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Addressing depression in the workplace.

Bonuses, stock options, expense-paid vacations--companies shell out a lot of money on incentives aimed at improving employee performance and increasing productivity. Yet many overlook one benefit that could increase return on investment by an order of magnitude: mental health support.

The U.S. Department of Health and Human Services reports that behavioral health disorders affect more than 20% of the nation's workforce and constitute 5 of the 10 leading causes of disability. Untreated and mistreated mental illness costs organizations $113 billion annually. Untreated depression alone costs companies upward of $50 billion per year in reduced productivity related to absenteeism, lack of motivation, concentration difficulties, and complaints of chronic pain.

Clearly, companies have a vested interest in promoting mental health in the workplace, but many have yet to see the light because of stubborn obstacles that obscure their view. In general, employers are not aware of the extent of the indirect costs of untreated depression, and they have mistaken assumptions about the availability of effective treatment. The workers' compensation system and the courts have been slow to recognize depression as a work-related disability, and as a result, employers have few incentives to treat and prevent workplace depression.

Additionally, providing access to services can only come after identifying employees in need. Lack of awareness among employees and managers, the stigma of mental illness, and fear of professional repercussions may all contribute to an individual's unwillingness to ask for help.

In a recent study, University of Michigan Depression Center surveyed 443 employees who acknowledged being treated for depression or receiving such treatment within 3 years, as well as 300 middle managers and 207 benefit managers--all from companies with more than 500 employees. Although 65% of the benefit managers reported providing an employee assistance program for depression, only 14% of employees had ever accessed one. Nearly 60% of the employees thought that acknowledging their illness would prevent them from getting ahead in their careers. In addition, 85% of the middle managers surveyed said they thought helping employees with depression was part of their job, but only 18% had received training to identify depression and intervene appropriately.

Another obstacle is the up-front investment. Developing a coordinated, integrated depression assistance protocol requires time and money--an investment some companies cannot or will not make. Studies indicate that treating workplace depression provides favorable cost offsets for employers, but the prospect of the immediate investment required to facilitate screening and intervention can be prohibitive. In the Michigan study, for example, 78% of the benefit managers believed that depression-related productivity losses were more costly to the companies than treating depression, yet only 11% reported facilitating screening.

The existing culture that allows depression and other mental health problems to pervade and serious disable the workforce needs to be changed. The first step toward that goal is promoting awareness, both among employers and employees. In an effort to raise employers' understanding of the impact of depression in the workplace, the National Partnership for Workplace Mental Health last year introduced an online depression calculator called the Productivity Impact Model (

Commissioned by Pharmaceutical Research and Manufacturers of America and endorsed by the American Psychiatric Association, the U.S. Chamber of Commerce, the Institute for Health and Productivity Management, and the Mid-America Coalition on Healthcare, the tool enables an employer to estimate the costs of depression in their company based on the demographics of its workforce, industry, and location. The calculator also projects the company's savings if depressed employees receive treatment.

Employees also need to be educated about the signs and symptoms of mental health problems, and managers need training to recognize performance problems that may be related to mental health issues and to address them appropriately.

Academia, with government support, is beginning to turn its attention to workplace mental health. Boston Medical Center recently received a 3-year grant from the Centers for Disease Control and Prevention to develop the Telephone-Linked Communications for Detection of Mental Health Disorders in the Workplace initiative. Called TLC-Detect, the intervention will use a computer telephone system to communicate confidentially with workplace employees, evaluate whether they have a mental health disorder, and provide referrals.

There is no one-size-fits-all solution, according to Thomas Carli, M.D., of the University of Michigan. "Implementing proactive, relatively inexpensive initiatives, such as screening, disease education, and manager training, can have a tremendous impact on overall employee well-being," he said.

RELATED ARTICLE: Interventions Are Good for Business

Nothing moves corporate America like a direct hit to the bottom line.

When the powers-that-be at Abbott Laboratories discovered in 1991 that the incidence of depression was second only to cardiovascular disease among its 42,000 U.S.-based employees and that depression accounted for the third most total treatment dollars spent and the fourth-highest average cost per case, they realized that ignoring the facts would be bad business.

To decrease employees' suffering and improve "the numbers," Abbott designed a comprehensive depression disease management program.

Debuting in May 2002, the program included depression education in the form of a comprehensive toolkit distributed worldwide to the company's employee assistance, human resources, and employee health personnel. It also included a confidential phone and Web-based screening tool for depression and bipolar disorder that offers immediate feedback and refers at-risk employees to the employee assistance program for treatment, and case management services--including, in some cases, biweekly follow-up calls from a care manager.

Since the program's inception, thousands of employees and family members have completed mental health screenings. An early analysis showed that of those individuals with indications of depression, nearly half accessed behavioral health treatment, mostly via employee assistance program services. A cost-benefit study showed an estimated savings of outpatient cost of nearly $40,000 (not including treatment-related productivity gains) for the first 10 months of the program, after adjusting for the start-up and program costs, according to the company.

An integrated disability management program on depression-related disability at First National Bank of Chicago showed similarly substantial reductions in treatment costs for depressive disorders in benefit analysis. The program includes managerial training aimed at reducing stigma and improving early recognition of depression, and an employee assistance program staffed by clinical psychologists (J. Occup. Environ. Med. 2000;42:1006-12).

In the early 1990s, Pacific Bell implemented a program of managed mental health care. The company reduced mental health care expenditures by 13%. In addition, both the average duration of mental health disability and relapse rate decreased significantly (Health Aff. [Millwood] 1998;17:40-52).

Clearly, much can be gained by workplace support for mental health issues. Not all companies can afford to implement formal, multitiered interventions, but it appears that most would be well served by preparing managers to recognize potential problems and to support employees in their efforts to address them.


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Title Annotation:PREVENTION IN ACT
Author:Mahoney, Diana
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Mar 1, 2005
Previous Article:Perspective.
Next Article:Emotional abuse may raise risk of mental illness.

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