Treating the Whole Worker
A Case Study in Occupational Mental Health Services
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Building a collaborative culture is critical for many organizations. At Rivian, a manufacturer of emissions-free electric adventure vehicles, collaboration is essential to meet the company’s mission. The complexity of Rivian’s products and customer ecosystems means that multifaceted skillsets must work together closely to make thousands of decisions daily. The company does not take for granted the magic that occurs when various thinkers and doers, with different lived experiences and perspectives, attack a challenge from all sides. 
Rivian’s wellness team supports a diverse group of employees through wellness programs and education. Workforce diversity includes geographic diversity as well as many types of workers. Rivian employs teams within manufacturing and operations, engineering, customer and vehicle service, research and development, and retail and corporate divisions. Wellness programs have been developed over the past three years under the pillars of physical, mental/emotional, and financial well-being, with an initial focus on global mental health support as a result of the COVID-19 pandemic. 
Occupational and environmental health and safety professionals have become proficient in the industrial hygiene framework (anticipation, recognition, evaluation, control, and confirmation of protection) when it comes to chemical, physical, and biological hazards in the workplace. However, psychosocial hazards are often overlooked because “controlling” the hazard can seem daunting, and some believe psychosocial hazards to be of less concern than physical hazards. Psychosocial hazards have always been important to evaluate and control, but they have, and will continue to be, increasingly important in the post-COVID work environment. Work environments, work processes, and work-life balance are changing, and these changes can all negatively affect worker well-being, including mental health.
NIOSH defines psychosocial hazards as “factors in the work environment that can cause stress, strain, or interpersonal problems for the worker.” Many factors surrounding the way work is organized at a company can cause stress for the worker. Shiftwork, overtime, inadequate staffing, and lack of training all contribute to worker stress. For example, the results from a recent study conducted by researchers in Sweden indicate that demanding psychosocial working conditions are related to earlier retirement in blue-collar workers. Additionally, according to the paper “Effect of Overtime Work on Cognitive Function in Automotive Workers” published in the Scandinavian Journal of Work, Environment & Health, stressors such as increased overtime substantially affect mental health issues like depression, fatigue, confusion, and impaired cognitive function. Fatigued workers are also more susceptible to musculoskeletal injuries of the upper extremities and the lower back.
Rivian has sought to address potential psychosocial hazards in multiple, constantly evolving ways. The current mental health-related programs Rivian offers to support psychosocial well-being include free access to coaching and therapy, self-guided content, provider-led webinars, and meditations. To increase accessibility, employees do not need to have medical insurance through Rivian to use the majority of wellness programs. These programs are also offered to workers’ family members whenever possible, with the hypothesis that employees have a greater opportunity to come to work at their best when they and the people they care about have the support they need. Gone are the days of a clear division between work life and home life. Many of us work from our homes. We walk out of our office into our kitchens for dinner; we even have email access one app to the left of the pictures of our kids.
The Rivian wellness team seeks partners with global capabilities that also augment our programs to address unique local needs. The concentration of team members at our manufacturing facility in Normal, Illinois, coupled with the lack of adequate access to mental healthcare in the surrounding area, led to the addition of on-site therapeutic support.
ORIGINAL CONCEPT AND GOALS According to “Mental Health in the Workplace: A Call to Action” published in the Journal of Occupational and Environmental Medicine (JOEM), research has shown that between 30 and 50 percent of adults in the U.S. experience mental illness at some point in their lives and 20.2 million have substance abuse disorder, with 7.9 million suffering from both. Employees suffering from mental health problems have increased rates of short-term disability, safety incidents, absenteeism and presenteeism, and stress imposed on team members. They have decreased retention, performance, productivity, and output. When considering that 63 percent of Americans participate in the labor force, the takeaway is clear: the workplace is a critical environment for addressing mental health. Traditional wellness programs and employee assistance program (EAP) benefits have been the employer’s standard response to the need for mental health services, yet the data suggest that this is not enough.
Worker demographics in automotive manufacturing facilities are similar throughout the country. Occupational health service teams typically see indications of poor employee mental health including panic attacks, emotional responses disproportionate to context, truancy/absenteeism, and increasing frequency of interpersonal conflicts on the manufacturing floor, with known outcomes attributable to psychosocial hazards. The majority of line workers who visit health clinics for issues like low back or lower extremity injuries also report mental health complaints (anxiety, depression, substance abuse, difficulty coping), and data from other wellness partners showed a lower level of well-being for line workers compared to workers not directly working on the manufacturing line.
The company running Rivian’s occupational health clinic utilized a third party to better understand the mental health needs of U.S. employers. A survey distributed by the client resulted in more than 300 responses to the question, “What level of urgency does your organization have in providing mental health solutions to your workplace?” Over 50 percent said that providing mental health solutions was very or extremely urgent, and more than 85 percent rated it as somewhat, very, or extremely urgent.
The survey results also mirror other national data. Research published in JAMA Network Open shows that the people who are struggling most with mental health issues are aged 18–39, without a college degree, and with an annual household income less than $45,000. This group has two to four times as many mental health problems as the rest of the population.
Rivian employees were offered affordable medical insurance as well as access to EAP benefits and tele-mental health therapists. But further investigation of utilization data revealed that the manufacturing workforce used the tele-mental health and remote solutions less than half as often as the other areas of the company. For plant workers, engagement with these solutions was in the single digits. It was clear that the EAP program, tele-mental health services, and the initiatives already in place were not reaching all manufacturing employees as intended.
Rivian wanted to do more, and this meant rethinking what was being offered. Thus was born the “company therapist”—a therapist practicing on-site in the same space as the occupational clinic. The concept was to bring a master’s-level therapist to the plant to primarily support the team members on the manufacturing floor. Rivian concluded that manufacturing workers would be interested in working with a therapist who was knowledgeable of the intersecting factors that affect manufacturing employees’ mental health, informed about the company, and immersed in the work environment.
Shiftwork, overtime, inadequate staffing, and lack of training all contribute to worker stress.
EMPLOYEE RESPONSE AND RESULTS The company therapist idea would not have made it to the starting line without buy-in from key stakeholders, including occupational health clinic leadership and the Rivian human resources, benefits, wellness, and environmental health and safety teams. Early conversations helped shape the vision and address preconceived notions. Through collaboration, these groups employed a pilot program to alleviate concerns. Prior to pilot implementation, the vision was presented to the ultimate decision-maker, Rivian’s chief people officer, who resoundingly supported moving forward. After the pilot began, the key stakeholders consistently met to review, debrief, and iterate based on feedback and data. Stakeholder buy-in and partnership were critical to the success of the pilot and continue to be crucial for ongoing evolution.
Preliminary Results, April to December 2022 The pilot kicked off in April 2022. To start, the mental health clinician was on-site in a part-time capacity, totaling 24 hours a week. Rivian employees had the option to meet with the therapist before or after their shift, during a midday break (depending on their job title and role), or during their days off. Throughout the pilot, 120 patients were seen in person, with 95 percent attending four or more sessions. The 120 patients were categorized by clinical complexity:
• Thirty-five percent were category 1, or low complexity, signifying needs that could be adequately addressed over two to six sessions.
• Forty percent were category 2, or intermediate complexity. These patients were each given a single diagnosis but required ongoing care that may have also included medication, a multidisciplinary approach, or both.
• Twenty-five percent were category 3, or high complexity. These patients received multiple diagnoses that required ongoing care and medication. They were also likely to need support from an outside provider and other types of multidisciplinary support.
Substance Use Comorbidity A known correlation exists between disordered substance use and depression or anxiety, and research has found that a startling number of workers are affected. A survey of employees across several major U.S. manufacturing sites reported in JOEM found that employees with depression report their productivity at 70 percent of peak performance. Additionally, approximately 80 percent of employees who reported depression also reported some level of functional impairment because of their depression, and 27 percent reported serious difficulties in their work and home life.
Social Factors All 120 patients in the pilot program reported that social factors contributed to decreased mental and physical health and significantly affected their quality of life. Most significant in this population was lack of knowledge about or access to healthcare, dental care, and childcare. And 85 percent of the pilot caseload reported instability in housing, transportation, or both.
Outcomes and Measured Improvement Throughout the course of individual therapy sessions, growth and improvement were measured using standard tools for charting an individual’s progress in areas such as self-regulation (cognitive, emotional, and behavioral), coping skills (the ability to confront issues and problems in positive and adaptive ways), and the functional impact of depression, anxiety, or substance use. Careful data collection at the start, first quarter, middle, third quarter, and termination of therapy provided clear evidence of the benefit of this type of mental health care offered in the workplace: 90 percent of the initial 120 pilot individuals showed marked improvement.
SUMMARY OF BENEFITS Qualitative findings from the pilot program were equally encouraging: • Ninety percent of patients reported improved interpersonal relationships with friends and family outside of work, leading to improved well-being and decreased stress, anxiety, and symptoms of depression.
• Sixty percent of patients who were found likely to benefit from medication were referred to outside psychiatrists and began prescribed medication for diagnoses such as depression, anxiety, mood disorders, PTSD, and ADHD.
Additionally, many of the participants reported an improved attitude toward colleagues, their superiors, and their employer. They attributed this improvement to a better ability to communicate, solve problems, and manage their own stress levels in adaptive or positive ways.
As the pilot period ended, the takeaway was clear: Rivian employees found the program to be valuable. Not only was participation much higher than expected, but the data showing 90 percent of patients with marked improvement was astounding and to be celebrated.
The pilot program also supported the hypothesis that Rivian’s Normal, Illinois, population feels supported by, and is more likely to engage in, conveniently located, face-to-face care vs. virtual care. Because of the success of the pilot, the on-site therapist transitioned from part-time to full-time to expand support to this high-need population. This change has allowed the therapist to take on a full caseload of roughly 30 clients. Even with this increase in hours, demand for on-site counseling far exceeds the number of hours currently available. With overwhelmingly positive employee testimonies and results, and a growing client waitlist, the Rivian wellness team has been encouraged by the success of the pilot and continues to investigate avenues to bring more mental healthcare on-site as well as expand communication and dispel myths about virtual mental health support. By operating the Occupational Health Services program at Rivian with a diverse team of professionals that not only includes the typical occupational health medical team but a certified industrial hygienist, a wellness team, and now a company therapist, Rivian is able to develop the policies and programs needed to comprehensively address the health of its employees.
JEFFREY W. BRADBURY, CIH, CSP, is the occupational health manager at Rivian.
KAITLIN AUBIN, CIMHP, MPH, LCSW, is a licensed clinical social worker at Medcor and the on-site therapist at Rivian’s facility in Normal, Illinois.
KRISTIN BECKETT is Rivian’s senior manager of wellness.
MARISA BURTON, MSMOB, is Rivian’s wellness program manager.
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European Journal of Ageing: “Do Good Psychosocial Working Conditions Prolong Working Lives? Findings from a Prospective Study in Sweden” (December 2021).
JAMA Network Open: “Prevalence of Depression Symptoms in U.S. Adults Before and During the COVID-19 Pandemic” (September 2020).
Journal of Occupational and Environmental Medicine: “Mental Health in the Workplace: A Call to Action” (April 2018).
NIOSH: “Psychosocial Hazards.”
PLOS ONE: “A Sustainable Working Life in the Car Manufacturing Industry: The Role of Psychosocial Factors, Gender and Occupation” (May 2020).
Scandinavian Journal of Work, Environment & Health: “Effect of Overtime Work on Cognitive Function in Automotive Workers” (April 1996).