When AT&T opened its health and wellness clinic, complete with an on-site psychologist, in February 2020, the Texas-based company had no idea just how in-demand mental and emotional health support would become. After three or so years of pandemic-driven isolation that dramatically worsened mental well-being and altered people’s relationship with work, AT&T’s in-house therapist is busier than ever.
Connie Siciliano Avila is the lone clinical resource for employees within AT&T’s downtown Dallas headquarters. Each month, roughly 1,000 employees grace her office seeking help to deal with stress in and out of the workplace, depression, anxiety, and trauma. You name it, she’s likely addressed it.
“I’m the same Dr. Connie that I am if I’m in private practice, though I am a little more mindful that somebody’s going to leave my office and go to work,” Avila says.
Since descending on AT&T’s campus, Avila has had 17,000 visits to her office. And total visits have increased by 45% since July of this year, according to the telecommunications company. Despite the jump in usage of her on-campus service, employees, on average, wait only a day to get an appointment, compared to the average nearly seven-week wait time for a therapy session outside the office, according to the National Council for Mental Wellbeing.
“I anticipate, though, we’ll likely need to expand,” Avila says. She is the second most booked person in the company’s health clinic, behind AT&T’s on-site chiropractic, a recently expanded service.
Global anxiety and depression rates ballooned 25% in 2020, with one in eight U.S. adults now taking antidepressants. The need for mental health support has reached a boiling point, and psychologists are struggling to fulfill demand. The American Psychological Association reported last year that 60% of therapists had no openings for new patients, and 72% of those with wait lists have seen them extend since the start of the pandemic. That’s left a hole for companies to fill.
Jobs contribute to some of that mental angst. One in three U.S. workers says their job hurts their mental health, according to a May report from the Society of Human Resource Management, and 45% of respondents struggling with mental health report a productivity loss of more than five hours a week, according to a 2023 report from membership-based primary care practice One Medical.
While seeing a mental health therapist has lost much of its stigma, doing so at work, under the same roof as the people who sign your checks and with colleagues ostensibly watching, can be uncomfortable. Is it still confidential? Will an in-house company therapist inform management of your conversations? Will your boss judge or treat you differently?
These are concerns Avila says she addresses with patients. She isn't technically an employee of AT&T, instead working for the on-site benefits provider Premise Health, of which AT&T is a client. Premise Health offers behavioral health services like therapy to companies like Capital One, Rocket Center, and carpet manufacturer Shaw Industries.
“By not being an AT&T employee, I don’t have dual relationships. That would be an ethics issue,” Avila says. “The first thing I tell [employees] is that AT&T does not have access to their records.”
Though in-house therapists are not a common workplace practice, says SHRM advisor John Dooney, 77% of workers believe that companies have a responsibility to support mental health at work. More companies seem up for that challenge, and Dooney says there’s been greater corporate interest in caring for workers’ mental well-being. Other companies that offer therapists on campus include Google, Delta Air Lines, and JPMorgan Chase.
As companies look for new ways to attract higher office attendance, an in-house therapist could be an incentive. These programs, says Katherine Morgan Schafler—a former on-site therapist at Google—show employees how committed a company is to caring about their mental well-being.
“The progress we’ve made on mental health in the last decade has felt like—finally,” Shafler says. “It’s about building as many bridges to mental health resources as possible.”
Schafler worked at Google for just under two years at the company’s California headquarters, then went into private practice working with clients on Wall Street.
The obvious benefit for employees is the convenience of on-site therapy that’s merely an elevator ride away, rather than a lengthy commute before or after work, during a lunch hour, or, if you’re lucky, on the weekend. And that’s after one has gone through the trouble of finding a therapist who accepts their insurance, is available, and connects with the patient.
Investing in employee mental health isn’t cheap. Companies and employees spent nearly $77 billion treating mental health issues in 2020, according to the Employee Benefit Research Institute. And an analysis by the National Safety Council and the University of Chicago found that organizations, on average, spend more than $15,000 annually per employee experiencing mental health issues. The same analysis, however, estimated that organizations investing in mental health support see a return of $4 for every dollar spent.
Early investment in mental health helps companies avoid the higher cost of treating more severe and unchecked mental health issues and absenteeism. Lauren Winans, an HR consultant who spent decades as a benefits director at companies like American Eagle, says that offering in-house therapy isn’t about the return on investment for most companies: “If ROI comes at some point, I’m sure they’d be thrilled.”
But some expected outcomes include higher productivity and engagement, and better talent recruitment and retention.
“I expect we’ll get to a point where we will see real financial impact,” says Alyson Smith, who oversees mental health programming at Delta. “I think right now, in this moment, while we deal with the stress and the wounds we didn’t even know we had, it isn’t the immediate focus.”
Delta recently expanded its on-site mental health offerings, hiring more clinicians that the company said better represent the demographic makeup of employees. The airline has on-site clinicians at all of its nine of its hubs.
From Smith’s point of view, corporate America’s approach to mental health shouldn't be all that different from physical health. Companies invest millions into other kinds of health benefits without the same level of scrutiny.
“I don’t see [the increased investment] relaxing or going away anytime in the near future,” she says. “We invest heavily in mental health care, and these on-site clinicians are really an extension of that.”
