Statistics suggest that physical health problems are often directly related to untreated mental health problems.
When it comes to controlling the escalating costs of healthcare, there have been two competing philosophies. The first is to limit employee access and manage utilization of services, and the second is to increase access with readily available preventive services and early intervention. And nothing has fueled this debate more than the results of the last two decades of “managed care.”
Despite industry efforts to use the skills of so-called “gatekeepers,” whose job was to “approve and authorize” necessary services, thereby reducing waste and increasing savings, healthcare costs have continued to rise at unprecedented levels. More recently, as observed in the Affordable Care Act, new calls have been made for the benefits of prevention and early intervention. Although counter-intuitive to the fiscally conservative, ready access to prevention and early intervention can significantly help control rising healthcare costs. Nowhere is this more evident than in the relationship of untreated mental health problems to the escalating costs of healthcare.
Mental & Physical Health Intertwined
It has been well-documented that 75 to 90 percent of all doctor’s visits are for stress-related ailments or complaints. In fact, 43 percent of Americans have been found to suffer the adverse effects of stress—at an estimated cost to American industry of $300 billion per year. More interesting is that, of the 26 percent of Americans over the age of 18 diagnosed each year with a serious mental health problem, 45 percent were also found to have a co-morbid physical health problem, such as headaches, insomnia, high blood pressure, digestive problems, diabetes, heart problems, skin conditions, asthma and arthritis.
Even more alarming, a 2007 Substance Abuse and Mental Health Services Administration study found that 60 percent of those diagnosed with a mental health problem never sought treatment! These statistics clearly suggest that physical health problems are often directly related to untreated mental health problems. In fact, research has found that those living with a serious mental illness face a significantly increased risk of developing a chronic medical condition and of dying 25 years earlier, on average, than other Americans.
Decreased Access… and Effectiveness
But sadly, access to mental health services has decreased in recent years. The United States spends just six percent of its total healthcare costs on mental health—monies that have increasingly gone away from inpatient and outpatient treatment toward prescription drug interventions. In addition, access to mental healthcare has also declined. In 2010, the Bureau of Labor Statistics found 53 million Americans living in primary care shortage areas, compared to 89 million living in mental healthcare shortage areas.
Further, mental healthcare is expensive, with 45 percent of untreated persons citing cost as the primary barrier to seeking help. State funding for mental health services has been cut due to the recession, while access has also been limited due to a lack of awareness and education in our schools. Again, largely due to budgetary constraints, schools have dropped developmental education and student counseling programs, so children have reduced exposure to mental health education and little to no experience with a mental health counselor.
Even employers that previously understood the value of comprehensive employee assistance programs (EAP)—which afford employees and family members unobstructed access to free, face-to-face, short-term counseling—have reduced the impact of their programs by decreasing the number of allowed sessions and switching to a less expensive and less effective telephone-based service. While this may translate into cost savings up front, it significantly reduces the EAP’s effectiveness in addressing employees’ overall mental health needs and ends up costing the employer much more in the long run—in later treatment of more serious mental health problems and their inevitable physical health consequences. Finally, despite the valiant efforts of public service campaigns, the stigma surrounding mental health problems and their treatment persists, and many are reluctant to seek out help on their own.
Early Intervention Is Critical
Mental health treatment is demonstrably effective. The National Association of Mental Illness reports that 70 to 90 percent of clients in treatment experienced a significant reduction of symptoms and improved quality of life. Early identification and treatment are critical to avoid deepening emotional problems, as well as complicating co-morbid physical health problems.
The best overall treatment involves a holistic approach that includes counseling and social support; medication for more serious symptoms; a physical health plan with a good diet, exercise and sleep program; the avoidance of substance abuse; and the use of alternative therapies such as meditation, massage therapy, yoga and supplements like fish oil that support healthy brain functioning. In addition, new technologies are available that utilize cellphone apps for symptom tracking and self-help, and neurofeedback to re-regulate the electrical activity of the brain related to various mental and physical health problems.
Today more than ever, employers and employees are well-advised to attend to their mental health needs. A happy and well-adjusted employee is a healthy and more productive employee. While stress and change may be inevitable, their debilitating effects are not. Employers who support and promote ready access to mental healthcare through company policies and benefit plans can avert more serious mental and physical health consequences in their workforce. A strong mental health prevention and early intervention strategy are essential in successfully managing today’s healthcare costs. iBi
Ted Chapin, Ph.D. is a licensed clinical psychologist and president of Chapin & Russell Associates and RMS Consulting. Brad Post, MSW is a licensed clinical social worker and vice president of both firms. For more information, visit chapinandrussell.com or rms4solutions.com.