When Arun Gupta, founder of the New York City health care company Quartet Health, couldn't find satisfactory mental health insurance for his team, he came up with a creative solution: confidentially reimbursing employees for out-of-­pocket expenses through a third-party vendor. "A lot of times, people might have to pay cash or have high co-pays attached to getting therapy. Now they can see anybody they want to see, as often as they need," he says. "We're pushing the envelope here, but it's good for business."

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That's because roughly 18 percent of American adults suffer from some form of mental illness, according to the National Institute of Mental Health. And that makes it a particular problem for smaller businesses, where every employee plays a crucial, often nonduplicated role. In the United States, the total economic burden of major depression alone is now estimated to be $210.5 billion per year, according to the consulting firm the Analysis Group. Even if you don't go as far as Gupta, there are many measures you can take to ensure your workers are at their best.

1. Fight the stigma.

Build employee well-being into your culture. Once a month at social-media company Buffer, "we gather online and discuss topics like self-care," says Courtney Seiter, the company's director of people. At those times, Seiter says, employees share their struggles with anxiety, obsessive-compulsive dis­order, and depression. Boston-based clothier Ministry of Supply matches every employee with a company veteran who can provide emotional support. Co-founder and CEO Aman Advani attributes the company's "incredibly low voluntary exit rate" to this approach.

16.2 million
Number of U.S. adults who had at least one major depressive episode in 2016.
$1 trillion
Annual cost of depression and anxiety disorders in lost productivity to the global economy each year.
$504 billion
Cost of opioid addiction in the U.S. in 2015.
68 percent
of corporate and public sector employers polled in the U.S. and Canada say they face more mental health and substance abuse challenges than they did five years ago.
62 percent
believe depression to be "prevalent" in their workforces.
Sources: International Foundation of Employee Benefit Plans, National Institute of Mental Health, World Health Organization, The Council of Economic Advisers

Even offering unpaid leave for mental health crises can help, says Lauren Steiner, president of Cleveland-based consultancy Grants Plus, which was awarded a Psychologically Healthy Workplace Award from the American Psychological Association in 2016. "We had someone struggling with a mental health issue who needed time, and that's really hard for a small company to handle," she says. "When she came back to work, initially it was just for a few hours per day until she was ready to come back full time. I know she was very grateful for the flexi­bility." In addition to building employee loyalty, the company avoided the costs of hiring and training a replacement.

2. Insure wellness.

Comprehensive mental health coverage is expensive, but some employers believe it pays for itself. Lisa Hannum, CEO of St. Paul-based Beehive Strategic Communication, provides her employees a choice of insurance policies with different mental health coverage options. She says this policy has played a role in the company's 60 percent reduction in sick days over the past two years.

"My product is people," Hannum says. "If they're not energized and healthy, we don't have a product." Carrie Espinosa, owner of Waukegan, Illinois-based insurance agency Horizon Benefit Services, encourages employers to provide a number of plans and have their workers contact her directly for advice on benefits packages. "Employees can call us and say, 'Here's my scenario--help me pick the best plan,' " she says, pointing out that federal law ensures the conversation is confidential.

3. Work the program.

One popular supplement to standard mental health coverage is an employee-assistance program. EAPs, which can be added to insurance policies or purchased singly, are pack­ages of mental health services, such as limited-duration crisis counseling. But EAPs vary widely in their cost. If you can't afford one, get together with other businesses to purchase an EAP as a group, advises Jodi Jacobson Frey, an associate professor at the University of Maryland's School of Social Work. Then make sure your employees know about it.

Most employers have an EAP, but not all do what they should to publicize them. I've always aggressively promoted the EAP, " says Dan Mendelson of consulting firm Avalere Health. "Employees need to see the leaders of the company acknowledge the importance of engaging with mental health professionals when it's needed."

Roughly one in 10 Americans has an alcohol or substance use disorder, so you're likely to have an employee with a problem at some point. If you suspect someone, tread carefully.

Know the law.

"It's illegal under the Americans With Disabilities Act to discipline or fire employees just because they're alcoholics. Current illegal drug use is not protected. Drug testing is regulated by state law, and the rules vary drastically. It's a good idea to talk to a lawyer before staging an intervention." -- Sachi Barreiro, employment law editor, Nolo.com

From the March/April 2018 issue of Inc. Magazine