Mental health remains one of the most overlooked and underused parts of a group benefits plan, according to Vincent Ng (pictured), director of group health solutions at RBC Insurance, largely because of how the industry has traditionally structured the offering itself.

“A lot of the programs take a barbell approach,” Ng said. On one end sits an expensive, high-intervention option like in-person therapy; on the other, a generic hotline. What’s missing, in his view, is everything in between.

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“Mental health care is not really a barbell,” Ng said. “It’s more of a continuum.” He pointed to structured online cognitive behavioural therapy as a lower-intensity option, virtual mental health support as a middle tier, and in-person care reserved for higher-intensity needs. Without that middle ground clearly available, Ng said many plan members default to assuming mental health support means sitting across from a psychiatrist, and rule themselves out from the start.

“Many plan users don’t realize that there are other types of interventions along that continuum that are now available to them, and that can be customized to what they need,” Ng said.

That continuum only works, though, if every tier is actually accessible, and Mark Spence, vice president, group health and life insurance, Canada at Westland Benefits, cautioned that isn’t always the case. Even as virtual and digital options have expanded in theory, he said a meaningful share of plan members still lack the comfort or access needed to use them.

“Not everybody has access to technology or instant comfort with new modalities,” Spence said. “It’s not like that for the entire working population that are covered by benefit plans.” For those members, the lower-intensity end of the continuum Ng describes may not be a real option at all, leaving them stuck choosing between a hotline and full in-person care regardless of what else is technically available.

Diet and nutrition support goes similarly untapped, according to Ng, despite ranking as a genuine priority for plan members. He pointed to a poll RBC sponsored asking Canadians what they most wanted to improve about their health; diet and nutrition came in second. Yet like mental health, Ng said, that kind of support tends to go untouched unless a plan member already knows exactly what to look for and where to find it.

Why it hides inside other conditions

Part of the problem comes down to timing. Mental health only became a workplace priority in earnest after the arrival of COVID-19, Ng said, and the years since have left it treated as its own separate category rather than woven into care more broadly.

“It’s often treated as a silo,” Ng said. But a mental health concern is frequently a byproduct of another condition rather than a standalone issue, he said, citing a plan member struggling to lose weight who becomes depressed about their progress, or someone managing a cancer diagnosis or multiple sclerosis.

That’s why Ng said the more effective chronic disease management programs now build mental health support directly into their design, rather than treating it as a separate referral. A healthcare professional managing a weight-loss program, for instance, can recognize a mental health component and layer in the right level of support without requiring the plan member to seek out a second, disconnected program. That approach, Ng said, reflects a broader shift in how insurers think about care: less about handing a plan member a menu of standalone services, and more about building a single pathway that follows whatever problem the person actually came in with.

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That underuse is compounded by cost pressure on the practitioner side, according to Spence, who has watched hourly rates for mental health specialists climb sharply amid a shortage of psychologists and other practitioners relative to demand.

“The hourly cost went through the roof,” Spence said. “I’ve seen it go from maybe $100 an hour to $215.” Insurers have had to raise their reasonable and customary charge benchmarks to keep pace, he said, a shift that shows up to employers only as rising premiums, even though it reflects practitioner costs rather than deliberate underinvestment in the benefit itself.

Evaluating whether a program is actually credible

For plan members trying to judge whether a wellness offering is worth using, Ng pointed to a basic first filter: if an employer offers it, it’s already been vetted at multiple levels.

“Employers often adopt programs that their advisor recommends, and the advisor has programs that the insurance companies offer,” Ng said. “It’s vetted at three different levels.” That alone, he said, is a reasonably strong starting signal.

Beyond that baseline, Ng pointed to two further checks. The first is who delivers the program.

Programs delivered by regulated health professionals are often a strong signal of quality, Ng said, since those professionals are accountable to a regulatory college and defined practice standards.

The second is whether the program can name a measurable outcome at all.

“Any credible care plan has to have a specific outcome,” Ng said. For a diabetes program, that might be A1C levels or blood pressure; for a mental health program, a clinically validated tool like the PHQ-9, or a return-to-work measure. “If the wellness program or the care program can’t name what it’s measuring, then it’s not really care,” Ng said. “It’s just fluff.”

The last filter, Ng said, is whether the program connects back to a plan member’s existing care outside of work.

“You want it to be part of your circle of care,” Ng said, pointing to a family doctor or pharmacist as the people a program should ultimately loop back to, rather than operating as a disconnected, standalone service. Taken together, Ng said, those three checks give plan members a practical way to separate a genuinely credible program from something that looks appealing on paper but doesn’t actually hold up.