Skip to content
Subscriber Assistance+1 215 942 8342
Subscriber Login
Shop Here
addressing the missing middle


Addressing the "Missing Middle"


Mental health is universal—everyone has it—and everyone can benefit from some form of support to maintain and improve their mental health.  It is an arresting statistic that 83% of people will experience at least one mental health issue by middle age, which makes up a significant proportion of a workforce. However, enduring stigma, a lack of awareness that a vast majority of issues can be managed effectively, and a huge and widening global shortage of trained clinicians remain significant barriers to improving our mental health. 

People spend one-third of their lives at work. Therefore employers are uniquely positioned to support employees’ mental health, both through avoiding harms and through promoting benefits.  The cost of failing to do so is steep, with meaningful losses in quality of life for employees and an outsize braking effect on business outcomes.

The Current State of Mental Health and Wellbeing Globally

Most, if not all, of us know someone struggling with their mental health.  Today, an estimated 1 in 4 adults are living with a diagnosable mental health condition. Nearly half do not seek professional treatment because of stigma, lack of confidence in care, and a preference for self-help.  And those who do seek professional care often have trouble accessing treatment due to a worldwide shortage of trained providers.

In the United States, over 112 million people live in federally designated mental health shortage areas, with less than one mental health provider per 350 individuals—a longstanding shortage simply cannot be addressed through training more professionals given the time and the cost required to do so.  In the UK, waitlists for psychological services almost always extend past 12 weeks, and over 75% of mental health patients turn to emergency services for help in the interim.  Globally, although the average number of mental health workers has increased slightly from nine professionals per 100,000 people to thirteen, there’s still a very long way to go to ensure access to care for everyone who needs it. 

Against this unsettling backdrop, demand for mental health services continues to grow—59% of working adults struggle with at least one mental health challenge, and 4 out of 10 Americans say they cannot access the care they need.  Poor mental health, specifically depression and anxiety, costs the global economy 12 billion working days and $1 trillion in lost productivity annually. 

The “Missing Middle”

A global pandemic, the cost-of-living crisis, and swiftly evolving ways of working underline the increasingly urgent need to support mental health and wellbeing in the workplace. However, while many organisations have added mental health to their benefits offerings, 3 in 4 employees feel employer-provided support is inadequate. This points to a clear disconnect between what employees need and want and the current approach to mental healthcare.

Many of the benefits organisations have invested in are too narrow in scope, focusing only on one end of the mental health continuum. This approach leaves many falling into the ‘missing middle’ – the large majority of the working population, people who sometimes struggle with their mental health, but don’t have an easy pathway to the right level of care for their needs, and who prefer self-care to professional treatment.

While therapy is apt for those employees who need more in-depth support it isn’t always the best fit for the large percentage of employees who prefer to self-care to manage everyday symptoms, maintain their mental wellbeing, and build resilience. 

Mental health is not a constant. Like physical health, it is a highly individual experience that changes in response to life circumstances. At any moment in time, we fall somewhere on a continuum ranging from wellness to acute illness. Providing effective, accessible mental health resources across this continuum addresses the needs of all individuals at all points on their unique journey—the ‘missing middle’ and beyond.

The Missing Middle

The Role Organisations Play

We spend roughly one-third of our lives working, and for nearly 70% of employees, managers have more impact on mental health than their doctor or therapist with an effect equal to that of a romantic partner. That puts employers and workplace leaders in a unique position to support mental health. HR directors and the executive leadership can work together to create a culture of mental health at work, where mental wellbeing is prioritised and spoken about openly. 

Employers can help employees get the right support for their unique needs with discreet and accessible pathways to care. More than half of those struggling with their mental health are not seeking treatment. A preference for self-help is one of the most cited reasons for not seeking care. 68% of workers say they do not use benefits to their full value because they are too time-consuming, confusing, or cumbersome. 

Education and effective communication are also key parts of this equation. Organisations that want to build a sustainable culture of mental health will need to educate stakeholders across all levels of the business on the importance of mental health and how to access the support available.

The Digital Advantage

The current approach to care can be frustrating and complex for employees to navigate. To make matters worse, a fixed supply base of mental health providers has forced many healthcare systems to increase their treatment thresholds for mental health services, leaving many without access to much-needed support.  Many of your employees (as many as 58%) don’t need or want therapy with a clinician.  Most want simple support to look after themselves, not an appointment with a therapist.

Digital technology enables insurers and employers to make the move from reactive to proactive care while controlling costs, incorporating prevention and maintenance care into pathways without the need to hire additional mental health professionals.  Early intervention is known to achieve better health outcomes, reduce the risk of sickness-related absenteeism, improve employee engagement and productivity, and reduce downstream clinical costs.

What’s Next?

To scale mental healthcare access and make mental wellbeing sustainable, employers must seek out innovative, effective solutions that can meet the wide-ranging needs of their unique populations.  Digitally-enabled mental health care allows organisations to maximise EAP and existing services uptake and widen access to care while containing or significantly reducing costs. 

With thousands of digital and app-based mental wellbeing solutions on the market today, it can be hard to find an evidence-based solution that meets the full range of your employees’ needs.  Ahead of World Mental Health Day this October 10th, organisations should seek answers to these questions when evaluating current and future investments in digitally-enabled mental health benefits:

  1. Who is creating and curating the content and services?  Solutions should be built by qualified experts utilising evidence-based methods and long-term, science-backed research.
  2. How are solutions tested and approved?  Clinical trials, peer-reviewed studies, and third-party evaluations can protect your organisation from falling for false and ungrounded marketing claims.
  3. What therapeutic frameworks are used?  Well-rounded solutions are based on multiple clinically-validated therapy modalities to meet the changing needs of each member of your workforce.

As a leader and pioneer in international health and security risk management, our Workforce Resilience solution integrates various channels of mental health support for our clients. Through our partnership with Koa Health we enable organisations to reach a global employee population - from the large portion of your workforce that falls within the ‘missing middle’ to those employees who need emergency support during a mental health crisis.  Through a combination of digital and human resources, our services allow employers to boost the resilience of their team, while reducing risks to both individuals and the business alike.  As part of an employer’s Duty of Care to their teams, we enable organisations to drive positive outcomes for both workers and employers in today’s challenging times.