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Behavioral Health The Forgotten Benefit

February 1, 2000
Related Topics: Health and Wellness, Featured Article
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It’s no fun being Jonathan (a composite character) these days. In fact, it’sdownright awful.

It started months ago. Jonathan had come to work as usual, but he could seesomething was wrong as soon as he entered his second-floor office suite and sawtwo uniformed cops talking with his supervisor. A few minutes later, he and theeight people who worked in his division were listening to details of theirco-worker’s automobile accident and death. Stunned, they sat in silence for afew minutes, and then began to ask questions.

But Jonathan showed little interest. His mind flashed to another time he waswith the police -- two years earlier -- the time he learned about his wife’sdeath in an auto accident. Overcome with emotions from the previous experience,he couldn’t focus on the current conversation, reliving the details of theearlier police report, going to the hospital, losing his wife.

Finally, he pulled himself together, and tried not to think about it anymore. But, later in the day, while he was working on a financial report,Jonathan suddenly broke into to a sweat. His hands started to shake, and hecouldn’t catch his breath. He was sure he was having a heart attack. One ofhis co-workers noticed the problem and called an ambulance, thinking thatJonathan was about to collapse.

The doctors in the ER assured him his heart was fine. They suggested he washaving an anxiety attack, and prescribed tranquilizers. Jonathan was able to goto work the next day, but several more attacks during the next few weeksprompted him to call his Employee Assistance Program (EAP) and get referrals topsychological counseling through his company’s managed care health program.After three sessions with a counselor resulted in some relief, he agreed to goalong with the counselor’s recommendation. She said he was improved, andstopped seeing her.

In the meantime, Jonathan continued to struggle at work. He was frequentlydistracted and grew more anxious as he would think about his co-worker’s deathand the loss of his own wife. He began having vivid nightmares, waking in coldsweats, and began using the tranquilizers with growing frequency to help himsleep and avoid the attacks.

Predictably, he started to show up late for work, to miss deadlines, and tohave difficulty concentrating. He was distracted during meetings, and slowlybecame irritable with his co-workers. He took more sick days, and begged hisphysician to give him a battery of medical tests after another major anxietyattack convinced him of an imminent heart attack.

Jonathan’s psychological problems were starting to cost his company realmoney -- in sick days, unnecessary medical intervention, lack of productivity,and overall loss of functioning. He knew his performance was suffering, but hecouldn’t do anything about it. And the health care he was being offered wasn’taddressing his real problem.

Emotional problems are invisible at first.

Jonathan may be a composite character, but he is real. He may not havedebilitating anxiety; rather, he could be violent or he could be depressed. Hecould develop a substance-abuse problem and be a hazard to his fellow workers.Employees don’t have to brandish pistols or automatic weapons to exhibit realpsychological problems that affect them, their co-workers and their companies.

Yet, even though the U.S. Surgeon General states 20 percent of all Americanswill have incapacitating depression sometime in their lives, and statisticscontinually point out that workers are suffering emotional stress thattranslates into workplace difficulties, the percentage of health care dollarsspent on mental health care has declined 54.7 percent since 1988.

At the same time, according to the Employee Assistance Program Association (EAPA),the return on investment for every dollar invested in behavioral health is $5 to$7. In other words, for every dollar spent, there’s a huge return in improvedproductivity, lowered absenteeism and less use of medical benefits.

It seems, however, as if no one is listening. Just look at the 1999 HayReport, "Health Care Plan Design and Cost Trends -- 1988 through1998," prepared for the National Association of Psychiatric Health Systems(NAPHS) and the Association of Behavioral Group Practices (ABGP). The findingsare dismaying, but not surprising. The study analyzed trends in the proportionof employer health care dollars spent on behavioral health care.

In 1987, 92 percent of employers were using fee-for-service plans; by 1998,only 14 percent of companies had them. In 1998, the most popular was thePreferred Provider Organization (40 percent), with Health MaintenanceOrganizations at 26 percent and Point of Service Plans at 21 percent. The valueof general health care benefits decreased 11.5 percent from 1988 to 1998, whilebehavioral health care benefits went down by more than 50 percent.

"There has been a revolution in how health care is delivered and fundedin the past decade, so we expected to see cuts in benefit dollars," saysMark Coval, executive director of Washington, D.C.-based NAPHS. "Whatshocked us is the magnitude of the cuts within mental health and the unrelentingdecline and disproportionate burden that this segment of health care is bearing.Behavioral healthcare has taken it on the chin. This has gone way beyond what isfair and appropriate."

The picture is equally distressing when you look at the percentage of totalhealth care benefit costs. In 1988, behavioral health as a percent of the totalhealth care benefit costs was 6.1 percent; in 1998 it was 3.2 percent. Is it anywonder that rumblings of discrimination are being heard?

The Mental Health Parity Act of 1996 (MHPA) prohibits health care plans fromimposing more restrictive limits on mental health benefit than on medical orsurgical benefits. The law doesn’t require companies to offer mental healthbenefits, and they can require higher co-payments and deductibles. (The HayBenefits Report data was collected before many of the companies were able tocomply with the MHPA.)

Find hidden problems before they’re crises.

Adolph Coors Co., based in Golden, Colorado, is one example of a company thatapproaches the employee holistically, and believes that behavioral interventionand health dollars are dollars spent wisely.

"If our employees are healthy, that leads to a healthier company,"says Joe Vollmer, supervisor of the Employee-Family Counselor Services (Coors’internal EAP program). "If you look at the costs of depression, anxiety,and other mental health-related illnesses, and the dollars of impact tobusiness, it’s foolish not to provide services. From a humanitarianperspective, we want to give our employees the benefits they need. If wecontribute to their health, it’s a dual benefit -- for them and for thecompany."

Coors’ 5,800 employees can choose between several insurance plans. Amongthem are in-patient mental health and chemical dependency coverage, as well asoutpatient mental health and chemical dependency. Depending upon the plan theemployee chooses, the provider is different.

The Coors’ EAP program provides assessment and referral services, 24-houremergency and crisis services, and critical incident stress debriefings. It alsoadministers and manages the medical leave policy for behavioral health, as wellas providing psycho-educational courses, lunch meetings, management training andwork-unit interventions.

Equally important, Vollmer and his staff will advocate for employees to besure they get the full use of their benefits. "We’ve always beenconcerned with the wellness of our employees, and approach them from a wholeperson perspective," he says. That means the company offers an integratedapproach to wellness, including a huge on-site Wellness Center.

But the EAP professionals intervene at the earliest beneficial time. Forexample, in a traumatic incident, such as an incident the affects the safety andsecurity of a work group or causes grief, counselors will contact employees andwork with them directly to be sure they’re coping all right. The counselorswill work with managers to educate them about what to look for that signifiesproblems. Then, the EAP professionals follow up with phone calls to ensure theemployee is fine. If not, they’ll encourage the individual to get further helpthrough the company’s mental health care benefits.

However, experts are quick to point out, a good EAP is a consultation servicethat provides free counseling and referral service for the employees, but it isnot a replacement for mental health benefit services. "The mental healthbenefit is part of the health benefit with diagnosis, third-party reimbursementand co-pay structure, whereas an EAP is a confidential, free service foremployees," says Mark Braverman, Ph.D, and founder of Newton,Massachusetts-based CMG Associates Inc. An EAP service is not a health benefit,but a place to get short-term service or referral (such as crisis intervention,coaching for managers, human behavioral issues within the workplace), but it isnot a replacement for treatment.

In this climate of cost containment and increasingly expensive health care,human resources professionals face a critical challenge. HR must be wary ofmarketing hype in this arena, and knowledgeable about the best way to getquality care. This part of the job is becoming more and more difficult, andemployees rely on HR to do it so their behavioral ailments are treated with asmuch respect as their physical ones.

Workforce, February2000, Vol. 79, No. 2, pp. 47-51 -- Subscribenow!

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