Carelon Behavioral Health on Workforce Mental Health and Modern EAPs

Brian Keefe, a board-certified psychiatrist and medical director of Carelon Behavioral Health, joined the America's Work Force Union Podcast to discuss the state of workplace mental health, the history and evolution of employee assistance programs (EAP), and a new product called Workforce Mental Health Complete that Carelon has developed in partnership with Lyra Health.

Keefe traced EAPs from their origins in the 1940s and 50s alcoholism programs – which he described as remarkably progressive for their time in treating alcoholism as a treatable condition rather than a character flaw — through their expansion to whole-person care in the 1970s and into a third wave now focused on proactively shaping workplaces where fewer people struggle in the first place.

Keefe also addressed the growing behavioral addiction crisis around legalized sports gambling and explained why putting a sportsbook in every American's pocket has created a public health problem with no easy parallel in recent history.

• Employee assistance programs have evolved through three distinct phases: a 1940s and 50s first wave focused exclusively on alcoholism in collaboration with AA and labor-management partnerships; a 1970s second wave that expanded to whole-person care staffed by licensed clinicians addressing anxiety, depression, financial stress and family issues; and the current third wave focused not just on reactive support but on proactively shaping workplace conditions. The most recent shift includes voice, belonging, dignity, predictable schedules and growth opportunities that determine mental health outcomes before workers reach crisis.
• Workforce Mental Health Complete, Carelon's new flagship employer product, pairs four decades of Carelon's clinical and operational behavioral health expertise with Lyra Health's AI-assisted provider matching platform, which uses large language model technology to connect employees with a compatible licensed clinician within a day or two. The new product addresses counseling, financial and caregiver support, social determinants of health including housing and food instability and critical incident stress debriefing for safety-sensitive industries under a single integrated platform.
• Keefe identified legalized sports gambling as the fastest-growing behavioral addiction concern in his clinical work. Moving gambling from a time-limited destination activity in Las Vegas or Atlantic City to a permanent presence on every American's phone has fundamentally changed its risk profile, he said. Keefe also noted that major sports league commissioners who once opposed gambling partnerships are now financial partners with the gambling industry, and that by definition, the financial viability of gambling apps depends on Americans losing money at scale.

One in Five Americans — and a Long Way From Addressing It

Brian Keefe opened the mental health conversation with a surprising statistic: approximately one in five Americans lives with some degree of a mental health condition. A board-certified psychiatrist with subspecialty training in consultation psychiatry and forensic psychiatry, Keefe currently oversees two functions at Carelon Behavioral Health: medical director of national crisis services, which includes the operation of 988 crisis lines across multiple states and municipalities, and medical director of workforce mental health. He provides clinical oversight for the employee assistance programs Carelon manages.

EAPs: From Alcoholism to the Whole Person to the Workplace Itself

Keefe offered one of the most concise histories of employee assistance programs heard on this show. EAPs began in the 1940s and 1950s as workplace alcoholism programs — specific interventions for workers whose alcohol use was affecting safety and job performance. The approach was rooted in AA and built on labor-management cooperation. Keefe described it as remarkably progressive for its era. Alcoholism was identified as a treatable medical condition rather than a personal failing, which gave workers a path to treatment rather than termination. That union of clinical understanding and labor advocacy set the template for everything that followed.

The second wave arrived in the 1970s, when practitioners recognized that alcohol was not the only thing pulling workers off course. It was determined that anxiety, depression, financial stress, relationship problems and caregiving responsibilities all affect job performance. EAPs went clinical, adding licensed professionals and expanding their scope to address the whole person. That model has been the dominant one for the past five decades, and by Keefe's assessment, it has delivered genuine results. It preserved jobs, improved productivity, reduced absenteeism and turnover.

The third wave is where Keefe said the field is heading now. The question is no longer only how to help workers after they are already struggling. It is about building workplaces where fewer people struggle in the first place. Having a voice at work, creating a sense of belonging and dignity, as well as providing predictable work schedules and opportunities for growth. are all workplace conditions with direct and measurable effects on mental health outcomes, Keefe said. Modern EAPs are increasingly helping organizations understand and address those conditions, rather than just connecting individuals to counseling after the damage is done.

The Gambling Crisis Nobody Is Talking About Loudly Enough

Keefe identified gambling as the behavioral addiction he is most concerned about right now. When gambling required a flight to Las Vegas or a weekend in Atlantic City, its risk was bounded by geography and time. The activity had a natural off switch. You went home. Putting legalized sports gambling on every American's phone eliminated that switch. It is always available, always accessible and always designed to take more money than it returns.

Gambling apps are only financially viable because more people lose than win, Keefe noted. The scale of that loss is the business model. He expressed particular concern about the transformation of major sports leagues from longtime opponents of gambling partnerships into financial partners. The shift happened quickly, with almost no public reckoning about what it means for the millions of people who now wager on their phones every day.

Workforce Mental Health Complete: What It Actually Does

The product Keefe came to discuss is called Workforce Mental Health Complete, a platform built on a partnership between Carelon and Lyra Health. He went on to explain the problem it is trying to solve: the EAP marketplace is full of siloed digital solutions — mindfulness apps here, CBT for insomnia there — that address narrow segments of behavioral health but do not bring the full spectrum of care under a single accessible roof. Costs keep rising. Outcomes are hard to measure. Access is slow.

Workforce Mental Health Complete addresses the access problem first. Using large language model technology, Lyra's platform walks an employee through a series of questions and generates a list of matched providers — people specifically suited to that employee's needs — who can typically see the employee within a day or two. Employees engage the platform through an app, a website or the telephone. The matching technology meaningfully increases the rate at which employees stay with their chosen clinician, thereby improving outcomes.

Carelon contributes what Keefe described as four decades of clinical and operational behavioral health expertise, including the work-life services that modern EAPs have expanded to encompass. This includes financial counseling and planning, caregiver support for employees managing elder care or childcare challenges and coordination around social determinants of health, including housing instability, food insecurity and neighborhood conditions — that do not show up in a DSM diagnosis but profoundly affect a person's ability to function. The platform also coordinates critical incident stress debriefing for safety-sensitive industries, manages fitness-for-duty evaluations, and addresses the regulatory requirements of high-stakes work environments.

Outcomes are measured at both ends. Employees can track their own symptom severity and functioning. Employers receive data on return on investment. The whole thing, Keefe said, was designed to be an end-to-end solution — premium support for employers, real improvement in workers’ lives.

More information is available at carelonbehavioralhealth.com.

If you or someone you know is in crisis, the 988 Suicide and Crisis Lifeline is available by calling or texting 988.

Go Behind the Scenes of the Labor Movement

Every victory at the bargaining table starts with workers standing together. From the shop floor to the statehouse, hear how activists are fighting for better wages, safer conditions and a stronger future. Subscribe to the America's Work Force Union Podcast to get the latest interviews with the leaders and organizers building worker power across America.