Executive summary
Every May, employers run a mental health awareness campaign, and every June the numbers that matter are unchanged. The share of US employees who strongly agree that their organization cares about their overall wellbeing fell from 49 percent in May 2020 to 21 percent in May 2026,1 across a period in which employer wellbeing commitments became common enough that 84 percent of executives say their organization has made them publicly, while 39 percent of employees recognize one.2 This paper argues that awareness is the cheapest part of the problem and the least useful part of the solution, and sets out what an employer can build in thirty days instead.
Mental Health America founded the observance in 1949 and has led it every May since,3 and it lands on a working population in which depression and anxiety account for an estimated 12 billion lost working days and about US$1 trillion in lost productivity worldwide each year.4
Awareness activity is measured in impressions, attendance and completion rates, none of which is a clinical outcome, and the routes those campaigns advertise carry a disclosure cost that falls hardest on physicians, attorneys and senior leaders.
Treat May as an access project: publish one confidential route to a licensed clinician, name the time to a first session, fund the sessions, and measure appointments attended rather than impressions delivered.
The organization ends the month holding a mechanism that still works in November, and a senior cohort that has a route it will actually use.
The problemAwareness is not the bottleneck§
The case for an awareness campaign rests on an assumption that has quietly stopped being true: that the obstacle between a struggling employee and treatment is not knowing treatment exists. In the United States, 23 percent of adults live with a mental health condition and about 6 percent live with a serious one.5 Roughly half of adults with any mental illness, 50.6 percent, received any mental health treatment in the past year.6 Among adults who had a major depressive episode, 61.0 percent received treatment, and among those whose episode carried severe impairment, 74.8 percent did.7 The international picture is starker: in high-income countries, only about one in three people with depression receive mental health treatment at all.8 These are not the numbers of a population that has never heard of therapy. They are the numbers of a population that has heard of it and cannot, or will not, reach it.
The second assumption is that a campaign moves the underlying experience. The tracking data does not support it. Gallup found 21 percent of US employees strongly agreeing in May 2026 that their organization cares about their overall wellbeing, against 49 percent in May 2020, with 27 percent reporting burnout very often or always and 53 percent reporting daily stress.1 Over the same span the volume of employer wellbeing communication rose rather than fell, and the perception gap widened: 84 percent of executives say their organization has made public wellbeing commitments and 39 percent of employees recognize one.2 The distance between those two figures is the subject of this paper, and it is widest at the top of the organization, where the people designing the campaign are also the people least able to use what it advertises.
A campaign is measured in impressions. A depressive episode is measured in weeks. Only one of those is an outcome, and it is not the one the budget is spent on. Martha Fernandez, LCSW · CEREVITY
The evidenceWhat the research shows§
Three bodies of evidence bear on whether a May campaign changes anything: population data on who actually receives treatment, workforce data on how employees experience their employer's commitments, and profession-level data on the groups for whom disclosure is expensive. The workforce layer is already well documented. The Surgeon General's framework for workplace mental health reports that 76 percent of US workers described at least one symptom of a mental health condition and 84 percent said workplace conditions had contributed to at least one mental health challenge.13 The Department of Labor's employer guidance works from the same base rate, nearly one in five Americans experiencing some form of mental health condition in a year.17 Awareness of the topic, in other words, is not scarce; what is scarce is a usable route, which is the distinction drawn in an honest comparison of the EAP route and private therapy.
21%
US employees who strongly agree their organization cares about their overall wellbeing. In May 2020 it was 49 percent.
Gallup, 2026
2.2x
Executives who say their organization has made public wellbeing commitments, per employee who recognizes one
Deloitte, 2023
$1T
Lost productivity worldwide each year from depression and anxiety
WHO, 2024
50.6%
US adults with any mental illness who received any treatment in the past year
NIMH, 2022
09, 10, 11, 05 American Medical Association. (2024). Physician burnout rate drops below 50%, AMA Organizational Biopsy, 12,400+ responses across 81 organizations.
CDC. (2023). Vital Signs: Health Worker Mental Health, Quality of Worklife Survey.
Anker & Krill. (2021). PLOS ONE, 2,863 employed attorneys.
CDC. (2026). About Mental Health, 2024 NSDUH.
Read together the figures describe a communication surplus and an access deficit. The population knows, and about half of it is not in care. The workforce is told, and a minority registers the telling. McKinsey Health Institute's survey of nearly 15,000 employees across 15 countries put the mechanism plainly: improving workplace factors was several times more predictive of employee mental health than providing access to resources alone, and employees reporting mental health challenges were four times more likely to want to leave their organization.14 The groups with the most to lose from a visible record are the least likely to walk through a door their employer built, which is the pattern behind why executive benefits go unused.
02 Deloitte and Workplace Intelligence. (2023). Workplace well-being research. 3,150 respondents: 1,050 C-suite leaders, 1,050 managers, 1,050 employees, fielded 3 to 14 March 2023.
| May activity | Unit it is measured in | What it leaves in place | The access equivalent |
|---|---|---|---|
| All-staff awareness email | Open rate, click rate | No named route, no named clinician, no stated time to a first session | One page naming the route, the confidentiality terms and the time to a first session |
| Speaker session or lunch and learn | Attendance, satisfaction score | Attendance skews to people already coping; the unwell rarely book a public room | Standing clinical intake capacity that requires no audience and no sign-in sheet |
| Ribbons, banners and social posts | Impressions, engagement | Visibility of the topic, which was never the scarce input | The production budget moved into session cost |
| Wellness or meditation app license | Seats activated, weekly active users | Self-care supports treatment and does not replace it for a diagnosable condition12 | A funded route to a licensed clinician for anyone above the two-week threshold |
| Manager mental health training | Completion rate | A trained manager with nowhere to refer is a trained manager holding a disclosure | A referral route the manager can name in one sentence and then step out of |
| Re-announcing the EAP | Announcement reach | The same route with the same disclosure profile, resent; BLS records EAP access for 40 percent of private industry workers in establishments under 100 staff16 | A second route carrying no employer record, for the people who will not use the first |
| A mental health day off | Days taken | A day off does not shorten a wait for an appointment | Days usable for appointments, and session lengths long enough to matter |
The frameworkA model you can name and own§
A campaign and a clinical outcome are separated by four distinct steps, and an employer that cannot say which step it is funding will fund the first one every year. The ladder below names them in the order a person climbs them, and it is deliberately unflattering to the top rung, because the top rung is what most May budgets buy. It also explains why the population that looks most robust on an engagement survey can be the population furthest from care, a pattern visible in what structured burnout treatment actually involves.
CEREVITY model
The Awareness-to-Access Ladder
A four-rung description of the distance between an awareness campaign and a clinical outcome. Each rung names a condition that has to be met before the next one can be, and each is funded by a different kind of decision.
Notice
The person learns that help exists and that the organization says using it is acceptable. This rung is cheap to produce and easy to count, which is why it absorbs most of the budget and most of the reporting.
Permission
The person concludes that using help will not cost them standing, a promotion, a license, a clearance or a partnership vote. Nothing said on rung one establishes this, and no volume of saying it will.
Reach
A route exists that the person can use without going through a manager, a benefits desk or a record they cannot see. Where the only route runs through the employer, this is the rung senior people stop on.
Attend
A first session happens and a second is scheduled. This is the first rung on which a clinical outcome becomes possible, and the only one a health outcome can be measured from.
SCHEMATIC Schematic, not measured data.
CEREVITY clinical framework, August 2026. Illustrative shape only; no underlying measurement.
The ladder is a budgeting instrument rather than a theory. Ask of every May line item which rung it moves. An email moves rung one. A confidentiality architecture moves rung two. A published route with a named time to a first session moves rung three. Paying for sessions moves rung four. The WHO guidelines on mental health at work make the same point in the language of evidence, separating organizational interventions, manager and worker training, individual interventions and return-to-work support rather than treating them as one program.15 Most campaigns spend the entire budget on the rung that was already the least binding constraint.
By professionHow it presents across roles§
Rungs two and three of the ladder are profession-specific, because what a disclosure costs depends on who holds the license, the clearance or the client relationship. Three groups make the point, and in all three the employer's own route is the one least likely to be used by the people highest in the structure.
Physicians and clinical leadership
Medicine has run mental health campaigns for longer and harder than most sectors, and it has the best-documented distress figures to show for it. The AMA's organizational survey of more than 12,400 physicians across 81 health systems put burnout at 48.2 percent in 2023, down from 53 percent in 2022 and a peak of 62.8 percent in 2021.9 The CDC's Quality of Worklife data on health workers more broadly shows the same direction of travel earlier: 46 percent reported often feeling burned out in 2022 against 32 percent in 2018, harassment at work rose from 6 to 13 percent, average poor mental health days in the previous 30 rose from three to five, and the share saying they were likely to look for a new job rose from 33 to 44 percent.10 Those are not the numbers of a workforce that has not been told about mental health. They are the numbers of a workforce that has been told repeatedly. Across CEREVITY's network the recurring reason physicians give for delaying care is not finding a clinician but the existence of a record: what a credentialing file, a license renewal or a claim history might later be asked to show. An employer that wants May to change anything in this population has to answer that question first, in writing, and the answer has to be structural rather than reassuring. A wellbeing week that ends without a route carrying no institutional record has moved rung one and left rungs two and three exactly where they were.
Individual physician-specific psychotherapy
Organizational physician burnout solutions for systems
Attorneys and firm leadership
The legal profession shows the same shape with a sharper edge on concealment. Anker and Krill's study of 2,863 employed attorneys, published in PLOS ONE in 2021, found roughly 30 percent screening positive for high-risk hazardous drinking while only about 2 percent self-reported a diagnosed alcohol use disorder, a gap the authors attributed to denial, stigma and a professional culture that normalizes heavy drinking.11 A quarter of women attorneys and 17 percent of men said they had contemplated leaving the profession because of mental health concerns, and risky drinking ran at 55.9 percent among women and 46.4 percent among men.11 The clinically important number in that set is the distance between 30 percent screening positive and 2 percent diagnosed. That distance is not an awareness problem. It is what happens when the cost of being on a record is higher than the cost of the symptom, and it is why firm programs that ask a lawyer to identify themselves to the firm collect very little. In CEREVITY's network the attorneys who present most often are partners and senior associates whose billing has held steady while everything underneath it has degraded, and the first question is almost always about who else will know. A firm running an awareness month can move that number only by building a route where the honest answer is nobody.
Individual attorney-specific psychotherapy
Organizational attorney wellness program for firms
Chief executives and the senior team
The senior team is the group most often left out of the campaign it commissioned. Deloitte and Workplace Intelligence surveyed 3,150 people in March 2023, evenly split across C-suite leaders, managers and employees. Around half of all respondents said they always or often feel exhausted, 52 percent, or stressed, 49 percent. Seventy-five percent of C-suite leaders said they were seriously considering quitting for a role that better supported their wellbeing, up from 69 percent the year before, against 64 percent of managers and 60 percent of employees. More than three in four executives believed their workforce's wellbeing had improved when it had not, and 89 percent said their organization was advancing human sustainability against 41 percent of employees.2 Two things follow. First, seniority is not protective; it is the level with the highest stated intention to leave. Second, the people commissioning the May program are systematically misreading its effect, which is what a perception gap of that size means in practice. The clinical pattern behind it is familiar: a chief executive whose performance is unchanged, whose sleep went first, and who cannot use the company route because the company route runs through people who report to them. Consider a hypothetical scenario in which the same executive signs off the awareness campaign in April and has no confidential route of their own in May. That is the ordinary case, not the exception.
Individual therapy built for chief executives
Organizational executive mental health benefit for companies
The stakesThe cost of inaction§
The cost of an awareness-only May is not the campaign budget, which is small. It is the year that follows it, and it lands in three places the organization already measures.
Senior turnover nobody priced
Seventy-five percent of C-suite leaders say they are seriously considering quitting for a role that would better support their wellbeing, against 64 percent of managers and 60 percent of employees.2 In health care the same pressure shows in the workforce data: 44 percent of health workers said in 2022 they were likely to look for a new job, up from 33 percent in 2018.10 At that level a departure is not a benefits line, it is a succession event.
Working days, not sentiment
Depression and anxiety account for an estimated 12 billion lost working days a year worldwide, at roughly US$1 trillion in lost productivity.4 At the level of one person the same cost appears as days: health workers reported an average of five poor mental health days in the previous 30 in 2022, against three in 2018.10 A campaign does not appear in either series, in either direction.
The half that never starts
About half of US adults with any mental illness received any treatment in the past year,6 and in high-income countries only about one in three people with depression receive treatment at all.8 Untreated conditions do not hold still. NIMH's stated threshold for seeking professional help is symptoms that are severe or distressing and have lasted two weeks or more;12 most of the cost in this category accrues after that point and before a first appointment.
02, 10 Deloitte and Workplace Intelligence. (2023). Seriously considering quitting for a role that better supports wellbeing, n=3,150.
CDC. (2023). Vital Signs: Health Worker Mental Health. Likely to look for a new job.
The solutionWhat effective care looks like§
Good care for this population is defined by three properties before any modality is chosen. It is confidential in a way the person can verify rather than be reassured about. It is available at a depth that matches the problem instead of the calendar slot. And it starts quickly enough that the decision to seek help survives the wait, which for a senior person who cleared an hour with difficulty is a matter of days rather than months. That describes a delivery model rather than a therapy, which is why the treatment philosophy behind it matters as much as the technique, and why the weekly hour is a starting point rather than the whole answer.
CEREVITY is a nationwide network of independent licensed clinicians, matched to the person rather than assigned by rota, delivered by secure video, and paid for privately so that no diagnosis code, claim or shared record is created on the employer's side. Sessions run in three formats. Where an hour keeps ending mid-thought, the extended format gives the work room to open and close in one sitting. Where a leader can clear a single block but not a weekly slot, the intensive format does in one day what a quarter of interrupted hours would not.
ImplementationHow to put it into practice§
What follows is a thirty-day plan a benefits or people team can run inside May and leave standing in June. It assumes no new headcount and no new platform. Each step names the artifact it produces, because an artifact survives a campaign and a message does not. Federal guidance points the same way: the Surgeon General's framework is built around protection from harm and workplace conditions rather than around communication volume.13
- 01
Days 1 to 5. Write the route down, then walk it yourself
Produce one page answering four questions in plain language: who a person contacts, the wait to a first session, what is recorded and who can see it, and what it costs. Then have a senior person use the route end to end and time it. If the page cannot be written, the route does not exist. If the walk-through takes longer than the page claims, publish the real number rather than the intended one.
- 02
Days 6 to 12. Settle confidentiality before you settle the messaging
Rung two is a structural question, not a messaging one. Document exactly what the employer receives about any individual, which for a well-designed route is nothing beyond aggregate use, and state it in the same sentence every time it is described. Where the existing route creates a record that a physician, an attorney or an officer of the company reasonably fears, add a second route that does not, rather than arguing with the fear.
- 03
Days 13 to 21. Fund sessions, not impressions
Move the production budget of the campaign into session cost, and set the number of funded sessions high enough to constitute a course of treatment rather than a taster. Decide in advance which formats are covered, including extended and single-block intensive work for people who cannot hold a weekly slot, and publish that answer alongside the route rather than on request.
- 04
Days 22 to 30. Change the measure, then book the November date
Retire impressions, attendance and app activations as headline metrics and report three instead: time from request to first session, the share of people who attend a second session, and route use by level. Then put a date in November for the same report. A number produced only in May measures the campaign. A number produced quarterly measures the mechanism.
RecommendationsWhere to start§
Clinical
Screen on duration, not on mood
The usable threshold is not how flat someone seems in a meeting. NIMH's stated guidance is symptoms that are severe or distressing and have lasted two weeks or more, with self-care positioned as support for treatment rather than a substitute for it.12 Train managers to notice duration and hand over a route rather than to assess, and route anything crossing that line toward private treatment for anxiety and depression.
Clinical
Match the format to the problem
A weekly fifty minutes is the right container for some presentations and the wrong one for others. Trauma work, a decision taken under acute pressure, and a couple in crisis are all poorly served by a container that ends before the material opens. Where an employer funds sessions, it should fund the depth the treating clinician judges necessary rather than the unit that is easiest to administer.
Structural
Publish one route and one number
Name a single route and a single time to a first session, and hold both to the standard you would hold any operational commitment. Where the existing route carries a record senior people will not accept, run a private-pay route alongside it; therapy that leaves no record an employer can see describes what that separation has to look like before anyone believes it.
Structural
Name the senior cohort explicitly
Executives are simultaneously the group most likely to say they are leaving for better wellbeing support and the group least likely to use a benefit their own organization administers.2 Design the senior route first, say plainly that it is separate, and resist letting it read as a perquisite. It is a risk control. Treating the C-suite as the audience for the campaign rather than as a population inside it is the most common way May misses the people whose absence costs most.
FAQCommon questions§
When is Mental Health Awareness Month?
What should employers do for Mental Health Awareness Month?
How do you support executives year-round?
How does private-pay billing work?
How is my privacy protected?
MethodologyHow this paper was built§
Methodology
This paper was assembled in August 2026 from published sources only. Searches covered US federal statistical and public health publications, namely the National Institute of Mental Health statistics pages drawing on the 2021 and 2022 National Survey on Drug Use and Health, the Centers for Disease Control and Prevention's mental health pages drawing on the 2024 NSDUH, the CDC Vital Signs report on health worker mental health using the Quality of Worklife Survey, the Bureau of Labor Statistics Employee Benefits Survey for March 2025, and the Department of Labor's Office of Disability Employment Policy guidance. International figures come from the World Health Organization's 2024 fact sheet on mental health at work, its 2025 fact sheet on depressive disorder, and its 2022 guidelines on mental health at work. Employer-side survey evidence comes from Gallup's ongoing employee wellbeing indicator, the Deloitte and Workplace Intelligence study of 3,150 respondents fielded 3 to 14 March 2023 across the United States, the United Kingdom, Canada and Australia, and the McKinsey Health Institute survey of nearly 15,000 employees in 15 countries conducted between February and April 2022. Profession-level evidence comes from the American Medical Association's organizational survey of more than 12,400 physicians across 81 health systems for calendar year 2023, and from Anker and Krill's 2021 PLOS ONE study of 2,863 employed attorneys. The Surgeon General's 2022 Framework for Workplace Mental Health and Well-Being supplied the workforce symptom figures, which originate in the MindShare Partners 2021 Mental Health at Work report. Every numeric claim in this paper is external and carries a numbered citation. No CEREVITY internal intake figures are used. The two network-level statements in section 04, on what physicians and attorneys most often raise at first contact, are qualitative clinical observations across the network and are presented as such rather than as measured data; no counts are attached to them and none should be inferred. Four limitations should be read alongside the figures. First, the surveys cited use different instruments and different populations, so a burnout rate from an organizational physician survey is not directly comparable with a hazardous drinking screen among attorneys; Figure 1 compares magnitude, not a common scale, and says so. Second, several of the employer-side findings are self-reported and cross-sectional, which supports statements about association and perception gaps but not about causation. Third, the Gallup series and the Deloitte study were fielded in different years, so the comparison between rising commitment and falling perceived care is a description of two trends rather than a measured relationship between them. Fourth, Figure 3 is a schematic of the framework proposed here and carries no underlying measurement; it is labeled as such in its caption and its source line. Where a source reported a session length other than 50 minutes, 90 minutes or three hours, no such figure was used, and none arose. Prevalence and treatment figures are point estimates from national surveys and carry the sampling error of those surveys.
References
- 01Gallup. (2026). Indicator: Employee Wellbeing. Gallup. gallup.com
- 02Deloitte and Workplace Intelligence. (2023). Workplace well-being research: human sustainability and the C-suite. Deloitte Insights. deloitte.com
- 03Mental Health America. Mental Health Month. Mental Health America. mhanational.org
- 04World Health Organization. (2024). Mental health at work (fact sheet). WHO. who.int
- 05Centers for Disease Control and Prevention. (2026). About Mental Health. CDC. cdc.gov
- 06National Institute of Mental Health. Mental Illness (statistics, 2022 National Survey on Drug Use and Health). NIMH. nimh.nih.gov
- 07National Institute of Mental Health. Major Depression (statistics, 2021 National Survey on Drug Use and Health). NIMH. nimh.nih.gov
- 08World Health Organization. (2025). Depressive disorder (depression) (fact sheet). WHO. who.int
- 09American Medical Association. (2024). Physician burnout rate drops below 50% for first time in 4 years. AMA. ama-assn.org
- 10Centers for Disease Control and Prevention. (2023). Vital Signs: Health Worker Mental Health. CDC. cdc.gov
- 11Anker, J., & Krill, P. R. (2021). Stress, drink, leave: An examination of gender-specific risk factors for mental health problems and attorney attrition. PLOS ONE, 16(5), e0250563. journals.plos.org
- 12National Institute of Mental Health. (2026). Caring for Your Mental Health. NIMH. nimh.nih.gov
- 13Office of the U.S. Surgeon General. (2022). The U.S. Surgeon General's Framework for Workplace Mental Health and Well-Being. U.S. Department of Health and Human Services. hhs.gov
- 14McKinsey Health Institute. (2022). Present company included: Prioritizing mental health and well-being for all. McKinsey & Company. mckinsey.com
- 15World Health Organization. (2022). WHO guidelines on mental health at work. WHO. who.int
- 16U.S. Bureau of Labor Statistics. (2025). Employee Benefits in the United States, March 2025. BLS. bls.gov
- 17U.S. Department of Labor, Office of Disability Employment Policy. Mental Health at Work. DOL. dol.gov
Licensed Clinical Social Worker
Martha Fernandez, LCSW is Co-Founder of CEREVITY and a Licensed Clinical Social Worker licensed in California, seeing clients by telehealth nationwide through CEREVITY's network of independent licensed clinicians. USC-trained and bilingual in English and Spanish, she works with founders, executives, attorneys and pilots on burnout, anxiety and depression in high performers, on trauma, grief and high-stakes transitions, and on couples and relationship strain under pressure. Her clinical work draws on cognitive behavioral therapy, acceptance and commitment therapy, behavioral activation, and narrative and solution-focused approaches. She is the author of Wired to Burn.
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