Despite at least two decades of extensive public education campaigns, increased workplace supports and advances in health care, mental illness remains a leading cause of disability in Canada. Many people experience a mental illness in their lifetime and the cost to the economy can be staggering. Add to that the devastating personal costs — unemployment, relationship breakdowns, reduced quality of life and, in extreme cases, suicide.
The reasons for the lack of progress also remain the same: limited access to specialist and services, a reluctance to seek help because of the continued stigma about mental illness and the complexities of receiving a diagnosis and access treatment.
Not an easy fix
It doesn’t help that the assessment and treatment of mental health issues is rarely straightforward. Mental illnesses often develop in conjunction with physical illness or chronic pain. For example, the symptoms of depression, the most common mental illness, can include physical complaints such as headaches, stomach aches and joint pain. Conversely, many chronic pain sufferers also experience severe levels of depression.
Difficult life events such as job stress, divorce, financial difficulties or trauma can also have a negative impact on physical and mental health, as do unhealthy coping behaviours like overeating, smoking or alcohol abuse. A lack of resiliency directly influences a person’s ability to cope, resulting in anxiety.
The real need is to have both a diagnosis and treatment plan for mental illness in order to simultaneously address physical and environmental issues. The assessment requires sufficient time for a proper mental health diagnosis, according to the white paper Mental Health Treatment: Changing Perceptions and Changing Needs by SCM Health Solutions, which includes an examination with diagnostic testing, as appropriate, as well as a review of relevant scientific literature, and the individual’s life circumstances and health history.
More integrated approach needed
For treatment, a more integrated psycho-educational approach is also needed, one that ensures collaboration and co-ordination between primary physicians, specialists, psychiatrists, government agencies, employers, insurers, private providers and, if required, case managers.
Currently, this is not what’s happening. Diagnosis of mental health conditions is often left to family doctors, with treatment often involving medication alone. The medication is to stabilize, not resolve, mental health issues.
Even when patients obtain treatment, the results can be mixed. When treatment is prescribed, about one-third of patients never fill the prescription, and another third fill it but do not take the medication, according to a 2006 report from the National Community Pharmacists Association in the United States.
Finally, the last third take the prescription, but there is no guarantee they are administering it to themselves properly.
This is not so much an indictment of physicians as it is an observation about the stark reality faced by users of the health-care system.
The challenge for general practitioners and patients is that accessing and co-ordinating these various supports can be extremely challenging, especially in more remote or rural areas.
Accessing treatment through Canada’s mental health system can be a difficult proposition.
The economics of mental health
The case for increased investment in providing advanced mental health support can be easily made from an economic standpoint. In any given week, according to a 2010 report in the Journal of Occupational and Environmental Medicine, at least 500,000 employed Canadians are unable to work due to mental health problems — often because of disability cases.
In fact, mental health issues continue to represent more than one-third of all short- and long-term disability claims and 70 per cent of short- and long-term disability costs.
Many employees suffering from mental health issues are doing so in silence. Mental health is often not visible.
And lost productivity from presenteeism — where employees are at work but because of an unaddressed physical or mental issue, are less productive — can be considerably greater than productivity loss from absenteeism.
In an effort to address the rising costs of mental health issues, more and more companies are re-evaluating workplace health programs and policies and turning to private health-care providers for new options and a co-ordinated, multi-faceted approach.
This includes managing clinical risk through objective medical consultations for employees at work or just accessing disability to prevent untreated conditions from becoming increasingly severe.
Today’s workplace health programs need to include:
Emphasis on early identification: Accurate and timely medical diagnosis through mental and physical health assessments, online information and support, as well as extensive employee and manager training programs are just some of the options to help individuals identify and proactively address mental health issues in order to move toward treatment and recovery.
Early interventions: As with physical illnesses, early treatment is essential. Delaying diagnosis and treatment can exacerbate symptoms and greatly increase costs. When employees have early access to treatment, employers save between $5,000 and $10,000 per worker per year in prescription medication, sick leave and replacement workers, according to Mental Health Works.
Integration: Integration of traditional and alternative health services within an individual’s care pathway through public services, insurer programs, EAPs and disability management providers can enhance recovery, avoid duplication of services and reduce costs.
Continuum of care: Workplace health programs need to include an array of health services spanning all levels of care: From education and prevention, physical and mental health risk assessments to medical file reviews, and from integrated and co-ordinated treatment with an employee’s treating physician, to return-to-work supports and ongoing support.
Education programs: These not only address physical and mental health risks and resiliency but address stigma surrounding mental illnesses. All levels of management should also be included to help them deal with mental health issues in the workplace and guide employees to the appropriate help.
Ease of use: Even the best programs are of no use if employees don’t, or can’t, access them. Resources should be available through a variety of platforms to meet generational and cultural needs: by phone, in-person and especially electronically.
Embracing new technologies
Above all, programs need to be adaptable and flexible. Canada has a multigenerational and culturally diverse workforce and a one-size-fits-all approach no longer works. Programs must be continually assessed and adjusted to meet changing
demographics and needs, and that includes embracing new and emerging technologies.
Telemedicine lets individuals speak directly to a doctor or specialist who assesses their needs while connected online — from anywhere and at any time. And it’s cost-effective for both the employer and individual.
In British Columbia, telehealth is available in more than 66 communities. In a recent survey by Canada Health Infoway in B.C. patients, 79 per cent of users reported receiving the same quality of care as an in-person visit, while 37 per cent felt the care they received was even better.
Another 13 per cent said they wouldn’t have otherwise sought medical attention at all. Expanding the telehealth program to improve rural and remote residents’ access to health services and specialists is now a priority.
A significant issue
Mental health continues to be a significant economic and social issue. While great strides have been made to reduce much of the stigma that once surrounded mental illness, more needs to be done.
Barriers to timely care also still exist — the demand for access to effective assessment services far outstrips supply with shortages of mental health professionals.
There are also regional disparities, a lack of cross-cultural services and difficulties navigating the public health-care system. New, more integrated, collaborative approaches to care pathways are required.
In an economy where critical skills are in increasingly short supply, and mental illnesses usually strike those in their peak earning years, Canada cannot afford to allow this situation to continue.
Doctors, government agencies, employers, insurers and private providers need to come together to embrace service alternatives that enhance the effectiveness of our health-care system. It’s time to rethink the way we diagnose and treat mental illnesses.
Karen Seward is president of SCM Health Solutions in Toronto, operating as Cira, MDAC, trm, Sibley. For more information, visit www.scmhealthsolutions.ca.
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