Mental and substance abuse disorders and their downstream impacts are becoming a growing concern for employers – with costs to employers estimated at $225.8 billion each year. Notably, the financial impact goes beyond absenteeism to include presenteeism as well. Presenteeism, or individuals working with untreated illnesses, is estimated to cost employers $1,601 per person each year according to the same Inc. Magazine article.
Many employers are actively looking for better ways to offer their employees support in this area – as they do for overall wellness and chronic conditions such as diabetes and high blood pressure.
Each year, an estimated 16.2 million adults (6.7% of the adult population) in the United States had at least one major depressive episode according to the National Alliance on Mental Illness (NAMI). NAMI goes on to say that approximately 37% of adults with major depressive episode did not receive treatment.
Further complicating the picture, Substance Abuse and Mental Health Services Administration (SAMHSA) states that mental health patients are much more likely to also suffer from some form of substance abuse disorder, and that 7.9 million adults in the U.S. struggle with both mental health and substance abuse. This combination puts patients at higher risk for homelessness, medical illness, suicide or other early death.
Barriers to Getting Needed Care
There are a significant number of barriers keeping people from receiving the care and substance abuse support they need. Among the top are time constraints, lack of local resources, transportation issues, perceived lack of insurance coverage / cost, privacy concerns, stigma, denial about needing care and embarrassment.
Severe lack of availability of locally accessible behavioral health resources is a growing concern. In a 2014 report to Congress, the U.S. Department of Health and Human Substance Abuse and Mental Health Services Administration reported that: “Behavioral health professionals are in short supply in rural and low income communities. In fact, 55 percent of U.S. counties – all rural – do not have any practicing behavioral health workers. And, as reported earlier, more than three-quarters of counties in the United States have a serious shortage of mental health professionals.”
Virtual Behavioral Health
According to a recent AHIP blog, “Today, with smartphone in hand, telehealth and mobile health tools can connect people to the mental and behavioral health care they need.” AHIP states that health insurers are embracing virtual behavioral health as it makes it easier and more affordable to access behavioral health care, and it improves overall health.
Virtual behavioral health solutions are delivering access to psychiatrists, psychologists, social workers and other needed resources. They are treating addictions, anxiety, bipolar disorder, depression, stress, trauma & PTSD, eating disorders, relationship issues, postpartum depression, grief and loss, LGBT issues, and more.
This additional benefit allows employers to expand their telehealth benefits to include virtual behavioral health services via video and telephone consultations. It is being shown to effectively remove many of the obstacles that hinder employees from getting needed treatment by:
Providing behavioral health appointments with less wait time than in-person interactions
Delivering more flexibility with appointment setting – with some providers offering evening and even weekend sessions
Eliminating transportation concerns as well as time and money spent traveling to and from appointments
Decreasing time off from work needed for in-person appointments
Better supporting employees and their dependents in geographies with limited local behavioral health providers
Addressing privacy concerns by supporting visits from home, work or another convenient location
Covering cost concerns through employer communications related to virtual behavioral health benefits coverage
Virtual behavioral health is not yet mainstream, but it is becoming a more common and acceptable means of addressing many barriers to behavioral health care. It is becoming more widely accepted by individuals of all ages who have become accustomed to on-line support for many other areas of need such as banking, shopping, and more.
Proven Positive Outcomes
Numerous studies have proven the effectiveness of virtual behavioral care across age and geography.
A recent study by the Journal of Anxiety Disorders was published in February of 2018 which stated: “Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis”.
An article titled “The child and adolescent telepsychiatry consultation: can it be a more effective clinical process for certain patients than conventional practice?” concluded that more research is still needed in this area, but that preliminarily “In this article we suggest, by reviewing the process of telepsychiatry with children, and illustrating relevant issues with five case studies of patients we have seen, that there is a valid case for arguing that in certain children and adolescents, telepsychiatry, as a consultation process, might actually be a superior method of psychiatric assessment to face-to-face consultation.”
The article further states that telepsychiatry may be a better method of psychiatric assessment than face-to-face consultations among certain children and adolescents with mental health conditions, due to novelty of the consultation, the authenticity of the interaction, and a higher comfort level among teenage patients in rural communities who prefer to see practitioners from outside their community.
Veterans and PTSD
For over two decades, the Department of Veterans Affairs has utilized telemental health services. These services have proven to be very successful in treating post-traumatic stress disorder and have significantly decreased hospital admissions and duration among veterans. “Telemental health technology is increasingly easing these burdens by making PTSD clinical and educational services available in remote areas.”
Retirees / Elderly
A study – “Benefits of a telepsychiatry consultation service for rural nursing home residents” calculated significant cost and time savings when telepsychiatry consultations were offered to rural nursing home residents. The abstract mentions: “Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment.”
Analytics Informing Employers’ Support
Thanks to current state and predictive population health analytics, clinical teams working on behalf of employers have access to more and more information related to those who are facing issues with behavioral health and / or substance abuse. Clinical team members can utilize this information to deliver more targeted support to those who are not yet receiving the care they need. The earlier they gain the insights that allow them to intervene, the better.
Often, an early indicator of issues can be seen in prescription data that shows prescriptions filled for conditions such as depression and anxiety prior to an official diagnosis of a behavioral health condition. Substance abuse potential can also be seen in prescription data where people are filling many pain prescriptions written by different providers and filling them at multiple pharmacies.
There are many areas of insight that are allowing earlier intervention and support in these critical areas.
For more information on how Advanced Plan for Health is supporting our employer clients in identifying those needing behavioral and substance abuse support, please contact us here.