Employers have a stake in the urgent need for mental health care

Mental health conditions affect millions of Americans, with more than 25 percent of people in any given year experiencing some kind of anxiety, depression or other condition, according to Mental Health America.

The ensuing fatigue, loss of energy, persistent sadness and more not only impact personal lives, but also carry over into professional lives with a loss of concentration, absenteeism and short-term disability.

Mental health conditions strike many Americans in their productive working years, and the results are so severe that World Health Organization research shows mental health conditions cause greater disability than cancer, cardiovascular disease, arthritis and diabetes.

“If (mental health conditions) go untreated, it really impacts business’ bottom lines,” said Dawn Zak, associate director of Mental Health America of Wisconsin.

In fact, mental illness, along with substance abuse, ultimately costs U.S. employers an estimated $80 billion to $100 billion in indirect costs each year, according to the Partnership for Workplace Mental Health.

Experts say employers need to understand that they, too, have a stake in addressing this burgeoning mental health crisis.
How mental health conditions affect work performance
Quite simply, happier people are more successful at work. According to Zak, they are more willing to help out co-workers and customers, describe their jobs in a more positive light and perform better on more objective, work-related tasks. They also tackle a wider range of job tasks, defend their organizations and cope better with organizational change.

“When people are in better mental and emotional states, they’re going to produce more and do a better job,” said Craig Modell, a psychologist and the owner and director of the four Stress Management & Mental Health Clinics in the Milwaukee area.

According to the Centers for Disease Control and Prevention, 40 percent of workers report that their jobs are, “very or extremely stressful.” When employees are pushed too hard at work, they will become angry and debilitative, and they will withdraw from an organization, Modell said.

For some employees, however, it goes beyond just being overworked and stressed. In fact, Mental Health America states that five out of 20 workers in an office will likely develop a mental health condition, which is defined as: major depression; bipolar, anxiety or panic disorders; post-traumatic stress disorder; or attention deficit hyperactivity disorder.

Those with depression alone average 5.6 hours per week of lost productive work time due to decreased work performance or presenteeism (the act of being present, yet not fully functional because of an illness), according to the Journal of Occupational and Environmental Medicine.

Furthermore, about two-thirds of people with symptoms of clinical criteria for having mental and substance use disorders do not receive any treatment at all for their condition, according to the Partnership for Workplace Mental Health.

Often, depressed employees do not seek treatment because they fear the effect it will have on their jobs, according to the MHA. Plus, they are concerned about confidentiality.

Left untreated, depression is as costly as heart disease or AIDS to the U.S. economy, costing more than $51 billion in work absenteeism and lost productivity and $26 billion in direct treatment costs, the MHA says.
While mental illnesses are more common than many people realize, Zak said recovery is very common, too, as 65 to 80 percent of individuals with mental disorders improve with appropriate diagnosis, treatment and ongoing monitoring.

These improvements typically result in lower total medical costs, increased productivity, lower absenteeism and decreased disability costs, Zak said.

Zak

How to manage stress
Stress is part of everyday life, but it is important to keep it in check, since it is capable of producing myriad health problems.

According to the American Psychological Association, 43 percent of adults suffer adverse health effects from stress, which has been linked to the six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and suicide.

“Although we are called human beings, we are often ‘human doings,’ and we need to teach our bodies to relax,” said Paula Carlton, a doctor of nursing practice with Aurora Advanced Healthcare in West Bend.

Carlton recently wrote a blog for Aurora that included seven tips to manage stress levels naturally.

They are: go to bed each night at the same time, wake up at the same time and get out in the sunshine; limit alcohol; avoid caffeine, sugar and processed food; do an exercise that relaxes your mind, such as yoga or walking in nature; get a monthly massage to relax muscles; take dietary supplements; and try meditation.
Additionally, live a life of purpose, she said, by doing things that bring you joy, whether it is traveling, cooking, running a marathon or something else.

Zak also recommends taking vacations (and really unplugging), doing fun and creative activities, being mindful of what you say yes and no to and relying on your circle of support.

People should become more aware of their own needs and desires and how to meet them on their own, Modell said. In other words, do not expect your spouse, partner or boss to meet your needs for you. Learn assertiveness in order to appropriately confront others, apply good time management, set realistic goals, practice mindfulness and develop a sense of humor and good self-esteem, he said.

“People who have better self-esteem make better choices and take better care of themselves,” Modell said.
While those are general stress management techniques that people can incorporate into their overall lives, employees can use other specific methods during the work day to help them cope with stress.

Carlton

For instance, Modell suggested taking a 30-second break every two to three hours for a “private meeting” with one’s self to evaluate how you are functioning and what you can do better. Then 15 minutes prior to the end of the work day, take a moment to reflect on the day, acknowledging your achievements but also what you could have done better.

Along those same lines, Carlton recommends staying present throughout the day and occasionally stopping to take five long deep breaths to re-center yourself.

Furthermore, learn to “roll with the punches,” she said.

Do not dwell on your sources of stress, but instead ask yourself why you are worried and develop backup plans for if those worst case scenarios happen.

Employees are also advised to take breaks and either go to lunch with a co-worker for some socialization or take some quiet time if needed.

Just do not eat lunch at the same time as you are working, advised Carlton, as the body’s cortisol level will be working double time.

Modell

When is it more than stress?
Stress management techniques may not be enough for everyone, though. Some still might feel anxious, irritable or fatigued, for example.

Everyone feels stress from time to time and has the occasional sad day, but Zak said a bigger problem may exist if these feelings of depression and anxiety last more than two weeks.

People should recognize the symptoms of depression and anxiety (see accompanying infoboxes), consider how long they have been feeling that way, and ask themselves what kind of impact those feelings have on their lives and to what extent.

“We forget sometimes that without mental health, health isn’t full,” Zak said.
There are many things, however, employees and employers can do to restore and foster good mental health.

What employees should do
Employees are responsible for taking care of their own mental health, according to Zak. This means being proactive about managing their stress, being aware of resources and receiving appropriate treatment.

She said it is a personal decision whether or not an employee wants to disclose his or her mental health condition to the employer, but it is important for employees to have a conversation with their supervisor or human resources department about what the employer can do to help them be more productive.

For instance, instead of an employee saying, “I have depression,” he or she can say, “I’m having concentration issues. This is what you can do to help me.” One solution for the employee might be closing the office door for a few hours to help him or her focus on work.

“We all can’t have ideal circumstances to work under, but there are things (employees) can ask for to help them do that,” Zak said.


What employers can do
First, employers should work to ensure they are creating a healthy workplace culture.

Mental health-friendly environments are advantageous for everyone because they lead to improved productivity and motivation, reduced absenteeism and presenteeism, as well as a reduction in turnover and health care costs, according to Zak.

Research from the MHA also shows that employers who support wellness through stress management have seen a 26 percent decline in health care costs, and workplace health promotion saves employers an average of $5.81 per dollar spent.

Zak said it is not, however, an employer’s responsibility to diagnose its employees or act as a therapist. For instance, an employer should never approach an employee and say, “Hey, I noticed you were down today. What’s going on?”

Instead, employers should be cognizant of changing work performances and start a conversation focused on that.

For instance, if an employer sees an employee who is ordinarily always on time coming in to work late several days in a row, the employer should say, “I noticed you’ve been showing up 10, 15, 20 minutes late the last few days. Is there anything I can help you with?”

Other examples might be an employee who suddenly is acting irritable or negative or an employee who can normally be counted on to step up in leadership roles not doing so.

Employers should offer employees resources and ask what the organization can do to help them with their work, but it is always important to keep the conversation in the context of the workplace.

It is also better to work with the employee on his or her performance issues sooner rather than later, before production further decreases, according to Zak.

“We’re just asking employers to do what they would typically do as a supervisor, which is to be aware of their employees,” Zak said.

Employers should also engage their employees on a daily basis, recognize their value and make them feel they are part of the team, according to Carlton. Offer break times throughout the day and provide days off of work.
Employers also can encourage exercise opportunities for their employees.

Lastly, Modell encourages employers to be aware of how hard they are pushing their employees.

“That relationship with employees is important because it’s how you’re building trust and cooperation,” he said. “People will work harder for you when you show that care in the workplace.”


Challenges in accessing mental health care
While most agree the stigma of seeking mental health care has declined in recent years, some challenges still exist that make it hard for people to get help.

One of the biggest obstacles is high insurance deductibles and copays, according to Andrew Kane, a clinical and forensic psychologist who owns Milwaukee-based Andrew W. Kane & Associates S.C.

“The problem is that even while a wide variety of companies offer wellness opportunities, including access to gyms, access to yoga and access to other things that are good for people, they don’t take a good look at what their insurance covers,” Kane said.

Kane has seen deductibles as high as $10,000 and copays of 50 percent or more. Subsequently, he receives calls from prospective patients on a weekly basis who cannot afford the cost.

Modell, who attributes the higher deductible plans to employers looking to save on health care costs, has also noticed a rise over the past year or so. He has seen deductibles as high as $1,000, $3,000 or $5,000 when they used to be $250 or $500.

“There’s an immense body of research that says people with good mental health are much better employees, and if businesses paid attention to that, they would cover the things they need to cover for mental health care,” Kane said. “The goal is to make mental health care accessible, and it’s not meaningfully accessible if it costs too much.”

Kane said copays in the hundreds and deductibles in the thousands effectively prevent people from receiving mental health care.

Some people may receive enough care after one or two visits, but he said those with a major mental illness require care over a substantial period of time, not unlike someone with cancer or heart problems.

Since health insurance and health savings accounts may not cover the cost of care for major mental illness, Kane recommends employers offer enough financial coverage for a year’s worth of therapy, which could cost as much as $10,000.

One step in the right direction toward providing proper mental health care, according to Kane, is the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, a federal law that generally prevents group health plans and health insurance issuers from imposing less favorable benefit limitations on mental health or substance use disorders than on medical/surgical benefits.

Prior to the law, it was common for insurance plans to provide less generous benefits for mental health coverage. For example, an insurer might have covered 10 therapy visits a year but an unlimited number of medical doctor visits, according to Sarah Fowles, an employee benefits attorney at Milwaukee-based Quarles & Brady LLP.

The law greatly expanded mental health coverage, but Fowles said some questions still linger, especially after the federal government enacted new regulations that went into effect on Jan. 1 for many plans.

For instance, Fowles said there are still some mental health limits that raise questions, such as exclusions for applied behavioral analysis for autism spectrum disorder and for residential mental health treatment facilities.

“When the law is intended to expand coverage of mental health benefits, that expansion will result in more challenges when a benefit is denied,” she said.

If an employer is found to be in violation of the mental health parity law, he or she can be subject to a penalty of $100 per day per individual the failure affected.

Not every mental health exclusion, however, is a violation. Thus, Fowles advises employers to examine their plan documents or consult with their insurers or third party administrators to ensure their plans are operating in compliance with the mental health parity law.

As for employees, Fowles urges them to review their plan documents or call their insurers to make sure they are clear on what their plans do and do not cover.

Another challenge for those seeking mental health care is a nationwide distribution problem among psychiatrists that leaves some settings and populations with shortages.

For example, 47 percent of rural hospital chief executive officers reported shortages of psychiatrists in their communities, and 82 percent of rural health clinic leaders reported great difficulty in recruiting them, according to Dr. Jerry Halverson, medical director of adult services at Rogers Memorial Hospital-Oconomowoc and president of the Wisconsin Psychiatric Association.

Nationwide, there are 3,968 total mental health care health professional shortage areas (HPSAs), which means only 51 percent of the need is met, according to The Henry J. Kaiser Family Foundation. About 2,700 practitioners are needed to eliminate the HPSA designation.

Wisconsin has 103 total mental health care HPSAs and meets just 21 percent of the population’s needs, which places it second-to-last in the United States. The foundation says 212 more practitioners are needed to remove the HPSA designation.

“We do not have enough psychiatrists, psychiatric nurse practitioners or psychiatric physician assistants in the state, so we have to continue to recruit more and retain what we have,” Halverson said. “We have to work to find ways to stretch what psychiatric resources we have, which include psychiatrists as well as primary care physicians and physician extenders, including prescribing nurses and physician assistants.”

Halverson said the shortage issue has been a problem for 10 years, but the decrease in the stigma of mental health care and the increase of people with insurance has made it more of a crisis over the past few years.

Adding to the problem, psychiatrists available for direct patient care are not keeping pace with the U.S. population due to an aging workforce and low state and federal funding that limits the number of graduates from psychiatric programs.

Besides lifting the cap on Medicare funding for Graduate Medical Education, Halverson said strategies to alleviate shortages include incentivizing redistribution of psychiatrists and psychiatric extenders to underserved settings and improving the retention of psychiatrists currently working in such settings.

The Medical College of Wisconsin is working to improve the retention and distribution problems in central Wisconsin, according to Halverson, through its proposed partnerships with entities including the North Central Health Care Center and the Marshfield Clinic. By providing residency opportunities in those underserved areas, Halverson said it increases the probability psychiatrists will remain in the area.

In the meantime, telepsychiatry is another way for those in underserved areas to receive mental health care. Rather than face-to-face sessions, patients and their psychiatrists conduct their sessions virtually.

Finally, selecting a mental health care provider can also make receiving care difficult for some.

For one, providers have a variety of terms, from psychiatrists to psychologists and from therapists to counselors.

While psychiatrists access and evaluate the need for medication and monitor it, psychologists, counselors and therapists provide the therapy work. Pay attention to providers’ credentials to make sure they are licensed and have gone through training, and check to see if they have expertise in treating the issue at hand, Zak advises. Also, do not be afraid to ask providers questions about themselves and their backgrounds.

Kane suggests seeking out a referral from a physician, family member or friend, and Modell added that people can call their insurance companies for help in finding a local provider.

For those who struggle to afford mental health care, Kane said help is available from local psychology training clinics, including the Wisconsin School of Professional Psychology’s Psychology Training Center and the University of Wisconsin-Milwaukee’s Psychology Clinic.

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