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Watch as a sea change moves through American employers, affecting how they confront behavioral health issues among employees and families. One-fifth of workers in any year hit a personal crisis that might hurt their work performance. The sea change is not in the number of incidents, but in the steeply rising skills to predict, prevent and contain these disruptions.

Year to year, tools to diagnose and intervene in workers' personal problems are being crafted out of ever stronger science. Ambitious, highly trained professionals are applying these tools, ready to take on hard cases, such as helping a worker with major depression to stay at work.

The vision is holistic: Work and private life can be balanced. Psychological forces behind nonwork disability, worker injuries, sick days, many leaves related to the Family and Medical Leave Act, medical overuse, presenteeism and turnover--all of these can be managed. An expanded-function employee assistance program connects anyone to an appropriate service to meet a work or private life crisis.

THE DIFFERENCE OF 20 YEARS

Consider a hypothetical case, set initially in 1997, involving a worker with a drinking problem. Travel through time. The same scenario is reset in 2007 and 2017 and retold with sharply different outcomes. Single, 35, Neil was a computer programmer for a large service company. His corporate information-technology department had paid a lot for him to learn new database management techniques. In 1997, late Monday arrivals at work brought Neil's case to the attention of his boss, Martha.

Signs pointed to alcohol, too much of which some co-workers felt he imbibed at an afterwork party. Martha herself noticed some slurring of words when Neil called from home. So when they met about Neil's performance, Martha asked, "Neil, will you call our company's employee assistance service?" Neil did not follow up. Nor did Martha.

Martha put Neil on a disciplinary regime. Several months later, with attendance not improved, Martha let Neil go. She told human resources, "I had to let him go. I don't know if he did anything about his drinking." Cost to employer: $50,000 in lost productivity.

Since 1997, the counseling ranks in America have advanced their understanding of alcoholism. They are today more alert to other conditions that can go along with or perhaps precede substance abuse. Counselors know that having only a drinking problem is about as likely as spotting a white buffalo. They've started training supervisors on how to handle problem cases.

Clearly, celebrity memoirs about severe mental disorders and the mass-marketing of mood-altering medications have rendered conditions like depression less stigmatizing, more open to care.

Consider Neil's case again, in 2007. Martha has been tuned into her company's employee assistance program through several telephonic coaching calls about dealing with employee personal problems. So Martha knows to phone her EAP contact about Neil: "I have an employee who is having problems getting in on Monday mornings. I think he drinks over the weekend."

The EAP asks Martha to step back from her well-meaning attempt to diagnose Neil's problem, and to make a concerted effort to induce Neil to call a counselor, which he does. At the EAP's suggestion, Martha specifies her performance concerns in a written memo, which also reminds Neil of resources he can turn to, such as his health plan, his human resource representative and the EAP.

The counselor meets with Neil and finds signs of both substance abuse and depression.

"Neil," the counselor says, "until you get help for both these possible conditions, the chances of more performance problems are very high."

Neil follows up and works in a dedicated way to use his new resources. His work improves. He holds onto his job.

Looking to the future, practitioners are counting on a world with better data; surer strategies for individual predicaments; and tighter, more integrated services. Predicting outcomes for troubled workers will become more fine-tuned and reliable. Fitness, counseling, and other work and life programs, today still rather scattered about, will merge into one available continuum of services, within the reach of a click.

Travel to 2017. After his third unplanned absence in two months, Neil will receive an automated e-mail from human resources. The e-mail will cordially remind him of the attendance policy and the impact of unplanned absences on his team. It will also state the employer's understanding that personal circumstances occasionally disrupt the lives and work of employees, and will remind Neil that the EAP can not only help him with specific challenges but can also confidentially explain employer benefits that are designed to support employees through tough times.

Martha will have received a similar e-mail that will invite her to consult with human resources or the EAP's executive consulting service about how to address Neil's attendance with both authority and thoughtfulness. The memo will provide talking points that can help Martha remind Neil of company resources for maintaining a path to success with the company.

It will dawn on Neil that he is drinking more, mainly to control feelings of loneliness and futility. He will turn to a self-exploration module at his online benefits Web site, which he will have been incentivized to use. He will read that being both depressed and drinking more puts him on a bright-red path toward poor job reviews and even termination.

He will click a button immediately connecting him to a live, warm counselor. In their 20-minute conversation, Neil will admit that he has fallen into a daily drinking pattern and that his primary care doctor is unaware of it. He will accept the EAP's offer for a "chemical health assessment," as well as the counselor's invitation to transfer his call on the spot to a department that can explain the range of medical and personal leaves that might be available to Neil.

He will take a few days of sick leave for appointments with his primary care doctor, a substance abuse clinic and a consumer credit group that will work with him to restore financial stability.

Neil will start going to Alcoholics Anonymous and taking physician-prescribed drugs. He will also improve his physical fitness. The self-diagnostic module will track his progress among his demographic cohorts.

TOMORROW'S AWARENESS

Neil's 2017 scenario is predictable based on what is happening now.

While we do not have Neil's self-exploration module yet today, it is clear we will make more use of self-assessment in the future because it works today.

New York City area physician Jeffrey P. Kahn and psychologist Charles Sodikoff of WorkPsych Associates Inc. recently asked employees of a Fortune 100 firm to describe what drives stress, absenteeism, presenteeism, turnover and medical overuse. They asked questions about a wide variety of possible root causes. Employees fingered the causes of presenteeism to be unclear reporting lines or assignments, difficult work tasks, specific anxiety and depressive disorders, perceived senior management indifference and negative opinions about their supervisor.

Kahn says that absenteeism and high outpatient medical care use had other causes. "A different set of specific anxiety and depressive disorders, home stress and being in a nonmanagement job," he says.

Intervention will be able to be performed with greater clarity going forward because the intervention strategies will be enabled by more potent databases.

Cigna Behavioral Health just released the initial but astounding results of a trial intervention involving enhanced information profiles of beneficiaries.

The trial, completed in 2006, involved about 500 claimants with major mental conditions such as depression. Many of them also had physical conditions including diabetes and cardiovascular problems. All were enrolled in Cigna health-care insurance programs. Their medical and disability experience could be tracked, step by step, in an integrated database. No easy task even today.

Cigna assigned telephonic care advocates to this population. The claimants received an average of 1.2 hours a week of coaching and encouragement. The enrolled population had 48 percent fewer outpatient visits for all purposes compared with historic patterns. In contrast, a control group experienced a 33 percent increase. Enrollee health-care expenses averaged $3,000 less than historical patterns.

Cigna is in the process of analyzing the effect of the care advocate program on disability duration. Advances like Cigna's put pressure on vendors to collaborate through their data. David Campbell, senior vice president at ComPsych says, "There is going to be a better system for sharing and merging data to predict potential programs. The only way we can do this is to share data among vendors."

TRICKLE-DOWN HEALING

The holistic model will eventually be embraced by companies beyond the Fortune 500.

Jim Walter runs Employee Services Inc., which provides EAP services primarily to small and midsize companies. EAP penetration rates, he says, "drop considerably when you go below 100 workers." Yet these small employers account for one-third of total employment. Relatively few of these small companies and midsize employers are using a holistic approach. Walter estimates that, when employers offer a wide range of services, their EAP use goes up considerably. That's good. "People will be more ready to use the EAP whenever there is a really serious problem," he notes.

The scientific study of psychology and the worker began 100 years ago in a few pioneering universities. Psychologists then sought to understand human potential through a set of rules and tables. The messiness of humanity and paucity of data got in the way. Today, with much better technique and information, that early optimism has returned.

PETER ROUSMANIERE is a Vermont-based writer and columnist for Risk & Insurance®.

June 1, 2007

Copyright 2007© LRP Publications