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Cultural change needed to tackle mental health care

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Cultural change needed to tackle mental health care

NEW ORLEANS — The crash of Germanwings Flight 9525 is a prime example of why employers must directly address workers' mental health conditions and absence management professionals must make their case straight to the C-suite.

Co-pilot Andreas Lubitz, who was suffering from a mental illness that he hid from his employer, crashed the plane into the French Alps in March 2015, killing 150 passengers and crew members.

Harry Spencer, vice president of compensation, benefits and corporate social responsibility at JetBlue Airways Corp. in New York, also discussed nonfatal incidents involving JetBlue employees having mental breakdowns, including a 2012 incident in which a co-pilot locked Capt. Clayton Osbon out of the cockpit because of his erratic behavior and a 2010 case in which flight attendant Stephen Slater exited a jet via an emergency slide because he was irritated with passengers,

“For me, the business case is clear, it's obvious, it's evident,” Mr. Spencer said during the Disability Management Employer Coalition's mid-July conference in New Orleans. “There's stresses in our business. There's stresses in every business. What can we do as an employer?”

Bringing chief financial officers into the discussion is critical, given that a February study by the Integrated Benefits Institute found that 85% of CFOs play a role in benefits decisions, with 53% saying they could make better benefits decisions if health-related im­provements in job performance were linked to business metrics.

“We're moving into this era where we have to prove the business case,” said Thomas Parry, president of the San Francisco-based institute. “You have to talk the CFO's language to make the business case.”

But the challenge is mental health conditions typically are underreported, often misdiagnosed or inappropriately treated, said Debra Lerner, the director of program on health, work and productivity at Tufts Medical Center in Boston.

“All those things make claims a little less trustworthy as a way to establish prevalence in your companies,” she said, adding that employers can apply federal data showing patterns based on age, race, gender and other factors to their workforce to help make the business case.

For JetBlue, behavioral health costs represent 5% of overall medical costs, but the average number of work days lost through short-term disability claims was 79.3 days when behavioral health was the primary or secondary factor — a “tremendous” amount of time that Mr. Spencer believes is still understated.

One reason that mental health conditions are understated is social stigma, which stifles diagnosis, treatment, dialogue and awareness. This is problematic because most people with mental health conditions can improve with treatment, said Rich Paul, senior vice president of employer strategy and development at Beacon Health Options Inc. in Norfolk, Virginia.

“People like to criticize (employee assistance programs) for having low utilization,” he said. “The reality is that it really is a culture-based issue. If you can have people more comfortable in seeking help and support, they will.”

Every year, about 30% to 40% of behavioral health claims initiated by employees are denied by the Aetna Inc. unit that evaluates them because they are driven by workplace-related issues such as conflict with a supervisor, a shift change, job demand changes or a poor performance evaluation, said Adele Spallone, vice president of business integration and strategy for disability and absence management with Aetna in Miami.

This gives employers an opportunity to educate managers and supervisors to recognize symptoms and help employees before a disability event occurs, she said.

“It starts with one word, and that word is culture,” Ms. Spallone said. “We can have the best programs in the world, but if the culture doesn't support those programs, you're not going to have the level of engagement that you're looking for.”

Pacific Gas & Electric Co. has an “amazing” culture that encourages employees to use the utility's EAP — 10.2% of employees and 14.6% of dependents do so — driven by “well-informed supervisors” making referrals, particularly when they see employees struggling, said Heather Holladay, PG&E's San Francisco-based integrated health manager.

One PG&E program involves about 40 employees who have suffered from alcoholism or substance abuse and who voluntarily have their names, phone numbers and photos listed on posters so other employees can reach out to them for help without judgment, which 500 employees did last year, Ms. Holladay said.

“One of the great things about that is that it breaks the stigma,” she said.

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