comes with variations. There's ups and downs, low lights, high lights. And at any moment of our lives, be it at work or at home, we may experience a situation where we are thriving, we are happy, but at the same time, later on, for some reason, we could be down, we could be stressed, we could be anxious, and probably lose the energy that is necessary to make our work or life better. And we all understand that in some circumstances, the workplace can be a place where violent emotions are visible by some employees, experienced by employees, either related to work or to personal life, or probably a mix of everything. And instances where employees feel sometimes overwhelmed and have an emotional breakdown are no longer exceptional. And you may have experienced this in your own organization, with your own team, your fellow colleagues. And all of this has an impact, definitely not only individual, because it's not a nice thing to experience at work, but also for the team and for the fellow colleagues and the managers as well, that may feel in some way responsible for the situations to happen. So no matter what the size of the organization, no matter the business, no matter what the environment we are working, no organization is immune to this situation where some employees may experience mental health issues. And that's probably one of the lessons we've learned past COVID, that every organization in a way has been dented in the overall collective mental health of employees, some of them more impacted than others, but in reality, the bottom line, the baseline of organization from a mental health standpoint has been impacted. What is the level of recovery? It may vary from one group to another. The reality is that everyone may, at a moment in time, may experience these mental ill health situations. According to the World Health Organization, one person out of eight in the world live with a mental health disorder, one out of eight. So that probably makes us six in this room that live with a mental disorder. So that's a reality that we need to acknowledge and recognize that at any moment in time, and if we are in charge of the health agenda of organizations, either as medical directors, but also as business leaders, as HR professionals, or occupational professionals, we have to deal constantly with the situation where the norm becomes employees at any moment in time may suffer and may experience situations where their emotional health is impacted. And despite enormous efforts that have been initiated over the last years to destigmatize, break the stigma, communicate, leave the anxiety, even celebrities sharing their struggles with regards to their own mental health issues, the trust is not there yet established. A study demonstrated that 49% of employees think that sharing their own mental health with their management would put their job at risk, one out of two, which is enormous. So definitely the trust is not yet established within organizations for employees to share their concerns, to be open about it, and to have a transparent conversation with their line manager to start with, and maybe with others, maybe fellow colleagues as well, to share that at some point they need support, they need to be recognized, and they need to be supported. And it is not new. This situation has been identified as a priority, you know, more than 20 years ago. This study that we are presenting here dates 2007, and it shows that at any moment in time, during their lifetime, our lifetime, up to the age of 75, individuals will develop an emotional issue or health disorder at some point of their time, that 55% of individuals, exactly, will experience a mental health or ill health situation by the age of 75. So that's a reality, that's a matter of fact. Definitely the challenge will be to define what do we mean by an emotional health disorder, knowing that probably there's, you know, extremely acute, complex ones to deal with, but probably the 80-20% rule where most of them are classical or emotional manifestation of emotional health that need to be taken care of, and that could be taken care of by organizations. So beyond the definition of mental or emotional ill health, definitely there's a vast array of disorders, mood, anxiety, psychosomatic, trauma, personality disorders, which probably aren't within the reach of our organizations. You know, the reach of our organization, the focus of our organization is probably to focus on these ones that probably represent the vast majority of issues that employees experience at the workplace, stress, anxiety, depression, and also as a consequence, the acute situation of burnout as an emotional exhaustion. So definitely, probably the priority of organizations to deal with this. Understanding that, as I said before, the baseline today within organizations may have been impacted by COVID. So we all understand that COVID not only impacted the overall status of individuals collectively, because we've all been through this situation, you know, the loss, the grief, the uncertainty, the disease, you know, financial issues, anxiety related to COVID, but also COVID has impacted and has consequences on the mental health and emotional health of individuals. For those who've been infected, or even for those who even don't know they've been infected, but this has had an impact to them. So these two studies demonstrate that even short-term prior infection that was published in 2020, individuals that had COVID had more anxiety, depression, insomnia, and early onset of dementia for those above the age of 65 years old. And a long-term perspective, even this study of the BMG did show that even after a period of one year, some individuals may have more risks of strengths, anxiety, depression, or even cognitive impairment to some extent. So COVID disease, in a way, increased the risk of being exposed to individuals that do suffer from these mental ill health parameters. And we all know what the consequences are in reality at the workplace. So we have three main categories. The first one, productivity, performance, engagement. Of course, when you're struggling with your own mental health issues, it's hard to focus. It's hard to be fully 100 percent at work and being engaged and productive. The second main bucket is probably the triad between absenteeism, presenteeism, turnover together. Of course, absenteeism, because when you are struggling with mental health issues, you may not come to work with it later on. But also presenteeism as an issue, when individuals are physically present at work, but are not focused because they are struggling with their issues and are not fully productive and engaged and supportive to their job. A massive issue. And a third category, definitely related to the association between mental health or mental ill health and safety and security, due to fatigue, loss of focus, loss of attention, errors, all of these leading potentially to safety or unsafe behaviors with safety consequences. So the consequences of mental ill health at the workplace is extremely well known from an operational standpoint, such as this is demonstrated. It is also well known from a financial standpoint to start with costs associated with short term, long term disability claims, drugs, treatments, all of these absolutely clearly known. But also, as we said, absenteeism and presenteeism has an impact on the workforce, not only on the individual himself or herself, but also on the team, the management, fellow colleagues, the organization, the disruption it brings to the work and the need to manage the business continuity with additional colleagues, new recruitment, new training, changing organization of way of working. So this has an impact as well on the collective performance, decreased performance of the teams that are impacted, that individuals that are not fully in capacity to meet the job expectations. And unfortunately, all of this may have a loop back mechanism, a vicious cycle. So the more employees are experiencing this situation, an employee who's suffering has probably a massive indirect impact on the team and organization he or she is belonging to. So beyond the tip of the iceberg that sick leave represents, the obvious consequence of someone that is not feeling well and struggling with his or her own emotional issues, there are a vast array of other consequences that organizations are exposed to related to the work, related to absenteeism, related to productivity, or the fact that the absence of these individuals decreases the overall capacity of teams and organizations in a way. From a financial perspective, this study, focusing on the United States, gives an idea of the magnitude of the costs of absenteeism. $225 billion U.S. dollars, that was in 2020, which averaged out as $1,685 U.S. dollars per employee. So it's massive, and that's not only a question of reducing productivity, but it's all the costs associated with replacing this lost capacity that employees that are struggling with mental issues do represent for their own employers. It's probably evident that when someone is struggling, when someone is not felt recognized, someone is felt stigmatized, unheard of, alone, this has consequences on the way he or she may self-take some decisions on their own life and habits and behaviors. And these individuals may take wrong decisions with regards to self-behaviors, could start with addictions, but unfortunately it could be much more serious with self-harm decisions. So if we get back to the human part of the problem, putting aside the financial aspects, the productivity aspects of this issue, from a human perspective, the cost and the toll of mental health issues can be enormous and can be sometimes dramatic, and we all have a responsibility to support this. How can we do this? As an organization, in many ways, we all understand this and may want to focus today on the employee assistance program. So employee assistance programs, for those who don't know yet what we're talking about, are workplace benefit programs that allow employees to have professional and personal and confidential assistance to help them deal with mental and emotional problems, be they related to work, home, finance, or whatever. But at least it's been taken care of by professionals. And it's a massive market, I would say. Everyone wants to run EAPs in the world. Why? Because the need is there, obviously. Look at the range, the magnitude of the potential market of EAPs. More than 1,800 EAP service providers globally, a vast array of choice, and quite a vast majority of employees within organizations are covered, have access to EAP services. The challenge may be related to the usage of these services. Do they know that they have access to these services? Do they use these services? When you look at only 5% of employees for their EAP programs, or only 5% of UK employees, that's a UK survey, have actually accessed their company EAP provider, there's questions to ask. Why is that so? Because these services are usually extremely good. They are run by professionals, they are available 24 by 7, at reach, immediately, wherever you are. So it's probably not a question of the service itself. The question is why employees are not using these services. There's a few examples that do demonstrate that when EAPs are integrated within a strategy or programs that do magnify their utilization. And it starts, of course, with communication around it, the ability to be freely speaking and sharing, and openly sharing emotional thoughts with managers, with fellow colleagues. Probably it participates to bring the stigma down, but also facilitate the utilization of this resource that EAP are, and facilitate the fact that employees may feel at ease to call on for such a support. So this is an example from Bell Canada, where as a communication company, the motto was, let's communicate, let's talk, let's speak. And as you can notice, in terms of leading indicators, the results are there. Not only because the EAP works, but also because EAP have been integrated within a strategy, whereas in more information, awareness, communication, access to treatment, access to care, not only limited to employees, but also to families. Employee and family assistance program utilization have raised. So it really shows that if these EAPs are well communicated, employees are well aware in each form of their value and benefit, the value in terms of human return, but also in terms of financial return is quite impressive. Many publications have demonstrated the value of investing in mental health. And there's a few fellow colleagues in this room that may give and substantiate this information better than I do, but definitely the return on investment is well known. In the experience of the council, it varies from an organization between $1 to $10, so $4 is probably a good average. But it really demonstrates that when integrated, communicated, and strategized for a long term, it does not bring overnight return for sure, but if it's part of the occupational management strategy of an organization, these programs do provide return. So now that we understand that the risk is there, it's a reality, maybe increasing, there are many factors that do increase the risk for employees to have bad mental health, we should ask ourselves, what is the duty and the role of our organization? Do they need to take their part of their duty of care to address mental health as part of this agenda? And the answer is yes, definitely yes. Why is that so? Because mental ill health can now be considered as a foreseeable risk, particularly post-COVID. We know that, again, the impact has been there. It's lasting. We do experience this on a day-to-day basis within our own organizations at different levels. So the duty of our organization, the moral imperative of our organizations is to embed and make no distinction between physical health, emotional health, mental health. No matter the way you label it, the priority is to consider this as an integral part of the responsibility of our organization and as part of their responsibility to address this issue as one of the many risks organizations have to deal with with their workforce. So the challenge is to define a strategy and to consider it at the highest level within our organizations, as a priority for organizations. It may go beyond the duty of our organizations to consider it as a strategic agenda. If we have a strategic, I would say a resilient workforce, we have resilient citizens in a way. It's a strategic component to building a strong emotional program and agenda for our organizations. The good news is there's a roadmap. You may say taking and addressing this issue is quite complex. ISO, as part of the 45,000 series, which is about occupation, health, safety management series, has designed and issued in 2021 this standard to focus precisely on psychological health and safety at the workplace, at site. And the value of such a guidance document is that it is applicable to any type, sort, size of businesses. No matter what organization you're working on, you are able to use this standard to drive and to draw your own strategy to address mental health, and as much as possible, to integrate it into your occupation, health management system or HSE organization, not to make it a standalone document somewhere, but definitely integrate it and help you implement and maintain it. So let me turn to my colleague, Rob, that will take us through the value of EAPs and particularly how can we enhance the value of EAPs with digital strategies. Thank you. Thank you very much, Philippe, for painting the picture and describing the landscape in this ubiquitous problem that we face globally. It never ceases to amaze me when Philippe was showing those statistics of EAP utilizations. So many organizations in every sector recognize the value of an employment assistance program, and they like to check the box and say, well, we've got one, but none of them are addressing the elephant in the room, which is less than 5% of these programs where the box has been checked are getting utilization. So those people that are in the EAP business are constantly looking for other layers, other solutions to add to the multiple layers already in place to address emotional illness at the workplace. And Philippe nicely laid out how big a problem this is. So it doesn't take a rocket scientist to recognize the problem is at every level, but at the end of the day, in any organization, in every sector that just looks at quarterly reports, productivity is being hit big time. And that's how you get the attention of the C-suite, and that's how you get the attention of creative people that can think about new ways, new layers to address this, what I call pandemic emotional illness. So many of the EAPs have now decided, well, let's turn to technology, and hence the purpose of our presentation today. Let's look at digital solutions because that seems to be the way of the land as of late. Interestingly enough, if one looks at all industry sectors, there is a big, big player in that landscape, and it's the technology companies, which are almost disproportionately impacted by emotional health issues. And we could sit here and discuss why that may be the case. I'm sure many of you have your own theories on that. But, in fact, organizations like the OSMI have studied what percentage of people in the tech industry actually suffer from emotional illness. And look at that number, 42%. So almost half of employees of any of these tech companies have some sort of recognized behavioral health issue. If you then take that and you look at the bottom line in these companies, you can see how they're functioning at such reduced capacity because of the absenteeism and the presenteeism that Philippe talked about that is an end result of these emotional health conditions. So because of this elevated level of emotional illness in this technology sector, it only makes perfect sense as clinicians and scientists that we say, well, let's take a tech company and let's study that tech company and let's see whether or not we can do an experiment as primitive as it might be to demonstrate that digital health may be able to be an official another layer to an employee assistance program. And so you can see if you look at the size of tech companies from a relative standpoint, if some of you are with EMI companies or big retail companies, whatever, they're not big. They're not big, big. So we decided to conduct our study in a medium-sized tech company in this area here. In fact, it was a company with about 17,000 employees. So the annual data provided to us from this medium-sized technology company of approximately 17,000 employees, and this data was all provided by the employer HR department, showed that right along what Philippe has been talking about, the EAP utilization was only 4%. Four percent. That means 96% of people either didn't use it, didn't want to use it for all sorts of reasons, which we might get into later. The absenteeism rate was approximately 3%. Short-term disability claims was approximately 90 per 1,000 employees, and long-term disability claims were 81 out of 1,000 employees. This was a very receptive experimental group. This company wanted to explore is there anything we can do to perhaps bring down that 42% number because that's going to have a direct impact on our productivity. Enter CheckMe. That's our experimental tool that we spent a few years putting together. We trademarked it, and it has its own website, which if any of you are interested, you can look it up, checkme.app, and basically what CheckMe is is it's a digital platform to help people measure and manage their emotional illness, and it uses standardized, peer-reviewed, and targeted tests while providing either access to relevant online remedies and solutions, or it serves as a gateway to a live therapist. So once one has CheckMe on their phone, they can use it in two different ways. They can measure or quantify how much stress, anxiety, and depression they may have. They can get a score of that stress, anxiety, and depression, and based on that score, they can make the decision, should I just speak to a therapist now, or should I look at the online content and perhaps come up with a resolution of my own? And all of you know as clinicians that there's different cohorts that work within our organizations, and some people don't want to talk to a therapist. They'd rather resolve this issue on their own. But by having this scoring system built in, it gives them a sense of security that it's really not that bad. My anxiety is not that bad. Why don't I explore some of the online material that's there? And all of it can be added to and deleted by whatever app we integrate CheckMe with. So it's all very agnostic. It can be updated, downplayed. Any way you want to slice and dice it is one of my friends I always used to talk about. It's both HIPAA and GDPR compliant, so the use of this can be anywhere around the globe. And the AI engine behind it is called CheckStress. So this tool, this CheckMe tool, we felt it was very important. In fact, Felipe and I were just talking about this yesterday, that we have standardized peer-reviewed metrics in this. So we're not plucking some sort of group of questions out of our back pocket, but rather we're using well-established tools that have been proven time and time again through the psychiatric DSM literature. And you're all familiar with these tests. It's a GHQ-12, which is just 12 questions. And it's right out of the literature. One can take this in 90 seconds or so. So you open up your phone and say, I'm going to get a screening test because I'm not feeling good about myself right now. And then based on your score in the GHQ-12, you will be directed automatically, and so you might want to take a targeted test because it looks like in your screening test you have a lot of anxiety. So if you have a lot of anxiety, why don't you take the targeted test, the GAD-7. So none of this is new. This is all well-established, peer-reviewed testing. But what is new is that it's all incorporated into this handheld tool, and it has legitimacy because of the fact that this is all peer-reviewed metrics. Felipe talked about the workplace today, and he had a slide that had a lot of scary images on it, and one of them was a noose, and that was his way of saying that people do commit suicide, which is horrible. But that does go on, and it goes on in every one of our backyards. And so do people harm each other. And so we thought it would probably be to our advantage when this tool was created to add to each of these tests, the PSS-10, the GAD-7, the PHQ-9, an extra question. So it was question number 11 here, number 8 here, and number 10, which was do you have any interest in harming yourself or harming somebody else. It's a real question. We have to talk about it. It's not a pleasant topic, but it's real, and it's our responsibility as clinicians to be able to bring that right out on the table, get that stigma out of the way. This goes on in our families, it goes on with our friends, and it goes on in our workplace. So put it right out there. Have that as one of the questions. In the event that the person presses yes, then there's an automatic built-in mechanism, and different companies use different pathways. But somebody is alerted, a real person is alerted at that time, and then there's a whole cascade of events that take place. And that's a way, primitive as it may be, to mitigate against something progressing to something much more serious. So the methodology we used in this simple little study that we did was we had the workforce of the 17,000 group of people in this medium-sized technology company alerted through e-mail and Internet that this study was going to take place. So it wasn't secret. Everybody knew about it, that it was going to take place. And then we had to decide, how big are our groups going to be? And we elected, and I won't bore you with how we came up with these numbers, but we decided that 250 was a good denominator size, and using the random number method, we were able to put people in the control group and the experimental group from those selected. The people in the experimental group were obviously given access to CheckMe, a platform which was seamlessly integrated with the company app. So it was there, it was downloaded, and they all had it on their phone. The platform included a functionality for user compliance with manager oversight. So we have built into it a way in that managers can ensure that if you're in the experimental group, you're using it because they can follow your use. And that was helpful in keeping the compliance at a fairly high percentage. No personal data was collected or stored, but that is built into the tool in the event that some company wants to take on that liability of storing personal data. So we did not do it in the study, and we don't typically do that. Each participant was incentivized with a monetary award upon completion of the study, which took place over six months. The rates of absenteeism and therapist engagement were collected in the experimental group over the six-month study. I will add, to emphasize that the tool can be just used simply as a gateway to a therapist 24-7, 365. That was one of the beauties and unique differentiators of this tool that we had partnered with a therapy group that had that ability to do that. So any time of the day or night, Friday night, Sunday morning, whatever it might be, if you just wanted to speak to a therapist, you could use this tool and get right to a therapist in real time. And the rates of absenteeism and therapist engagement were collected in the control group over the six-month study. Here were the results. Experimental group compared to the control group. We found a 25% reduction in absenteeism over that six-month period and a 50% reduction in the engagement of therapists. You might want to think about that. How is that 50%? How does that make any sense? So despite having the 24-7 access to a therapist on this platform, the engagement, as you saw, was significantly reduced. And this was probably for two reasons. Number one, that we did provide online access to solutions to whatever your condition might be. So if you were suffering from depression, you could automatically be connected in real time to different modalities on the internet that address depression. And again, if that wasn't working, you could immediately press the icon in the corner and talk to a therapist. But as I said, there are people that would prefer to manage their own emotional health condition in the privacy of their own home. So as I said, it was a consequence of providing the user with a score on their targeted test as well. And the reason why that was important was that we found out serendipitously, I guess, that when people know, based on their score, that my anxiety level or my level of depression or my level of stress is not in the red zone, then maybe I don't need to talk to a therapist. Maybe I can just wait a day and take the test again or wait a few hours and take the test again. It doesn't matter. So we felt those two elements were why there was less therapist engagement. And the second conclusion was that since absenteeism is directly linked to short and long-term disability claims, which Philippe had alluded to earlier, we encourage further studies be done to demonstrate how this platform or any digital platform, for that matter, may reduce such claims. So we really, the next step would be to demonstrate a return on investment in this kind of technology. And that would be the kind of arithmetic that a C-suite would want to see to make the determination, do we want to have this in our portfolio as part of our employee assistance program? All right, we'll stop there. And there's a microphone right here at the front. We'd love to hear from any of you, your own experiences with your own EAPs, what you were struggling with in your workplace, regardless of what sector you are with emotional health. I can't imagine there's anybody in here that's not. So feel free to come up. I think we have some time for questions. Thank you very much for listening. Hello, Dr. Fabius. Hi, Dr. Fabius from Health Next. I just wanted to help set the table a bit more to follow up on Philippe's comments. I've been doing a great deal of work. I was formerly the chief medical officer of what today is called Meritiv, previously called IBM Watson Health, before that was called Truven Health Analytics, arguably the largest medical database in the corporate world. And we do a tremendous disservice on the data side by reporting to all of you mental health issues separately. So you'll see a list that says you have 7% of your people have depression, 9% have anxiety, 11% have attention deficit disorder, 6% have substance abuse issues. It's really incumbent of all of you to add those numbers together. Now that doesn't mean that there may be some overlap, and some people have two or three of those issues, but one of the views that you really have to take to the C-suite is what Philippe was saying. In my research, for the average company, it comes out to be about one out of every four employees or one out of every five employees. And you have to say it to the C-suite that way, not even use percentages, to give them some idea of the magnitude of this issue. When you look at prevalence from a population health scale, this may be the number one prevalent issue for all of us to deal with inside a workforce population. And then I also encourage all of you to look at it from an employee and family perspective, employee independence. And one of the more recent things that we've been looking at is the percentage of families that have a mental health issue. And that's coming out to be closer to two in five. So it may not be the index employee who has a mental health issue, but they're dealing with a mental health issue with one of their spouses. When you look at white collar work, it comes out almost always to be the number one issue. In the blue collar work world, it's only second to musculoskeletal issues. And I thank you so much. For that reason alone, we have to look for technological solutions to this issue. Thanks, Dr. Fabius. Yes, ma'am. Can you provide us the raw data on that 25% and the 50%? It's funny you should ask that. The company, as you notice, I didn't name them, and they wanted it to remain anonymous. And if you like, this was somewhat of a beta test. And the reason they did that is it's a very competitive marketplace, and they were testing the waters, and they wanted to see whether or not this can work. And so I know what they are doing internally as we speak, which is they're looking at those numbers much more closely to come up with what I said, which was, how does this translate into money saved in terms of short and long-term disability claims and productivity? Can we monetize, excuse me, can we calculate the impact that has? So the answer to your question in brief is no, but I'm hoping that I'll be able to publish that sooner than later. Hi, Rob Cantor, Ford Motor Company. I was wondering if you could expand on something that you had mentioned before. You had said that the return on investment for money used or utilized for mental health issues is approximately four to one. Are you able to go into any further detail about what perhaps the most effective elements of that might be? That's a simple question with a complex answer, I would say, because to get to that number, you need to be able to have a lot of data, and probably more than you would expect, because calculating ROI based on direct health care costs, short-term disability and long-term disability is maybe within the reach of many organizations. But understanding what would be the return in terms of additional indirect costs, which probably are higher or equivalent in terms of productivity, engagement. You mentioned presenteeism. I'll give you an example. A study was conducted by Deloitte in 2020 in the UK in terms of costing mental health issues, and the cost associated with absenteeism were estimated to be at seven billion pounds a year. The cost associated with turnover were estimated to be at nine million pounds. And the cost associated with presenteeism were associated between 27 to 29 billion pounds. So that's more or less four times the cost of absenteeism or turnover. But it's only based on data that can calculate this presenteeism. And calculating presenteeism, as Rob said, you need to record this information. And there's ways to record presenteeism at work. There's some scores that are available. I think there's a Stanford score of presenteeism that allows you, if you're asking the right question, to calculate what is presenteeism, and out of which then you can calculate the return or what you lost in terms of presenteeism. So you need a lot of additional data of indirect costs to be able to come up with an ROI. But we look at the literature that the most sophisticated studies do collect data on the effectiveness of employees at work, in addition to the health care costs that are usually the easiest ones to obtain. And so I mean, there's a lot of literature. I mean, I've mentioned the range of 1 to 10, maybe, Ray, you may want to comment as well. But that's overall, I think the challenge as well is to put the same definition under the same name. The publications are hard to compare in reality because we are not comparing the same programs. When we mean by mental health intervention or wellness intervention or health care programs, what does it really mean? Is it comparable from one survey to another or from one program to another? So this is why today, I mean, I think we're able to safely come up with a range, an order of magnitude, which I think is good enough for our managers when you have to promote the value of these services and engagement to your bosses, you know, the financial guys. If you come up with this with studies and publications that are as close as possible to your own business or to your own environment, I guess you're credible enough to push this agenda further. I will add, that's a perfect answer because it's a complex answer. I agree. It's interesting that you should ask that question, sir, because we just completed our two-day International Corporate Health Leadership Council, and we spent a lot of time trying to develop metrics to address this kind of an issue. How do you quantify it? How do you compartmentalize it? And one theme that kept coming back over and over again, and it wasn't because we had been talking to each other beforehand, was the iceberg image. And we all seemed to go to that, and it was something originally presented by Ron Lemke, who's a very well-esteemed member of this college. And he, in a publication some years ago, talked about the direct and the indirect costs of healthcare. And I think if you look at that image and how so much of the iceberg is the indirect cost, which is below the water, it's a great metaphor, if you like, of helping one figure out just what are the numbers we're talking about and what is really impacted there. And if you dissect that out, it helps you come up with, in your organization, what a real ROI would mean, because you're looking at both of those subsets. Any other questions? I just had a quick comment. I think the numbers in healthcare may be higher than in health. I think it's just understudied. What we have seen during COVID was anxiety, like 40%, and in the post-COVID world. And I think it even... Depression is as high as, you know, 50%, but my question is about the organizational factors. Do you guys quantify that? Are you able, especially in the corporate world, are you able to say, you know, your organizational culture or the burnout of the worker is contributing towards our emotional health? Do you... How do you say that diplomatically? Fair point. I think it was presented yesterday by Richard Safian. I think it's all about the culture of health, you know, that you establish in your environment, be it through healthcare one or, you know, a group of people. And definitely, a number that was very striking, you know, the level of influence your manager has on your own emotional health than your spouse or partner, you know. So it starts with the organization, it starts with the individual, it starts with managers. And definitely, I mean, beyond the organization at work, it starts with, you know, helping managers to behave and act as managers that are caring, understanding, listening, available, and that can act as a buffer between, you know, upper management that put a lot of pressure on them and probably the other, the weakest part of the organization that has been known. So definitely, it starts with training, education, and awareness. It was referenced as well yesterday on the fact that there's absolutely no course whatsoever in business schools or MBAs or whatever. The value of the human capital of driving a team as a manager, you know, comes naturally for some. It doesn't for, I think, 60% or I think that's the number. So you know, it should be part of, you know, and some organizations, including this part of the induction program of the newcomers to say, you know, you will be acting as a representative of the organization. We count on you to behave that way, you know, that's the culture of the organization. So we want you to embrace it right away, immediately, yeah. Maybe just one comment on that, because I think, you know, the digital piece, as you said, is a key layer in the whole process. And the workplace, you know, has its influence on mental health too. And just a quick little story, there was a professor I was speaking to, one of the top professors on burnout, and he was talking, he was asked to go give a talk at an automotive facility. And I just saw Ford there, so I just, that idea came into my head. And this wasn't a Ford facility, so. And he said, look, you know, you've had a couple of suicide attempts, you know, everyone's stressed out, Doc, you know, come give a talk on mental health. And so he went to the factory, and he was, you know, waiting to have the talk, and he said, you know, can I have a tour around of your facility? And so he has a tour around the facility, and he sees the assembly line, and his mouth kind of drops, and he says, this is your mental health problem. You know, it was a little bit like Lucille Ball, right? It was just disorganized and crazy, and it was causing a lot of the mental stress of the workplace. So you have all these layers, right, of the individual, you know, inherent mental health, but the workplace also has its influence. So he said, look, if you can try to fix your assembly line, you know, you're really going to improve the mental health of the workforce. So I think we all have the opportunity inside the workplace to see what is influencing the stress, and can we help, you know, change some of the processes. I was talking about, you know, I'm also with International SOS, and as doctors, we're always on call, and when I started out, it was like one in three call, and, you know, if you didn't take a holiday, you were completely burned out. And today, it's taken our organization about, what, 15 years, so that we don't do call anymore. We follow the sun. And suddenly, all the doctors are not stressed out, and we're not having people leave and turn over. So I think process is another one of those layers, right? You've got the digital health, you've got the counseling, but then really looking at what is, you know, how can we influence the workplace to reduce stress? Yes, madam. I'm going to answer the first part of your question first, if I may, because I think that was a very, very relevant issue and it was one that I struggled with, which was if I'm having an anxiety attack or if I'm feeling hopeless and helpless, I don't want to wait three days to talk to somebody. And when I first launched, or when we first launched this platform, there was that reality because of this limited access to therapists in real time. So I felt that was, and we felt as a group, that this was very, very much of a challenge and we were never going to succeed if we couldn't overcome that obstacle. So I ended up partnering with a group called Workplace Options, which you may or may not have heard of, which is based in Raleigh and it's got a global footprint, but it literally is a force multiplier and it has an unlimited access of people who can be on that call in real time, 365, 24 seven. Now if you decide to use this platform and press, I want to speak to a therapist, you will speak to somebody in real time. It may not be a psychologist, but it's a screening individual who can decide right away, are you at risk of harming yourself or somebody else? Are you really suicidal? Are you really, really hopeless and helpless? And they're trained technicians, if you like, who can talk to that individual and the arrangement we have is that they can talk for as much as 45 minutes and then they set up appointments with the real therapist. So there is a screening triage system and many times what I've observed is that just having the ability to talk to somebody at three in the morning on a Friday night or Sunday morning at six in the morning is a good head start. Is it perfect? No, because of the situation you described, but it's better than waiting three days just to have a conversation. So that was the organization that we partnered with because they had that force multiplier capacity, which I felt was a requirement. This tool in and by itself is not the solution. You need to have access to a real person. Yes, sir. Thank you both for the presentation. I was just curious in terms of engagement based on the data that you've had so far, if you might have noticed a difference in terms of engagement if the individual was using a work issued device as opposed to their personal device. So for example, their work laptop, work phone, was engagement a bit higher as compared to using their own personal device? That's an interesting question. To be quite honest with you, I don't know the answer to that because we never looked at that. But what I will say, and Philippe had alluded to this earlier, that some of the reluctance to engage EAP may be because Big Brother's watching and they don't like that and maybe that's where you're going with this. But if you noticed, when we decided to do this study, immediately it was put out on the internet. Everybody in the company knew what was going on. Everybody knew this was happening. And so the thought of whether they want to access this resource on their personal device or the company device never really crossed their mind because it wasn't being done under the carpet, so to speak. So I don't have that data. But it's an interesting question because it still does point out the fact that there is a cohort of people that are going to say, I don't want anybody knowing that I'm doing this, that I'm gauging this resource, and they could perhaps find that out on my company-issued device. That was your point, yeah? Right. Yeah. Thank you. Okay. Are we on time? We're on time. Okay. That's it. Well, thank you again, everybody. Just on time, yeah.

mental health issues

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International Corporate Health Leadership Council

emotional health

stress

anxiety

depression

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organizational culture