How Much Does Quality Mental Health Care Profit Employers?

EAP 2.0: reimagining the role of the employee assistance program in the new workplace

Mental illness is a highly prevalent problem that affects millions of individuals. Like many other previous natural disasters and terrorist attacks, the recent Covid-19 pandemic has placed an enormous stress on the world and its workforce. In many ways the pandemic revealed gaps in the quality and availability of mental health resources, and, by magnifying the intense demand, it also spurred innovation. Telemedicine and virtual trauma-related services became examples of ways in which evaluation, treatment and counselling services could be delivered directly and efficiently to people who were confined to their dwellings and hospital beds. For many, the workplace has been a source of stress but also a vital component of one's self-worth, day-to-day purpose, and a resource for wellness programs and brief counselling services, not to mention, at least in many countries like the United States, a source for health insurance. The employee assistance program (EAP) is an example of a workplace-counselling and triage service that has enormous potential to meet the growing needs of individuals both in 'normal' times and during disasters. By better understanding the EAP's current structure alongside the advent of new technologies, it may be possible to develop a new and improved EAP model to meet a changing global landscape. For EAP to succeed and ultimately be scalable in an increasingly competitive and value-conscious marketplace, its processes of care will first require a bottom-up review with meaningful outcomes data. This will be necessary to drive continuous quality improvement and to demonstrate EAP 2.0's value to both employer and employee alike.

Prevalence of Mental Illness and Mental Health Care Use Among Police Officers

IMPORTANCE

Limited literature has characterized patterns of mental illnesses and barriers in seeking mental health care among police officers.

OBJECTIVES

To assess the prevalence of mental illness (diagnosis) and symptoms of mental illness, evaluate the characteristics of officers interested in seeking mental health care, and characterize perceptions of mental health care use.

DESIGN, SETTING, AND PARTICIPANTS

This survey study was conducted among officers at a large police department in Dallas-Fort Worth, Texas. Focus group sessions were conducted from April 1, 2019, to November 30, 2019, and the survey was conducted from January 1 to February 27, 2020. A total of 446 sworn, employed patrol officers who were present during the recruitment briefing were eligible to participate in surveys and focus groups.

MAIN OUTCOMES AND MEASURES

Officers reported lifetime or current diagnosis of depression, anxiety, and posttraumatic stress disorder, as well as current mental health symptoms (using validated screeners of depression, anxiety, posttraumatic stress disorder, and suicidal ideation or self-harm) and mental health care use in the past 12 months. Focus group data were collected to contextualize mental health care use. Logistic regression analyses were used for quantitative data, and focus groups were iteratively coded by 4 coders using inductive and deductive thematic identification.

RESULTS

Of the 446 officers invited to participate, 434 (97%) completed the survey (mean [SD] age, 37 [10] years; 354 [82%] male; 217 White [50%]). Of these officers, 19 (17%) had sought mental health care services in the past 12 months. A total of 54 officers (12%) reported a lifetime mental health diagnosis, and 114 (26%) had positive screening results for current mental illness symptoms. Among officers with positive screening results, the odds of interest in using mental health services was significantly higher for officers with suicidal ideation or self-harm than for those who did not (adjusted odds ratio, 7.66; 95% CI, 1.70-34.48). Five focus groups were conducted with 18 officers and found 4 primary barriers in accessing mental health services: (1) inability to identify when they are experiencing a mental illness, (2) concerns about confidentiality, (3) belief that psychologists cannot relate to their occupation, and (4) stigma that officers who seek mental health services are not fit for duty.

CONCLUSIONS AND RELEVANCE

The study found that although few officers were seeking treatment, they were interested in seeking help, particularly those with suicidal ideation or self-harm. Additional interventions appear to be needed to systematically identify and refer officers to health care services while mitigating their concerns, such as fear of confidentiality breach.

Implementing interventions to reduce work-related stress among health-care workers: an investment appraisal from the employer's perspective

Purpose

The Stress-Prevention@Work implementation strategy has been demonstrated to be successful in reducing stress in employees. Now, we assess the economic return-on-investment to see if it would make for a favourable business case for employers.

Methods

Data were collected from 303 health-care workers assigned to either a waitlisted control condition (142 employees in 15 teams) or to Stress-Prevention@Work (161 employees in 15 teams). Main outcome was productivity losses measured using the Trimbos and iMTA Cost questionnaire in Psychiatry. Measurements were taken at baseline, 6, and 12 months post-baseline.

Results

The per-employee costs of the strategy were €50. Net monetary benefits were the benefits (i.e., improved productivity) minus the costs (i.e., intervention costs) and were the main outcome of this investment appraisal. Per-employee net benefits amounted to €2981 on average, which was an almost 60-fold payout of the initial investment of €50. There was a 96.7% likelihood for the modest investment of €50 to be offset by cost savings within 1 year. Moreover, a net benefit of at least €1000 still has a likelihood of 88.2%.

Conclusions

In general, there was a high likelihood that Stress-Prevention@Work offers an appealing business case from the perspective of employers, but the employer should factor in the additional per-employee costs of the stress-reducing interventions. Still, if these additional costs were as high as €2981, then costs and benefits would break even.

This study was registered in the Netherlands National Trial Register, trial code: NTR5527.

Impact of Employee Assistance Services on Depression, Anxiety, and Risky Alcohol Use: A Quasi-Experimental Study

OBJECTIVE

To test the impact of Employee Assistance Programs (EAPs) on reducing employee depression, anxiety, and risky alcohol use, and whether improvements in clinical symptoms lead to improved work outcomes.

METHODS

The study used a prospective, quasi-experimental design with propensity score matching. Participants (n = 344) came from 20 areas of state government. EAP (n = 156) and non-EAP (n = 188) employees were matched on baseline demographic, psychosocial, and work-related characteristics that differentiate EAP from non-EAP users. Follow-up surveys were collected 2 to 12 months later (M = 6.0).

RESULTS

EAP significantly reduced symptoms of depression and anxiety, but not at-risk alcohol use. EAP reductions in depression and anxiety mediated EAP-based reductions in absenteeism and presenteeism.

CONCLUSIONS

EAPs provide easy-to-access work-based services that are effective at improving employee mental health.

EMPLOYER CHOICES IN EAP DESIGN AND WORKSITE SERVICES

In today's complex private healthcare market, employers have varied preferences for particular features of behavioral health products such as Employee Assistance Programs (EAPs). Factors which may influence these preferences include: establishment size, type of organization, industry, workplace substance abuse regulations, and structure of health insurance benefits. This study of 103 large employer purchasers from a single managed behavioral healthcare organization investigated the impact of such variables on the EAP features that employers select to provide to workers and their families. Our findings indicate that for this group of employers, preferences for the type and delivery mode of EAP counseling services are fairly universal, while number of sessions provided and choices for EAP-provided worksite activities are much more varied, and may be more reflective of the diverse characteristics, organizational missions and workplace culture found among larger employers in the US.

Psychological morbidity, quality of life and their correlations among military health care workers in Taiwan

To estimate the prevalence of psychological morbidity among health care workers in military hospitals in Taiwan and studies the association between psychological morbidity and quality of life. We sent surveys to 1,269 health care workers working in military hospitals. Participants completed structured questionnaires that included the General Health Questionnaire (GHQ), and the WHO Quality of Life Questionnaire (WHO-QOL). The survey was completed by 65 physicians, 416 nurses, and 304 other specialists. Nurses had the highest GHQ scores (nurses 32.1% vs. physicians 28.3% and other 22.4%). On the WHOQOL, nurses had worse psychological and environment domain scores (12.7 and 13.1, respectively) and physicians scored the worst for the physical and social domain as compared to nurses and other specialists. The younger, hypnotic drug use and life events had higher percentage in psychological morbidity group (Odds Ratio 1.04, 12.5, 2.38; p=0.008, 0.028 and 0.014, respectively). In regression analysis, job category, life event and hypnotic drug use could predict GHQ; age and GHQ could predict QOL (p<0.001). The GHQ might be a mediating factor to QOL. Programs should be developed to educate younger health care workers with psychological morbidity to adjust the stressors associated with their jobs to improve their QOL.

Employment equity and mental disability

PURPOSE OF REVIEW

Recent research on the civil rights issue of employment equity for people with psychiatric disabilities is reviewed.

RECENT FINDINGS

Mental disorders, particularly depression, are the most frequent source of occupational disability worldwide and are expected to grow. Employers are increasingly aware of the productivity costs associated with mental disorders and the importance of fostering a mentally healthy workforce. Few firms, however, have explicit policies to include disabled people in their workforce, and many employers continue to express prejudicial views toward people with mental disabilities which would exclude them from competitive work. At the same time, disability legislation has not offered the hoped-for protection for people with mental disorders. Employers have expressed concerns over the costs of making workplace accommodations and have successfully battled for a legal definition of disability that excludes many individuals with mental disorders.

CONCLUSION

In the absence of antistigma efforts directed toward the business community, one wonders if the growing awareness of the productivity costs associated with mental disability will foster greater employment equity, or fuel more subtle forms of employment discrimination. Low employment levels among people with disabilities remain a major determinant of the social disparities they face.

Employee health and presenteeism: a systematic review

INTRODUCTION

Many employers focus on their large and easily measured cost of health care, yet until recently they have ignored the impact of health on productivity. Studies of some chronic conditions and some health risk factors suggest that costs of lost productivity exceed costs of medical care. This review will examine the literature to explore the link between employee health and on-the-job productivity, also known as presenteeism.

METHODS

Searches of Medline, CINAHL and PubMed were conducted in October 2006, with no starting date limitation with "presenteeism" or "work limitations" as keywords. A total of 113 studies were found using this method. Each study was evaluated based on the strength of the study design, statistical analyses, outcome measurement, and controlling of confounding variables.

RESULTS

Literature on presenteeism has investigated its link with a large number of health risks and health conditions ranging from exercise and weight to allergies and irritable bowel syndrome. As expected, the research on some topic areas is stronger than others.

CONCLUSIONS

Based on the research reviewed here, it can be said with confidence that health conditions such as allergies and arthritis are associated with presenteeism. Moreover, health risks traditionally measured by a health risk appraisal (HRA), especially physical activity and body weight, also show an association with presenteeism. The next step for researchers is to tease out the impact of individual health risks or combinations of risks and health conditions on this important outcome measure.

Knocking at the wrong door: insured workers' inadequate psychiatric care and workers' compensation claims

OBJECTIVE

To describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims.

METHODS

Records of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described.

RESULTS

22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type.

CONCLUSIONS

The majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.

Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment

Depression is a highly prevalent condition that results in substantial functional impairment. Advocates have attempted in recent years to make the 'business case' for investing in quality improvement efforts in depression care, particularly in primary care settings. The business case suggests that the costs of depression treatment may be offset by gains in worker productivity and/or reductions in other healthcare spending. In this paper, we review the evidence in support of this argument for improving the quality of depression treatment. We examined the impact of depression on two of the primary drivers of the societal burden of depression: healthcare utilisation and worker productivity. Depression leads to higher healthcare utilisation and spending, most of which is not the result of depression treatment costs. Depression is also a leading cause of absenteeism and reduced productivity at work. It is clear that the economic burden of depression is substantial; however, critical gaps in the literature remain and need to be addressed. For instance, we do not know the economic burden of untreated and/or inappropriately treated versus appropriately treated depression. There remain considerable problems with access to and quality of depression treatment. Progress has been made in terms of access to care, but quality of care is seldom consistent with national treatment guidelines. A wide range of effective treatments and care programmes for depression are available, yet rigorously tested clinical models to improve depression care have not been widely adopted by healthcare systems. Barriers to improving depression care exist at the patient, healthcare provider, practice, plan and purchaser levels, and may be both economic and non-economic. Studies evaluating interventions to improve the quality of depression treatment have found that the cost per QALY associated with improved depression care ranges from a low of 2519 US dollars to a high of 49,500 US dollars. We conclude from our review of the literature that effective treatment of depression is cost effective, but that evidence of a medical or productivity cost offset for depression treatment remains equivocal, and this points to the need for further research in this area.