December 19, 2025

Engineering Mental Health: Building a Strategy from the Ground Up

This Guide informs the development and execution of a comprehensive mental health strategy built on three pillars: 1) Organizational factors that impact employee mental health; 2) Initiatives to promote mental health; and 3) Benefits and programs to treat mental health conditions and substance use disorders.

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Supporting workforce mental health continues to be a priority for employers as employees and their families experience myriad challenges impacting their emotional well-being. Mental health conditions ranked as a top five cost driver among respondents in Business Group on Health's 2026 Employer Health Care Strategy Survey.¹ This environment underscores the imperative for a cohesive and comprehensive strategy - one that assists every employee, from those who are thriving to those with mental health conditions and substance use disorders and everyone in between, and that prioritizes value.

A comprehensive mental health strategy is good for employees and for business. Extensive research documents the significant challenges related to poor mental health. According to a Milliman study of commercially insured adults in the U.S., claims for those with mental health conditions cost twice as much as those for individuals without them.^2,3

Worldwide, depression is the leading cause of poor health and disability according to the World Economic Forum.⁴ And employees experiencing stress are more likely to miss work, become disengaged and leave jobs.^5,6 What’s more, life expectancy is either stagnating or declining depending on the country, which is in part attributed to “deaths of despair”—overdoses, suicides and alcohol-related liver disease.⁷ Thus, there’s a burning platform to prevent and treat mental health and substance use disorders, and there are many opportunities for employers to make a positive impact on both business outcomes and employees’ lives through the development of a cohesive mental health strategy that attends to the spectrum of employee needs and focuses on value.

There is growing agreement among major health- focused entities, including the World Health Organization (WHO), the U.S. Surgeon General’s Office and leading voices in mental health, that creating a comprehensive strategy must involve assessing and addressing multiple factors, or “pillars,” in concert to best support workforce mental health.^3,8,9 While different organizations may use their own terminology, these pillars typically include:

• 1 | Organizational factors that impact employee mental health;
• 2 | Initiatives to promote mental health; and
• 3 | Benefits and programs to treat mental health conditions and substance use disorders.

This Business Group resource is for employers – those in executive leadership roles, as well as those responsible for health benefits and employee well-being, and their health industry partners. The resource informs the development and execution of a mental health strategy built on the three pillars above. It covers:

• An in-depth review of the three pillars, including the benefits of focusing on each;
• The role that benefits and well-being leaders have in advancing each pillar, including actionable solutions for implementation; and
• Areas of opportunity for measurement, integration and accountability within and across each of the three pillars.

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