Since a Supreme Court decision overturned Roe v. Wade and the federal right to abortion last month, companies like Yelp, Amazon, Disney and Citigroup have announced new benefits to pay for travel expenses for employees who must go out of state to access abortion care. This adds a new dimension to the employer-employee relationship that is already bringing up a lot of concerns about privacy, trust and stigma.

Perhaps the closest comparison is getting mental health care through an employer program. This arrangement is pretty common — and so is a reluctance to talk about it.

When Catherine started a new job as a manager of a warehouse in mid-2020, like a lot of people, she was feeling anxious. She didn’t want to use her full name because the topic is sensitive and her job is on the line.

Catherine’s company sent out information about its employee assistance program, a standard benefit that usually includes access to mental health care, but she had concerns.

“Starting out new — to share that side in terms of mental health struggles felt extremely vulnerable,” she said. “Are you going to be met with compassionate support? Or are you going to be met with kind of a mental Post-it note in their file on you?”

These benefits are usually administered through an outside company, which is supposed to keep names and details private.

“You believe it on its face, but I wasn’t wanting to dip my toe in the water at a time of pain or crisis,” Catherine said. “That wasn’t when I was wanting to find out if it was legitimate or truly confidential.”

Patrick Byrnett sees this response a lot. He’s the chief talent officer for Stafford County Public Schools in Virginia.

“A lot of times people hear, ‘Oh, have you considered calling the employee assistance program?’ And as with any other mental health issue, there’s a stigma attached to — ‘What are you saying, I’m crazy?’ that people don’t want to actively engage in the services,” he said.

These concerns are hard to overcome, Byrnett said, though he’s gone full-court press to spread awareness of mental health benefits in onboarding, staff meetings, emails and with a team of what the district calls “wellness ambassadors.”

“We realize that this is the type of thing where people are going to be the pathway,” Byrnett said. “I talk about my own mental health issues, because I’m like, ‘Hey, I’m trying to put myself out there to say this is OK.'”

That kind of top-down signaling is important to create a culture of safety, according to Julie Fabsik-Swarts, the CEO of the Employee Assistance Professionals Association.

“When a CEO embraces mental health and says, ‘I use this when I need it — I’m going to my therapist,’ not just ‘I’m going to the doctors’,’ we’ve seen much better usage of EAP rates.”

The share of employees using these benefits has always been on the low side, she said, but during the pandemic, uptake jumped by more than 25%.

Brian Kropp, head of human resources research at Gartner, said the more public, shared trauma of the last two and a half years has created opportunities for some companies to promote their mental health resources.

“What they’ve actually done is created moments across the year to reinforce the importance of that,” Kropp said. Things like periodically shutting down work for a day to give employees time to take care of themselves, or acknowledging painful current events and giving employees ways to connect.

“Just creating this culture of understanding where managers are completely accepting when their employee says, ‘I have a personal health situation,'” he said.

But there are still some big taboos, like mental health issues around addiction, said Paula Allen, global leader and senior vice president of research and total well-being at LifeWorks, an HR service firm focused on employee wellness.

“People who might talk about their depression might not talk about their drinking,” she said. “They’re more worried about getting fired, they’re more worried about people thinking it’s just a behavior that they can snap out of if they had the moral strength.”

Substance use increased significantly during the pandemic, according to the Centers for Disease Control and Prevention. And a survey from the American Psychological Association found that 1 in 4 adults increased drinking to cope with stress. But Allen said that’s not getting enough attention.

“That’s why I think it’s important for employers to start speaking about substance use disorder in a very obvious way, make sure that the mental health resources are front and center,” she said.

Treatment for substance use accounts for less than 3% of all employee assistance program services sought in LifeWorks’ most recent report.