Employers are making progress: many companies recognize the human and business costs of mental illness, but more could be done to help employees recover.

Mental health advocates have found a strong ally in a somewhat surprising place--corporate America. Increasingly, human resource (HR) executives recognize the toll mental illness takes on their organizations and the benefits of taking action.

In a recent survey of more than 500 HR executives conducted by the American Psychiatric Foundation's Partnership for Workplace Mental Health and Employee Benefit News magazine, respondents overwhelmingly said that mental illness has more effect on indirect costs such as increased absenteeism and lost productivity than any other health condition. In recent years, the Partnership has seen a shift in the number of employers aware of the impact of mental illness, and a growing number of leading employers are taking action by instituting proactive education and screening programs. These employers are seeing firsthand the improvement in performance and reduction in costs that can result when treatment is not only available, but used--without fear of stigma--by those who need it.

Education Needed

Yet much still needs to be done. The Innerworkings: A Look at Mental Health in Today's Workplace survey also showed that HR executives' awareness about the cost of mental illness is not always shared by their colleagues in other corporate departments. Less than one-quarter of respondents said they believed that managers in their companies have an overall understanding of the toll mental illness takes on a person. And unfortunately, in many companies little is being done to change this. Two-thirds of respondents said that their companies do not educate managers on mental health issues, and only 15% said that they train managers in recognizing problems and directing employees to treatment.

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Those numbers represent countless missed opportunities. Education programs needn't be complicated or costly, and often result in actual savings. "We got the biggest bang for our buck by training our managers in recognizing mental illness," Daniel J. Conti, PhD, the EAP director at JPMorgan Chase, said about a program that taught his company's managers how to react when they suspect an employee may be suffering with a mental health disorder. (1) Sprint had great success in raising awareness with such basic communication tools as a survey, "lunch and learn" series, Webcast, and "mental health matters" brochure. "We want our employees to know that it is treatable," said Collier Case, Sprint's corporate benefits manager. (2)

Programs Are Cost-Effective

Mental health programs should be proposed like any other corporate program--with a focus on the benefits to the company. "Emphasize that this is an investment," said Catherine Baase, MD, global medical director at Dow Chemical. (3)

For many companies, the first step is to determine how much mental illness is costing them. Online tools that can help include those at www.depression calculator.com, www.alcoholcost calculator.org, and www.bipolar solutions.com. Companies also can refer to several studies on the cost of mental illness. Key findings include:

* A worker with major depressive disorder averages 27.2 lost workdays annually due to absences or poor functioning on the job, and someone with bipolar disorder averages 65.5 days lost. (4)

* Annual indirect costs per employee are $4,426 for someone with major depressive disorder and $9,619 for bipolar disorder. (4)

* More work loss and impairment are caused by mental illness than chronic conditions such as diabetes, asthma, and arthritis. (5)

* Mental illness and substance abuse cost employers an estimated $80 billion to $100 billion in indirect costs each year. (5)

When companies look at the numbers, the value of mental health programs often is apparent. IBM decreased outpatient costs by almost $500,000 with its Care Advocacy Model, a program that integrates physical and mental health treatment, promotes voluntary screenings, and monitors people at risk. The program led to a 6% increase in use of behavioral health services and a 50% decrease in outpatient cases requiring acute or intermediate care. (6)

Roadblocks

While those of us in the mental health field are well aware of the advances in mental health treatment, many others are not. When asked why employees often don't seek treatment, more than 40% of Innerworkings survey respondents said they thought one reason was that people "are unaware of available treatments or don't believe that they help," with nearly three-quarters saying because "they do not realize they are ill or believe they can solve the problem on their own." This points to the value of screening programs.

Unfortunately, most companies do not include mental health with other health screening reminders. When selecting from a list of ten common screening procedures, Innerworkings survey respondents said their companies were least likely to actively recommend screening for mental illness. More than 70% said their companies encourage mammograms and blood pressure monitoring; nearly half provide information urging weight management; and one-quarter recommend bone density tests. However, only 12% said their companies provide information on the benefits of mental health screening. Despite links between physical illnesses and mental health disorders, more than half do not include screening for mental illness as part of the treatment for chronic physical diseases. According to respondents, even routine monitoring of employee morale and stress is conducted by only 38% of companies.

Considering mental illness's costs, one would expect that all companies would be doing everything they can to raise awareness and encourage screenings. However, a number of factors often stand in the way.

Many corporate leaders underestimate the prevalence of mental illness. More than two-thirds of Innerworkings survey respondents estimated that at any given time, 3% or less of their employees suffer from a mental illness; one-quarter said less than 1%. Yet according to a study by the Substance Abuse and Mental Health Services Administration, in 2003 the rate of serious mental illness among adults employed full time was 8.2%. (7)

Today's increasingly competitive, 24-7 workplace discourages any sign of vulnerability. More than half of the Innerworkings survey respondents said that the following statement describes their companies: "We are in a fast-paced, competitive industry where people need to be at the top of their form at all times." This attitude often permeates through all levels of a corporation.

Former CNN CEO Tom Johnson suffered silently with depression for years. He said, "A CEO is expected to be a strong, stable, dynamic leader. I didn't want to provide a bullet that could be used against me." (8) After finally seeking treatment and finding relief, he went public with his struggle in 2002. Johnson continues to receive thank-yous from people across the country for shining light on this taboo subject. The openness and advocacy of Johnson and other public figures, numerous government and academic reports, and extensive scientific research all underscore the prevalence of mental illness and the benefits of treatment.

Stigma continues to stand in the way of recovery. When asked to pick the major reasons why an employee would refrain from seeking treatment, 80% of Innerworkings survey respondents cited the "shame and stigma that may be associated with a diagnosis." More than half said because of "concern that their employer or co-workers could find out."

Raising awareness and decreasing stigma clearly are the first steps to improving behavioral healthcare in corporate America. It is estimated that each year, less than one-third of the people with a diagnosable mental disorder receive treatment. (9) Every company owes it not only to its employees, but to itself and its bottom line to do all it can to foster workplace mental health.

Resources

The good news is that most companies already have a strong foundation on which to build and improve their mental health programs. According to Innerworkings survey respondents, the majority of companies offer mental health coverage (90%), employee assistance programs (76%), and return-to-work assistance for employees on disability (63%). About two-thirds of companies offer workplace support for employees with mental health problems; this includes unpaid leave (80%), flex time (62%), a change in office environment such as more privacy or the use of headphones (41%), or the option to work from home (38%). These findings represent companies of all sizes and in more than 50 industry sectors. According to respondents, while more than half of the companies have more than 500 employees and more than one-quarter have more than 3,000, another one-quarter are small businesses with fewer than 100 people.

Numerous resources are available for corporate leaders who want to institute or improve their mental health programs, including:

* the Partnership for Workplace Mental Health's A Mentally Healthy Workforce--It's Good for Business, which includes success stories and a guide for evaluating, constructing, and strengthening a corporate mental health program (www.workplacementalhealth.org/pdf/businesscase12112006.pdf);

* An Employer's Guide to Behavioral Health Services: A Roadmap and Recommendations for Evaluating, Designing, and Implementing Behavioral Health Services by the National Business Group on Health (www.businessgrouphealth.org/pdfs/fullreport_behavioralhealthservices.pdf); and