Psychiatrists, insurers, and employers in Pittsburgh are in the early stages of an effort to improve recognition and treatment of depression at the workplace.
APA, the Pittsburgh chapter of the Pennsylvania Psychiatric Society, and city employers hope to improve treatment, lower costs, and heighten productivity through a program launched by the Pittsburgh Regional Health Initiative (PRHI). PRHI is a consortium of individuals and organizations that provide, purchase, insure, and support health care services in the region. Partners include clinicians, hospitals, insurers, large- and small-business health care purchasers, corporate and civic leaders, and elected officials.
Local and national leaders say the effort points to some heightened awareness on the part of business leaders about the importance of untreated depression and substance abuse in the workplace.
"Business people in Pittsburgh really recognize the importance of treating depression," said psychiatrist Alan Axelson, M.D., medical director for behavioral health services at HighMark Blue Cross/Blue Shield of Western Pennsylvania.
He told Psychiatric News that PRHI has focused attention on specific disease conditions that affect worker performance and employer health costs including, recently, depression and diabetes. The two conditions have much in common, he said.
"These are two chronic diseases that are parallel in terms of what we need to do to improve current standards of care and to engage patients as active partners in their care and treatment," he said.
Axelson said Highmark has brought its primary care and specialty care networks together, doing away with the mental health carveout of the past, to facilitate integration of care between primary and specialty care. Meanwhile, it has collaborated with local employer Pittsburgh Plate Glass (PPG) to improve recognition of depression in the workplace.
"PPG has been working with Highmark to educate itsemployees about mental health issues, to develop work-site initiatives around the identification and destigmatization of depression, and to get patients to have appropriate expectations of their primary care physicians," Axelson told Psychiatric News. "That means employees should expect their primary care doctor to screen regularly for depression and bring the subject up themselves."
Axelson said Highmark is also working with PPG to inform occupational health nurses employed by the company about depression.
PPG Medical Director Alberto Columbi, M.D., told Psychiatric News that the input of local psychiatrists is vital.
"We are trying to translate knowledge given to us by experts into action at the work site," he said. "We are not trying to create occupational psychiatry, but to facilitate access to existing services. Our role is to increase awareness of depression, combat stigma, and provide our employees with knowledge about treatment resources."
Columbi continued, "Specialists can help in providing guidelines to be followed by primary care physicians, provide support for difficult cases, and help in the rehabilitation and return to function and work of affected active employees. They can also provide work-site talks to increase awareness, reduce stigma, and familiarize the public with the principles of early recognition and early treatment and rehabilitation of depression. The work-site interventions can be organized directly with the employer, while clinical interventions can be organized through the health plan."
Norman Clemens, M.D., who is chair of APA’s Business Initiative and visited the city on behalf of APA, said the Pittsburgh effort is in its early stages but represents the kind of collaboration that is essential.
"APA feels the Business Initiative is vital because private employers finance and influence more than 50 percent of the health care economy," he said. "Employers, like insurers, hate mandates. But unlike insurers, they have an interest in the health of their employees. They have proved to be responsive to data showing the bottom-line value of mental health care in enhancing productivity and retention of their employees and reducing disability, absenteeism, and the high utilization of medical care that often accompanies insufficiently treated psychiatric disorders. Depression, anxiety disorders, and substance use disorders are especially costly to employers." ▪