It's not often that employers, clinicians, health plan executives, and
government officials can unite around a common agenda, especially one as
complex as the mental health component of disability, but APA won a major
victory recently in its effort to engage the purchasers of health care.
On October 18-19, 30 leaders from the corporate world, public sector, and
medical arena met in Chicago for a "consensus workshop" on
disability and return-to-work issues. In a day and a half, attendees crafted a
mission statement, produced an action plan, and formed a steering committee to
carry out the plan.
On behalf of APA, the Partnership for Workplace Mental Health (a program of
the American Psychiatric Foundation) hosted the conference. APA participated
as a primary stakeholder with representatives from the Committee on
APA/Business Relations and the Corresponding Committee on Psychiatry in the
Workplace attending. Other participants included leaders from DuPont, Coca
Cola, Reed Elsevier, Aetna Behavioral Health, Aetna Disability Services,
Cyberonics, United Behavioral Health, Aon Workforce Strategies, AstraZeneca,
UnumProvident, Midwest Business Group on Health, and Mid-America Coalition on
Health, Tufts—New England Medical Center.
In addition, Martin Gerry, deputy commissioner for disability and income
security programs at the Social Security Administration, represented that
agency, a major stakeholder often overlooked in conversations about
William Yang, M.D., M.B.A. (left), medical director of Coca-Cola
Company, expands on his view of mental health disability to Stephen Heidel,
M.D., a member of the Committee on APA/Business Relations, during a"
consensus workshop" hosted by the Partnership for Workplace
Mental Health, a program of the American Psychiatric Foundation.
APA President Steven Sharfstein, M.D., spoke to the participants by phone.
He emphasized that not being able to work is a mental health, as well as an
economic, issue. "We firmly believe," he said, "that APA can
be part of solving mental health problems in the workplace if we listen to and
talk with the payer community. We need to put our heads together to keep
people at work and to bring them back to work." He assured participants,"
We're in this for the long run."
Representing the Business Relations Committee, Stephen Heidel, M.D.,
expanded on that notion, saying, "The problems of mental health
disability and their solutions are bigger than any one of us can address. It
will take all of us to solve them."
Before the conference, participants completed a questionnaire about what
they thought were the key problems concerning mental health disabilities. They
listed a need for more mental health information; more data; more training for
the treatment team on how to return employees to work successfully; more
creative thinking by corporations, perhaps using incremental or transitional
strategies; and improved coordination among the stakeholders. More than one
person said, "Leaving work should be considered a medical
During the meeting, participants agreed to the following mission
All stakeholders are integrated and aligned in the idea that work is
central to a person's identity and social role. These stakeholders (employee
and family, employer, practitioner, benefit plan, government, and union) must
work together to maximize productivity by minimizing the incidence and
duration of mental health presenteeism, absenteeism, and disabilities.
Debra Lerner, M.S., Ph.D., an associate professor and senior scientist at
the Institute for Clinical Research and Health Policy Studies at Tufts-New
England Medical Center, opened the meeting by painting a costly picture of
depression in the workplace. She noted that half of those with depression are
undiagnosed, and fewer than half who are diagnosed with depression receive
adequate treatment. She pointed out as well that depression accounts for $26.1
billion each year in direct medical costs and up to $51.5 billion (in 2003
dollars) in lost productivity.
Lerner then reviewed the findings of her team's research on the impact of
depression in the workplace. She and others reported in the December 2004
Psychiatric Services that they found a high level of function loss in
employees with depression. For example:
Lerner proposed a research and action agenda that included developing
accurate, consistent methods for measuring work disabilities and assessing the
population at risk of developing them. Kenneth Mitchell, M.S., Ph.D., of
UnumProvident voiced what many in the room were thinking: employers want to
know "what interventions work" and "what's our return on
investment?" "We have to be able to measure successes," he
The return-to-work problem becomes even more acute at the federal level.
When disabled employees become eligible for Social Security benefits, the
Social Security Administration picks up the tab. The statistics are grim:
Gerry told attendees that only .2 percent of their employees ever return to
work. "We are open to new ideas," he said.
"We got the buy-in from the employers and health plans—and now
the federal government—that we were looking for," said Irvin (Sam)
Muszynski, J.D., director of the Office of Healthcare Systems and Financing."
We are ready to take this to the next level."
Clare Miller, director of the workplace partnership, saw the buy-in as an
important first step in tackling disability. "Each step taken seems to
bring a larger number of stakeholders to the table who are willing to work
with us," she said. Her staff and Ed Muldoon, consultant to APA on
disability issues and the conference leader, are gathering comments from the
participants to finalize the action plan. ▪