Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Forum on the Business Sector and Mental Health
"Working Together: The Business Case"
April 28, 2006
San Juan, Puerto Rico
PowerPoint version
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Slide 1
Good morning. It is my privilege to be here this morning with Dr. Galarza, Mr. Puras, and all of you…distinguished leaders of business and industry…for this
The prevailing sentiment today is —“when business talks, everybody listens…as business goes, so goes the world.” I think it’s an accurate expression and explains why when an issue impacts the business sector…the problem receives a great deal of attention.
This morning, I want to talk to you about a number of issues that are as critical to business as they are to our larger society— the impact of behavioral health in the workplace, the social and economic costs of mental disorders, and the important role you and your companies have in the future of your communities.
As business leaders, addressing mental health issues is both the right thing to do for people…and, a critically important thing to do to protect the health of your business…your bottom line….and the vitality of the communities you live. Citizens with good mental health are essential to a productive workforce. Communities that promote positive mental health make better places to live and work.
My mission is two-fold. I am here today to urge you, as business leaders…as people with influence…to use your power in the private sector to help advancean initiative that will transform mental health care. I am here to invite you to focus on and invest in the mental health of your workforce…and in doing so, become a model for the rest of the world. I am here to ask you to join us as agents of transformation.
I am very passionate about these subjects and have spent many hours in deep discussion with people from almost every state and commonwealth who are committed to the transformation of the behavioral health care system.
However, I don’t have to quote other people from other places to make this point. Instead, I’d like to open our discussion with a very powerful message that is home grown —a passage from the Puerto Rico Children’s Mental Health Plan FY 06.
In Section 2 of the plan, Puerto Rico’s Service System strengths were itemized and prioritized. At the end of this technical section was a final paragraph with just this statement:
Slide 2/Quote
“We have a shared dream; working together is the only way to realize it.”
That one sentence eloquently sums up the vision, the reality, and the reason that we are all here today. You are facing many of the same challenges that are confronting us in the broader behavioral health community. We are dependent on each other…those of us in business and those of us in public health…to take action to achieve our shared vision.
The statistics drive home the message: behavioral health is an urgent public health priority. Mental illnesses are more common than cancer, diabetes, or heart disease.
Slide 3/Statistics
In the United States, more than 40 million individuals have a diagnosable mental disorder. Substance use disorders are also common. About 22 million Americans have a serious substance abuse problem. More than 4 million Americans have serious co-occurring mental and substance abuse disorders.
There is a need for more research and comprehensive data collection that focuses specifically on the needs of Puerto Ricans. However, a large study conducted in Puerto Rico reported similar rates of mental disorders among residents of the island, compared with those of citizens of the mainland United States.
And the challenges are mounting. Mental health disorders are major concerns for all of us.
The World Health Organization predicts that by 2020, disability from mental illness will increase by 50% globally—a larger proportionate increase than that for cardiovascular disease.
Slide 4/Need vs. Access
Worse, yet, in spite of the fact that a range of effective treatments exist for most mental illnesses, less than half of those people in need of mental health services get treatment! We estimate that two-thirds of children and adolescents who need mental health services do not receive them.
The National Institute of Mental Health reports in their survey that people who do seek treatment typically do so after a decade or more of delays, during which time they are likely to develop additional problems. To make matters worse, the treatment a person receives is often inadequate…it fails to meet minimal standards of care established by evidence-based treatment guidelines.
These issues appeal to us as human beings…as members of a society that values the dignity of the individual and the richness of our relationships with our families, our neighbors, and our communities. As leaders of industry, I know that the business case for improving behavioral health care is equally compelling to you.
Slide 5/The Business Case
Mental illness and substance use disorders, as a group, are considered to be one of the 15 most expensive health conditions in the United States. These illnesses impose costs on individuals and families, local communities, States, the federal government, and employers.
Consider the impact of depression on the workplace. Depression is one of the most pervasive and debilitating of the major chronic diseases. It is one of the leading causes of disability worldwide.
A Rand Corporation study found that the effect of depression on a person’s day-to-day functioning is comparable to that of a chronic heart condition. It’s estimated that depression alone costs the United States up to 44 billion dollars annually. Approximately 200 million workdays are lost each year.
Mental illness causes more days of work loss and work impairment than many other chronic conditions such as diabetes, asthma and arthritis.
According to the US Surgeon General’s Report on Mental Health:
“The burden of mental illness on health and productivity in the United States and throughout the world has long been profoundly underestimated.”
Substance use disorders exact a similar financial burden. According to the 2003 National Survey on Drug Use and Health, approximately 10 percent of America’s workforce regularly abuses or is dependent on alcohol or drugs. These disorders cost U.S. businesses an estimated 100 billion dollars a year in lost productivity, higher health care costs, and worker compensation.
Employee health has long been seen as a key factor in productivity, although it has traditionally been evaluated only in terms of the direct cost of providing health benefits. Increasingly, employers are realizing that there are significant indirect costs—in the form of lost work time and impaired performance—created by poorly managed or unidentified employee health problems.
Employees who are depressed at work have been shown to lower the morale of their coworkers, resulting in a higher turnover and general discontent.
“Presentee-ism” is a major source of concern for employers. The term refers to when an employee goes to work sick but cannot work at full capacity. Researchers report that this can affect employers three times—first by the low productivity of the employee at work; secondly, when the worker leaves; and a third time when other workers have to compensate for the affected worker’s low productivity.
This research challenges the old way of thinking…in the past, most business people considered health benefits as a budgetary line item that had to be controlled. Today, many employers are taking a systems approach, and are beginning to assess total costs related to employee health. Employers are looking not only at direct health care costs, but also costs that are indirectly related to employee health—including absenteeism, prolonged disability, turnover rates, and productivity levels. In many cases, these indirect costs substantially exceed the direct costs of health care.
Let me repeat that…employers have found that in many cases, the indirect costs of employee health issues substantially exceed the direct costs of health care.
Slide 6/Effective Treatment Benefits Employees
On the other hand, treatment of conditions such as depression saves employers money. A recent study showed a 6.2% increase in productivity and 22.8% fewer absences over two years for depressed individuals who received regular phone calls to encourage them to continue with treatment and medication. Employers saved more than $2600 annually for each employee.
Treatment for mental illnesses works…and people do recover. Successful treatment returns people to work. Successful treatment of mental illnesses also reduces costs for other medical conditions. And, because patients with inadequately treated mental illness are heavy users of medical services, if appropriate mental health services and treatments were made available, the resulting decrease in medical utilization could generate large savings for health care programs.
Slide 7/ Successful Treatment Benefits Communities
When we widen the scope of this discussion, and look at the impact on the larger community, the stakes grow even higher. For example, providing appropriate mental health services for children and their families saves money in other service systems. A recent national study comparing costs in communities with and without systems of care for children and youth found that expenditures for juvenile justice, the child welfare system, and inpatient mental health systems were all higher in the non-system of care communities. Untreated disorders in children disrupt their education and early careers. Untreated disorders reduce lifetime earnings and future tax payments, and may lead to the need for income supplements, housing and employment supports. Can you see what happens when mental health treatment is not available in your community? The human cost and financial burden are staggering.
Yes, the impact of behavioral health on the workplace…and on the communities in which your employees live…is clear.
But, what can you do, as a business leader to make a difference? You can transform the way you think about and address issues related to mental health and substance abuse in your business. In doing so, you can provide a model for other business leaders…and help advance a wholescale transformation of our behavioral healthcare system that will change the face of care for generations to come.
Slide 8/Achieving the Promise
The vision of a transformed behavioral healthcare system began several years ago, with the work of President Bush’s New Freedom Commission on Mental Health.
In its final report to the President, Achieving the Promise: Transforming Mental Healthcare in America, the Commission called for nothing short of a fundamental transformation of the mental health care delivery system in the United States.
Achieving the Promise envisioned a transformed system…a mental health system that is driven by individual and family needs…a mental health system that focuses on building resilience and is centered on recovery.
It is a vision that moves the role of consumers and their families far beyond simply participating in the system…they become the reason for the system. It is a powerful idea and very different from the status quo. It requires each of us to change the way we think about the delivery of mental health services.
I’d like to take a moment here to look at what we mean by “transformation.” As we move forward, it is imperative that we all understand the meaning of our shared goal.
Slide 9/Transformation
Transformation calls for a different set of values…an entirely new way of thinking…and a better way of providing services to consumers and families. Transformation calls for fundamental change at the very core of a system…not on the margins. It leads to new behaviors and new ways of doing things. It changes how we do business. In transformation, we are able to do things we were unable to do before.
Transformation is meant to identify, leverage, and even create new underlying principles for the way things are done. New sources of power emerge. And once the process of transformation begins, a profoundly different system materializes…a system changed in structure, culture, policy, and programs.
Achieving the Promise outlined 6 broad goals and 19 more specific recommendations.
Slide 10/Transformation Goals
These are the six goals. I won’t go through each one of the goals this morning, but I would like to use the first one as an example of why partnerships with the private sector business community are essential to our ability to make transformation happen.
Goal 1 calls for an end to the stigma and discrimination that prevents many individuals from seeking treatment. Here in Puerto Rico, the Mental Health and Anti-Addiction Services Administration (MHAASA) has promoted and cooperated with mass media efforts to focus on mental health awareness and early intervention. We have been working on a similar campaign in the States with the Ad Council.
As business leaders, you have the power to create your own strategy to end stigma in the workplace. For instance, there is a widely-held myth that people with mental illnesses cannot work. This is simply false.
Slide 11/Quote
In point of fact, in any given year, 39 million adults age 18 to 54—the “working” population—experience a mental illness and/or substance use disorder. Contrary to popular belief, most individuals with mental illness and substance abuse disorders work. Approximately 90% of adults classified as having a substance use or dependence disorder and 72% of individuals with a mental illness work.
Discrimination against persons with mental disorders causes those who are employed to fear that seeking treatment will harm their career or end it altogether. The real truth is that not seeking treatment is more harmful to a person’s career. Undiagnosed and untreated disorders can have negative, long-term consequences that extend into every aspect of a person’s life and can even become life threatening.
It’s important to note that many people who would never think of themselves as suffering from a “mental illness” are actually experiencing it. In the world we live in…the only thing constant is change. This can create a high degree of stress and anxiety. On the front page of every newspaper, on the radio, television, and Internet we hear about downsizing, mergers, losses, and the radical effects that global competition can have on companies…and that, in turn, impact us as people and as employees.
Earlier this month, in The Washington Post, there was an article by Jennifer Huget that described how the fear of losing one’s job takes a greater toll on mental and physical health than actually being laid off or fired. Researcher, Sarah Burgard, from the University of Michigan drew her data from The Americans’ Changing Lives survey that has questioned more than 3,600 adults on topics ranging from employment history to health-related behaviors every few years from 1986 to 2002. Burgard and her colleagues concluded that chronic job insecurity—an employee’s ongoing perception that his job might be at risk—was more strongly linked to poor health and depression than was actual job loss or a brush with life-threatening illness.
The implications of this are troubling. Burgard is quoted as saying, “This could mean that policymakers need to think about how to reduce the threat associated with job loss… and to rethink the health-care costs and productivity losses that could occur in workforces composed of a rising number of insecure employees.”
Re-thinking the way mental health care is perceived, accessed, delivered, and financed is what transformation is all about. Another fundamental component of transformation is collaboration. The burden of mental illnesses…and the responsibility for protecting mental health and promoting recovery…crosses all organizational boundaries. People with mental disorders have complex and multiple needs that no one agency, no one organization, no one system can meet on its own. The speed and extent of transformation hinges on how well we all work together for change. The more we collaborate, the more we help.
Slide 12/Action Agenda
At the Federal level, we have engaged nine departments and 13 agencies within the U.S. Department of Health and Human Services to carry out a collaborative Federal action agenda. Last July, the Federal Partners Workgroup for Mental Health Transformation issued Transforming Mental Health Care in America: The Federal Action Agenda. This agenda outlines the first steps we will take to achieve the goals of the transformation.
Last fall, we awarded the first Mental Health Transformation State Incentive Grants (SIGs) to seven States to begin making the systemic changes necessary to meet the goals of Achieving the Promise at the State level…the real center of gravity for transformation.
We will use the experiences of the these States to inform other States on which strategies work best in developing comprehensive service systems.
Here, in Puerto Rico, the Mental Health and Anti-Addiction Services Administration is an important partner in transformation. You have demonstrated a deep commitment to creating a recovery-focused system through a number of transformative activities, including:
- The Educational Summit on Mental health that actively engaged 1,000 consumers and their relatives;
- The Special Communities Program that conducts an outreach program using peers;
- The Department of Health Early Intervention program to prevent drug use;
- Your sponsorship of ongoing research through academic institutions like the Institute of Behavioral Science at the University of Puerto Rico and the School of Public Health at the State University; and
- The Integrated Specialized Family and Juvenile Court Project, where MHAASA provides fast coordination for outpatient services and hospitalization for referred children and adolescents…along with mental health and substance abuse services to juveniles in custody.
SAMHSA needs more partners like the MHAASA to make the transformation vision a reality. We are also on an urgent mission to enlist private sector partners as agents of transformation. One notable example: we have launched a collaborative effort with the National Business Group on Health that will result in improved behavioral healthcare services for persons served in both the public and private sector.
The Business Group members are primarily Fortune 500 companies and large public sector employers. This organization was started to foster the development of a quality healthcare delivery system and treatments based on scientific evidence of effectiveness. Their membership includes companies like American Express, Bank of America, Dell, General Mills, IBM, Lucent Technologies, Wal-Mart Stores, PepsiCo, Time Warner, and Xerox Corporation.
In January 2004, SAMSHA funded a meeting of the National Committee on Employer-Sponsored Behavioral Health Services that was convened by the Business Group. The Committee of 25 experts was charged with reviewing the quality and structure of employer-sponsored behavioral health services. These experts, specializing in areas such as research, employee assistance plans, pharmacology, disability insurance, and other types of health benefits, analyzed major trends and prepared recommendations.
The first outcome of this partnership is the publication of a new guide entitled—An Employer’s Guide to Behavioral Health Services—that recognizes the public sector system for its use of evidence-based behavioral health care services and recommends that employers utilize these services.
The Employer’s Guide serves as a roadmap for evaluating, designing, and implementing affordable and effective behavioral health care services. It recommends less fragmentation and duplication of services and increased access to quality services by private health plans.
The public sector can play an important role in these changes over time, as its providers are increasingly included in new networks of care. The recommendations in The Employer’s Guide are based on the best-available administrative and clinical practices; these practices have years of evidence to support their immediate and widespread implementation.
Slide 13/Employer’s Guide
This resource provides problem identification, specific actions, and recommendations that will enable you and other employers to create and implement a system of affordable, effective, and high-quality behavioral health services. Here’s where you can download a copy of the SAMHSA-funded “An Employer’s Guide to Behavioral Health Services”: www.businessgrouphealth.org
Why is this important to you? Basically, because people are the bottom line.
The members of the National Business Group on Health and many other employers around the world have transformed their way of thinking about business in many areas, but most importantly, about the way they think about their employees…the people that work in their organizations.
They are beginning to look at the employee benefits function not as a cost center, but, as a catalyzing force for promoting human and intellectual capital.
These transformational leaders are realizing that protecting and promoting their employees mental health is an investment.
After all…people, not organizations, are our most valuable assets. People create. People innovate. In the places we work, it’s the individual efforts and the relationships that people form that ultimately determine whether businesses succeed or fail.
As the leaders of businesses and industries, identifying and removing impediments to individual performance is one of the most important things you do. The transformation of the mental health system requires we take the necessary actions to remove these barriers to performance…to make transformative things happen.
Joel Barker, an author and futurist, said:
“Vision without action is merely a dream.
Action without vision just passes time.
Vision with action can change the world”
The need for vision with action is critical. What are some of the things that you can do today?
Slide 14/What Can You Do?
You can commit to opening more jobs to people that might have behavioral health issues. You can volunteer to serve as mentors. Most importantly, you can agree to continue to work together with the people in this room. You can agree to recruit more employers and build on the energy of a working partnership with the MHAASA.
We have a shared vision. The key to a successful vision is to move beyond what you think is possible. Instead of limiting your vision to what you think mental health care can be, think about what mental health care should be!
Think about how you can be proactive—rather than reactive—in addressing mental health concerns in the workplace. The greatest risk of failure is not from making changes. Instead, the greatest risk of failure comes from struggling to maintain the status quo when change is all around you.
Slide 15/Quote
“We have a shared dream; working together is the only way to realize it.”
Working together, we can realize the vision of a transformed system. We can do more than transform our businesses and our communities. We can do more than transform our mental health care system.
We can transform lives.
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