Employers are stepping up efforts to connect employees and their families to mental health benefits/programs because they recognize that poor mental health raises costs and impedes productivity and safety in the workplace.

Cost- and productivity-conscious employers recognize that “you can't really separate the mind from the body,” said Clare Miller, director of the Partnership for Workplace Mental Health, a program of the American Psychiatric Foundation, in Arlington,

Virginia.

Employers also are realizing that mental health can affect physical well-being and vice versa, so many are weaving mental health into existing programs, said Ms. Miller, whose organization collaborates with employers to promote effective mental health care.

This is increasingly important with the shift to a service- and knowledge-based economy. As reported in Business Insurance from the Disability Management Employer Coalition's 2015 conference, a presentation outlined the threat of common mental

health issues — depression, anxiety and adjustment disorders — to knowledge-based workers.

Citing a 2012 study in the Journal of the American Medical Association, conference speakers noted that depression will rank first in total economic burden among all high-income countries by 2030.

Employers are responding, stepping up efforts to connect workers and their families with mental and behavioral health benefits and services.

Caterpillar Inc., for one, is creating a “total employee well-being” strategy. John Pompe, manager of integrated health programs at the Peoria, Illinois-based construction equipment maker, said it is working to ensure that mental health and substance abuse “get

sufficient bandwidth” among other health topics.

For instance, generic psychotropic medications, those used to treat depression, anxiety and stress, are in the zero-copay tier of the company's pharmacy benefits plan. And at large facilities, the company maintains “wellness rooms” or “wellness walls” where employees can grab a map of local walking paths and a brochure on the employee assistance program.

In 2016, six of the company's 12 annual wellness campaigns will be dedicated to mental health, substance abuse or social issues, and even physical health topics such as managing diabetes will highlight mental and behavioral aspects, Mr. Pompe said.

“We don't present 'health' or 'wellness' information where (mental health/substance abuse) topics aren't included,” Mr. Pompe noted.

Health risk appraisals, for example, often include questions about a person's mental status. Of 32 large employers responding to a 2008 survey question about HRAs, all said they routinely ask about mental health and 78% ask about mental status and substance abuse, according to the National Business Group on Health.

Aggregated, deidentified data help businesses and health plans deploy programs targeting risks, such as stress and depression.

In disability and absence management, mental health screening and referrals to employee assistance programs are becoming more prevalent. DMEC's 2014 employer survey, for example, shows 32.9% screen for psychological or psychosocial issues, up 3 points from 2012. Even if a worker is out on a chronic back injury, addressing co-morbid depression, for instance, may reduce costs and speed an employee's return to work, studies suggest. That is because people who suffer from chronic disease are more likely to have depression, which can contribute to work absences and presenteeism, says the U.S. Centers for Disease Control and Prevention.

More employers are looking to promote strong mental health in the workplace and prevent situations that trigger the need for services, said Kathleen Mahieu, leader of Aon Hewitt's Behavioral Health Solutions practice in Norwalk, Connecticut. They offer the more traditional employee assistance programs, but also meditation and yoga, to help workers cope with daily life, she said.

One in four U.S. employees experiences a mental or substance abuse disorder, according to the CDC. Alcohol abuse, depression and anxiety are the most common such diagnoses in the workforce, the CDC says.

Most large and midmarket employers cover mental health and substance abuse services through their health benefit plans. Under federal parity legislation, those benefits must be on par with employers' medical coverage (see related story, page 7).

Many employers, especially those with more than 1,000 workers, also offer employee assistance programs as a core benefit. EAPs traditionally provide mental health- and substance abuse-related services and referrals, and many have expanded their repertoire to include preventive services, such as smoking cessation, relaxation techniques and mindfulness meditation.

Yet too few employees seek help for mental disorders, substance abuse and other behavioral health conditions.

Based on interactions with employer clients, Ms. Mahieu observes that 5% to 6% of employees use mental health services under their health benefits plans. By contrast, slightly more than 13% of adults in the U.S. receive treatment for a mental health problem, according to the Substance Abuse and Mental Health Services Administration.

Paul Fronstin, director of the Employee Benefit Research Institute's Health Research and Education Program, in Washington, said he would expect the percentage of workers accessing those benefits to be lower than for the general adult population because employees tend to be healthier and may be concerned about privacy or discrimination.

Likewise, behavioral health experts say users of EAP services as a percentage of all employees often fails to exceed the single digits — typically 3-4%, experts say. The Employee Assistance Professional Association does not calculate a national EAP utilization rate due to large variations in programs based on employee populations and other factors.

“You're almost always comparing apples to oranges,” said Marina London, a licensed clinical social worker and EAPA's manager of Web services in Arlington, Virginia. It makes more sense for companies to track their own utilization over time, she said. At Caterpillar, which combines onsite and offsite EAP services, U.S. employee utilization was 7.6% in 2014.

Mental illness and substance abuse costs U.S. employers an estimated $80 billion to $100 billion annually, including in productivity and employee absences, according to the NGBH in 2005 data, the most recent available.

The International Risk Management Institute Inc. in Dallas says the concept of “behavioral risk management” — identifying and addressing mental and behavioral health problems that affect workplace costs and productivity — has been around since the mid-1990s. Author Rudy Yandrick's 1996 book, “Behavioral Risk Management: How to Avoid Preventable Losses from Mental Health Problems in the Workplace,” was among the first to advance the concept.

In 2006, DMEC began surveying members on their use of behavioral risk management. The number of employers including a behavioral health component in their coordinated disability/absence management program has swelled to 60% in 2014 from 31% in 2006.

“We've come a long way in 10 years, but we're still not where we need to be,” said Terri Rhodes, DMEC's CEO, in San Francisco. Employers recognize the toll of behavioral health conditions in the workplace, “but not many employers, I think, feel they can impact it,” she said.

Employee suicides and events such as the Germanwings crash in the French Alps in March in which the co-pilot since was found to suffer severe depression and downed the plane, killing 150, also highlight safety concerns stemming from untreated mental illness.

To boost participation in behavioral health offerings, employers must overcome the social stigma associated with having a mental disorder and seeking treatment for it. The percentage of employers who say the perception of stigma by several measures rose considerably in DMEC's 2014 survey from 2012. More than 24% of employers in 2014 say the stigma associated with having a psychological or psychiatric problem has increased, up from 7.6% in 2012. More than 25% agree that the stigma of using EAP services has increased, up from 3% in 2012.

Another potential barrier is the lack of coordination of mental health services among vendors and between an employer's medical plan and its vendors. Fragmentation can frustrate efforts to ensure that employees get timely case management services and that employers receive data on the number of cases being managed, as an example.

Ms. Rhodes advises employers to dig deeper into the integration question: “Tell me how you connect the dots when someone has (a Family and Medical Leave Act) event? How are you connecting the dots if it's a mental health issue?”

Engaging employees in mental health and substance abuse services also remains a huge challenge. That's where technology may come into play.

Minneapolis-based Ceridian HCM Inc., through its LifeWorks EAP, introduced a video counseling program in July 2014. So far, about 2% of the population needing clinical counseling for issues such as stress, depression and family relationship troubles, has used the service.

Worker age is also a consideration for employers. Video, texting and other technologies are considered crucial for connecting with millennials. “That's where we should be heading,” Ms. London said.