Mental Health Benefits: Meeting US Employee Expectations

The American workplace has undergone a profound transformation in recent years, with mental health benefits evolving from optional perks to essential components of competitive employee packages. For international companies hiring in the US or expanding their US operations, understanding and meeting these expectations isn’t just about compliance—it’s about attracting top talent, reducing turnover, and building a thriving organizational culture.

The statistics paint a clear picture: 57% of US employees are experiencing at least moderate levels of burnout, while 92% say mental healthcare coverage is essential to creating a positive workplace culture. Additionally, 51% of employees say they would use a free, confidential mental health support resource if offered by their employer. For companies entering the US market or scaling their American workforce, these numbers represent both a challenge and an opportunity to differentiate themselves in an increasingly competitive talent landscape.

At Foothold America, we’ve helped hundreds of international companies navigate the complexities of US employee expectations around mental health support. Our extensive experience managing American workforces has taught us that successful mental health benefits programs go far beyond basic coverage—they require cultural understanding, strategic implementation, and ongoing commitment to employee well-being.

The Current Mental Health Landscape in US Workplaces

Understanding Employee Expectations

American employees today expect comprehensive mental health support as a standard part of their employment package, not a bonus. This shift reflects broader cultural changes in how mental health is perceived and discussed in American society.

“We’re seeing a fundamental change in how US employees view mental health benefits,” explains Angelique Soulet-Bangurah, PHR, Head of EOR Services & Talent Acquisition at Foothold America. “It’s no longer something people are embarrassed to ask about. Candidates routinely inquire about mental health coverage during the interview process, and existing employees expect their employers to expand and improve these offerings continuously.”

The COVID-19 pandemic accelerated this transformation, bringing mental health challenges into the mainstream workplace conversation. Remote work, increased stress levels, and blurred work-life boundaries created new mental health challenges that employees expect their employers to address proactively.

The Business Case for Comprehensive Mental Health Benefits

The financial impact of mental health on business operations is substantial. Globally, depression and anxiety cost the economy US$1 trillion per year in lost productivity, with an estimated 12 billion working days lost annually. In the United States specifically, employees with unresolved depression experience a 35% drop in productivity, costing organizations $210.5 billion annually in absenteeism, reduced productivity, and medical expenses.

Companies that invest in comprehensive mental health benefits typically see significant returns through reduced healthcare costs, lower turnover rates, and improved productivity. Research shows that employers receive £4.70 for every £1 invested in mental health interventions. Workplaces prioritizing mental health see 13% higher productivity, with employees 2.3 times less likely to report feeling stressed and 2.6 times more likely to experience reduced absenteeism.

Regional and Cultural Considerations

Mental health benefit expectations vary across different regions and demographics within the United States. West Coast tech companies often lead with innovative mental health perks, while traditional industries in other areas may focus more on fundamental coverage and access. Understanding these regional differences helps companies tailor their benefits to local market expectations.

Generational differences also play a crucial role. Nearly half of young workers aged 18-29 (47%) report that their job has negatively affected their mental health, and 91% of Gen Z workers say they have struggled with mental health issues at least “sometimes” during the past year, while 62% struggled “often”. These younger employees have significantly higher expectations for mental health support and are more willing to discuss these needs openly.

Essential Components of Competitive Mental Health Benefits

Health Insurance Mental Health Coverage

The foundation of any mental health benefits package is comprehensive health insurance coverage that includes mental health services. Under the Mental Health Parity and Addiction Equity Act, health plans that offer mental health benefits must provide them at the same level as medical and surgical benefits.

However, compliance with federal requirements represents the minimum standard, not the competitive benchmark. Leading employers offer plans with lower deductibles for mental health services, expanded provider networks, and coverage for alternative treatments like therapy apps and wellness coaching.

“The key is understanding that basic coverage isn’t enough to attract and retain top talent,” notes Jamie Neill, PHR, HR & Client Service Manager at Foothold America. “Companies need to think beyond traditional therapy and consider the full spectrum of mental health support that American employees expect.”

Employee Assistance Programs (EAPs)

Modern Employee Assistance Programs have evolved beyond traditional counselling referrals to encompass comprehensive support for various life challenges. Effective EAPs provide 24/7 access to mental health professionals, crisis intervention services, and resources for family members.

The best EAPs offer multiple access points, including phone, video, chat, and in-person sessions, recognizing that different employees prefer different communication methods. They also provide specialized support for everyday workplace stressors like financial concerns, legal issues, and childcare challenges that can significantly impact mental health.

Digital Mental Health Platforms

Technology-based mental health solutions have become increasingly popular among US employees, particularly younger workers who appreciate these platforms’ convenience and privacy. Popular options include meditation apps, therapy platforms, stress management tools, and mental health assessment resources.

Companies are finding success with platforms offering self-guided resources and professional support. These include apps like Headspace for Business, Lyra Health, or BetterHelp for Business, which provide employees with immediate access to mental health resources without the barriers often associated with traditional healthcare systems.

Flexible Work Arrangements

Flexibility has become one of the most valued mental health benefits, with employees recognizing the connection between work-life balance and mental well-being. This includes flexible hours, remote work options, compressed work weeks, and mental health days.

The concept of “mental health days” has gained particular traction, with many companies now offering specific paid time off for mental health needs separate from traditional sick leave. This acknowledges that mental health maintenance is as essential as physical health care and shouldn’t require employees to justify their needs or pretend to be physically ill.

Implementation Strategies for International Companies

Assessing Current Needs and Gaps

Before implementing new mental health benefits, companies should thoroughly assess their current offerings and employee needs. This typically involves reviewing existing health plan coverage, surveying employees about their mental health needs and preferences, and analyzing utilization data to identify gaps.

Employee surveys should be designed to capture what benefits employees want and how they prefer to access these services. Some employees prefer traditional therapy, while others benefit more from digital solutions or peer support programs. Understanding these preferences helps companies allocate resources effectively.

Partnering with the Right Providers

Selecting mental health benefit providers requires careful consideration of network coverage, service quality, and employee experience. Companies should evaluate providers based on their geographic coverage in target markets, the diversity of their provider networks, and their ability to integrate with existing benefits systems.

It’s also essential to consider providers’ experience working with diverse populations and their ability to offer culturally competent care. The US workforce is increasingly diverse, and mental health providers must be equipped to serve employees from various cultural backgrounds with sensitivity and understanding.

Communication and Promotion Strategies

Even the most comprehensive mental health benefits are ineffective if employees don’t know about them or feel comfortable using them. Successful implementation requires ongoing communication campaigns that normalize mental health conversations and promote available resources.

“We often see companies invest significantly in mental health benefits but struggle with utilization because employees either don’t know what’s available or feel stigmatized about using these services,” explains Geanice Barganier, Vice President of People & Operations at Foothold America . “Effective communication strategies are just as important as the benefits themselves.”

Communication should be multi-channel and ongoing, not just a one-time announcement. This might include lunch-and-learn sessions, manager training programs, employee testimonials, and regular reminders about available resources through various company communication channels.

Managing Mental Health Benefits Across Different Employee Categories

Full-Time vs. Part-Time Employees

US companies must navigate complex decisions about which mental health benefits to extend to different employee categories. While full-time employees typically receive comprehensive benefits packages, part-time workers’ access to mental health resources varies significantly across organizations.

Leading companies are increasingly extending mental health benefits to part-time employees, recognizing that mental health challenges don’t discriminate based on employment status. This might include access to EAP services, digital mental health platforms, or wellness programs that don’t require health insurance enrollment.

Remote and Hybrid Workers

The rise of remote and hybrid work has created new challenges and opportunities for mental health support. Remote employees may face stressors like isolation, difficulty setting boundaries, and technology fatigue while potentially having a better work-life balance.

Companies must ensure their mental health benefits are accessible to remote workers and address remote-specific challenges. This includes providing digital mental health resources and virtual wellness programs and ensuring that remote employees feel connected to available support services.

Legal and Compliance Considerations

Federal Requirements and Protections

Companies must understand their legal obligations regarding mental health benefits and workplace accommodations. The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodations for employees with mental health conditions, which might include flexible schedules, modified duties, or workspace adjustments.

The Family and Medical Leave Act (FMLA) allows eligible employees to take unpaid leave for severe mental health conditions, and some states have expanded these protections with paid family and medical leave programs. FMLA applies to employers with 50 or more employees within a 75-mile radius. However, companies using an Employer of Record (EOR) may need to comply with FMLA requirements regardless of their actual employee count, since the EOR’s total employee base typically exceeds the 50-employee threshold. This means even small companies with just a few employees could be subject to FMLA obligations when working through an EOR. Companies need policies and procedures that comply with these requirements while supporting employee mental health needs.

State-Level Variations

Mental health benefits requirements and protections vary significantly across states. Some have enacted legislation requiring specific coverage, while others have expanded employee protections related to mental health leave or workplace accommodations.

Companies operating in multiple states must navigate these varying requirements and often find implementing comprehensive mental health benefits that exceed the minimum standards in all locations simpler. This approach ensures compliance while providing consistent support to all employees regardless of location.

Privacy and Confidentiality

Mental health information is highly sensitive and subject to strict privacy protections under HIPAA and other regulations. Companies must ensure that their mental health benefit programs comply with these privacy requirements and that employee mental health information is protected.

This includes training managers and HR staff on appropriate responses to mental health disclosures, ensuring that mental health benefit providers have appropriate privacy protections, and developing policies that protect employee confidentiality while enabling necessary workplace accommodations.

Creating a Supportive Workplace Culture

Leadership Training and Support

Managers are crucial in creating psychologically safe workplaces where employees feel comfortable seeking mental health support. This requires training programs that help managers recognize signs of mental health challenges, respond appropriately to employee disclosures, and connect team members with available resources.

“Manager training is often missing in mental health benefit programs,” says Jamie Neill. “Managers are on the front lines of employee interaction, and they need the skills and confidence to support their team members’ mental health needs while maintaining appropriate boundaries.”

Training should cover topics like recognizing signs of mental health challenges, having supportive conversations with struggling employees, making appropriate referrals to available resources, and managing workplace accommodations. It should also address managers’ mental health needs and stress management strategies.

Reducing Stigma and Promoting Open Dialogue

Creating a culture where mental health conversations are normalized requires intentional effort and ongoing commitment. This might include mental health awareness campaigns, employee resource groups focused on mental health and leadership sharing their own mental health experiences.

Companies can also promote mental health awareness through participation in national campaigns like Mental Health Awareness Month, hosting mental health speakers or workshops, and integrating mental health topics into regular company communications and training programs.

Cost Management and ROI

Budgeting for Mental Health Benefits

Mental health benefits represent a significant investment that typically provides strong returns through reduced healthcare costs, lower turnover, and improved productivity. Companies should budget for direct expenses like insurance premiums and EAP services and indirect costs like training and communication programs.

Cost-effective approaches might include starting with digital platforms and EAP services before adding more expensive benefits like enhanced insurance coverage or on-site counseling. Many companies find that employee demand and utilization help justify expanded investment over time.

Measuring Return on Investment

ROI for mental health benefits can be measured through various metrics, including reduced healthcare costs, lower absenteeism and turnover rates, improved employee engagement scores, and decreased workers’ compensation claims related to stress and mental health.

Companies should establish baseline measurements before implementing new mental health benefits and track changes over time. While some benefits may take months or years to show measurable impact, others, like reduced absenteeism and improved employee satisfaction, may be visible more quickly.

Leveraging Tax Advantages

Many mental health benefits qualify for favorable tax treatment, reducing the effective cost to employers. Health Savings Account (HSA) contributions can be used for mental health services, and through an HSA, many health benefits are tax-deductible as business expenses.

Companies should work with tax professionals to understand how to structure their mental health benefits to maximize tax advantages while ensuring compliance with relevant regulations.

Future Trends in Mental Health Benefits

Emerging Technologies and Solutions

The mental health benefits landscape continues to evolve with new technologies and approaches. Virtual reality therapy, AI-powered mental health assessment tools, and personalized wellness programs are becoming increasingly available and may become standard expectations in the coming years.

Companies should stay informed about emerging trends and be prepared to adapt their mental health benefit offerings as new solutions become available and employee expectations continue to evolve.

Generational and Cultural Shifts

As younger generations become a larger workforce, mental health benefit expectations will likely continue to expand. These employees expect proactive mental health support, personalized solutions, and integration with other aspects of their employee experience.

Cultural shifts toward greater openness about mental health will also likely increase the utilization of mental health benefits and create pressure for more comprehensive offerings. Companies anticipating and adapting to these changes will have competitive talent acquisition and retention advantages.

Integration with Overall Wellbeing

The future of mental health benefits lies in integration with comprehensive employee well-being programs that address physical health, financial wellness, career development, and work-life balance. This holistic approach recognizes the interconnected nature of different aspects of employee well-being.

“The most successful companies we work with understand that mental health isn’t a standalone issue,” explains Angelique Soulet-Bangurah. “It’s interconnected with every aspect of the employee experience, from workload management to career development opportunities to financial security.”

Conclusion: Building a Mentally Healthy Workplace

Creating comprehensive mental health benefits that meet US employee expectations requires strategic planning, cultural understanding, and ongoing commitment. For international companies entering the US market or expanding their American operations, these benefits represent a crucial investment in building a competitive, sustainable workforce.

The key to success is understanding that mental health benefits are no longer optional perks but essential components of competitive employee packages. Companies that approach mental health benefits strategically, focusing on employee needs, cultural factors, and business objectives, will find themselves better positioned to attract and retain top talent while building thriving organizational cultures.

Your Next Steps:

1. Assess Current Offerings: Evaluate your existing mental health benefits against US market expectations.
2. Survey Your Workforce: Understand your employees’ mental health preferences.
3. Develop a Strategic Plan: Create a comprehensive approach that addresses identified gaps and supports business objectives.
4. Implement with Support: Work with experienced HR professionals to ensure effective implementation and ongoing management.
5. Monitor and Adapt: Continuously evaluate program effectiveness and adapt to changing employee needs and market trends.

At Foothold America, we’re committed to helping international companies navigate the complexities of US employment expectations, including mental health benefits. Our comprehensive HR solutions ensure that your mental health benefit programs meet compliance requirements and support your strategic objectives for talent acquisition, retention, and organizational success.

As you build or expand your US workforce, consider how comprehensive mental health benefits can give you a competitive advantage in attracting top talent while demonstrating your commitment to employee well-being. With proper planning and implementation, mental health benefits become not just a cost of doing business but a strategic investment in your company’s future success.