When insurers, and often their employer clients, as well, deal with mental health problems while planning health insurance investments, they have long tended to be parsimonious at best about the mental health category of covered conditions and services.  After all, mental illness is not usually measurable in objective terms, often takes years of therapy to “cure”, and can be very expensive with uncertain benefits compared to costs.  As a result, it often takes mental health advocacy organizations to push insurance mandates through state or federal legislatures, in order to secure even some coverage.

But when dealing with mental health in the domain of employee health management (EHM), the dynamics and thinking become very different.  For one thing, it is often the mental side of physical illness, as much or even more then the physical side per se, that causes the most impairment in employee productivity and performance.  And many chronic diseases, such as heart disease and diabetes, in particular, are often accompanied by mental “co-morbidities”.

These mental/emotional/behavioral co-morbidities, dysfunctions, disorders, or symptoms are often among the greatest sources of employee impairment, and the labor costs associated therewith, to say nothing of missed opportunities for higher quality, customer satisfaction, market share and new business gains.   Committed, passionate, and unimpaired employees can be worth many times as much to employers as those who are anxious, sad, depressed, distracted, or similarly impaired, whether or not they also have a physical illness.

For example, when the Dupont Company analyzed the conditions that caused the greatest impairment among its mainly “knowledge” employees, it found that the biggest source of impairment, in terms of its prevalence in the population times the degree to which affected employees were impaired, were allergies first, and mental/emotional problems second. Allergies had an average impairment cost per employee affected of $7763 per year, with employees mainly affected at the same time, during “allergy season”. With 18.9% of employees affected, this one condition aded $1467 to labor costs for every employee in the workforce.

Mental/emotional problems had an average impairment cost per employee affected of $23,754, more than twice the impairment affect, counting both absenteeism and presenteeism, as any other condition analyzed.  Fortunately, its prevalence in the workforce was only 4.3%, less than a quarter as common as allergies, so the average addition to labor costs per employee from this problem was only $1108.

But most of the other chronic conditions identified commonly have mental/emotional co-morbidities – heart disease; chronic head, neck or back pain; stomach/bowel disorders, and breathing problems.  Only the costs where mental/emotional disorders were described by employees as their primary health problem were counted as costs in this category.  The effects of co-morbidities where another physical problem was primary were not included, but no doubt added to impairment effects and costs.

[These figures are based on published research — J. Collins, et al. “The Assessment of Chronic Health Conditions on Work Performance, Absence and Total Economic Impact for Employers” JOEM (Journal of Occupational and Environmental Medicine June 2005 547-557; and S. Nicholson, et al.  “How to Present The Business Case for Health Care Quality to Employers” Applied Health Economics and Health Policy  4:4 2005 209-218.  The calculations themselves were made by author.]

Mental health programs were once offered only in specialized facilities, “sanitoriums” or “asylums”.  Then they were commonly offered in acute general hospitals, but payment for hospital-delivered care became inadequate to sustain many if not most such programs, and specialty hospitals are major sources of care now.  There are examples of both being addressed in a coordinated fashion, at least, as in Cincinnati, where Greater Cincinnati Behavioral Health Services and the HealtCare Connection have opened a joint program. [“Providers Link to Treat Mental, Physical Health” Business Courier of Cincinnati Sep 7, 2007 (cincinnati.bizjournals.com)]

Increasingly, EHM providers are offering interventions focused on labeled mental problems, along with behavioral difficulties related to stress, insomnia, etc. because of the high levels of productivity and performance impairment associated with such problems. While these also account for significant medical care expenses in many cases, they mainly add to labor costs by causing absences and presenteeism, and reduce the likelihood of optimal levels of quality, customer satisfaction and loyalty, new business, etc.

When combined with general levels of individual and team or group motivation, satisfaction with their job and organization, etc., mental/behavioral disorders or difficulties represent major opportunities for dramatically improving employee and employer performance.  Medical and pharmaceutical services are likely to be major options, but cognitive/behavioral therapy, social support, employee assistance programs, etc. also play major roles in promoting mental/behavioral health, and thereby improved productivity and performance.

The social or economic stigma attached to mental health with respect to health insurance should not interfere with the importance and potential value of positive mental/behavioral health in terms of employee performance and employer costs/revenue benefits.  Fortunately, the EHM market and its providers are not repeating the history of second-class importance that has long been accorded mental health in the sickness care and insurance domains.