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Making the business case: plenty of studies prove that employers should invest in their workers' mental well-being.

Recent surveys show growing appreciation among employers for the importance of supporting workplace mental health. (1) There is good reason to be concerned about employees' mental health, as mental illness is common among working-age people. The most recent nationally representative study found that an estimated 26% of Americans ages 18 and older--one in four adults--have a diagnosable mental disorder in a given year. (2) This prevalence rate for mental health disorders among workers--and their family members--puts pressure on employers to respond to this problem with effective and informed action.

The good news for employers is that major review papers, offering important insights into this complex area, recently have become available. The research results provide a compelling case for why businesses should invest in employees' mental health.

The Need

Last year the World Health Organization (WHO) released a major literature review report that profiled the general nature of major mental disorders, their prevalence, their cost burden, the effectiveness of treatment, the cost-effectiveness of treatments, and the social policy implications of these findings. (3) Similarly, Watson Wyatt Canada recently completed a comprehensive literature review of the research on workplace mental health in Canada and the United States. (4) This paper reviewed findings from more than 150 studies and summarized what is known today about mental health in the workplace, as well as identified the gaps in research that need more study.

A number of conclusions from these reviews support the need for more employer attention to workplace mental health issues:


* Mental health disorders are widely experienced among working-age populations.

* Many people with mental health disorders also suffer from chronic medical conditions (such as heart disease, diabetes, and hypertension).

* People with alcohol and drug addictions also have a high rate of mental health disorders.

* People with mental health disorders often are underdiagnosed and undertreated.

* Untreated mental health disorders place a large cost burden on employers and society.

* Many factors contribute to the development and exacerbation of mental health disorders, including biologic, social, and workplace conditions.

* Most mental health treatments are clinically effective and cost-effective.

* Mental health treatment cost savings from workplace outcomes (improved employee productivity in particular) are typically far greater, and occur much sooner, than the savings obtained from reductions in overall healthcare costs.

* Enough evidence now exists to support a "business case" for providing workplace mental health disorder prevention and treatment.

* Additional efforts are still needed, however, to increase access to mental health services and overcome stigma and lack of awareness about mental health issues.

Clinically Effective

According to a 1993 landmark study that examined more than 300 meta-analysis papers (each paper itself a review of other many original studies), outpatient mental health treatment is largely effective at improving patient functioning. (5) National surveys of mental healthcare consumers also have found generally positive perceived outcomes from the perspective of clients who see therapists. (6,7) More recently, a 2005 WHO report concluded that "Over the last two decades, numerous studies in mental health promotion and mental disorder prevention have proven that such programmes can be effective and lead to improved mental and physical health and social and economic development." (8)

Treatment in outpatient settings. Mental health treatment is delivered most often in outpatient clinical settings by licensed psychologists, psychiatrists, social workers, or other professionals. The success rates for this kind of treatment for some of the most common mental health disorders are quite high. People with major depression, bipolar depression, anxiety, social phobias, and panic disorders typically get relief from these problems and can work effectively again. (9,10)

Treatment in workplace settings. The majority of large and mid-size companies now provide mental health disorder prevention, assessment and referral, and brief intervention treatment services through employee assistance programs (EAPs). Studies show that when appropriately administered, these services produce positive clinical change; improvements in employee absenteeism, productivity, and turnover; and in a few studies, savings in medical, disability, or workers' compensation claims. (11-13)


Almost a decade ago, the U.S. Surgeon General's report on mental health concluded that the evidence for mental healthcare's clinical and cost-effectiveness was both substantial and sufficient. It recommended that future research be directed more at understanding why more people are not using mental health services rather than at questions of whether such treatments are effective. (14) Indeed, given the immense cost burdens of these disorders, the relatively low cost per intervention, and the high success rate for most mental healthcare treatments, the cost-benefit (in terms of overall healthcare cost savings offset for providing these services) is clear. This is especially true for employers. Losses from decreased workplace productivity and increased absences can be easily recouped by getting workers into appropriate treatment. (15)

Most researchers and industry experts now believe that there is enough solid evidence to "make the business case" for providing greater access to traditional and workplace-based mental health services. This trend has coincided with recent advances in the validity and reliability of self-report tools for measuring employee productivity, absences, and health factors. (16-18) Review papers in peer-reviewed journals in the past few years have summarized the scientific and industry evidence, concluding that there is a financial return on investment for providing workplace mental health services. (19-21) Some aspects of these business-value conclusions require further replication and more thorough investigation, but the preponderance of empirical evidence supports the clinical and cost-efficacy of mental health treatment.

Top 10 Resources

An important next step in this education process is to share this information more widely with employers and health service providers. Toward this goal, I offer in the table a "top 10" list of resources for making the business case for workplace mental health. I chose these papers because they are the most recent, are the most comprehensive, are written for business readers, and--most importantly--are available online at no cost. Most of the reports are supported by organizations devoted to promoting workplace mental health and have many other resources online. Many other organizations also offer materials, training, and support for addressing workplace mental health issues. (See Appendix B in the Watson Wyatt Canada 2007 report, which profiles more than 50 organizations, university centers, clinical providers, and leading researchers in the United States and Canada. (4))


The research results are clear: Once people with mental health disorders access a provider, treatments are generally effective at restoring better mental health and work functioning. In addition, the net financial cost savings from mental health treatment also have a strong evidence base. And numerous sources provide credible, high-quality, evidence-based summary reports and HR staff support materials, which employers can use in efforts to increase access to, and quality of, mental healthcare available to employees.

Dr. Attridge was Chair of the Research Committee for the Employee Assistance Professionals Association from 1999 to 2004. Dr. Attridge is a scientific reviewer for the National Registry of Effective Prevention Programs, Workplace Division, for the U.S. government. He is also President of Attridge Studios, a family business in the fine arts and consulting. He can be reached at (612) 889-2398 or


1. Employee Benefit News, Partnership for Workplace Mental Health. Innerworkings: A Look at Mental Health in Today's Workplace. 2007.

2. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62(6):617-27.

3. Hyman S, Chisholm D, Kessler R, et al. Mental disorders. In: Disease Control Priorities Related to Mental, Neurological, Developmental and Substance Abuse Disorders. Geneva, Switzerland: World Health Organization; 2006: 1-20.

4. Watson Wyatt Canada ULC. Mental Health in the Labour Force: Literature Review and Research Gap Analysis. 2007.

5. Lipsey MW, Wilson DB. The efficacy of psychological, educational, and behavioral treatment. Confirmation from meta-analysis. Am Psychol 1993;48(12):1181-1209.

6. Harris Interactive. Therapy in America 2004. 2004.

7. Seligman ME. The effectiveness of psychotherapy. The Consumer Reports study. Am Psychol 1995;50(12):965-74.

8. Hosman CMH, Jane-Llopis E. The evidence of effective interventions for mental health promotion. In: Hermann H, Saxena S, Moodie R (eds). Promoting Mental Health: Concepts, Emerging Evidence, Practice. Geneva, Switzerland: World Health Organization; 2005;169-87.

9. Kahn JP, Langlieb AM (eds.) Mental Health and Productivity in the Workplace: A Handbook for Organizations and Clinicians. San Francisco: Jossey-Bass; 2003.

10. Simon GE, Barber C, Birnbaum HG, et al. Depression and work productivity: The comparative costs of treatment versus nontreatment. J Occup Environ Med 2001;43(1):2-9.

11. Blum T, Roman P. Cost-Effectiveness and Preventive Implications of Employee Assistance Programs. Rockville, Md.: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 1995.

12. Kirk H. The effectiveness of a problem resolution and brief counseling EAP intervention. J Workplace Behavioral Health 2007;22(1):1-12.

13. McLeod J, McLeod J. How effective is workplace counseling? A review of the research literature. Counseling Psychotherapy Research 2001;1(3):181-91.

14. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, Md.: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 1999.

15. Wang PS, Simon G, Kessler RC. The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatr Res 2003;12(1):22-33.

16. Loeppke R, Hymel PA, Lofland JH, et al. Health-related workplace productivity measurement: General and migraine-specific recommendations from the ACOEM Expert Panel. J Occup Environ Med 2003;45(4):349-59.

17. Kessler RC, Barber C, Beck A, et al. The World Health Organization Health and Work Performance Questionnaire (HPQ). J Occup Environ Med 2003;45(2):156-74.

18. Institute for Health and Productivity Management. Measuring Employee Productivity: A Guide to Self-Assessment Tools--The Gold Book. 2005.

19. Attridge M. The business case for the integration of Employee Assistance, Work/Life and Wellness services: A literature review. J Workplace Behavioral Health 2005;20(1/2):31-55.

20. Goetzel RZ, Ozminkowski RJ, Sederer LI, Mark TL. The business case for quality mental health services: Why employers should care about the mental health and well-being of their employees. J Occup Environ Med 2002;44(4):320-30.

21. Langlieb AM, Kahn JP. How much does quality mental health care profit employers? J Occup Environ Med 2005;47(11):1099-109.



Mark Attridge, PhD, is a consultant and researcher in the employee assistance field.

Table. Ten online resources for making the business case for greater
employer involvement in mental healthcare

2006 Business and Economic Plan for Mental Health and Productivity
Global Business and Economic Roundtable on Addiction and Mental Health.
Toronto; 2006. 154 pages.

A Business Case for the Management Standards for Stress Bond FW, Flaxman
PE, Loivette S. London: HSE Books; 2006. 46 pages.

A Mentally Healthy Workforce--It's Good for Business
Partnership for Workplace Mental Health-American Psychiatric
Foundation. Washington, D.C.; 2006. 28 pages.

An Employer's Guide to Behavioral Health Services: A Roadmap and
Recommendations for Evaluating, Designing, and Implementing Behavioral
Health Services Finch RA, Phillips K. Center for Prevention and Health
Services. Washington, D.C.: National Business Group on Health; 2005.
100 pages.

Depression and Work Function: Bridging the Gap between Mental Health
Care and the Workplace
Bilsker D, Gilbert M, Myette TL, Stewart-Patterson C. Vancouver, B.C.:
Depression in the Workplace Collaborative; 2004. 128 pages.

Depression in the Workplace, a special publication from Managed Care
Six articles. 2006;1(1). 22 pages.

How much does quality mental health care profit employers?
Langlieb AM, Kahn JP. J Occup Environ Med 2005;47(11):1099-1109.

Mental Health at Work ... From Defining to Solving the Problem. Booklet
1: Scope of the Problem: How Workplace Stress Is Shown. 20 pages.
Booklet 2: What Causes the Problem? The Sources of Workplace Stress.
24 pages. Booklet 3: Solving the Problem: Preventing Stress in the
Workplace. 20 pages.
Quebec City: Universite Laval Chair in Occupational Health and Safety
Management; 2005.

Mental Health in the Labour Force: Literature Review and Research Gap
Watson Wyatt Canada ULC. 2007. 125 pages.

Mental Health in the Workplace, special issue of the journal
2004;5(2). 17 research and commentary papers.
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Author:Attridge, Mark
Publication:Behavioral Healthcare
Date:Nov 1, 2007
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