By Len Strazewski
As employers recognize benefits of mental health insurance,
agents have opportunity to educate
Producers who bring mental health solutions to their clients may find a warm reception for their proposals from both employers and their employees.
Employees whisper about it at the water cooler. People who need it sometimes pretend they don't. Too few seek out help.
That's how the workplace used to regard mental health benefits payable under employer-based health insurance plans and workplace counseling benefits such as Employee Assistance Programs (EAPs).
And, as a result, many individuals who needed help never got it. Untreated minor concerns blossomed into expensive psychiatric residential treatment, say mental health experts.
The stigma of mental health treatment, however, may be disappearing and with it, employers' reluctance to add mental health benefits to their insurance programs and counseling services to their workplace benefits, according to a new poll conducted by PacifiCare Behavioral Health (PBHI) in Laguna Hills, California, and Harris Interactive.
PBHI is a mental health and EAP services provider that works with health plans and self-insured employers around the country. Harris Interactive is the international polling company known for the Harris Poll on American lifestyles.
The Harris poll on mental health issues conducted in February and March of this year contacted more than 2,200 adults in the United States who admitted needing or receiving mental health benefits in the past two years.
The poll revealed that statistically, one in four American adults (27%) or an estimated 59 million people have received mental health treatment in the past two years. Within that group, about 80% said the treatment was effective and about 85% said they were satisfied or very satisfied with the treatment.
However, the poll also revealed that about one in three respondents who said they believed they needed treatment (37%), did not get it, primarily because of cost issues (30%), lack of health insurance that covered mental health treatment (26%), or a lack of confidence with treatments or their providers (32%).
Of those who received treatment, 81% said their treatment involved prescription medication.
More than half of the respondents (52%) said they believed that mental health treatment was difficult to access and more than a third (37%) of respondents with health insurance were unsure as to whether or not their insurance covered treatment.
"The survey results confirm what we have always believed," says Dr. Jerry Vaccaro, a psychiatrist and president and chief executive officer of PBHI. "People who know they need treatment are simply not getting it--even in situations where they may have access to care through insurance."
Legislative restraints and cost concerns contribute to the problem. The Mental Health Parity Act, originally passed in 1996 and extended in 2003, prevents employers that provide mental health benefits as part of their medical insurance benefits from declaring separate lifetime limits for those benefits. Prior to that law, health plans capped benefits at a separate lifetime maximum ranging from $25,000 to $50,000.
While the law provided two key exemptions for small businesses with 50 or fewer employees or businesses that could document a measurable increase in cost, the law has been consistently opposed by employer groups.
The trade groups, including the American Benefits Council in Washington, D.C., said they believed the law would raise overall medical benefits costs and intimidate small to medium-sized employers from extending mental health benefits to all employees.
As health insurance costs continue to rise in double digits, employee benefits experts have generally been unable to document exactly how much of the increases have been a result of the act. However, small employers continue to shun adding benefits--even though workplace studies have indicated a high return on investment for mental health benefits and EAPs.
The law continues to be controversial, and new proposals that would modify the parity requirements, which have been introduced in the U.S. Senate, remain under discussion.
Dr. Vaccaro says that the pay-off of mental health coverage and available treatment is tangible, with rewards in both lost time in the workplace and reduced overall medical costs. A 2002 study of the PBHI's managed care plan called Assertive Care Management (ACM) revealed a 36% reduction in inpatient/residential care for enrollees and an 18% reduction in inpatient days for members who received that level of care.
Few employers, however, are completely aware of the cost relationship between mental health issues such as depression, workplace productivity and general health benefits costs, Dr. Vaccaro says.
Producers who bring mental health solutions to their clients may find a warm reception for their proposals from both employers and their employees. Poll results indicate that individuals are more open to treatment than ever, but may lack good consumer information and guidance in accessing care.
The Harris poll indicated that the stigma attached to mental health issues is disappearing. Almost half of respondents (49%) reported that they know someone who has received treatment and nearly two-thirds (61%) said they do not view the choice to receive therapy as a sign of character weakness.
About four of five respondents (79%) said that they didn't believe that receiving therapy would interfere with a colleague's work and 7% actually said they believed therapy would make a colleague work more effectively.
About 40% of respondents also said their parents would have benefited from therapy.
However, the poll also indicated that individuals need more information about services available under their health plan, proximity of services to home or work and costs before they make a choice to receive treatment.
"Agents and brokers are always looking for ways to educate their clients and differentiate themselves from other insurance marketers. By assisting their clients in understanding the value of these benefits and providing a range of health plans with mental health coverage, counseling services and work/life benefits, they can provide a powerful additional service," he says.
"Employers are always concerned about both cost and quality of any of the services provided under their health plans and they need to be able to control for cost and control for quality when they make a service or health plan decision or in subsequent evaluations," Dr. Vaccaro explains. "Many employers will rely on their brokers for assistance in making these choices."
Where can agents or brokers start in focusing their clients' attention on mental health treatment issues? EAP services have gotten wide recognition for their ability to respond to minor employee mental health issues and workplace programs and they have become a staple of large employers, Dr. Vaccaro notes.
Agents can develop marketing relationships with EAP providers in their area and help communicate the value of the plans to employer clients. You can locate EAPs in your area by searching the provider database of the national Employee Assistance Professionals Association (http://www.eapassn.org).
Also, here are some tips from the U.S. Substance Abuse and Mental Health Administration Division of Workplace Programs that can help you screen for qualified EAPs. An effective EAP should provide:
* Expert consultation for employees and managers
* Training for employers and employees in helping to resolve behavioral, health, or job performance problems
* Confidential, appropriate and timely problem assessment services
* Referrals for diagnosis, treatment and other assistance
* Establishment of referral links between the workplace and community services
* Follow-up services
* Education and information designed to prevent alcohol and other drug problems
* Consultation about environmental changes that could prevent or minimize employee problems. *
The author
Len Strazewski has been covering employee benefits issues for more than 20 years and is employee benefits editor of Human Resource Executive magazine. He has an M.A. in Industrial Relations from Loyola University.