By Suzanne F. Delbanco
April 8, 2018

The U.S. spends an estimated $201 billion on mental illness, including anxiety, depression and stress, making it among the costliest health conditions in the country. Almost half of us will experience symptoms of these conditions in our lifetime.

Mental health impacts all demographics, from high-powered executives to factory workers. Employers need to recognize this and make mental health a major priority for their workforce.

Unfortunately, even the most committed and informed employers face sizable barriers to delivering quality mental health care to their employees. My nonprofit, Catalyst for Payment Reform, worked with eight employers and other health care purchasers, including AT&T, Equity Healthcare, and Service Employees International Union (SEIU) 775 Benefits Group, to expose these obstacles and determine how employers can overcome them. We were surprised to hear how many pain points this group shared, despite buying health care on behalf of populations with entirely different demographics and from different parts of the U.S.

To start, it is incredibly difficult to secure sufficient access to mental health services in our country. Shortages of psychiatrists and psychologists, especially in rural areas, mean that patients can face up to a six-week wait or four-hour drive for a routine appointment. Because these providers are in demand, many of them feel empowered to decline to accept insurance. This makes it difficult for employees to gain access to services if they can’t afford to pay out of pocket, even when they have employer-sponsored coverage.

Given these hurdles, it’s no wonder that 56% of adults with mental illness went untreated in 2017. Stigma is another widely acknowledged contributor, as many employees are uncomfortable seeking mental health care to begin with.

When employees do get treatment, employers struggle to measure and track the quality of the care they are receiving. While our health care system has made strides toward measuring quality of care for conditions like hypertension and diabetes, we have barely begun to define what “good” looks like for treatment of depression and anxiety. The lack of information about the relative quality of mental health providers leaves employers feeling helpless in their attempt to determine which providers can make a meaningful difference to the mental health of their populations.

The problem of assessing quality of care goes beyond clinical aspects, with one participating employer sharing an anecdote about an employee whose initial appointment took place in a basement with a psychiatrist who wasn’t wearing shoes. Professionalism, trust, and safety between a patient and a provider are vital when treating mental health and yet, today, can go unchecked.

Given these barriers, mental health care is ripe for innovation. Each purchaser in our group is inundated by vendors claiming to have digital or scalable solutions to meet their needs. To move the needle, employers need to take a close look at which solutions are clinically proven to address these conditions and find ways to drive meaningful usage of the ones that are effective.

Employers have long-provided employee assistance programs (EAPs), for example, to serve as the first line of support for employees, but they are ubiquitously underused. Creative campaigns like Stamp Out Stigma can reduce the shame people associate with seeking mental health treatment and can help jumpstart greater use of mental health services. More health insurance plans and telemedicine companies are starting to offer tele-mental health services too. Remote mental health care can help fill gaps in geographies where mental health specialists are not readily available or provide a more private way for employees to seek help without fear of running into someone they know in the waiting room.

But the real answer may lie in better integration of mental health services into primary care. Primary care providers are uniquely positioned to screen for depression and anxiety disorders during routine visits, reducing patients’ concerns about the stigma they may associate with seeking help from a mental health professional. Employers and other stakeholders are pushing for more primary care and behavioral health providers to co-locate their services or jointly operate under an accountable care organization or patient-centered medical home arrangement. Furthermore, better integrating medical care with various behavioral health solutions, such as telehealth, EAPs, or computerized cognitive behavioral therapy, may pay off. A 2008 study showed a direct link between untreated mental health issues and increases in medical costs for urban family medicine patients.

To enhance access to services, quality, and integration with medical care, employers will need to experiment. It is too costly and harmful to ignore the risks and impacts of untreated mental health conditions. Altering benefit designs, pushing for reforms to how providers deliver care, helping to devise more standard measures of the quality of care, and asking health plans to create incentives for those providers through payment reform each have potential to greatly impact the long-term well-being of people and businesses.

Suzanne F. Delbanco is the executive director of Catalyst for Payment Reform.

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