Cost of Mental Health Disorders Cost of Mental Health Disorders and Practical Solutions and Practical Solutions

October 18, 2011October 18, 2011

Bruce Cedar, CMG Associates

Sara Herman, Screening for Mental Health

Valerie Dickerson-Codero, Families for Depression Awareness

Massachusetts Workplace Massachusetts Workplace Mental Health InitiativeMental Health Initiative

Screening for Mental Health, IncScreening for Mental Health, IncMassachusetts Department of Public HealthMassachusetts Department of Public Health

CMG AssociatesCMG AssociatesFamilies for Depression AwarenessFamilies for Depression Awareness

Mission and History of the Massachusetts Mission and History of the Massachusetts Workplace Mental Health InitiativeWorkplace Mental Health Initiative

The GoalThe Goal of the WMHI is to increase awareness by MA of the WMHI is to increase awareness by MA employers and companies about the benefits of good employers and companies about the benefits of good employee mental health, to train employees about employee mental health, to train employees about recognizing signs of stress and depression, and to recognizing signs of stress and depression, and to provide intervention via screeningprovide intervention via screeningThe MA WMHI is a workplace collaboration, funded by The MA WMHI is a workplace collaboration, funded by MDPH, formed in 2007 in response to the growing MDPH, formed in 2007 in response to the growing financial and emotional toll that untreated mental illness financial and emotional toll that untreated mental illness has on Massachusetts communitieshas on Massachusetts communitiesBackground of MA WMHI Background of MA WMHI

Members of the CoalitionMembers of the CoalitionMass Department of Public HealthMass Department of Public Health– Funds coalitionFunds coalition– Helps support development of coalition materials and planningHelps support development of coalition materials and planning

Screening for Mental Health, IncScreening for Mental Health, Inc– A national non profit dedicated to promoting the improvement of mental A national non profit dedicated to promoting the improvement of mental

health by providing the public with education, screening, and treatment health by providing the public with education, screening, and treatment

resources.resources. www.mentalhealthscreening.org www.mentalhealthscreening.org CMG AssociatesCMG Associates– CMG Associates is a team of psychologists, organizational CMG Associates is a team of psychologists, organizational

consultants and social workers  dedicated to helping you keep consultants and social workers  dedicated to helping you keep your workplace healthy your workplace healthy www.cmgassociates.comwww.cmgassociates.com

Families for Depression AwarenessFamilies for Depression Awareness– A national nonprofit organization helping families recognize and cope A national nonprofit organization helping families recognize and cope

with depressive disorders to get people well and prevent suicides. with depressive disorders to get people well and prevent suicides. www.familyaware.org www.familyaware.org

Are any of these concerns for your Are any of these concerns for your company? company?

• Rising costs?Rising costs?

• Decreasing productivity?Decreasing productivity?

• Incidents of evident drug/alcohol abuse, theft, Incidents of evident drug/alcohol abuse, theft, family violence impacting the workplace, family violence impacting the workplace, suicide, etc.?suicide, etc.?

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AgendaAgenda

• DepressionDepression• Cost to EmployersCost to Employers• Best PracticesBest Practices• Practical SolutionsPractical Solutions

DepressionBruce Cedar, CMG AssociatesBruce Cedar, CMG Associates

Why Address Mental Health in the Workplace?Why Address Mental Health in the Workplace?

How does depression affect organizations?How does depression affect organizations?

Depression is number one cause of disability in US, and it ranks among top Depression is number one cause of disability in US, and it ranks among top three workplace problems addressed by Employment Assistance Programs. three workplace problems addressed by Employment Assistance Programs.

Depression tends to affect people in their prime working years and may last a Depression tends to affect people in their prime working years and may last a lifetime if untreated. lifetime if untreated.

More often than not, a depressed employee will not seek treatment because More often than not, a depressed employee will not seek treatment because they fear the affect it will have on their job and they are concerned about they fear the affect it will have on their job and they are concerned about confidentiality. confidentiality.

Approximately 225 million workdays are lost annually due to productivity decline Approximately 225 million workdays are lost annually due to productivity decline related to depression.  This amounts to more days of work loss and work related to depression.  This amounts to more days of work loss and work impairment than many other chronic conditions such as diabetes, asthma, and impairment than many other chronic conditions such as diabetes, asthma, and arthritis. arthritis. 

"Sustaining Productivity: Addressing the economic burden of workplace depression," "Sustaining Productivity: Addressing the economic burden of workplace depression,"

A Special Supplement to Advancing Suicide PreventionA Special Supplement to Advancing Suicide Prevention, 2007., 2007.

John’s Story

What Depression Looks LikeWhat Depression Looks Like

What depression feels like to the employee

What depression looks like to the employer/ co-workers, clients

Slowed thoughts Poor quality work

Lack of concentration Procrastination, accidents on the job

Reduced interest, low motivation

Presenteeism

Self-medication Missed deadlinesAbsenteeism

In Men, Irritability, angerIn Women, Crying, upsetIn both, over-reaction

Poor relationships with co-workers, boss, clients; low morale in workplace

Can’t get going in the a.m. Late to work

Aches and pains Trips to the doctor, increased health ins costs

Ray’s StoryRay’s Story

Men & DepressionMen & Depression

Men are less likely to seek help than Men are less likely to seek help than women due to:women due to:

– Gender-role socializationGender-role socializationBelief that help seeking is a “female trait” –Belief that help seeking is a “female trait” –antithetical to masculine gender roleantithetical to masculine gender role

– Social Costs to Help-SeekingSocial Costs to Help-SeekingIncompetence, Dependence and Inferiority which Incompetence, Dependence and Inferiority which result in a perceived loss of power and control for result in a perceived loss of power and control for the person seeking helpthe person seeking help

– Fear of being stigmatized Fear of being stigmatized by family/friends/colleaguesby family/friends/colleagues

Cochran SV, Rabinowitz FE. Men and Depression: clinical and empirical perspectives. San Diego: Academic Press, 2000.

Men & DepressionMen & Depression

* Robbins and Reiger (1991) ** Kessler, McGonagle, Zhao, et al. (1994)

Abusing alcohol and drugs

Hand in HandHand in Hand

The federal government estimates that, 8.9 percent of full-time workers – 12.7 million people - have drinking problems. Substance Abuse and Mental Health Services Administration

Mental Health Disorders are Mental Health Disorders are TreatableTreatable

80% of people with depression get well!Illness is invisible when treated.

• Nearly 86% of employees treated for depression report improved Nearly 86% of employees treated for depression report improved work performance.1work performance.1

• 80% of those treated for mental illness report “high levels of work 80% of those treated for mental illness report “high levels of work efficacy and satisfaction.”2efficacy and satisfaction.”2

• Treatment of depression results about a 40-60% reduction in Treatment of depression results about a 40-60% reduction in absenteeism/presenteeism.3absenteeism/presenteeism.3

1 Finkelstein SN et al: Improvement in Subjective Work Performance after Treatment of Chronic Depression: Psychopharmacology 1 Finkelstein SN et al: Improvement in Subjective Work Performance after Treatment of Chronic Depression: Psychopharmacology Bulletin, vol. 32, 1996, pp. 33-40.Bulletin, vol. 32, 1996, pp. 33-40.

2 Therapy in America 2004: Poll Shows Mental Health Treatment Goes Mainstream. Therapy in America 2004: Poll Shows Mental Health Treatment Goes Mainstream. 3 Dunlop, DD Am J Pub Health 2005. Wang, PS Am J Psych 2004. Simon, GE Gen Hosp Psych 2000. Claxton, AJ JOEM, 1999. 3 Dunlop, DD Am J Pub Health 2005. Wang, PS Am J Psych 2004. Simon, GE Gen Hosp Psych 2000. Claxton, AJ JOEM, 1999.

Cost to Employers

Why address mental health in Why address mental health in workplace?workplace?

• Lower costsLower costs• Disability leave, sick days, health careDisability leave, sick days, health care• Average depressed employee loses 32 Average depressed employee loses 32

workdays per year* workdays per year* • Disability leave: 7-20% are psychiatricDisability leave: 7-20% are psychiatric

• Increase productivityIncrease productivity

* archives of psychiatry, Oct. 2007* archives of psychiatry, Oct. 2007

Costs of mental health disorders in Costs of mental health disorders in the U.S. workplacethe U.S. workplace

• Depression #1 cause of disability in U.S.*Depression #1 cause of disability in U.S.*• Mental illness and substance use disorders Mental illness and substance use disorders

annually for employers: $80 to $100 billion in annually for employers: $80 to $100 billion in indirect costs alone.**indirect costs alone.**

• 32 workdays/year lost per depressed 32 workdays/year lost per depressed employeeemployee

• 225 million work days lost/yr225 million work days lost/yr• Depression worsens other health conditionsDepression worsens other health conditions

• Even greater costs***Even greater costs***

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1 NIH 2007 2 Finch, R. A. & Phillips, K. (2005); 3 Katon, et. al. (2010)

Impact to the WorkplaceImpact to the Workplace

MedicalMedicalMental health/substance abuseMental health/substance abuse

PharmacyPharmacyDisabilityDisability

Presenteeism and lost productivityPresenteeism and lost productivityAbsenteeismAbsenteeism

Overtime to cover sick-day Overtime to cover sick-day absencesabsences

Unrealized outputUnrealized outputOverstaffing Overstaffing

Temporary workersTemporary workersStress on team membersStress on team members

RecruitmentRecruitmentHiring costsHiring costs

RetrainingRetraining

Depression and WellnessDepression and WellnessTypical wellness programs include weight loss, exercise, Typical wellness programs include weight loss, exercise,

smoking cessation.smoking cessation.Root cause can be depression.Root cause can be depression.

• 50% to 80% of those with a mental illness smoke.50% to 80% of those with a mental illness smoke.1

• 45% of people with asthma and 27 % of people with diabetes 45% of people with asthma and 27 % of people with diabetes have co-occurring depression.have co-occurring depression.2

• 17% to 27% of those hospitalized with cardiovascular 17% to 27% of those hospitalized with cardiovascular disease have depression.disease have depression.3

• Many of those who are obese have depression, there Many of those who are obese have depression, there appears to be a cortisol abnormality. If someone is appears to be a cortisol abnormality. If someone is overweight, then experience stress, weight will usually overweight, then experience stress, weight will usually increase.increase.4

1Smoking Cessation Leadership Center; 2Schatzberg AF. J Clin Psychiatry. 2004;3Depression and Cardiovascular Disease, Science Daily, 10/17/2007; 4psychcentral.com, Biological Link to Obesity and Depression, Rick Nauert, 6/12/2009

ExamineExamine Your CostsYour Costs

• Go to www.depressioncalculator.com• A tool that uses an algorithm established in clinical

research to estimate costs of depression

• Get the following costs from your providers:• Days missed due to absenteeism• % of disability cases that are due to psychiatric causes• Annual disability costs• Utilization of Employee Assistance Program (EAP)

Best PracticesValerie Dickerson-Codero, Families for Depression Valerie Dickerson-Codero, Families for Depression

AwarenessAwareness

Care Team: Peer Assistance CommitteeCare Team: Peer Assistance Committee Interested employees (crewmembers) are trained to listen to employees by phone or in person and

provide emotional support, and help them make use of JetBlue's employee assistance program (EAP) and benefits.

Trained on depression by Family Speakers who tell personal stories from Families for Depression Awareness.

225 peer assistants. Health Risk Assessment (HRA)Health Risk Assessment (HRA) Available to all employees and their families over 18. Gather detailed stats and provide more

specialized health programs to person.Disease Management ProgramDisease Management Program Disease Management Program for diabetes/ asthma/back pain/ heart, if depression also present,

then provide with treating clinician.NurselinesNurselines 24/7 telephone line for self care and advice (e.g., if person has depression, can discuss medication,

treatment options)EAP UsageEAP Usage 10.6% in 2010 compared to 3-4% average, attributed to ongoing reminder communications and

Peer Assistance Committee referrals

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Culture of Caring and Safety

~13,000 employees

GoalGoal• Manage health care costs through better health management. Personal Health PortalsPersonal Health Portals• WebMD/Ingenix partnership. Provide employees with their health care records and

health and wellness programs. EMC able to analyze aggregate data on top employee health issues, prescription drug usage, results of programs.

Targeted Wellness ProgramsTargeted Wellness Programs• Based on data of depression and antidepressant prescriptions, realized need for

depression workshop, sleep disorders, etc.On site Counseling: United Behavioral HealthOn site Counseling: United Behavioral Health• Counselors next to EMC locations, get free visits and better access to clinicians• Telepsychiatry is next step so that people can do counseling virtually, saves time,

money.Clinical Study Partnerships/Pilot ProgramsClinical Study Partnerships/Pilot Programs

• Tufts Medical Center Workplace Depression Study: 6-8 mo NIMH study. For employees 45 or older and depressed, receive online health coach.

• Partners Health Care SmartBeat hypertension program pilot, 70% of participants saw a decline in blood pressure

Training Article, Boston Globe “Targeting Untreated Depression in the Workplace: Training Article, Boston Globe “Targeting Untreated Depression in the Workplace: • http://www.boston.com/yourtown/news/waltham/2010/11/waltham_group_targeting_untrea.html

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EMC is an IT company behind online banking, health records, data storage, sharing, transferring.

25,000 US employees

Summary of Best PracticesSummary of Best Practices

• Assessing your organization’s needsAssessing your organization’s needs• ScreeningScreening• TrainingTraining• Employee communicationsEmployee communications• Improving access to mental health servicesImproving access to mental health services• Inclusive health strategyInclusive health strategy• Are you including mental health in all health strategies (e.g. disease Are you including mental health in all health strategies (e.g. disease

management, wellness programs, disability management)?management, wellness programs, disability management)?

Practical Solutions

How We Help YouHow We Help You

• Customizable, anonymous mental health Customizable, anonymous mental health online screening programonline screening program

• Training for management and employeesTraining for management and employees

• Tools to help you make the case to take Tools to help you make the case to take action (e.g., innovations database)action (e.g., innovations database)

How We Put our Mission Into How We Put our Mission Into ActionAction

The MA WMHI provides:The MA WMHI provides:– Free access to a customizable, anonymous Free access to a customizable, anonymous mental mental

health online screeninghealth online screening program program– Free trainingFree training, conducted at the organization, about , conducted at the organization, about

the financial and human cost of suicide and mental the financial and human cost of suicide and mental health issues in the workplace – also helps health issues in the workplace – also helps employees identify and cope with stressemployees identify and cope with stress

– Consultation to workplacesConsultation to workplaces to help devise the best to help devise the best strategy to adequately support the mental health strategy to adequately support the mental health needs of their unique workplaceneeds of their unique workplace

More details… Mental Health Online More details… Mental Health Online Screening ProgramScreening Program

Each organization is given a unique URL to place on their website where Each organization is given a unique URL to place on their website where employees can go to take anonymous screenings for Depression, Bipolar, employees can go to take anonymous screenings for Depression, Bipolar, Anxiety, PTSD, Alcohol Abuse and Eating Disorders Anxiety, PTSD, Alcohol Abuse and Eating Disorders

Organizations can run utilization reports Organizations can run utilization reports

The Screening is customizable, organizations can customize:The Screening is customizable, organizations can customize:– Welcome messageWelcome message– LogoLogo– Color SchemeColor Scheme– Referral Message (most important, EAP/HR resources can be listed, along with Referral Message (most important, EAP/HR resources can be listed, along with

local community support resources)local community support resources)

All online screening tools are validatedAll online screening tools are validated

Provided by Screening for Mental Health, Inc

• Managing Mental Health Issues in the WorkplaceManaging Mental Health Issues in the Workplace• A program for supervisors and managersA program for supervisors and managers

• QPR Training: (Suicide Prevention Strategy)QPR Training: (Suicide Prevention Strategy)• Question, Persuade, ReferQuestion, Persuade, Refer

• Post-VentionsPost-Ventions• Debriefing and support for the workplace following a suicideDebriefing and support for the workplace following a suicide

Workplace Consultation and TrainingsWorkplace Consultation and Trainings

Coping with Stress WorkshopCoping with Stress WorkshopProvided by Families for Depression AwarenessProvided by Families for Depression Awareness

One-hour, fifteen minutes workshop:One-hour, fifteen minutes workshop:– Employees discuss impact of stress on Employees discuss impact of stress on

their livestheir lives– Shows your commitment to employee Shows your commitment to employee

well-beingwell-being– Tools and techniques for managing Tools and techniques for managing

stressstress– Discuss stress, anxiety, depressionDiscuss stress, anxiety, depression– Helps employees recognize depression Helps employees recognize depression

and anxiety and seek treatmentand anxiety and seek treatment– Employees know where to go for help Employees know where to go for help

Includes Coping with Stress BrochureIncludes Coping with Stress Brochure

Coping with Stress Workshop"We need to have seminars like

this at least on a quarterly basis.""I learned how to cope withstress in ways I hadn't triedbefore. It was a good class.""It was valuable to learn the

difference between stress and depression”

Next Steps…Next Steps…ContactsContacts– Sara HermanSara Herman

Screening for Mental HealthScreening for Mental Health 1 Washington Street, Suite 3041 Washington Street, Suite 304 Wellesley, MA 02481Wellesley, MA 02481 781-591-5233, SHerman@MentalHealthScreening.org781-591-5233, SHerman@MentalHealthScreening.org– Valerie Dickerson-CoderoValerie Dickerson-Codero Families for Depression AwarenessFamilies for Depression Awareness 395 Totten Pond Road, Suite 404395 Totten Pond Road, Suite 404 Waltham, MA 02451Waltham, MA 02451 781 890-0220, valerie@FamilyAware.org781 890-0220, valerie@FamilyAware.org– Bruce CedarBruce Cedar CMG AssociatesCMG Associates

381 Elliot St., Suite 180L381 Elliot St., Suite 180L Newton, MA 02464 Newton, MA 02464

617 969-7600 bcedar@cmgassociates.com617 969-7600 bcedar@cmgassociates.com