Article first published in Health and Protection
Debating EAP regulation
The issue of regulation within the Employee Assistance Programme (EAP) sector has always been a contentious topic.
Supporters of more regulation insist that it will provide a consistent level of quality, confidentiality, and privacy for employees, and increased accountability for EAP providers. Those that argue against increased regulation maintain that rigid directives will increase administrative costs that will reduce the availability and scope of EAP services and for patients with more specific cases.
But what does regulation for UK EAP providers look like in practice?
In a low regulation environment, EAP service quality is hard to guarantee
The fact is that EAPs in the UK are very lightly regulated. UK EAP providers are typically Employee Assistance Programme Association (EAPA) accredited, and a member of the British Association for Counselling and Psychotherapy (BACP), but ongoing audits of practices and reviews of codes of conduct don’t exist within the UK market.
There is a constant pressure on EAPs to support clients with increasingly complex needs, in an environment of decreasing NHS services. However, it is crucial to note that the best EAP providers can deliver value for their customers without sacrificing their quality of services, relationships and clinical outcomes.
Unfortunately, escalating EAP costs from increased EAP utilisation rates, shrinking margins, increased operational costs and reduced corporate budgets have led some EAP counselling providers, especially low-cost EAP providers, to cut corners and engage in a race to the bottom.
This has resulted in allegations of highly inappropriate working practices such as:
- Breaching confidentiality, privacy and data protection laws
- Hiring unqualified, unlicensed clinicians to provide the necessary mental health services
- Drafting in non-clinical staff to answer helpline calls from vulnerable patients
- Requiring counsellors to keep referral rates below a certain threshold
- Failing to provide adequate training and supervision for counsellors
Unfortunately, the level of regulation in the UK EAP industry hasn’t acted as a strong enough safeguard to prevent such alleged abuses, which will inevitably occur when EAP mental health providers are commercially driven and not clinically driven. Realistically, being accredited by the BACP and EAPA is a hygiene factor for EAP providers, not a differentiator, and high standards of quality must be applied, driven, and championed by EAP providers themselves.
How the best EAP service providers can improve standards through self-regulation
To ensure a quality, clinically led, outcomes-focused service, EAP providers should engage in the following EAP best practices:
(i) Hold mental health services to a higher standard, similar to primary care services
Given counsellor-led mental health services aren’t formally regulated, there can be significant differences in the definition of quality and how it is measured. However, a significant step forward for EAP providers would be to regulate their mental health services to the same conceptual frameworks that we see in the primary care sector. This would facilitate providers to uphold a higher standard across their GP and EAP online counselling services through establishing processes such as ongoing monitoring, audits, feedback mechanisms and action plans to address identified issues.
At HealthHero, our GP services are highly regulated, and we apply this same level of governance to our mental health and EAP services, including all aspects of mental health assessments, single session counselling, and structured EAP counselling sessions, to ensure the highest levels of client safety and clinical outcomes. For instance, HealthHero’s EAP services consistently achieve an NPS of well over 50 (classified as excellent), and often over 70 (considered world class). For a service that serves users with mental health conditions such as depression, this represents extremely positive user experience.
To safeguard our standards and maintain our excellent level of clinical outcomes, HealthHero established a Clinical Governance Board (CGB). This includes representatives from all levels of our clinical team as well as external clinical advisors, which provides a professional perspective, independent judgement and expertise to guide our decision-making processes and creates an environment where clinical excellence will flourish. The CGB has oversight of all aspects relating to the clinical governance of HealthHero’s mental health services, including:
- Risk management
- Clinical audit
- Education, training and Continued Professional Development (CPD)
- Evidence-based care and effectiveness
- Service user experience and involvement
- Staffing and staff management
- Information management
Prioritising the mental health and wellbeing of patients should be the constant theme that drives all operational decision making. Top EAP providers should never assign fixed targets, budgets or quotas for referrals to bring any commercial influence on either the referral rate or number of structured EAP counselling sessions per case. All clinical referrals from assessment into structured therapy should be purely clinical decisions, as is the case at HealthHero, where we refer between 45% and 50% for service users for structured therapy, following clinical assessment, with those who engage with therapy having, on average, five sessions per case as part of a standard 6-session model.
Every patient who calls an EAP mental health helpline or books an EAP triage needs to be guaranteed a proper assessment with a qualified clinical counsellor - this should be a cornerstone at the core of any EAP service. At HealthHero, every client (patient) who reaches out to us for EAP counselling services has a session with a qualified counsellor.
The best EAP providers should have a strong policy to safeguard all their clients and customers. All mental health clinicians and designated staff should be required to complete internal safeguarding training. Ultimately, the safety and confidentiality of service users should be the priority. To ensure this, providers must obtain consent from the service users for processing data and ensure full GDPR compliance.
(iii) Invest in your counsellors and clinicians' skills and wellbeing
Clinicians’ wellbeing should receive the same high standards of consideration and support as service users. The highest clinical and quality standards should be reflected in stringent vetting procedures and codes of conduct for all clinicians including counsellors, as well as ongoing monitoring, audits, and the provision of guidance and training. Employed clinicians should be provided with an extensive and effective induction process to ensure that they are familiar with clinical protocols and practices and be required to undergo regular professional development to keep their skills in line with the most up to date evidence-based practice.
Counsellors should be managed and supported by experienced senior clinicians who have the independence and authority to change the priority of their workload with support from duty senior clinicians and quality officers where risk calls are encountered i.e. where there is the need for a case review and/or a break from delivering support in circumstances where a case creates unusual emotional impact.
EAP providers may balk at the additional effort and cost this requires, but HealthHero can attest that this ultimately pays off. Several of our strategic customers have worked with us for a very long time, due to the quality of our clinical service provision. Some of these relationships extend over decades and have been subject to many retendering exercises.
High standards, quality care and great outcomes for employees’ mental health
In summary, the lack of regulation of UK EAP providers, has led to a range of unethical practices and breaches of privacy that have resulted in vulnerable patients not receiving the quality of care that they deserve. Being accredited by the relevant associations is only a starting point, and the onus should be on EAP providers to drive overall quality of care. Whether you’re a global EAP provider or an EAP provider for a small business, your offering must be built on core principles of integrity, respect, confidentiality and a commitment to excellence to ensure that their services are clinically led and professional, with a focus on positive outcomes for patients, clinicians and employees alike.
Learn about how HealthHero are supporting organisations to prioritise the mental health of their employees here.
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