Covid-19 is exposing the inequality of mental health care access for essential workers

Instacart workers are essential during the pandemic—but they don’t necessarily always access to health benefits.
Instacart workers are essential during the pandemic—but they don’t necessarily always access to health benefits.
Image: REUTERS/Cheney Orr
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Michelle Lovero-Holliday has taken a step back from the hustle of delivering groceries.

In the early, chaotic stages of the coronavirus pandemic, Lovero-Holliday says she was unsure how to protect herself, both from the virus—she was especially worried about bringing Covid-19 home to her husband, who has two collapsed lungs—and from the stress of fighting for Instacart orders to fill. When demand was high, she says, she was frequently swiping at her phone “two to three times a second,” trying to snag more work.

Lovero-Holliday, 50, got into gig work after being laid off two years ago from her job as an HR manager. Prior to the pandemic, she says, her gig-work stress was mostly about money: Could she get enough orders? Would she be able to pay her bills? Now, her worries include whether she’ll “make it out alive today without bringing anything home.”

“I worry every time that I go out,” she says. “I’m extremely neurotic with my gloves and my mask and my spray, and I wipe down everything.”

Her worries and exhaustion compounded as lockdown restrictions were loosened in states like Georgia, where Lovero-Holliday lives, and Covid-19 cases increased. She has paused her delivery work for now. Her husband still leaves the house for his job delivering air conditioners for trains, but it’s solitary work; they feel he’s in a safer position to continue working.

The pandemic has laid bare the inequalities between those who get to stay home and those who have to leave their house to work; in countries like the US, Covid-19 has highlighted racial injustice, as infections disproportionately impact Black and Hispanic workers. But it has also exposed a less commonly discussed inequality: mental health, and the care accessible to white-collar and non-white-collar workers.

According to the Kaiser Family Foundation, one in five US adults reported having a mental illness last year. Despite the widespread distress, discussions of mental health had long been taboo in the workplace, and in recent years tended to focus on white-collar professionals and the impact of working long hours.

But with about 50 million frontline workers in the US alone—from healthcare providers to cashiers to delivery drivers—toiling through a public health crisis, it’s hard to ignore the mental wellbeing of these workers.

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The state of mental health for frontline workers

Before the pandemic, essential workers—a category that often overlaps with low-wage workers—already tended to face difficult conditions on the job. They often confront inflexible schedules, labor-intensive work, and, especially in the case of healthcare workers, proximity to trauma.

And in an era of social distancing and high unemployment, experts warn that mental health problems and substance-abuse issues are likely to increase.

A Kaiser Family Foundation study published in April found that low-income workers in the US were more likely to report major negative mental health impacts from worry or stress over coronavirus—14% of those making $90,000 or more reported experiencing a major negative mental health impact, versus 26% of those making less than $40,000.

Eva Caraballo, a sterile-processing technician at a hospital in Tampa Bay, Florida, says that before the pandemic, she was regularly concerned about being able to put food on the table for her two kids. When Covid-19 emerged, the pressure on the single mother only increased, as a sharp decline in elective medical procedures led to a reduction in her hours.

“It’s a lot of mental overload,” says 42-year-old Carabello, who gets $17 an hour and one mask for each of her 16-hour shifts.

One lever that could reduce essential workers’ stress is more money. A 2016 study led by Oxford University sociologist Aaron Reeves found that the introduction of a national minimum wage in the UK two decades ago reduced financial strain and boosted low-wage workers’ mental health.

In the gig economy, in which drivers and delivery workers who are considered independent contractors have suddenly become essential personnel, the Ubers and Lyfts of the world have not provided extra financial support. Erika Sabbath, an associate professor at the Boston College School of Social Work, says that raising the cost of gig services like rides and food delivery could help to ensure that workers “are actually paid commensurate with the level of effort that it takes to do the job.”

But salary is likely just one factor explaining the difference in stresses for frontline and white-collar workers, and the ways in which they’re addressed.

Frontline workers may “not have a whole lot of control over their time, [while] having a lot of competing demands and not enough time to do the things that they need to do,” says Sabbath, whose research focuses on workplace stress and worker health, particularly among low-wage earners.

Meanwhile, white-collar workplaces have been generally accommodating in letting people work from home for longer, even in places where government restrictions on office attendance have eased. “If you have an essential job, you don’t necessarily have that luxury,” Sabbath says.

She says that while essential workers, such as janitors and cashiers, may take pride in providing a social good at work, the positive emotions may be outweighed by feelings of stress, especially if customers or other people they encounter on the job are coughing or not wearing masks.

The chronic stress can lead to anxiety as well as sleep disturbances, and set the stage for health conditions like heart disease and diabetes, she said.

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Access to care

Access to mental health resources has long been unequal, whether because of cost, social stigma, or, as is frequently the case in the US, a distinction between the level of benefits provided to white-collar and frontline workers. Benefits can even vary between positions in the same company.

In the white-collar world, employers with large millennial workforces have offered increased support for workers’ mental health over the past several years. Russell Glass, CEO of Ginger, a mental health services app, says that’s partly because stigma has eroded enough that well-off millennial workers are willing to ask for help.

Now, in the wake of both the pandemic and recent protests against racism, Glass says he believes there’s more public pressure for companies to address the mental wellbeing of workers across occupations and salary ranges.

Many companies are capitalizing on the explosion in telehealth. In April, the US retail chain Target rolled out additional mental health apps to help workers navigate stress and improve their sleep. At rival Walmart, all US workers now have access to three free behavioral counseling sessions. Instacart, meanwhile, has a partnership with Stride, which provides access to telemedicine, support lines, and therapy apps; the availability and cost of each resource varies.

The day I spoke with Glass, he said he had been on a call with a global fast-food chain interested in providing support for both corporate staff and frontline workers. The company sounded “much more worried about those in the store who are both dealing with having to come in and serve people during a pandemic,” he said.

It’s a dramatic change from the historical stance of employers. But Glass sees it mainly as an acceleration of trends that were taking shape before the pandemic began. “[N]ow companies are saying, okay, we’re going to have to make a decision faster on this than we were doing,” he says.

Ginger, which is backed by Kaiser Permanente Ventures and former LinkedIn CEO Jeff Weiner, provides mental health solutions for around 100 organizations, many of which employ frontline workers. Workers at places like Sephora, Planned Parenthood, and US discount retailer Grocery Outlet can access behavioral health coaching through Ginger, delivered via a HIPAA-compliant chat. For those who need more care, Ginger provides access to therapists and psychiatrists.

During the first week of June, Glass says, Ginger saw a more than 200% increase in clinical sessions and a 101% increase in the use of coaching services, compared to pre-pandemic weekly averages from August 2019 to January 2020.

It’s hard to say how effective programs like Ginger’s are just yet. There’s also the looming question of whether employers will continue to provide these perks post-pandemic. Some employers of essential workers, for example, are already planning to roll back hazard pay intended to compensate for the risk of exposure during work—a choice that could itself have an impact on workers’ mental health.

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Preventative measures

Rather than just expanding access to mental health care, Sabbath says her research shows that the most effective way to protect employee health and mental health is to change working conditions. Mental health treatment is needed, she says, but so is preventing people from getting to a place where they feel they’ve reached a breaking point.

Even small concessions, like encouraging workers to take periodic 10-minute breaks or allowing more flexible starting and stopping times, could make a difference, she says. At Grocery Outlet, which has stores in California, Oregon, Washington, Idaho, Nevada, and Pennsylvania, Karen Hague, the chain’s vice president of HR, says there’s an increased need for managers to be on the floors to check in more frequently with workers and ask how they’re doing. “Everyone’s situation is different and unique,” she says.

But as employers of essential workers hire thousands more to meet demand, some methods of addressing mental health in the workplace may require more time and attention than many companies are ready to give.

The pandemic has also forced a new level of acknowledgment of workers who are often dehumanized by those who depend on their labor. The question now is whether employers will do more to assure these workers’ mental wellbeing, and whether the rest of society will demand it of them.

What’s clear is that the pandemic has brought about greater awareness, at the very least, of the obstacles to workers’ wellbeing, as hurdles to mental health support come down. Covid-19 has not been an equalizer. But as Sabbath says, “people are maybe more willing to talk about how stressful it is and how scared they are at work, because the virus is something that everyone is thinking about.”