Stress Tests

Weight-loss programs. Smoking cessation support. Health-club memberships and discounts. Biometrics-based insurance-premium incentives. Healthy snack offerings. The strategies and tactics of improved employee health and fitness are innumerable, and U.S. companies have invested billions in the battle to reduce the costs of employer-paid health insurance. But too often, executives in the field say, all of those programs combined fail to take into account one of the biggest drivers of lost time and lowered productivity: Mental health.

“Cancer can kill you, but if you catch it at stage 1, there are treatments that can cure it or beat it back for a while,” says Susan Crain Lewis, president and CEO of Mental Health America of the Heartland. “But you have to catch it early.” It’s the same with mental health, she says. If more efforts aren’t made to identify early-stage illnesses, including workplace anxiety, job stress, depression, the effects of divorce, separation or death—the causes are myriad—companies will continue to absorb unnecessary financial costs, turnover and less-than-optimal productivity.

“How many beds do we need for cardiac care?” Lewis asks. “Well, if there are no doctors who can prescribe statins, we need a lot, because we’re going to see a lot of heart attacks. If we have good doctors and good medications, we don’t need as many beds”—or the higher costs of staffing them. “It’s a piece that’s really essential.”

Evidence that people are carrying additional emotional baggage shows up in various metrics. The Centers for Disease Control and Prevention say the nation’s suicide rate increased 24 percent between 1999 and 2014, and deaths by overdoses of prescription painkillers were up 300 percent in the same period. On average, 50 Americans die every day from those drugs, primarily opioids.

Increasingly, though, there are signs that employers are becoming more aware of mental-health issues and their impact on the workplace. Federal health statistics say one in four Americans will suffer some form of mental illness in their lifetimes, and larger companies are moving to raise awareness of that and reframe workplaces to reduce the sense of shame that some feel about mental illness—shame they wouldn’t feel about a broken leg, appendicitis or injury from a fall.

Christine Leslie, senior vice president for employee-assistance programs at New Directions Behavioral Health, said that over her 20 years in the field, “what we’ve really seen is are companies—we deal with many different organizations, like education, technology and retail—but companies addressing these issues in two ways: One, by promoting well being, trying to see a culture of resiliency and get individuals to be resilient, and two, if they have identified an issue, making sure employees know what to do and what to bring to the work force.”

The national advocacy group Mental Health America has conducted a workplace health survey, which showed that 80 percent of employees stated that workplace stress affected their personal relationships, and that 35 percent of employees “always” miss shifts each month because of workplace stress. A massive effort that entailed more than 17,000 respondents the study found that even at the executive level, stress is taking its toll: 57 percent of top-level executives said stress from their jobs affected relationships with family and friends, slightly more than the percentages for mid-level and front-line respondents.

The costs of all that? Penn State University researchers crunching demographic and other data from 2008 to 2014 determined that economic loss nationwide came to $53 billion. And that was based on just a single additional lost day of work per month. “This starts to give us an idea of what the gain could be, if we did spend more money to help people with poor mental health,” said Professor Stephan Goetz.

For businesses, mental health still carries a stigma in the workplace, but its prevalence calls for change: The World Health Organization,  in a poll of U.S. workers, found that more than two thirds of respondents said that within the past year they had experienced personal problems that interfered with work. And 28 percent said their workplace was a source of anxiety.

A separate study by the Anxiety Disorders Association of America found that nearly half of those surveyed said workplace anxiety disorder had interfered with co-worker relationships, showing up as reluctance to contribute in meetings or withdrawal from company social settings. It also said only one in four employees had told their employer about their condition, reflecting the power of that stigma.

Nearly two in five feared that disclosure would make supervisors suspect that they were just trying to avoid work, and more than a third thought disclosure would hurt their chances for career advancement.

The good news? Treatment works. The Center for Workplace Mental Health has tracked employees through the process, and 80 percent said their job satisfaction and productivity increased after treatment.

Emerging best practices in management of employee mental-health issues is coming from organizations working in the health-care space. That’s not entirely coincidental: According to the Occupational Safety and Health Administration, health-care settings experience more instances of workplace violence than all other settings—combined.

At the University of Kansas Hospital, part of a health system of more than 13,000 employees and affiliated practice groups, the task is to help staff maintain emotional balance in a setting where life and death issues are part of the daily routine.

The effort, says Terry Rusconi, vice president of performance improvement, is multi-pronged, and starts with managers who strive to stay attuned to what’s happening in the workplace. “Every day, they see the intensity of emotion that’s going on, and can reach out and get resources,” he said. “Our staff gets attached to patients they care for over a long period of time, like those with cancer. The loss of one of those folks is emotionally impactful.”

Another resource that not many large businesses have, he said, is the large cadre of chaplains from various faiths. But, like other large employers, the hospital also has its own Employee Assistance Program, and a critical-response team combining spiritual care with advanced-psychiatry nurses.

Also in the health-care arena is Netsmart, the Overland Park-based provider of behavioral health and post-acute care technology, where part of the strategy is grounded in changing the social response to mental illness. The company has more than 1,700 associates, nearly half of them in the Kansas City area.

“Definitely, there has been a stigma associated with mental health and substance use,” said CEO Mike Valentine. Netsmart also supports a 501(c)3, EverydayMatters, a non-profit focused on to eliminating that stigma. “It is a place for people to get educated, feel safer and seek resources,” he said, and it’s an in-house response to Netsmart’s commitment to its clients who serve those with mental health and substance-use challenges.

“Physical and mental health have traditionally been siloed,” Valentine said. After passage of the Affordable Care Act, hospitals and physicians’ offices had financial incentives to automate health records, which boosted business for software providers Cerner, Epic and others. “But the mental-health providers were left out of that funding,” he says, and as a result, are not yet as automated. “We provide that technology for them, helping integrate behavioral health and physical health. We believe whole-person care is what everyone wants and deserves.”

Employers have a number of tools at their disposal, including some taking innovative approaches to identifying need and starting early treatment. One of those is Blue KC’s Spira Care, a foray into treatment between the health insurer and both Olathe Health and Shawnee Mission Health.

“It has many selling points, but I think one of the big ones is that the care centers have a behavioral health clinician on site,” said Sarah Nelson-Johns of New Directions, which is administering that part of the operation. “That means that behavioral-health issues can be identified quickly and treatment can begin as soon as something is identified,” and at no additional cost to Spira Care enrollees. “This saves the employer and member money in the short term and long term and makes for happier and healthier employees,” she said.

That shift in approach, Nelson-Johns said, has great potential to address costs, because “we know that about 20 percent of primary care includes a behavioral-health component,” she said. “Sometimes people are waiting so long to access mental-health services that things have gotten out of hand. The goal is to meet people as early as possible, providing better long-term outcomes.”

New Directions’ Leslie said another tool, especially for smaller employers, is the development of peer-support programs, which create something of a mental-health first-aid approach. “Even with suicide prevention, there’s a CPR corollary, QPR, for question-persuade-respond,” she said, “and it teaches others to recognize signs and symptoms in coworkers, and gives them a sense of community and empowerment.”

Lewis, of Mental Health America of the Heartland, said large employers with more resources had made the biggest strides in employee benefits. “But the smaller companies, where they don’t have an HR manager, their supervisors aren’t necessarily trained in how to manage these cases. They came up from the line where they were really good at doing something, but don’t have that context.”

Mental-health issues, she believes, will continue to gain visibility in part because they often tied to co-morbidities like obesity, diabetes, cancer or heart disease—all of which impose emotional tolls on patients. And some of those, diabetes and obesity especially, are reaching the stage of public-health crisis.

“About 5 percent of Americans have major depression,” she said, “but for those with complications from diabetes, you’re looking at close to 70 percent. If all you do is diabetes treatment but not depression…. We have a huge need to make sure people get all the treatment they need.”