NFP's Deb Smolensky on why mental health benefits fail workers long before they pick up the phone
Deb Smolensky (pictured) has been standing in front of rooms full of HR professionals for ten years making the same offer: find your Employee Assistance Program on your phone within ten seconds and the $100 bill in her hand is yours.
Nobody has ever claimed it.
That single demonstration, simple, repeatable, captures everything Smolensky has spent 30 years trying to say about the gap between what employers think they are providing their people and what employees can actually access when they need it most. As SVP National Practice Leader of Vitality and Well-Being Solutions at NFP, based in Chicago, she has built her career at exactly that intersection, first across 15 years advising Fortune 500 companies, then at NFP for the past 16 years, building a practice designed to bring that same strategic rigor down to the mid-market.
“I’ve found my passion and purpose really at the intersection of helping employees make their days at work healthier and happier,” she says. “And the biggest influence on that is the workplace.”
That purpose has only sharpened as the data has grown harder to ignore.
The gap nobody wants to talk about
NFP’s most recent trend report surfaces a paradox that Smolensky says she has been flagging since 2020: employee use of mental health benefits is rising, yet employer investment fell approximately 7 percent in 2025. “We have made tremendous progress as a whole in expanding the mental health benefits. We now just need to close the gap between checking the box of what is just offered versus what’s accessible but more importantly, what actually improves people’s lives.”
Employers broadly felt they had done their job when COVID forced the benefits conversation open. Offerings expanded. But investment in making those offerings actually work has since stalled or retreated, even as employee need and out of pocket usage continue to climb. That paradox, more usage and less investment, is exactly the kind of signal HR has been slow to act on.
The reason, she says, is a fundamental misdiagnosis. Too many employers have treated poor mental health engagement as a communications problem. It is actually an employee experience problem, and the difference matters enormously.
“Does someone know where to go? Can they even talk to somebody confidentially without stigma? Can they get an appointment? Can they afford it? Do they trust it’s confidential?” she asks. “It goes way beyond sending a postcard.”
She also points to a structural flaw that runs deeper still. The US healthcare system was simply never designed for mental health. Medical plan networks are evaluated based on the volume of primary care physicians, not psychologists. Provider directories were built for physical ailments, not for finding a therapist with an appointment available within the month.
“You can’t get good mental health care by using the back of your ID card like you can for every physical element,” she says. “The system just wasn’t built for it.”
That is why NFP’s trend report has been tracking the financial wellbeing implications alongside the clinical ones. When the medical system cannot deliver mental health access, employees go out of network and pay for it themselves.
COVID blew the door open. Now what?
Smolensky has been making the case for mental health at work since 2012, long before it was a mainstream benefits conversation. She credits COVID with doing what years of advocacy could not: forcing the door wide open. But she draws a sharp distinction between expanded awareness and actually moving outcomes.
She is also precise about why mental health has a uniquely far-reaching impact on organizational performance that physical conditions do not.
“You might have a physical ailment like diabetes or a musculoskeletal issue, but still work and be a top performer,” she says. “If you have mental health challenges, it’s a one-for-one impact on everything from that employee’s health and life to the organization’s health.”
And employees have completely changed how they look for help. They ask AI about every health concern. They expect frictionless access. Yet most benefits ecosystems still rely on guides, postcards, and open enrollment packets, the same tools that have been failing people for a decade.
“I heard a doctor say we’re living in a world of infobesity,” she says. “People don’t need more information. For benefits communication, I think it’s now become benefits activation. They need the right solution at the right moment when they need it most.”
That shift requires HR leaders to be asking about digital transformation and AI strategy in the same conversation as plan design, not as a separate technology discussion, but as a core part of how benefits get into the hands of the people who need them.
Parity, compliance, and keeping your GPS on
The 2024 mental health parity rules, which require mental health benefits under the Affordable Care Act to be equivalent to medical benefits, have been complex to administer, and the way they were written has left employers and HR teams with real uncertainty. Smolensky offers a clear perspective on navigating it.
“This one was written in a way that made it really hard for employers to evaluate effectively, even with our compliance teams involved,” she says. “Regulatory uncertainty is always in our industry.”
Her recommended approach is deliberate and two pronged: stay across the compliance changes, but simultaneously maintain a deep, unwavering strategic commitment to mental health regardless of where the regulations land.
“The regulations may change, but the need for accessible, affordable mental healthcare doesn’t change,” she says. “That should be our GPS. We absolutely have to stay on top of compliance but more importantly, making sure we clearly understand and continue to articulate and move forward their mental health strategy, because that’s the value.”
And that strategy, she insists, needs to sit at the table alongside cost containment on physical health and GLP-1 drug spend, not treated as a line item that gets trimmed when budgets tighten.
“Healthy brain, healthy organization,” she says. “People aren’t your best assets, they’re only your best assets when they’re Brain On.”
Three pillars, one strategy
NFP’s wellbeing model has shifted away from the traditional four-bucket benefits structure, largely centered on physical health with mental health as a side note, toward what Smolensky describes as a holistic workplace wellbeing model built around three core interlocking pillars.
The first is clinical mental health: ensuring the right access, care, and outcomes for employees with diagnosed conditions. The second, which she is most passionate about, is mental wellbeing: the daily cognitive stress and subclinical overload that affects every single employee, not just those with a clinical need. The third is career wellbeing: the quality of management, opportunities for growth, and whether someone is paid fairly.
The distinction between the first two matters more than it might appear. At any given time, it is estimated that only 20 to 30 percent of employees have a clinical mental health need. But 100 percent of them have a brain, and 100 percent are managing cognitive demands every single day.
“We make sure they’re at least advised on what the best practices are that equate to better access, better care, better outcomes at a financially reasonable pace,” she says. “But 100 percent of us at work have a brain. And our brains have cognitive overload.”
Career wellbeing is the most under addressed pillar and the one most likely to make an employer’s entire wellbeing investment pointless if ignored.
“Even if you have the right care and you’re going to therapy, you’re managing your stress, if you don’t have a great boss, or you have no growth, or you’re not paid appropriately, that’s a direct hit on the organizational health and wellbeing,” she says. “You might as well just burn your money.”
In practice, the framework functions as a diagnostic lens for HR rather than a rigid checklist. When cost conversations focus on GLP-1 spend, the mental wellbeing conversation is already in the room because stress, nutrition, and behavioral health are deeply intertwined. And the metrics worth tracking go beyond traditional utilization numbers: rate of access, first call resolution speed, and increasingly, AI safety protocols in mental health delivery, specifically at what level of clinical acuity an employee should be talking to an AI versus a human therapist.
Beyond the annual enrollment
The role of HR in shaping workforce wellbeing has expanded considerably, and so have the expectations on it.
According to LIMRA data, approximately 79 percent of US employers turn to their group benefits advisors to help evaluate benefits choices. That puts HR leaders in a powerful position: the questions you ask of those advisors, and the strategic framing you bring to those conversations, will largely determine whether your benefits investment moves the needle or simply occupies a line in your renewal deck.
“Those that are transactional will not be around,” Smolensky says of advisors who fail to evolve. The same challenge applies to HR functions that treat open enrollment as the finish line rather than the starting point. The financial scale of benefits spend means HR is operating at the same level of strategic importance as an organization’s legal counsel or its accountant.
The right questions to be asking are not about what sits in the benefits stack. They are about what would genuinely move the needle on workforce health, whether the gap is awareness or access, and whether the approach connects to what the chief executive officer is actually trying to achieve.
“This is not a cost containment strategy,” she says. “This is a business imperative investment strategy.”
What the next two to three years look like
Smolensky is deep into writing NFP’s 2027 trend report when we speak, and she is careful not to give away the full picture. But the direction is clear.
Mental health access, having a virtual option to talk to someone, is now oversaturated. The next frontier is outcomes: whether people are actually getting better, and how AI handles clinical triage at scale. Cognitive overload and digital wellbeing are emerging as distinct categories. And the primary care doctor shortage has quietly become both a major trend and an urgent tactical problem. When employees cannot get a primary care appointment for six to nine months, the traditional wellbeing model built on biometric screening and the annual physical has no foundation to stand on.
“The waitlist is absolutely insane,” she says. “We need different ways to do annual physicals. We need to solve that as almost an urgent issue versus a trend.”
Further ahead, she sees appetite building for an integrative, microbiome based approach to metabolic health, moving away from treating individual symptoms with point solutions like GLP-1s or musculoskeletal programs, and toward asking what is working inside before layering on a band aid. She also expects some employers to exit group benefits entirely in favor of individual coverage health reimbursement arrangements (ICHRAs), subsidizing employees to buy individual market coverage, which she says will create “a whole host of other issues” that NFP is already preparing for.
Her two to three year forecast if employers fail to make the connection between brain health and organizational health is blunt: rising quiet quitting, cognitive overload, error rates, absenteeism, and declining retention.
“We’re at a brain health epidemic,” she says. “Both from the acceleration of technology, the infobesity, everything is coming to a head. And we need our brains to work.”
Flow state, tai chi, and Paris on Friday
When the conversation turns to life outside work, Smolensky’s answer is rooted in exactly the frameworks she applies to her clients.
“I don’t go out and garden,” she says. “It doesn’t fill me up. I have to be out in the future.”
What restores her is learning from the best, reading, listening, staying permanently oriented toward what comes next. She practices mindfulness and HeartMath, a biofeedback based technique designed to keep the nervous system in what she calls a “flow zone” rather than fight or flight, and has taken up tai chi.
“Learning from the best of the best lights me up and relaxes me at the same time,” she says. “I blend the two to really just live in my passion as a restorative practice while walking in the park or petting my dog.”
She is, it should be said, also days away from Paris when we speak. She mentions it in passing, almost as an afterthought, in the same breath as talking about cognitive overload and brain health epidemics. It feels entirely in keeping with someone who has spent 30 years insisting that how you live outside work shapes everything about how you show up inside it.