Imagine you've had a sudden, serious heart attack. You're unable to work, you have unending financial obligations, are just about to send your first child to college, and you're seriously concerned about making ends meet.
All too often, this is the situation employees find themselves in when they're saddled with a short- or long-term disability. Medical concerns aside, there are mental health issues, stress and depression for example, that crop up as a result of the disability claims.
If left untreated, mental health issues could impede an employee's physical recovery, delaying the victim's return to work.
Mental health, it turns out, is present in many disability cases, according to a recent study by Cigna. The study found that in almost half the disability cases, depression is a secondary factor.
"Behavioral health conditions, when associated with a medically related disability, result in poorer outcomes," says Barton Margoshes, chief medical officer, Philadelphia-based Cigna Group Insurance.
Chronic pain, heart disease, diabetes, asthma and low back pain are often associated with higher rates of depression, he says. That can influence the course of the medical condition.
Depressed workers lose about 5.6 hours of productive time on the job each week, compared with an average of 1.5 hours for workers who are not depressed, according to an article in the June 2003 issue of the Journal of the American Medical Association.
When it comes to disability management, "you need to treat both the physical and mental components of a disability," says David Whitehouse, corporate medical director of Cigna Behavioral Health, Eden Prairie, Minn.
"You need to look at the human psychology of what it means to be disabled--the physical and emotional issues, loss of your sense of self, feelings of guilt and loss of the ability to contribute to the family," he says. "There are many psychological issues and changes that may impede an employee from getting back to work."
RETARGETING EMPLOYEE PROGRAMS
One of the ways employers and insurers are addressing the issue of mental health is by focusing on the use of employee assistance programs.
Once thought of as programs only for employees with alcohol or substance abuse problems, these programs have grown into counseling and referral services that can assist employees and their dependents with behavioral health, wellness and life management issues.
Having an EAP can go a long way toward helping to prevent a disability in the first place. It also speeds recovery and the time it takes to return an employee to work when disabilities arise, according to a June 2002 report, The Disability and Health Care Connection, issued by Cigna. As a way to promote and maintain a healthy and productive workforce, life assistance programs and employee assistance programs are being integrated with disability programs to ensure that these issues are addressed before an employee is injured or suffers an unexpected illness.
"The goal is to keep people from becoming disabled in the first place," says Margoshes.
In many cases, employee assistance programs address workplace, family, legal and financial issues, such as providing assistance with childcare, eldercare or higher education.
Companies with EAPs in place have a 21 percent lower absenteeism rate and a 14 percent higher productivity rate, according to the Substance Abuse and Mental Health Services Administration of the U.S. Dept. of Health and Human Services.
Cigna says it has a behavioral health specialist in its disability claim office. If the need arises for a life assistance or mental health service in the course of a claim, the call is transferred from the disability nurse case manager to an employee assistance program professional, but only with the permission of the client.
This approach avoids delays in the client's recovery and improves his or her chances of returning to work faster, particularly because employees often don't call an employee assistance program professional for help.
The Hartford, as part of its group disability offerings, also makes available an employee assistance program. This kind of program has proved its worth, says one Hartford executive.
A 4 percent to 6 percent employee assistance program utilization rate could "significantly reduce" unscheduled absences, says Carol Harnett, national practice leader with Hartford's Group Disability and Life Practices.
In one instance, she also says, a client found that a 1 percent to 2 percent employee assistance utilization rate translated into "close to the majority" of employees returning to work, even after experiencing a disability.
Unum Provident in Chattanooga, Tenn., has enhanced its group disability program with an employee assistance program. Employee assistance program consultants serve as "care coaches" who can help develop action plans, monitor employees' progress and facilitate referrals.
"Anytime someone is felled by illness or injury and is unable to go to work, they're missing an important set of positive mental health reinforcements," says David McDowell, co-chief medical officer at Unum Provident. "When people aren't able to go to work, the integrity of their daily structure falls apart. They may be unable to sleep; [they may] turn to alcohol for assistance. They may feel a lack of collegiality due to loss of socialization from work colleagues and friends."
Employee assistance programs can motivate employees and encourage their return to work, McDowell also says.
In a 2004 survey conducted by Ceridian, the provider of UnumProvident's employee assistance program services, 94 percent of the insurer's customers who used the service reported they were satisfied.
The survey also found that 80 percent of the respondents said it helped reduce stress, 74 percent reported missing less work and 70 percent said it improved their productivity. The program is a feature of most of UnumProvident's group long-term disability plans.
Ronald S. Leopold, national medical director and vice president of MetLife Disability in New York, says the best way to let employees know about the existence of an employee assistance program is when they are dealing with a short-term disability claim.
In 2003, psychiatric claims made up 7 percent of all of MetLife's short-term disability claims. The majority of them (55 percent) were related to depression. Another 30 percent were related to stress and anxiety. Taken together, these conditions may cost U.S. employers an estimated $344 billion annually in lost productivity and medical fees, according to MetLife.
"Employee assistance program services provide a good link between employers, employees and providers," adds Edward Jones, chief clinical officer at PacifiCare Behavioral Health in Santa Ana, Calif. Looking at the integration of medical and behavioral issues along with physical and mental issues is at last getting the attention it deserves among employers and insurers, he says.
"These behavioral issues are often missed, as the individual may not be truly depressed with a clinical disorder," he also says. "But depression related to the disability impairs people's ability to adhere to medical advice and may cause other physical problems down the line."
Behavioral health programs provide the integration between physical and mental health issues, according to Jones, because they help break the fragmentation in health care treatment plans. That results in individuals taking charge of and managing their own health.
"An individual's behavioral health greatly impacts their recovery from a medical illness," says Karen Friedman, vice president, account management, in the Employee Solutions Division of Magellan Health Services in Farmington, Conn.
Physiological components of an injury need to be dealt with because they have an impact on a person's ability to heal. A disability may have an impact on the person's ability to provide childcare, eldercare or a college education. "An employee assistance program can address all of these issues and support employees' wellness and productivity, even before a disability occurs," says Friedman.
While it's true that the stigma associated with EAPs seems to have diminished as they've taken a more "life-management" vs. mental health approach, employees may still be afraid to ask for help, says Marcia Carruthers, co-founder of the Disability Management Employer Coalition, based in San Diego, Calif.
"Many employers are doing a better job of publicizing employee assistance programs to their employees, helping to remove the stigma associated with their services and focusing on helping employees deal with high stress levels, letting them know there are resources available to address their concerns," she says.
And the sooner a company acts, the better.
"In many cases intervention through a behavioral disability management program or employee assistance program within the first couple of weeks of treatment helps get an individual back to work as soon as possible," she says. Very often, employees are even appreciative of their employer's extra help.
MINDY TORAN, a former Risk & Insurance® staff editor, is a freelance writer and contributes frequently to this magazine.
May 1, 2005
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