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Depression is estimated to cause 200 million lost workdays each year at a cost to employers of $17 billion to $44 billion — 81 percent due to reduced performance while at work, the World Health Organization has reported.

Lost productivity prompts businesses to prioritize health promotion, including mental health

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As many as 8.4 hours are lost per employee per week as a result of major depression, the Journal of the American Medical Association estimates. That’s 26 lost days per year compared to 17 days for cancer.

Mental disorders are common throughout the United States, affecting tens of millions of people each year, and only a fraction of those affected receive treatment, according to the National Institute of Mental Health.

More than one-quarter of adults with serious mental illness also deal with substance dependence or abuse, according to the CDC.

Lost productivity in particular seems to be pushing businesses to be increasingly attentive to mental health issues in the workplace, said Dr. David Flynn, professor of economics at UND. 

“They have to be thinking about costs and benefits,” he said.  

Businesses look at expenses — in terms of time and money — as they relate to the cost of disability and training new workers, for example, that result from employees’ mental health problems, he said.

Analysis of those costs has prompted businesses to take steps to promote the health of their employees, including disease prevention, which usually lowers costs, Flynn said.

“It’s in a business’s best interest to pay attention to mental health issues,” he said, “and everything from burnout to mental health concerns is in that realm.”

Mandated time off

Accounting and law firms, for example, have mandated days off in an effort to force employees to take a break, he said. “They say, ‘You cannot be in the office on New Year’s Day or the Fourth of July.’

“It’s part of a broader labor-leisure choice dynamic in the United States,” Flynn said. “We’re working ourselves harder than (people in) other countries.

“The value of another hour of work is starting to be reevaluated by younger workers — and older workers, too.”

Paying attention to employees’ mental health “is seen as an effective cost-benefit strategy in business,” he said.

“If you view your worker as an asset — as cold as that sounds — you want to take care of that worker, provide the proper ‘maintenance.’ You have already invested in employees in time and money; you want to make sure they don’t burn out and don’t break down.”

While concern for their fellow human beings is likely a “major part” of the strategy, he said, this is one area “where human concerns and profit concerns can overlap.”

“At any given time, between 10 and 20 percent of an employee population is going to be dealing with a mental health issue,” said Darrin Tonfeldt, division director of behavioral health and financial services at The Village Family Service Center in Fargo.

“That can range from mild anxiety to severe depression.” 

Businesses are recognizing that chronic stress has implications for autoimmune disorders and heart disease, he said.

“They know the cost of these things, and they’re seeking ways to put practical interventions in place to help employees become and stay healthy.”   

Among those interventions is a “strong employee assistance program” that offers online and face-to-face counseling to help people cope with vexing challenges of life.

 The movement toward offering such services to employees is bolstered by studies that show their effectiveness, Tonfeldt said.

“The science is getting better,” he said. “It’s not so much guess-work anymore.”  

Performance suffers

Officials of the Altru Health System in Grand Forks, which employs more than 4,100 people, said that performance on the job is where mental health issues come into play.

“We may see excessive absenteeism, deterioration in job performance or mood change” that suggest an employee is experiencing a mental health problem, said Rick Gessler, manager of employee relations.

A person who is having difficulties may be referred to registered nurses, serving as case managers, in the occupational therapy department “who help support our staff,” said Ashley Nordstrom, supervisor in human resources.    

Mike Dewald, manager of clinic psychiatry services, said, “If someone is struggling … at work, they can be distracted. It often creates a safety risk (especially) for people who work with machinery or dangerous chemicals.”

It’s also common for depression to accompany physical ailments, such as unrelenting back pain, he said. 

When the depression is occurring along with another disabling condition, disability durations are 30 percent longer than a control group, according to the Integrated Benefits Institute.

Employees who are grappling with mental health disturbances may hesitate to seek help.

Generally, “people with physical illness, after a day or two, would get help,” Dewald said. “But sometimes people with a mental health issue will hold onto to it for months or even years before getting help.”   

People may not want to admit to having these problems, “but they are so common,” he said. “It’s normal; it’s part of life.”

While the stigma surrounding mental illness “is still there,” Dewald said, “we’re lifting the veil. The stigma gradually lightens. People are not hiding in the shadows.”

At Altru, employees may take advantage of free counseling services offered through Midwest EAP Solutions, Gessler said.

Services available around the clock and every day of the year include counseling for depression, stress and anxiety; alcohol and drug abuse concerns; marital, relationship and parenting issues, and legal and financial problems.           

About eight percent of Altru’s employees use these services, Gessler said. “That’s about average for health care (organizations).”

Employee contact with the EAP is confidential, he said.  No individual information is released to Altru.

Federal, state requirements

Federal and state laws mandate how organizations treat mental health issues in the workplace, such as granting leave for persons with serious illnesses, Nordstrom said. 

Still, more should be done to address mental health needs, professional mental health associations and other groups say.

They would like to see mental health care services covered by insurance at “parity,” or at the same level, as other health care services, Dewald said.    

Although a law enacted in 2008 attempted to bring parity to health care coverage, “I think there’s been pretty spotty compliance,” he said. 

The expense of providing such coverage is “a consideration for big companies.” 

“Addiction is a chronic disease; substance abuse is a chronic disease,” he said. “The cost is a big part of that for big companies.”   

Even so, the outlook for people who need mental health care is improving, said Dewald, who is a licensed addiction counselor.

“They certainly have opportunities (to get help). It’s much improved over the years I’ve been here.”

Blue Cross Blue Shield of North Dakota works with health care providers, legislators and “other key groups” to identify and address mental health needs in the state, the company said in an email to the Herald.

“While employer groups rarely share concerns about access and coverage for mental health services, BCBSND works closely with our largest employer group customers to identify trends that impact their future benefit design decisions.”

Companies that “are really paying attention to health care costs and their employees’ wellness are not waiting for folks to tell them what to do,” Tonfeldt said. “They’re seeking out (solutions) and managing those things in a forthright way.”       

In the past, Flynn said, “it was thought that the individual is to blame when there’s a mental health issue, and employers didn’t cover it.” 

He pointed to the military as an example of how views concerning mental disorders, such as post-traumatic stress disorder, have shifted. “It used to be called ‘shell shock.’ Now there’s more acceptance of that, if you will.”

Society’s perceptions of mental health issues are changing, he said.    

“We’re not in a great place or in a horrible place (but) we’re moving in a better direction.”  

The mental health of workers is an area of concern to organizations, according to the federal Centers for Disease Control and Prevention.

Depression is a major cause of disability, absenteeism, presenteeism (attending work while sick) and productivity loss among working-age adults, the CDC says.

The ability to identify major depression in the workplace is complicated by a number of issues such as employees’ concerns about confidentiality or the impact it may have on their job that cause some people to avoid screening.

The CDC reports that:      

  • In a given year, 18.8 million American adults (9.5 percent of the population) will suffer from a depressive illness.
  • An estimated 20 percent of people aged 55 years and older experience some type of mental health issues. Depression is the most prevalent mental health problem among older adults.
  • About 80 percent of persons with depression reported some level of functional impairment because of depression, and 27 percent reported serious difficulties in work and home life.
  • Only 29 percent of all persons with depression reported contacting a mental health professional in the last year, and among the subset with severe depression, only 39 percent reported such a contact.
  • In a three-month period, patients with depression miss an average of 4.8 workdays and suffer 11.5 days of reduced productivity.
  • In 2003, national health expenditures for mental health services were estimated to be more than $100 million.
  • Research shows that rates of depression vary by occupation and industry type. Among full-time workers aged 18 to 61 years, the highest rates of workers experiencing a major depressive episode in the past year were found in the personal care and service occupations (10.8 percent) and the food preparation- and serving-related occupations (10.3 percent).
  • Occupations with the lowest rates of workers experiencing a major depressive episode in the past year were engineering, architecture and surveying (4.3 percent); life, physical and social science (4.4 percent), and installation, maintenance and repair (4.4 percent).      
  • Research suggests that 80 percent of patients with depression will improve with treatment. 
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