Benefits professionals know that behavioral health has long been eclipsed by physical ailments within the larger context of health plan management, even with mental health parity laws. That’s largely because there are more tangible treatment options for colds, flus, accidents and diseases, which represent low-hanging fruit for cost management.
But it’s not nearly as easy to treat or manage mental health and substance abuse issues, even though the need to find meaningful solutions has never been greater. Unchecked mental illness, for example, costs the U.S. more than $105 billion a year in lost productivity, according to the National Council for Behavioral Health. The group also notes that 35 million work days are lost every year as a result of this problem, while more than half of managers have no training to recognize the telltale signs of mental illness or substance abuse.
Roughly 61 million U.S. adults experience mental illness in any given year, yet 60% of them won’t ever receive the treatment that they need, explains Betsy Schwartz, who oversees the NCBH’s Mental Health First Aid course. Depression alone has a huge impact on the workplace because of presenteeism and absenteeism. “Someone who’s depressed might have difficulty concentrating,” she says.
But organizations such as American Express, DuPont and others are finding ways to raise awareness about workplace depression, promote early recognition of symptoms and reduce the stigma surrounding mental illness.
American Express, for example, was recognized earlier this year by the American Psychological Association for its Healthy Minds program, which integrates behavioral health and emotional well-being into its health and wellness offerings. Dr. Wayne Burton, corporate medical director for American Express, says the company’s focus on mental health goes hand-in-hand with its business goal of providing exceptional customer service.
“We know that to provide exceptional customer service you have to have exceptional employees and we have to support our employees around the world in their physical, as well as their mental, health issues that they may have from time to time,” he says. “That’s what it comes down to.”
Under an expanded employee assistance program, Healthy Minds offers workers eight free sessions with a mental health professional, either at one of the company’s onsite clinics or through the EAP vendor. The company also invited actress and mental health advocate Glenn Close to its New York City headquarters to speak to employees about her family’s experience with mental illness and partnered with her organization, Bring Change 2 Mind, to raise awareness. And in addition to the usual webinars and other communication channels Amex uses with employees, the company is piloting an online meditation program.
“It’s at your desk and you get a brief introduction to what it means and how to meditate, and then [employees can] take some brief time, a couple of times a day, and do some meditation exercises,” explains Burton. “It’s very short, very practical. The research shows that it can be very useful to people.”
The National Council for Behavioral Health, meanwhile, recently announced that up to 15 million working Americans who are covered under Aetna’s group insurance plans have an opportunity to take its Mental Health First Aid course in the fall. This groundbreaking, eight-hour training is managed, operated and disseminated by NCBH, along with the Maryland Department of Health and Mental Hygiene and Missouri Department of Mental Health. This disparate partnership was created to bring the course to the U.S. in 2008 from Australia, where it was created.
“Mental Health First Aid is really a skills-based and literacy program,” Schwartz says. “People learn about specific illnesses, whether it’s depression, anxiety, addiction, eating disorders, suicide, panic attacks, trauma. People learn how to recognize signs and symptoms of different problems.”
Whereas the American Red Cross teaches CPR and how to tie a tourniquet, MHFA helps people spot and respond to those in emotional crisis. It’s offered as part of Aetna’s employee assistance program and employees can sign up at any time during the year.
A certified pool of corporate instructors teach the class, which can be completed in one day or split into four-hour classes. It features quite a bit of role playing and experiential learning, and hopes it will elevate conversations about behavioral health issues as well as make it more acceptable to talk with co-workers about the signs or symptoms of mental health or addiction related problems.
Research shows that a psychologically healthy workforce is productive, creative and engaged, according to Louise Murphy, VP of Aetna Behavioral Health.
“Mental health problems can strongly influence employee performance, rates of illness, absenteeism, accidents and staff turnover,” she says. “But most employers do not know what to do about it. Mental Health First Aid provides the education, resources and support to change the conversation and ultimately a company’s culture around stigma, stress, mental health and substance abuse.”
One Aetna group health customer, Carolinas HealthCare System, trained 1,700 employees and community members in 2014 and 1,154 during the first half of 2015. In addition, 120 community partners and employees have been trained as instructors since last year.
Andrew Hall, a Carolinas HealthCare System spokesman, says the ACA sets expectations that not-for-profit hospitals better understand, address and report on how they impact identified community health needs.
“The goal is to help at-risk community members be able to take charge of their health, access appropriate care and avoid unnecessary illness,” he says. “Mental Health First Aid is one way that Carolinas HealthCare System approaches mental illness, one of the most commonly identified health needs in all communities, in order to raise awareness, reduce stigma and arm community members with the skills to necessary to assist and support someone with mental illness.”
One way DuPont has helped create a culture of support is through its ICU program, an awareness campaign that includes a five-minute video designed to teach employees how they can appropriately connect with distressed peers who may need support.
“ICU is building on the analogy of an intensive care unit, when sometimes we need someone to step in and really provide some intensive assistance. Similarly, it also translates to ‘I see you,’ says Clare Miller, director of the American Psychiatric Foundation’s Partnership for Workplace Mental Health. “It teaches people about some of the signs of emotional distress [and] encourages people to just connect with one another. Maybe that's just offering some support, lending a listening ear, or it could be actually encouraging that person to make use of the employee assistance program, mental health benefits, the wellness program, or whatever kinds of services that the employer wants to pair with the video.”
DuPont has made the video available worldwide to its 70,000 employees and has also donated it to the Partnership for Workplace Mental Health for other employers to use free of charge.
The ICU program “gives permission for a sense of normalcy around emotional distress,” said Paul Heck, global manager of employee assistance and work/life services at DuPont.
“Many employees fail to recognize their own behavioral health issues, whether it’s with substance abuse or really understanding that it’s not just another bad day at work, but that there’s an underlying stress disorder or a depression,” says Jennifer Schneider, M.D., chief medical officer of Livongo Health, and former chief medical officer of Castlight Health.
Earlier this year, Castlight introduced a self-assessment tool that enables employees and their families to make educated choices about their treatment options for mental health and substance abuse. The cloud-based technology accesses and synthesizes data from multiple health plans and uses proprietary algorithms to create personalized recommendations. The Castlight Elevate module is part of a larger cost and quality transparency platform called Castlight Essentials.
The technology helps employees recognize these key differences and become more familiar with their care options. Schneider believes it can help increase the use of employee assistance programs, whose utilization tends to be in the single digits, as well as document and demonstrate high quality care.
“There’s a big stigma still attached to mental health disorders,” Schneider observes. “Many people are afraid to walk to a psychiatrist’s or a psychologist’s office for fear of being seen by someone else that they know. We’re able to actually improve that experience by giving them some privacy with tele-therapy or computerized cognitive behavioral therapy.”
Also see: 3 hidden effects of workplace depression
In addition, all searches on Castlight’s platform adhere to security and administrative protocols involving protected health information, and they do not display specific words or phrases traced to individual queries.
Adopting a more holistic approach to managing employee health with greater access to behavioral health services is critical to improving outcomes and reducing cost. “If you are depressed, your chances of actually following any medical guidelines or protocols or treatment programs are drastically reduced,” Schneider says.
She adds that the cost of chronic conditions such as diabetes, hypertension or hyperlipidemia could swell if coupled with depression “in large part because people are unable to work with their doctors to meet the standards and get the care that they actually need.”
“Mental health is a real big issue and continues to be at the forefront for many of us,” says Schneider, who is enthusiastic about being able to leverage health care technology in a way that helps patients self-identify, break down barriers to care and provide high quality, consistent care. Schneider says behavioral health issues are responsible for 40% of missed work, and yet 70% of those who suffer go untreated.
While greater access to care is an integral part of health care reform, integration of physical and mental treatment protocols is becoming even more important.
The Association for Behavioral Health and Wellness recently released a paper entitled, “Health Care Integration in the Era of the Affordable Care Act,” which highlights efforts by some of the nation’s largest health plans and managed behavioral health care organizations to carve in or carve out behavioral health care.
Also see: 7 signs of a toxic workplace culture
“The key takeaway for employers is to understand that an integrated approach to the delivery of physical and behavioral health care treats the whole person and all of their illnesses, which can frequently save money and keep people out of less intensive treatment,” says Pamela Greenberg, president and CEO of the ABHW. The group’s member companies have provided insurance coverage for mental health and addiction to about 150 million people during the past 30 years.
She says it’s imperative for employers to learn the importance of identifying and treating behavioral health problems as early as possible, including knowing what to look for when purchasing a behavioral health benefit. “Behavioral health illnesses are treatable,” she explains. “People do recover and can be productive members of the workforce.”
As for compliance, Greenberg says it’s essential that employers with over 50 employees understand mental health parity legislation and know how their insurance carriers are implementing parity in their policies.
“Not only is it important to confirm that employees are getting the full behavioral health benefit that is required under the law,” she cautions, “but also because noncompliance can lead to penalties of up to $100 per day. In situations where there is a separate vendor for behavioral health benefits, employers can assist in parity compliance by encouraging the medical plan to share the necessary documentation with the behavioral health plan to help ensure parity compliance.”
Bruce Shutan is a Los Angeles-based freelance writer.
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