By Dr. David Berube, Chief Medical Officer,
VP at Lincoln Financial Group
Mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day, and each person will have different experiences, even people with the same diagnosis. It is not the result of one event, rather, according to research, mental illness is a culmination of several factors. According to the National Alliance on Mental Illness, factors could include genetics, environment and lifestyle. And, in the workplace, it can have various affects for those who suffer and those who employ them.
Pervasiveness of Mental Health Illness in the Workplace
The pervasiveness of mental health illness (MHI) in the workplace is high. In fact, it affects almost twenty percent of employees and costs employers over $80 billion annually, mostly for lost productivity and absenteeism.1 The most common mental diagnoses are: anxiety, depression, and substance abuse, and together, they account for over eight percent of all long-term disability claims.2 Although treatment may improve mood, behavior, productivity, and absenteeism,3 and can be cost-effective for employers,4 studies have shown that many people with MHI don’t get proper treatment.5
Barriers to Treatment
Why does this problem persist? Three major factors that may prevent those who suffer a mental illness condition from seeking and staying in treatment include a low perceived need for treatment, stigmatization surrounding MHI, and financial support for treatment. For example, employees and their family members may not be aware that they have a significant problem or that the problem they have is treatable; also, primary care may not adequately address screening for MHI.6 Additionally, workers may be concerned about stigmatization and discrimination at work or in their community. Then there is insurance; co-pays for healthcare visits and pharmaceuticals can be daunting, and insurance coverage for therapy may be limited.7
This doesn’t address the courage it takes for someone to seek help, the time it could take to find the right practitioner for quality care, and the potential challenge for confidently returning to work. Patients often wait a month or more for an appointment with a psychiatrist,8 while often times primary care physicians, who have limited training and specialization in MHI, may have to fill in for mental health professionals. The quality of patient care has also been a problem. One study shows that only fourteen percent of insured MHI patients received care that met best practice guidelines.9 Another unanticipated challenge is the ability for someone to effectively return to work. In the workplace, employers are often unsure about how to help someone with MHI stay at work or even return to work, citing concerns about confidentiality, stigma, managing the employee, and the accommodations needed for a successful employee transition.10 Because such protocols might not exist yet for an employer, employers may not recognize or address psychological, social and organizational job characteristics that could potentially affect work outcomes.11
Insurance Can Pave the Way to a Solution
Although these barriers to successful treatment exist, the good news is that effective solutions are available; they often relate to education, awareness and access. In specific scientific investigations and as well as consensus recommendations, there are proven circumstances that stand as evidence employers can achieve better results to support these employees. In fact, studies show that with good health insurance coverage (often employer-provided) for MHI, workers are much more likely to pursue treatment.9 Also, now more than ever, there are online and in-person resources to help educate employees about early recognition and treatment. There are also tools for for mental health professionals to assist MHI patients cope with life’s challenges, and the expected results in terms of better function at work and at home.12 Finally, a private prescreening can be the difference between someone who knows they need help, and those that take that first step to getting care. Confidential screening for MHI, in person or by phone, can identify MHI and engage people to initiate treatment early on if linked to the right interventions.13
Telecommunications Can Boost Timeliness of Treatment
In healthcare technology, automation has helped to speed up MHI patient access and care. Advances in telecommunications, like telepsychology, can be as effective as in-person therapy, in breaking down the stigma often associated with MHI, and enabling those who might not other wise reach out to do so. In turn it may reduce the shortage of professionals available for in-person treatment.14,15 As any other service provided, positive results will depend on engaging trained, licensed mental health professionals who are adept at using telepsychology.16
Regardless of how care is delivered, scientific evidence supports specific treatments that are most effective. Health insurers can have a significant role in ensuring quality and compliance — especially through MHI disease management.17
Employers Can Offer Return to Work (RTW) Strategies
For the employer, accommodating for employees with MHI can be challenging, but the basic principles are similar to those for other medical conditions. An important starting point for companies to support those returning to work after a MHI disability, is to ensure that there is a clear policy and protocol in place, as well as strong, consistent leadership to support those employees. Employers have generally had success when they offer encouragement, respect and confidentiality, and inquire about what types of accommodations would be helpful. The ultimate goal is to engage case managers and RTW coordinators to facilitate communication and the RTW process in a supportive environment.18 RTW strategies may include modified training and supervision, and gradually increasing hours and work demands.19 Effectively addressing MHI is challenging, but material evidence now exists for what works and how to achieve better results.
The time and effort needed to focus on RTW for employees with MHI is an investment in the workplace community for the longterm and far outweighs the cost of replacing critical talent. Early recognition, appropriate treatment, and productive accommodations are good for your bottom line and, more importantly, good for your employees.1
Dr. David Berube is the Chief Medical Officer at Lincoln Financial Group, a member of the Council for Disability Awareness. Dr. Berube is an occupational medicine specialist in West Haven, Connecticut. He received his medical degree from University of Rochester School of Medicine and Dentistry and a Masters in Public Health at Yale University. He’s been in practice for over 25 years.
1American Psychiatric Association Foundation. Business Case for Mental Health and Substance Use Disorder Treatment. 2010.
2 Council for Disability Awareness. Long Term Disability Claims Review. 2013.
3 Beck A, LA Crain, LI Solberg, et al. The Effect of Depression Treatment on Work Productivity. American Journal of Managed Care. 20(8):e294-301. 2014..