The Ultimate Guide to

Workplace mental
health strategies

The 2023 edition

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Guide Summary

The economic burden of mental health issues has become a serious reality across all Canadian organizations and industries. Stress, burnout and presenteeism are key factors impacting employee productivity, with few resources to turn to for help or treatment. What can HR leaders do to implement robust and effective mental health programs in the workplace? Our Ultimate Guide will help HR professionals understand common mental health issues and trends among employees, establish the wellness needs of their teams, and implement strategies to help create and maintain a healthier workplace.

The ultimate guide to workplace mental health strategies-1

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Canadian adults spend more time at work than anywhere else in their lives; it comes as no surprise that their work environment has a direct impact on their well-being.1 The joys of producing rewarding work and having solid team dynamics can provide motivation and forge a sense of belonging, but sometimes stress and the realities of life outside work manage to seep in. People at work are not only employees; they wear many hats outside their clocked-in commitments. It has never been more important to minimize employee suffering by fostering an inclusive, destigmatized professional environment where all feel they have access to compassionate care to alleviate the burden of feeling down.

These last few months have resulted in a secondary pandemic of sorts, in the form of burnout. Our new normal created months-long waiting lists for mental health professionals as more and more people began dealing with increased stress and anxiety. According to a 2021 Environics Research study2:

25% of Canadians

indicated that the pandemic
has worsened their overall health

45% of Canadians

indicated that the pandemic has
worsened their mental health specifically

Mental health issues are debilitating conditions that require a lot more than a few deep breaths and a quick cry in the bathroom. There is a cost to mental illness3:

Every week,

500,000 Canadians miss work

due to mental illness


This represents an economic burden of

$51 billion a year

Group 1

That number is projected to rise to an astounding

$2.5 trillion in 20 years

Looking to the future, we will need to keep our eyes peeled for residual anxiety disorders (including obsessive-compulsive tendencies), depression, and chronic loneliness, but more on that later.

01 Back to basics: defining mental health

Back to basics: defining mental health

According to the World Health Organization (WHO), mental health is defined as a state of well-being in which an individual recognizes their abilities, can cope with the normal stresses of life, work productively, and contribute to their community.4 Mental health issues manifest in many forms, including depression and anxiety (the most-diagnosed duo in Canada), substance abuse, eating disorders, and in the most severe cases, suicide.5 In any given year in Canada, regardless of age, education, income level, and culture, 1 in 5 people will experience mental health issues. The way people experience them and their resulting reactions can vary, depending on their genetic and biological predisposition, environmental factors, and personality.

Despite no one being immune to mental health challenges, there still exists stigma and discrimination, which ultimately prevent people from getting help when they need it, sometimes even foregoing treatment entirely. As HR professionals and health ambassadors, it may come as no surprise that this outcome is entirely undesirable in the way of overall well-being. Such issues tend to get even more hush-hush in professional environments, where it is generally expected that employees leave any emotional baggage at the door. Implementing a workplace approach to supporting mental health can have a huge impact on employee well-being at the office, leaving room for safety, inclusion, and understanding.

02 Tell-tale signs of stress and burnout

Tell-tale signs of stress and burnout

Anxiety and depression top the leaderboard in terms of most-diagnosed mental health conditions in Canada, and a successful mental health strategy needs to address these common but debilitating conditions. However, in the workplace, stress and burnout stand out from the crowd as related but distinct issues experienced by employees.6

Stress and burnout don’t stop at psychological symptoms; there are physical signs to watch for as well.

Signs of workplace stress

Work-related stress occurs when there are negative discrepancies between workplace demands, employee capabilities, access to resources, and their needs.7 The perceived pressure or expectations from these triggers put added emotional or physical strain on the employee.

Physical symptoms include:

Muscle tension
Muscle tensions
Teeth grinding
teeth grinding
Restless sleep
restless sleep
Stomach or digestive problems
Stomach or digestive problems
Sweaty palms
Sweaty palms
Rapid heart rate
Rapid heart rate

Psychological symptoms include:

Difficulty concentrating
Difficulty concentrating
Low productivity
Low productivity
Mood swings
Mood swings
Avoidance or social withdrawal
Avoidance or social withdrawal

Signs of employee burnout

Employee burnout, on the other hand, occurs when an employee enters a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.8 People suffering from burnout at work tend to feel emotionally drained and unable to function in their job and other areas of their life.

Physical symptoms include:

Excessive fatigue
Excessive fatigue
Loss of appetite
Loss of appetite
Sleep disruption (either too much sleep or not enough)
Sleep disruption
Backaches and headaches
Backaches and headaches
High blood pressure
High blood pressure

Psychological symptoms include:

A drastic drop in productivity
drop in productivity
A drastic drop in motivation
drop in motivation
Feelings of helplessness
Feelings of helplessness
Feelings of hopelessness
Feelings of hopelessness
Increased occurrence of errors
Increased occurrence of errors
Debilitating self-doubt
Debilitating self-doubt
Substance abuse
Substance abuse

Stress and burnout are less like siblings and more like distant cousins: they’re related but manifest differently.9 Someone experiencing stress generally tends to become over-reactive and hypersensitive, but over a shorter time period. On the other hand, those dealing with burnout tend to disengage, even becoming depressive and detached, resulting in the mismanagement of their symptoms.

03 Mental health in the workplace

The cost of absenteeism

The cost of absenteeism

As workplace stress continues to drain employees of their energy, organizations are experiencing a strain of their own. With mental health-related short-term disability rates continuing to rise, Canadian companies are spending billions in payroll costs, talent management expenses and lost productivity.10 The financial and human impact of mental health issues is significant:

Group 625-1

Absenteeism costs employers $16 billion per year.

Stress affects

72% of employees.

1 in 5 Canadians

requires disability leave every
year, citing mental health issues
as the number one cause.

Issues at work

Managers might create a stellar work culture and integrate values everyone is proud of into their team projects, but employee mental health could still be compromised if impacted by professional or personal circumstances.

Issues at work could include:

  • a heavy workload
  • a recurring struggle to maintain a work-life balance
  • an abrasive relationship with one’s manager

Personal stressors that may affect the work environment include arguments with significant others, caring for a sick loved one, or moving house. The effects of the pandemic have added new worries to the mix, too:

Almost 40% of Canadians still working from home

are worried about returning to the workplace among unvaccinated peers.11

44% of Canadian benefits plan members

are reluctant to turn back to their daily commute.12

17% of Canadian benefits plan members

worry about losing control over their work hours.

What is presenteeism?

Presenteeism occurs when employees have a mental health condition but opt to come in or log in to work instead of calling in sick. The tendency is born from ongoing workplace stigma and the desire to protect the sanctity of team spirit. Little do most know that this “good sport” mentality of showing up when unwell impacts every part of an organization.

Stigma is a dominant player. If there isn't a corporate culture that exists around appropriately managing and acknowledging mental health issues, employees are less likely to seek appropriate help when they need it. Furthermore, many employees lack knowledge about the symptoms of mental illness. Without knowing that what they’re experiencing can be successfully treated, they won’t be able to seek appropriate help. They’ll ignore the psychological pain or discomfort they’re in, often with the belief that they will feel better if they push on through. In the absence of that knowledge, they show up to work, think they’re pulling their weight, and believe they’re still contributing to their team. The truth is: they aren’t; they’re unwell.

04 How does mental health stigma impact organizations?

How does mental health stigma impact organizations?

Mental illness is unfortunately still closely followed by stigma. Almost 40% of people suffering from depression or anxiety forgo looking for a mental consultation due to the worry of being judged or misunderstood.13 While the number of people with mental health concerns continues to grow, there still exists a stigma around therapy, which hampers some from getting help when they need it most.14

Mental health in the workplace is a particularly delicate subject to broach. In an RBC study, approximately 75% of Canadian employees would either be reluctant to tell or entirely refuse to tell a manager or co-worker about their mental illness.

Canadian employees who are stuck between the desire to get help and facing fears of being treated negatively risk making the wrong choice for their mental health.

  • Almost 50% of Canadians claim to have partially met or entirely unmet mental health needs.15
  • 23% of these Canadians with unmet needs would prefer to manage their mental health on their own, in their own time, if they had the chance.
How does mental health stigma impact organizations 2?

Wanting to get help privately doesn’t mean this 23% wants to forgo treatment entirely. Companies can help ensure all people in need receive their preference for care by opting for services that offer self-led opportunities. Programs like internet-based cognitive behavioural therapy (iCBT) can help improve and increase employee well-being while remaining cost-effective for organizations:

  • Autonomy and privacy: An iCBT program provides members with 100% confidential access to clinically proven self-care toolkits.
  • Longer continuity of care: An iCBT program is accessible 24/7, allowing members to choose their own self-care journey anytime, anywhere.

05 Addressing and prioritizing employee mental health

What makes a good mental health program?

A good mental wellness program is easily accessible, used by employees, and acknowledges the mental health needs of the workforce. These programs should be backed by a work environment where employees feel safer and more comfortable working in an environment where stress is manageable, mental health is freely spoken about, and that encourages plan members to benefit from services available to support them.

Employers are responsible for creating a culture that supports physical and mental employee health. Mental health programs can help create psychologically healthy workplaces, which will make for16:

  • A higher quality of employee engagement
  • Better overall morale in the workplace
  • Higher levels of employee satisfaction
  • Higher retention rates and more attractive recruitment positioning
  • A more productive organization

Look for these key features in a mental health program

that will truly make a difference for your employees and have a positive effect on your organization:

Proactive prevention Proactive prevention mobile

Proactive prevention

Look for a program that fights mental health stigma in the workplace through proactive outreach initiatives using tools like mental health questionnaires and stress screenings, material on wellness tips and tricks, webinars on well-being, or even a library of self-led educational material.

Easy, convenient access to therapy Easy, convenient access to therapy

Easy, convenient
access to therapy

Employees are more likely to take advantage of therapy if it’s easy to access and fits into their schedule. Virtual therapy via video conferencing allows people to meet with a therapist from home, saving them the time and hassle of commuting to an in-person appointment. Enabling plan participants to get care according to their preference (self-led versus practitioner-led, or a bit of both) allows organizations to reach a broader employee base and improve utilization.

Multidisciplinary,  holistic treatment Multidisciplinary,  holistic treatment

holistic treatment

The program will ideally offer access to a multidisciplinary healthcare team. Members will be matched to the right professional among a roster of mental health specialists, psychologists, psychotherapists, doctors, and nurse practitioners, to help treat the unique needs of as many employees as possible, ensure adherence to treatment and timely resolution of issues. Treatment should also depend on where users are in their mental health journey, contributing to higher remission rates over time.

Focused on positive clinical outcomes Focused on positive clinical outcomes

Focused on positive
clinical outcomes

Mental health solutions should leverage a treatment approach that is effective and quick to resolve issues within scope and help to prevent relapse, such as cognitive behavioural therapy. Additionally, maintaining a therapeutic relationship with a patient leads to better outcomes more quickly, so a solution should include options such as unlimited sessions until remission or the option to continue with the same professional if sessions are limited.

Focused on positive clinical outcomes Focused on positive clinical outcomes

continuity of care

Follow-up sessions are also a vital part of ensuring positive outcomes. Employees should have follow-ups with the same care professional, track their mental health score every two weeks using GAD-7 or PHQ-9 assessments, and then jointly discuss their experience to assess whether they’re building resilience and developing the coping mechanisms necessary for a full recovery.

Measurable health and business outcomes Measurable health and business outcomes

Measurable health and
business outcomes

At Dialogue, we can actually quantify positive outcomes. We’ve learned a lot from the over 1 million consultations we’ve provided so far.

In regard to mental health, Dialogue has helped reduce short-term disability to less than 6 weeks in 70% of cases (compared to a Canadian average of only 30%), which means:

Less than 6 weeks of short-term disability

Ultimate_guide_mental_health_chart Ultimate_guide_mental_health_chart_mobile

Your employees are 40% more likely to recover more rapidly.

Your employees are

3 times more likely

to require a shorter disability leave (under 6 weeks)17.

Our data-driven approach to focus on outcomes using our robust technology has proven that our solution:

is budget-friendly: Companies can expect a 5X return on investment (ROI) from avoiding disability leave through preventative action (by investing approximately $5 per employee per month, organizations can save $31 per employee per month)


drives happiness:
The member satisfaction rate with our mental health programs sits at 96%

is effective:
93% of program members experienced a positive life change

It may seem difficult to quantify the potential revenue gains that come from building a culture of wellness at work, but the effects of having a happier, more engaged workforce compound positively to influence everything from attracting the best talent to making optimized business decisions.

Build a culture of health and wellness

Build a culture of health and wellness

Build a culture of health and wellness

Promote plan member participation

Managers must be active promoters of mental health programs and employee well-being to create a workplace culture that values wellness. The current reality is that there is an unfortunate lack of employee awareness with regard to what benefits they have access to:

  • 2 in 10 Canadians with employee benefit plans are not even aware of the benefits available to them.18
  • 24% of Canadians with benefit plans indicate that the mental health support available in their benefit plan is not sufficient.
  • Over 25% don’t know how to access the benefits available to them (via an app, a toll-free number, etc.).
Normalize mental health and wellness

Normalize mental health and wellness

To fight mental health stigma, organizations must become the leading advocates for employee wellness, from ensuring employees are taking valuable breaks or using vacation time, to encouraging honest feedback and monitoring overall well-being using feedback software. This creates a culture where mental health is valued and openly discussed, and employees are encouraged to seek appropriate help for mental health issues.

Promote healthy living

Promote healthy living

Another quick way to start prioritizing mental health is by promoting healthy living. Healthy activities that can help employees feel good and stay on top of their game include:

  • Exercise and nutrition
  • Meditation and sleep quality
  • Therapy or building resilience through iCBT

From meditation sessions to planning a healthy meal together, there are plenty of ways to help employees take breaks from work that will help them relax, re-energize, or refocus. Work wellness is a challenge taken on by an increasing number of important players. Major Canadian companies like Bell have created massively successful awareness campaigns, like Bell Let’s Talk Day, which aim to reduce the stigma associated with mental illness by encouraging people to talk openly about their challenges. Implementing similar initiatives is conducive to the small-scale reward of positive, incremental organizational changes in behaviour and perception.

What makes these programs successful is a top-down commitment to being open about and encouraging mental healthcare discussions. If employees feel encouraged to access their mental health benefits, they will more likely be able to acknowledge and seek help for symptoms before a problem escalates. Organizations benefit from a happier workforce and possibly reduce disability-related costs in the long run by leveraging a preventative approach to treating mental health issues.

Build a mental health toolbox


Appoint internal ambassadors and
create corporate promotional campaigns

Your service provider should equip you with all the resources needed to promote your benefits program within your organization. Engagement campaigns help boost awareness and address the benefits of virtual care. This may involve email campaigns, posters, and multiple reminders, but it will help boost adoption and adherence to treatment plans. Internal ambassadors should communicate the benefits to the employees often, alleviating the burden of stigma, and helping managers guide their team members when in need.

Appoint internal ambassadors and create corporate promotional campaigns

Consider one platform to house many
health care services

Integrated platforms provide access to holistic care from the same place. One common application drives employee awareness and adoption, simplifying access to the services they require most. Receiving care becomes much easier and the care given is coordinated and consistent across services, helping employees feel supported depending on their needs.

Consider one platform to house many health care services

Flexible mental health treatment options

The ideal mental health program uses a stepped care approach to determine the most effective treatment based on symptom severity, with the goal of resolving the issue and improving quality of life as soon as possible while reducing the overall cost of treatment. For this to be successful for both your organization and your employees, look for a truly integrated blend of self-led and practitioner-led therapy that can seamlessly support members over time, no matter what their care preference is or where they are in their mental health journey.

  • Self-led therapy: iCBT provides self-paced, interactive toolkits and psychoeducation that are available anytime, anywhere via a mobile app or web browser. Because of its immediate access, this type of therapy can be used for proactive prevention, to treat mild to moderate cases of depression and anxiety, and after a more intensive therapy program to continue maintaining a healthy wellness level and prevent a relapse.
  • Practitioner-led therapy: The option to speak to a mental health specialist should always be available, even if the member prefers to pave their own way through their challenges. Ideally, the member is supported by a multidisciplinary team – from a specialist to help members stay on track and achieve their self-care goals autonomously, to a licensed therapist who will work with them until they get back on their feet. Exceptional virtual care plans will offer all the care required to get help during trying times and promote health outcomes and a longer continuity of care.
Flexible mental health treatment options

Employee assistance programs

Most organizations offer employee assistance programs (EAPs) to employees as a bare minimum; as a result, it’s crucial that these be easy to use, access, and satisfy their users. A virtual model helps promote higher adoption and satisfaction with quick access to all services from a centralized, digital platform, and face-to-face counselling without the inconvenience of in-person appointments. It just makes sense to assist employees with anything that could prevent or harm job performance in the future in a fast, reliable way.

Employee assistance programs

Primary care

As we saw previously, mental health issues can also result in physical symptoms, like poor sleep quality, aches and pains, and stomach issues. These symptoms are easier to recognize, and members are more likely to reach out if they’re feeling physically unwell. When psychological symptoms turn physical, it’s important that employees have easy access to primary care, which helps treat non-urgent medical issues. 70% of in-person consultations could be treated virtually: general health inquiries, dermatology issues and general advice on minor injuries usually present good opportunities to seek a digital consult. This gets employees on a path to treatment more quickly, whether the plan is to manage physical symptoms or pursue mental health treatments instead.

Primary care

Every single one of these components is part of a well-oiled machine: the goal is to cover as many health-related inquiries as possible through one centralized resource. ​​An all-in-one member journey to address both physical and mental health issues avoids fragmented care across multiple health providers and ensures that the employee is on the right path to recovery.

06 How virtual care makes happier, healthier employees

Awareness of available resources

Awareness of available resources

As most HR professionals already know, it’s crucial that employees be aware of their workplace telemedicine mental health program, have access to assistance when signing up, and are trained on how to use it effectively and safely before implementation. After all, what’s the point of an employee benefits program if nobody is actually benefiting from one? Clearly defining how virtual care will fit into your current employee benefits and partnering with a virtual care provider who can assist with all these points is critical to achieving a successful utilization level of the service.

The member journey

The most effective workplace programs are those designed to holistically meet the needs of employees. By providing employees with convenient access to virtual care, mental health issues can be identified proactively through screening tools. They can then be addressed rapidly with a personalized approach, wellness resources, iCBT, and more. Close follow-ups with a trusted professional are key to ensuring employee outcomes are positive, and developing a relationship with the practitioner is a key milestone to opening up and committing to their self-betterment. For this to happen, the care should be consistent and coordinated for the duration of treatment. Good things happen when employee help and information are not separate or siloed.



Several barriers to care or treatment (like limited access to healthcare resources, the time off work required, the time to travel and wait for an appointment, feelings of shame) are easily eliminated through a more convenient and integrated solution like virtual care. When an employee is unwell, having a seamless option accessed from the convenience of their own home improves the chances of seeking help and the efficiency of the delivery of care, maintaining patient engagement, and encouraging treatment adherence.



Corporate investment in employee mental health initiatives has unquestioningly increased, but mostly out of necessity.19 Compared to the high cost of traditional therapy, virtual care is considerably more affordable. With the proactive approach of a holistic solution that addresses physical and mental health issues, the objective is to minimize mental health-related costs like short-term and long-term disability.

Enhanced privacy and member confidentiality

Enhanced privacy and member confidentiality

Since virtual care involves the transmission of sensitive personal information, it’s important to reassure members that their data is safe and secure; it’s the bare minimum they should expect from a virtual platform. Privacy is a common concern with virtual care, but this is gradually subsiding: only 49% of Canadians are now concerned about privacy, down from 58% in 2020.20 When it comes to the safety of members and data protection, virtual care providers must take all the necessary measures to keep client information confidential.

The best virtual care providers meet all regulatory requirements in the jurisdictions where your organization operates, and ensure that all third-party vendors are safely managing and storing your data. They should also have earned certification for being SOC2 compliant, which reports internal measures that organizations take to govern the services they provide. A provider’s SOC2 compliance ensures that your employees’ information is protected against deliberate and accidental threats and vulnerabilities.

While building trust and encouraging employee engagement should be your top priority, quantitative and qualitative reporting and metrics you need to demonstrate the business impact of the program are important as well. As long as you are using aggregated, anonymized data, you can still get a clear picture of your return on investment in your workplace mental health program without jeopardizing employee privacy.

07 How Canada’s best companies are
delivering workplace wellness via Dialogue

Via Rail Canada

Via Rail Canada

Via Rail’s HR team wanted to invest in a service that would ensure that the health and well-being of their staff members – both in-office and on the trains – were at their best. Dialogue’s primary care program was introduced to all of their employees Canada-wide in 2020.

Read the case study
Vector (2)-1

High satisfaction and
engagement rates

3.8 hours

away from work saved per
episode per employee


all-time average satisfaction score

Otsuka Canada Pharmaceutical Inc.

Otsuka Canada Pharmaceutical Inc.

As a pharmaceutical company, Otsuka Canada Pharmaceutical Inc. sought to provide employees with proactive resources to help tackle issues particularly around mental health, such as stress management. Dialogue’s mental health program provides employees with the appropriate tools and hands-on resources to actively take control of their mental health and well-being.

Read the case study
Group 806

Access to hands-on resources and preventative tools

Group 803-2

Access to mental health care quickly through our intuitive platform

Vector (1)

Great fit for their corporate culture

PSP Investments

PSP Investments

With a very fast-paced work environment and with a desire to continuously deliver a best-in-class employee experience, PSP wanted to make sure that their employees could have quick and trusted access to professional medical support whenever they needed it. PSP implemented Dialogue’s primary care services within their entire workforce.

Read the case study


improvement in anxiety


improvement in depression


all-time average satisfaction score

08 Health is everything. Don’t settle.

The virtual care market has grown exponentially in recent years with mental health being an ongoing battle for many organizations, and they’re now faced with an overwhelming number of options when it comes to selecting a provider. It’s important to remember that not all virtual care services are created equal; choosing a provider that prioritizes positive employee outcomes is one of the best things you can do for your employees and your organization. Every individual is different, but a truly effective mental health program supports the unique needs of every member.

Identifying a virtual care provider who can assist with all these points is critical to ensuring a successful utilization level of the service.

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Reference Sources

1 Mental Health Commission of Canada. 2021. Workplace Mental Health.
2 Environics Research. 2021. Canadian Attitudes on Health and Virtual Care.
3 CAMH. Workplace Mental Health – A review and Recommendations.
4 World Health Organization. March 2018. Mental health: strengthening our response.
5 CMHA. July 2021. Fast Facts about Mental Health and Mental Illness.
6 Koutsimani, P., Montgomery, A., & Georganta, K. March 2019. The Relationship Between Burnout, Depression, and Anxiety:
A Systematic Review and Meta-Analysis.
7 Mood Disorders Society of Canada. May 2021. Mental Health in the Workplace.
8 CAMH. 2021. Career Burnout.
9 Ibid.
10 Mercer. April 2018. How much are you losing to absenteeism?
11 Benefits Canada. October 2021. 2021 Benefits Canada Healthcare Survey.
12 Benefits Canada. November 2021. What are Canadian employees’ top concerns about returning to workplace?
13 CAMH. 2021. Addressing Stigma.
14 RBC. September 2019. Canadian workers increasingly recognize mental illness as a disability, but stigma remains: RBC Insurance.
15 Statistics Canada. 2018. Mental health care needs.
16 Government of Canada. April 2018. Mental health in the workplace.
17 Dialogue. December 2021. What Dialogue learned about virtual care best practices after 1 million consultations.
18 Environics Research. 2021. Canadian Attitudes on Health and Virtual Care.
19 Harvard Business Review. October 2021. It’s a New Era for Mental Health at Work.
20 Environics Research. 2021. Canadian Attitudes on Health and Virtual Care.