Nervous about Mental Health Benefits?
By Mike Johnson, Employee Benefits Practice Lead
Back in 2014 the first large-scale survey of mental illness and its treatment in the United States since the early 1990s was completed by Harvard Health Publishing. Keep in mind that this was back in 2014 when the world of mental health was still largely kept behind private, closed doors. Entering 2020, the stigma around mental health is changing and the topic is no longer taboo.
The 2014 study showed that almost half of American adults at some time, and nearly a quarter in any given year, have had a psychiatric disorder. In the study, interviewers asked the following question: “Have you ever been treated for problems with your emotions, nerves, or use of alcohol or drugs?” About 80% of people with a psychiatric disorder responded that they had eventually sought treatment, but often after a long delay. The average time to receive treatment was 10 years after symptoms first appeared. This was the one statistic from the study that really stood out to me as an Employee Benefits consultant.
Guess what those individuals who, on average, are waiting 10 years to seek treatment after symptoms first appear are doing every day? Showing up to work, suffering in silence. We spend roughly 1/3 of our adult lives at work; do you think this issue is impacting the workforce? Significantly.
This problem shows up in claims data as well. Disability carriers are seeing an increase in claims for diagnosable mental health related issues from 8-9% historically to 12-15% in 2018. Financial services are particularly impacted from 15% in 2015 to 21% in 2018.
So, how are employers responding to this? It’s by far one of the top 3 conversations I am having daily with employers, but there is no clear roadmap. So, here are 3 strategies I recommend looking into:
Suggestion – Look into having all your front line managers and human resources staff complete a Mental Health First Aid training course. Mental Health First Aid teaches you how to identify, understand, and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis. Journey Mental Health (Madison) is one company that offers these courses.
- Issue #1 – Lack of training. Employers are in a tough spot here. Despite the growing awareness of mental health, some reports show that 50% of managers believe no one in their workplace is currently affected. That might be mathematically impossible considering the 10-year gap we discussed earlier. On top of that, employees are still concerned about disclosing a mental health condition to their employer for fear of job loss and negative perceptions. This makes the situation for managing mental health, especially when on the surface everything seems ‘fine’, extremely difficult. Open, trusted dialogue about mental health needs to happen for any type of change to occur. But as managers, are we equipped to have these conversations if we’ve never been taught how?
Suggestion: Look at your data! Obviously, the information you have access to will be unidentifiable, but it will give you a sense of how you should set up a communication plan. Are you offering enough face-to-face visits or can more be purchased or negotiated? Can you integrate a web-based mental health app into your program? You need to market this benefit like you would any other benefit offering. Work with your consultant to set up a communication plan via text message, video, or printed materials.
- Issue #2 - Do your employees even know what an EAP is or how to use it? Often times Employee Assistance Program (EAP) services are a free add-on from your life & disability carrier and might be communicated once around annual enrollment time as a listed benefit…and that’s it. Also, employees may be concerned that their participation in an EAP will be known by their employers. More often than not, these concerns exist because employees are not properly informed about the structure and intent of their company’s EAP. Today’s new age EAP services are investing resources in developing apps, or other methods that provide technology-based mental health solutions. That is an extremely important development, because timely access to mental health professionals is becoming increasingly rare.
Suggestion: You can get disability insurance if you have a mental illness, but your coverage could be limited. You really need to review and shop around for a plan that fits your needs and intent as an organization. I can tell you a large majority of employers haven’t looked into this in much detail. Here are a couple talking points (there are many more points, but these are some of the bigger ones):
- Issue #3 – Disability contract language regarding mental health. If I were to flat out ask you the difference between a cancer claim and a mental illness claim in your current disability contract, could you answer confidently?
This is a very deep issue employers and employees are facing. If you as an employer are providing professional training to proactively identify and respond to signs of mental health or substance abuse disorders, effectively communicating what benefits are already available within your organization, and ensuring you are offering adequate coverage that matches your intentions as an employer for mental health or substance abuse when it is needed most, all I can say is “thank you” from the people out there silently suffering.
- The 24-month mental health limitation is included in most LTD contracts. It is standard language for most carriers and has been for some time. It can be removed at request, but it will carry a significant rate load (between a 4-6% increase in total premium, generally speaking). If you're receiving LTD payments due to depression, anxiety, post-traumatic stress disorder, chronic fatigue syndrome, or a similar impairment, you may be limited to receiving 24 months of benefits. I have seen some policies have this limitation as short as 6 months! Also, is that 24 months a lifetime maximum or per occurrence?
- Short-term disability insurance – You might have heard that short-term disability insurance doesn’t cover mental illness. This widely depends on the insurer, but double check to make sure your policy is matching your intentions.
- Failure to continue treatment – LTD policies generally require you to submit periodic proof of your continuing disability. This can be an annual re-certification by your physician, for example. One of the most common reasons LTD benefits are terminated is that a person has failed to receive regular medical treatment. This can occur even if your doctor tells you that there is “nothing more that can be done for you”, which can often times happen in mental health situations. With the access issue regarding mental health, be sure you understand what the language around “regular treatment” means.