Beyond the EAP: A Q&A with Castlight’s Director of Behavioral Health

Mental health has become a much bigger part of the benefits conversation in recent years. What used to be a secondary offering is now a key driver of employee wellbeing, engagement, and overall health. Mental Health Awareness Month is a good time for employers to take a step back and ask whether their current approach is really meeting the needs of their workforce.

We sat down with Sarah Oslund, PhD, Director of Behavioral Health, to talk about how the role of behavioral health is evolving, where traditional models fall short, and what employers should be thinking about next.

How has the role of behavioral health evolved within employer-sponsored benefits over the past few years?

The role of behavioral health within employer-sponsored benefits has evolved from a secondary offering to a key driver of employee wellbeing, engagement, and overall health. Mental health has become a much bigger part of the benefits conversation in recent years instead of a benefit employers may or may not choose to “check the box.” Employees are asking for it and employers are recognizing the benefit of these offerings.

Nearly 97% of employers now have some kind of mental health offering or coverage for their employees. It is increasingly linked to business outcomes such as cost control, engagement, and leave management. We have seen a significant increase in the number of employer sponsored offerings available really since the start of the pandemic. Over the past few years, the focus has shifted to ensuring the resource is valuable. Employers are evaluating solutions that deliver better outcomes, smarter spending, and validate ROI, while also driving workforce resilience and retention.  

Where do traditional EAPs fall short when it comes to supporting employees’ mental health?

First off, I want to say that it “takes a village” to serve all of the mental health needs there are. Employee Assistance Programs (EAPs) are a good resource to have and many people find benefit from having a brief interaction with a mental health professional or being referred to longer term care via the EAP. I think it is important to think about providing benefits beyond the EAP, however.

Traditional EAPs fall short in supporting a broad spectrum of employees’ mental health needs. They have a limit on the number of sessions and are often focused on triaging, providing support, and referring to longer-term care, rather than resolving the core issue. It is nearly impossible to fully provide evidence-informed interventions with the session limits in place with EAPs.

As a result, we do not see as strong of outcomes from EAP services that we do from other levels of behavioral health services. EAPs often lack robust networks of providers, limiting availability to members and often do not have processes in place to evaluate quality of care. Employees tend to not use these resources as much as other services, with the average utilization of traditional EAPs falling between 2-5%. Many benefits leaders are starting to recognize the need for solutions that deliver better outcomes, smarter spending, validate ROI, and drive workforce resilience and retention.

Tell me a little about Castlight’s behavioral health program and how is our approach different from a traditional EAP model?

Castlight’s behavioral health program is comprised of an amazing group of licensed mental health clinicians (Licensed Professional Counselors, Licensed Social Workers, and Licensed Psychologists) who are passionate about providing quality, accessible care.  Our services go beyond triaging and referral.  Our behavioral health clinicians offer comprehensive treatment cycles rooted in evidence-based practices for individuals facing a broad array of mental health challenges. Our goal is to make connecting with quality mental health easy.  We are able to get individuals in to see a mental health provider often same or next day.  

In addition to providing high quality mental health care, we focus on the holistic health of the individual.  Too often mental health happens in a silo.  Because of who Castlight is and what we do, we recognize the need for individuals to engage in all of their health, especially preventative care.  Using screeners within Castlight, asking the questions, and noticing what people are asking for help with, we are able to offer up support early and often.  This allows us to provide individuals who are struggling an option for support and intervention without them having to search and guess.  When they engage with our Behavioral Health Clinician, those clinicians are not only treating mental health needs, they are helping to identify any gaps in care the individual has from a physical health perspective and working with care guides to get the individual connected to the right services.  They are also connecting with other health care providers when the member agrees to ensure that their mental health care is integrated into their overall care plans.  

What does a typical member journey look like—from first appointment to ongoing care?

We make it easy to be seen.  

Its tough to describe the beginning of the journey, because people can get to us in so many ways.  They may have taken a screener within Castlight or maybe searched for resources for a specific concern.  Or maybe they called into a care guide and asked for some help in finding support.  We try to offer lots of entry points into mental health care.  And because we do more than just mental health, we have opportunities to encourage getting support more than just a stand alone behavioral health company.  What I can say about the entry point is it is easy.  Individuals do not have to search for who is in network, who has availability, who is accepting new patients.  They can simply go on the app or ask a care guide and they get an appointment.  They can request a brief appointment to begin with to learn more or they can have a first session at that first meeting.

At the first session, the Behavioral Health Clinician  (BHC) will take some time asking a lot of questions to try and get a good idea of what is going on with the member.  They then work with the member to create a treatment plan that makes sense for the member, setting goals that are meaningful.  From there, they will meet with the member on a regular cadence (every week or every two weeks) and start doing the work.  Each time they meet with the BHC, they will take some screeners to see how things are going and the BHC will make adjustments to their treatment as needed.  We are focused on working on what the member is struggling with currently and helping them to feel better.  Our BHCs are digging in with the member and helping them do the real work.

Beyond utilization, how should employers really be measuring success in behavioral health programs?

A solid behavioral health offering should not be about quantity, it should be about access (most importantly- easy access), quality and collaboration. Yes, we want to engage members who need services but we want to do a whole lot more than that. Services should be easily accessible and accessible in multiple ways. And once a member is in services, they should expect that they are receiving high quality care that helps them feel better.

Of course, I am biased and think the behavioral health program should also encourage members to take care of their whole health, but I know that is not how traditionally mental health has operated. I am a firm believer that mental health should not happen in a silo. Mental health and physical health are so connected, it is important that we make sure the behavioral health program is encouraging the member to take care of all aspects of health.  

Finally, what should benefits leaders be thinking about as they evaluate behavioral health solutions today?

There are many great solutions out there.  Those that are great should:

• have good access for all
• make it easy for the member to get connected and engage
• and they should be able to demonstrate strong outcomes for members.

A benefits leader should look for a solution with all of those things as well as one that helps to identify those who may be in need. It is so hard for people to ask for help or even recognize when they need help. Having a resource that proactively identifies those in need and offering support is ideal.  

They should also consider how much of a benefit it would be to their members if their behavioral health solution is able to integrate with other pieces of the member’s healthcare journey. I would highly encourage benefits leaders to recognize that they have options and it’s not necessary to settle for a program that does not excel at all the things I listed here.