APA, Corporate Leaders Discuss Coverage for Mental Illness

When APA leaders and prominent researchers get together with companies like AT&T and Delta Air Lines, the chances that employees will gain access to quality mental health care improve.

Last month, at the invitation of APA and the Carter Center, nearly 100 representatives from business, government, and academia met at the Carter Center in Atlanta as part of APA’s effort to improve the mental health care coverage employers provide workers in their health insurance policies.

Among the companies that accepted the invitation were AT&T, Hughes Electronics, Coca-Cola, Lucent Technologies, Delta Air Lines, DuPont, PricewaterhouseCoopers, Bank One, Towers Perrin, IBM, Dow Chemical, United Air Lines, 3M, William H. Mercer, Anheuser-Busch, and the Southern Company. Representatives from federal and state government agencies, such as the Office of Personnel Management and the Ohio Department of Mental Health, also attended.

“The response from business exceeded our expectations,” said Daniel Borenstein, M.D., immediate past president of APA and a champion of the APA/business initiative.

Former First Lady Rosalynn Carter attended the symposium and urged participants to capture the momentum it generated to provide workers with quality mental health care services. She was introduced by APA President Richard Harding, M.D., who applauded her long-time efforts on behalf of the mentally ill.

The symposium, titled “The Business Case for Mental Health Care,” was the first major event of APA’s outreach to the business community. In his opening remarks, Borenstein said, “This initiative is the result of our growing concern about the inability of individuals to access quality mental health care and a realization that to properly and effectively address the problem, we need to partner with the group that provides one-half of all the health care coverage in this country—the business community.”

Researchers who spoke at the meeting, such as Ronald Kessler, Ph.D., professor of health care policy at Harvard Medical School, and Ron Goetzel, Ph.D., vice president of consulting and applied research at the Medstat Group, presented reports illustrating the link between mental illness and workplace disability, lost productivity, absenteeism, and the new “ism” of the day, presenteeism, which means the employee is “present” but not 100 percent functional on the job.

These reports of the cost of untreated mental disorders are no surprise to business. As Norman Clemens, M.D., chair of the APA Committee on APA/Business Relations, noted, “In every meeting with business I have attended, businessmen and -women are aware of these studies and are, therefore, very receptive to what we have to offer.”

Several attendees noted, however, that timing is critical. Business is looking to APA and others for answers now because of the crisis in finding quality mental health care services for their employees. All the corporate representatives acknowledged the critical problem of identifying enough psychiatrists, which was covered recently by the Wall Street Journal (May 9 and June 13) and the Boston Globe (June 17). Scott Rothermel of PricewaterhouseCoopers noted that “APA has a relatively small window of opportunity right now. If no solutions are presented to business quickly, then I fear the momentum created [at the Carter Center meeting] may be lost.”

A number of companies presented case studies showing their approach to dealing with mental health problems in the workplace. Some were extremely sophisticated, and a few unique, such as Owens Corning, which established and manages its own nationwide mental health practitioner network.

APA members addressed some of the key concerns of business and provided information on productivity, management of disability/return to work, violence, and absenteeism.

Lloyd Sederer, M.D., director of the APA Division of Clinical Services, provided an informative tutorial titled “Demystifying Quality Measurement,” designed to help businesses measure and determine whether quality mental health care is being provided to their employees. (APA members can obtain a copy of the the tutorial by e-mailing [email protected].)

Access to quality mental health care was a theme that pervaded the event. Clemens, for example, explained the difficulties psychiatrists are experiencing when trying to treat patients effectively and at the same time they are forced to perform burdensome administrative tasks for low reimbursement rates.

“The inability of psychiatrists to provide their patients with the treatment they deem most appropriate,” Clemens stated, “has dramatically reduced professional satisfaction and has led to a decline in the number of physicians willing to participate in networks of care.”

From the corporate perspective, the major obstacles to effective treatment were the increasing difficulty in gaining prompt access to psychiatric treatment for employees and finding psychiatrists knowledgeable about workplace issues.

In the town-hall-style meeting that closed the symposium, it was clear that there was general agreement with the key points made by APA Vice President Marcia Goin, M.D. She delivered the message that mental illness, especially depression, is a serious problem in the workplace; that mental illness goes undiagnosed as much as 50 percent of the time; and even when it is properly diagnosed, effective care may not be available to employees.

“Every participant agreed that something must be done,” Sam Muszynski, director of the APA Office of Healthcare Systems and Financing, said after the Carter Center symposium. “The symposium opened up a dialogue with business and presented a number of opportunities that APA and the business initiative committee can now move forward with,” he added. “The crucial issue is how APA and the committee can create a long-term presence for the initiative and capitalize on the opportunities that now exist for APA members and their patients.”

Muszynski expressed his appreciation to the Washington Business Group on Health, which was instrumental in promoting the meeting, and to Pfizer Inc., which provided an educational grant to support the symposium.

Sandra Hass is editor of the APA newsletter Psychiatric Practice and Managed Care and on the staff of the Office of Healthcare Systems and Financing.

Additional information about the Carter Center symposium will appear in the September/October issue of the APA newsletter Psychiatric Practice and Managed Care. A set of the research handouts distributed to symposium attendees is available via e-mail from Sandra Hass at [email protected]. ▪