Working women shoulder most caregiving duties and when school starts, the mental load becomes a plan sponsor’s problem, says Dr. Primiano
When summer ends and the school year begins, working women face a collision of demands that hits harder than most employers realize.
The return to structured schedules, packed calendars, and the invisible weight of household planning creates what Dr. Sandra Primiano calls “a perfect storm,” which also compounds the mental health load women disproportionately carry.
Fall season hits working women hardest
"Vacations are over, people tend to start getting busier at work, everybody's back wanting meetings, different events and customers coming together and whatever business needs start to happen. And then, well, there's school," said Primiano, senior director of EFAP (Employee and Family Assistance Program) and mental health programs at Montreal-based Dialogue, emphasizing the fact that children also need lunches packed, supplies bought, and schedules reorganized when back-to-school season arrives.
“[Women] might have like 10 things going on in [their] head at the same time in addition to work or whatever they’re dealing with in that moment,” Primiano added.
Moreover, Primiano pointed to 2022 data from Statistics Canada that found 52 per cent of women bear caregiving responsibilities compared to 42 per cent of men. She suggests that gap generates what clinicians call mental load - the constant background hum of planning and logistics that runs alongside every other obligation. That sustained pressure left unchecked, Primiano underscored, doesn’t stay situational, particularly as ongoing stress can slide into anxiety, feelings of being overwhelmed, and eventually depression.
"It's all of that pressure combined, as well as the fact that women just carry more of it," she said.
Why more women are seeking care now from employers
When asked whether the wave of September stress represents a new wave of mental health issues, Primiano framed it more as an increase to reduced stigma, faster access to virtual care, and the fact that women are more likely than men to seek help in the first place.
"I don't think it's anything new and emerging. I think that we're more aware and we talk about it more, which is great," she said.
Yet, Primiano acknowledged how summer itself may also obscure what’s already there, noting that vacation gives people space to disconnect and set aside concerns, but once routines resume, the underlying problems resurface. She pointed to a similar pattern in January and February, when the post-holiday return to normal produces its own consultation spike.
"When things settle down and you go back into your routine… you have that time to focus on what is not working well," she said.
Reducing friction in mental health access
Still, the harder question is what happens with the women who never reach out and Primiano acknowledged the blind spot - without engagement, there’s no data to track. She argued that the most effective response is reducing friction at every point of entry, from flexible appointment times, self-guided resources like articles and videos, and digital tools such as internet-based cognitive behavioural therapy.
The more options available, the better the odds of reaching women whose schedules leave little room for traditional appointments, she said.
She also underscored that awareness can’t be a one-time effort. After all, employees regularly forget what benefits they have and how to access them. Primiano said employers need repeated registration campaigns and reminders so that when a crisis hits, the infrastructure is already in place as accounts are set up, information is entered, and the path to support is short.
On the benefits design side, Primiano flagged scheduling as a structural barrier that can disadvantage women without intending to. For example, if a working mother's only free window is 9 p.m. after the kids are in bed, the question becomes whether that’s a realistic time for a therapy session.
She argued that employers need to build flexibility into the workday itself.
“If you think of schedules and that mental load, the best thing you can do is have accessible care and meet people where they're at. Like if they don't want to go in-person or vice versa, you need to be able to be flexible and from an employer perspective, maybe that also means giving them time in a workday for an appointment,” she said.
To that end, Primiano pointed to the clinical evidence around virtual care, noting that it produces outcomes equivalent to in-person treatment, including for women. She acknowledged a common pattern where clients start with in-person sessions to build rapport, then shift to virtual once convenience outweighs the perceived need for face-to-face contact.
As for acute periods like September, however, she argued that speed of access matters more than format. Getting an appointment fast and preventing escalation should take priority over waiting for what feels like a perfect fit.
Beyond benefits, Primiano urged plan sponsors to act on the policy and workplace design side. She pointed to pre-fall awareness campaigns, like workshops and webinars focused on stress management and resilience for women, as one lever employers are already pulling.
Why early intervention saves ROI
To that end, she emphasized how communication and education ahead of the crunch, rather than during it, can make all the difference.
She also argued for temporary flexibility in return-to-office mandates. If the standing policy is three days a week in the office, employers should consider scaling that back during months they know will be more intense, allowing more remote work or adjustable schedules to ease the pressure on women managing competing demands at home and at work.
Primiano emphasized how the cost of inaction is ultimately measurable. She warned that when women's mental health deteriorates, “there are lots of repercussions and fallout," she said, pointing to rising absenteeism, more sick days, and a spike in presenteeism where employees show up but cannot perform to capacity.
Early intervention during high-stress periods like September can prevent that slide from worsening, potentially keeping employees off disability leave altogether, she said.
“The case for ROI comes down to getting ahead of the severity, hopefully preventing it from increasing and from people going on leave,” she said.
