Labor Day is distinctive among American holidays. It does not derive from major events in American history, the lives of great Americans, or religious traditions; it was created to celebrate the efforts of the American labor movement, the social and economic achievements of workers, and the enobling nature of work itself.
Employers have long played an important role in the development of our health care system, which is rooted in this country’s industrial beginnings. Employers are not only purchasers of health care benefits; they design and solicit benefit models, choose whether (or not) to provide mental health benefits, and determine the administration of those benefits. Educating employers about the importance of investing in mental health benefits has been a major focus of APA and the American Psychiatric Foundation’s Partnership for Workplace Mental Health under the leadership of cochairs Alan Axelson, M.D., and William Bruning, J.D., M.B.A.
In conjunction with APA’s 2014 annual meeting in New York, I met with many leading regional, national, and international employers to talk about employee mental health and the value of providing employees with high-quality mental health benefits. The Northeast Business Group on Health, a coalition of employers, hosts regular summits in New York City focused on mental health, and this meeting was held under its sponsorship and that of NAMI-NYC Metro. Among the corporations that were represented were American Express, Bank of America, BNY Mellon, CBS, Deutsche Bank, Deloitte, JPMorgan Chase, McKinsey & Company, and PricewaterhouseCoopers.
When it was my turn to speak, I told the group I had long hoped for such an opportunity, especially because if we are going to change the mental health insurance system, we need to change the thinking of the employers who purchase insurance. Additionally, when one considers how much time people spend at work, the sense of self-worth they derive from their work, and the importance of mental health for maintaining productivity, APA has an essential responsibility to engage employers in such an educational dialogue.
As I noted at the beginning of my APA presidency, one of the tasks before us is to advocate for patients. One way to do this effectively is to address workplace issues that impact mental health and understand how businesses think about those issues. They get that workplace mental health has a direct impact on workers and companies. When employees have access to high-quality mental health treatment, including treatment for substance abuse, not only does it improve the lives of employees and their families, but also businesses benefit from reduced medical and disability costs (people who have untreated mental illness use nonpsychiatric inpatient and outpatient services three times more than those who receive treatment), increased productivity, and the retention of the very workers they need.
More days of work loss and work impairment are caused by mental illness than many other chronic conditions such as diabetes, asthma, and arthritis. This should not surprise us, knowing as we do the high prevalence of mental illness. Additionally, these illnesses dominate the causes of disability among people in their 20s and 30s, when they are entering the workforce or have not yet become established in their careers.
Significant costs are also related to commonly co-occurring mental health (including substance abuse) and chronic medical conditions. For example, people who have both mental disorders and chronic medical conditions are far more likely to visit emergency rooms and to be hospitalized than people with chronic medical conditions alone.
The health care of the more than 60 percent of Americans with private insurance is determined directly by their employers through their purchasing decisions—and only secondarily by their health plan, managed care organization, or HMO. Sixty-two percent of employers consider their employees’ mental health a priority and part of their health- and productivity-improvement strategies.
Importantly, employers are key to implementing parity. While much attention is focused on health plans’ compliance with the parity law, noncompliance poses a significant financial risk for employers. Penalties can be as high as $100 per member per day of noncompliance. APA and the Partnership for Workplace Mental Health regularly collaborate to educate employers on parity requirements. Employers can also play a powerful role in reducing the stigma of mental illness.
In our efforts to advocate for patients, we should not lose sight of the fact that for many people living with mental illness, work itself is an essential cornerstone of their recovery. It contributes to a strong sense of identity and self-esteem, provides access to health care benefits and services, facilitates valuable social contact, and is a source of income and financial independence. Employers can do their part by establishing healthy and welcoming environments and supporting individuals who suffer from a mental illness.
As we welcome the close of summer with the arrival of Labor Day—and for many of us a return to work after a well-deserved break—let us remember that ensuring the mental health and well-being of our country’s workforce (which includes the people with whom we work) is not only the smart thing to do, but also the right thing to do. ■