Mental health ROI is the new bottom line for employers, says Dialogue

Each month at BPM, we offer a slate of articles and content pieces that go deep on a particular topic. This November, we’re exploring employee and plan members' mental health. 

When it comes to investing in employee mental health, employers increasingly want more than anecdotes and good intentions, they want data. But calculating the return on investment (ROI) for mental health programs is rarely straightforward.

Dr. Sandra Primiano argues that measuring the effectiveness of mental health programs should be treated with the same rigour as physical health monitoring. Especially in a climate of tighter budgets, she believes organizations can’t afford to overlook ROI.

“We have to pay closer attention to ROI,” says Dr. Primiano, licened psychologist and senior director of EAP at Dialogue. “I think mental health needs to be like physical health. Any kind of measures we would take at a doctor's office for blood pressure or temperature, we should be doing the same. We should be using measurement-based care and tracking clinical outcomes.”

She underscored how tools like Patient Health Questionnaires (PHQ-9) and General Anxiety Disorders (GAD-7), which are standardized measures for depression and anxiety, act as essential “vital signs” for mental health. These metrics provide psychological, behavioural and emotional data points and allow organizations to monitor employee progress before, during, and after treatment as well as over time. Without this data, she argues, employers are essentially flying blind.

Notably, she ties clinical improvements directly to productivity: for every point improvement in PHQ-9 scores, she notes a gain of 0.88 hours in productivity. In Dialogue’s case, “we see about 4.2 hours gained per case, which is incredible,” she noted.

She links the effectiveness of mental health benefits not just to the tools used, but also to how well they’re implemented. When employers work with vendors that support onboarding and engagement, utilization improves significantly, underscoring that benefits are only as valuable as their usage. When asked what utilization rates look like across the board in Canada, EAP usage rates average between 3 per cent and 5 per cent, while Dialogue averages around 12 per cent.

She argues that this deeper engagement - both at the program level and with individual users - helps drive measurable ROI. Higher utilization means more people are accessing early interventions, reducing the likelihood of long-term leaves or escalating mental health issues.

And yet, as Primiano points out, outcomes don’t show up overnight. She disagrees with the notion that ROI should be immediate.

“We want everything to be immediate, but that's not quite accurate or fair,” she said, noting that for employers, meaningful data begins to emerge around the six- to twelve-month mark.

Beyond productivity, she connects tracked improvements to reduced absenteeism and shorter disability leaves, particularly as higher engagement leads to measurable business outcomes. Dialogue has seen clear reductions in absenteeism and leave durations through its extended care program, Mental Health Plus.

The typical disability leave, Primiano explained, has dropped from a 65-day national average to 35 days. That improvement, she says, comes from integrated care models that treat mental and physical health together. Instead of isolated interventions, therapists and medical professionals collaborate on the same case, adjusting treatment plans in real time.

Primiano also points to less obvious but equally important metrics like engagement, satisfaction, and retention. She notes clients often report increased workplace morale after implementing more robust mental health services. This, she adds, has a direct effect on turnover, one of the costliest challenges employers face. Her approach is anchored in evidence-based practices, backed by Accreditation Canada, ensuring that the outcomes tracked are both credible and actionable.

In terms of how employers can track improvements in engagement and retention, Primiano suggests using a mix of qualitative and quantitative tools like engagement surveys, satisfaction indexes, turnover data, and of course, clinical metrics.

“When we're focused on mental health, we see greater employee engagement and satisfaction in the workplace. We see that people are more committed to the workplace, are happier, are more satisfied and in turn, will help with turnover. We know that's a huge problem in the workforce and becomes very costly as well to then have to replace people, interview, train, and then they're gone,” said Primiano.

She also emphasizes the value of integration between psychotherapy and medical support. When mental and physical health are treated together - addressing issues like insomnia, gastrointestinal problems, or chronic pain – outcomes tend to improve.

But while both EFAP and extended therapy programs can address conditions like anxiety, stress, burnout, or depression, the approach is different. With EFAP, the goal is immediate, short-term coping strategies, whereas in extended care, the process digs deeper.

“If I’m helping with panic attacks and I have eight to ten sessions with you, I’m going to be able to understand why they developed, how they presented themselves and then looking at more of those resources and interventions,” she explained.

Primiano believes proving the value of virtual mental health solutions ultimately comes down to data and how much of it an employer is willing to share. But as employers become more sophisticated in evaluating mental health outcomes, she sees a shift in expectations because plan sponsors are increasingly asking for hard data and ROI to justify program spend.

“Over the last five years, it’s become much more significant than I would have seen like 10 years ago,” she said. “People want to offer programs, whether it's in EAP, extended mental health, but they also need to justify in terms of budgeting… How else do we know if something is effective and is worth our investment?”