Substance abuse and other mental disorders cost the nation's employers as
much as $17 billion a year, according to a year-long study by the National
Business Group on Health (NBGH).
Indirect costs associated with mental illness, including substance abuse,
range between $79 billion and $105 billion a year, the group says.
In an interview with Psychiatric News, NBGH Vice President Ron
Finch said the study and its recommendations emphasize the importance of
integrating services and programs across employee benefits, including employee
assistance programs (EAPs), disability benefits, and health insurance
The NBGH, headquartered in Washington, D.C., represents 240 mostly large
employers and advocates for their perspective on health care issues.
Finch said that mental health carveouts had cut costs as much as possible
in the last two decades, while also fragmenting the care of workers with
"Over the last several years the cost of health care has been brought
down and contained as much as it can be," he said. "I think
employers understand that they have to focus on improving and maintaining the
overall health status of beneficiaries in their plans.
"But one of our major findings is that behavioral health, like
general health, is fragmented and lacks integration. It is fairly rare to find
employers that have well-integrated employee assistance, disability health
care, and preventive health programs. Those that do have lower disability
costs and less use in general of their health care plans. They also have
better outcomes with those chronic conditions where there is comorbid
Funded by the Center for Mental Health Services of the Substance Abuse and
Mental Health Services Administration, the NBGH study was conducted by the
National Committee on Employer-Sponsored Behavioral Health Services.
The NBGH formed that committee to review the state of employer-sponsored
behavioral health services and develop recommendations to improve the design,
quality, structure, and integration of programs and services. The committee
also reviewed the recommendations of the President's New Freedom Commission on
Mental Health to determine how they might apply to employer-sponsored mental
health benefits and programs.
The committee consisted of 25 experts including academic researchers,
disability-management professionals, EAP professionals, health care benefit
specialists, representatives from managed care and mental health carveout
companies, and medical directors and benefit managers from member NBGH
APA President Steven Sharfstein, M.D., said the group's findings, and the
prominence of NBGH as a leader in promoting innovative health care strategies
in the workplace, underscore the widening recognition of the value of mental
health and substance abuse treatment by the nation's employers.
"The National Business Group on Health has taken the lead in
promoting access to behavioral health care as an essential component of good
business practice," he told Psychiatric News. "There is
increased recognition that treatment works, and workplace interventions
combined with good insurance coverage pay for themselves many times
Finch said that the NBGH findings stress the value of collaboration between
primary care and mental health specialists and of treatment by specialists
"Currently, the primary care and general medical system has become
the default mental health system, with about 70 percent of mental health cases
being seen in primary care, with the main mode of treatment being
antidepressants or other psychotropic medications without concurrent
psychotherapy," he noted.
Benefit designs that favor treatment in the primary care setting are
driving the phenomenon, he said. "Deductibles are much lower for primary
care, and that is driving utilization to the primary care setting. But we are
concerned that clinical effectiveness is much lower than when patients are
being seen by behavioral health specialists," Finch said.
He pointed out that this study underscores the need for collaboration
between general medicine and mental health specialists in the care of patients
with chronic conditions—such as diabetes and heart disease—in
which there is significant comorbid mental illness.
"Without access to indicated treatments [in mental health care
insurance coverage], patient compliance with disease management is
undone," he said. "This is costing employers dollars in terms of
Finch also highlighted the organization's concerns about the costs of
disability to employers, saying mental health problems and associated time
away from work are the highest-cost item for disability plans. "We are
finding that patients are being certified as disabled at the general medical
setting, with initial certification of disability being up to two months, with
medication as the only treatment they are receiving," he said."
Without an active treatment plan, this initial period of disability
disconnects the employee from the workplace without engaging the employee in
an active treatment plan."
For this reason, NBGH recommends that employees in these circumstances be
certified by a mental health care specialist with an active treatment plan and
that employees on disability be referred to the company's EAP to ensure
transition back to work.
A report on the study with its 12 findings and 18 recommendations is