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
SAMHSA/U.S. Office of Personnel Management (OPM)
Federal Employee Assistance Program (EAP) Summit
Creating a Strategy for Transformation
Washington, DC
July 19, 2005
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. Title slide]
Good morning, and thank you for your warm welcome. Before I begin my remarks, I want you to look at the people around you. Is the person sitting nearest to you a woman?
[SLIDE 2. Workforce demographics—will click on female, minority, and older face]
Today, women make up about half the national workforce. Is the person from a racial or ethnic minority group? Today, minorities represent more than a quarter of the workforce. Hispanic employees make up the largest minority group. [CLICK] What is the person’s age? Guess, don’t ask. Today, baby-boomers between the ages of 46 and 64 make up nearly half the U.S. workforce. [CLICK] Furthermore, most aging baby-boomers intend to remain in the workforce past normal retirement age. This is the changing face of the American workforce—wonderfully diverse and talented . . . . and also increasingly complex in terms of work-life needs.
As the workforce has evolved, so too has the work of Federal Employee Assistance Programs (EAPs). No longer do EAPs focus solely on resolving productivity issues related to substance abuse. EAPs [pronounced E-A-Ps] now provide mental health services that help employees deal with an array of work-life issues that may affect productivity.
Some of the issues, such as sexual harassment or racial, gender, and age discrimination, are a direct result of an increasingly diverse workforce. Other issues simply reflect the stressful challenges employees face while balancing the demands of a job with family and community life. These are issues such as caring for children or elderly parents or finding close, affordable housing. The role of EAPs has expanded to the point of offering employees cradle-to-grave services to help them cope with life’s challenges. Why has your role expanded?—because an employee’s personal mental health status is essential to professional achievement.
Any of the demographic characteristics I just mentioned—gender, race, culture, and age—significantly affect the services that EAPs may or should offer. Women employees, for example, experience more depression than men and also tend to make greater use of EAPs. Women also are more likely than men to engage in preventive health programs offered in the workplace. Individuals with limited English proficiency may require bilingual services. To be effective, the EAPs of today must be able to provide services that are just as diverse as the needs of the people they serve.
But what about EAPs of the future? Workforce and service demands will continue to change. How can EAPs respond to them most effectively? The answers to this question is what you are here to determine. You are here to envision how EAPs fit within a changing environment and then to create a strategy for transforming mental health services to meet evolving demands. Let’s refer back to the changing workforce. According to the Hudson Institute’s Workforce 2020 study, more than half of those entering the workforce this year will be minority persons. What concrete steps can EAPs take to ensure greater cultural competency in their programs, providers, and performance measures?
[SLIDE 3. Asimov quote]
Your job at this summit brings to mind a quote by Isaac Asimov, the science fiction writer. He made this observation about planning for the future: “It is change—continuing change, inevitable change—that is the dominant factor in society today. No sensible decision can be made any longer without taking into account not only the world as it is, but the world as it will be.” That is your true challenge—to prepare Federal EAPs to meet the changes to come.
Not all of the changes affecting EAPs are, or will be, workforce changes. This summit focuses on several factors that affect your work and that also are evolving, such as financing and technology and science and services. You also can anticipate that accountability requirements for EAPs will intensify. Federal dollars are increasingly limited. Future program funding will depend to some degree on how well you demonstrate positive results in measurable ways. For EAPs, positive results will be measured on two interrelated scales: employee performance and employee behavioral health.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has joined with the U.S. Office of Personnel Management (OPM) to co-sponsor this summit. Our goal in organizing this meeting is to help you create a strategy for change—one that can guide Federal EAPs toward more effective services.
Have we given you a difficult challenge? Yes! To achieve this goal, you first must develop a clear picture of the Federal EAP industry. How large is it and how many people does it serve? What services does it provide and what are the expected outcomes?
[SLIDE 4. Framework for EAP vision]
In developing a strategy for change, you also will need to examine the evolution of national policies regarding EAPs. What factors influence your expanding role? What are your opportunities to achieve these industry-wide objectives: national standards of care, . . . core performance indicators, . . . and service delivery through modern information technology? What about the inclusion of Federal EAPs in the health delivery system? It is very likely that EAPs will become the front end of behavioral health care. This already is happening in the private sector, where EAP services are being integrated within an organization’s larger health plan. Employees soon will be required to access EAP services before they can draw on their behavioral health care benefits.
Your most basic question, however, is this one: How can EAPs best serve two masters: the organization and the people within it? SAMHSA and OPM are jointly sponsoring this summit because we recognize the critical relationship between organizational health and employee mental health. We also are acknowledging the essential role of EAPs in safeguarding workplace productivity by promoting the behavioral health of several million Federal employees.
EAPs are one of the largest providers of behavioral health services in the United States. Your support of employees with or at risk of mental and substance use disorders is tremendously valuable to both individuals and the workplace. Without your help, organizations could lose valuable employees and employees could lose everything—their jobs, their homes, their health, and their hopes for recovery.
Research has well documented the importance of work to a person’s personal well-being. The National Alliance on Mental Illness summed it up this way:
[SLIDE 5. NAMI quote]
“Work is at the core of contemporary life for most individuals, providing financial security, personal identity, and the opportunity to make a meaningful contribution to community life.”
Think about it. When meeting someone new at a party or the office, what is often the first piece of information we exchange after our names? It’s our occupation! Take away a person’s job and you take away a part of his or her sense of self—the part that gets a person out of bed, out of the house, and working for a better life.
Employment is tied so closely to a person’s mental health status that re-employment has been shown to be one of the most effective ways to promote the mental health of the unemployed. SAMHSA has made supported, competitive employment a national outcome measure for both mental health and substance abuse services. Effective programs are those that can demonstrate increased or retained employment among adults with a serious mental or substance use disorder.
The value of EAPs to organizational health is clear. If we consider the prevalence of behavioral disorders, we can understand easily their potential impact on the workplace. I’m going to describe the magnitude of mental and substance abuse disorders in the United States. Then, I’m going to tell you about a national initiative to help reduce and prevent the impact of these disorders by transforming mental health care in America.
As EAP professionals, you need to be aware of how mental health services are changing and how these changes will affect the way you do business. The services you provide are a portal into the larger mental health community. We cannot fully achieve mental health transformation without your participation.
[SLIDE 6. Comparative illnesses]
Mental illnesses are extremely common in this country. They are more common than cancer, diabetes, or heart disease. Nationwide, more than 40 million individuals have a diagnosable mental disorder. Substance abuse disorders also are common. About 22 million Americans have a serious substance abuse problem. More than 4 million Americans have serious co-occurring mental and substance use disorders.
The link between mental and substance use disorders is quite strong. In fact, up to half of individuals with a serious mental disorder will develop a co-occurring disorder at some point in their lives. This overlap points to a necessary shift in service perspective by EAP professionals. The services you offer must focus more on integrated services, rather than services geared solely to a mental illness or a substance abuse disorder. In addition, you should give greater attention to preventive and early intervention services that can help individuals avoid developing multiple disorders.
I’m sure you’re aware of the impact of mental and substance use disorders on the workplace. When employees develop mental or substance abuse disorders, organizations can pay a heavy price. Their costs accrue from direct treatment of individuals as well as from absenteeism, reduced productivity, and more frequent safety risks.
[SLIDE 7. Impact of depression]
Consider the impact of depression on the workplace. Depression is the third most common problem confronted by EAP professionals, following family crisis and stress. 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 Nation up to 44 billion dollars annually! Approximately 200 million workdays are lost each year.
Substance abuse creates 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.
Mental illnesses and substance use disorders have become public health crises that affects all Americans. The National Institute of Mental Health just completed a major survey of mental illnesses in this country, called the National Comorbidity Survey Replication. This is what the survey found: Less than half of those in need of mental health services get treatment. Those who do seek treatment typically do so after a decade or more of delays, during which time they are likely to develop additional problems. In addition, the treatment a person receives is often inadequate. For this study, a treatment was considered inadequate if it failed to meet minimal standards of care established by evidence-based treatment guidelines.
These survey results affirm the findings of two other recent reports on American health care. The first report is called “Crossing the Quality Chasm: A New Health System for the 21 st Century.” This report, by the Institute of Medicine (IOM), compared the health care Americans receive with the care that could be provided.The conclusion?—Between the care needed and the care provided “lies not just a gap, but a chasm.”
[SLIDE 8. Four strategies]
The IOM report identifies four key strategies that we can use to guide major service reform. These are to:
- Transform health care financing
- Transform human resources
- Transform treatment through rapid integration of evidence-based practices and performance measures, and
- Transform health care through the expanding use of information technology.
As you can see from your agenda, these strategies are embedded throughout your working-group sessions about potential areas of change.
The second report on American health care focused specifically on mental health. You will have received a copy of this report, called Achieving the Promise: Transforming Mental Health Care in America, in your registration package. Achieving the Promise is a national call to action. It recommends nothing less than a fundamental transformation of our national public mental health system. The report outlines 6 six broad goals and 19 more specific recommendations for a transformed system. These are the six goals.
[SLIDE 9. Goals]
The ultimate goal of this transformation is to create a system that is consumer driven, is focused on recovery, and helps to build a person’s resilience to face life’s challenges. SAMHSA is leading the Federal charge to make achievement of this goal a reality. Nine Federal departments and the Social Security Administration are united behind this effort. Together, we have created an action agenda that describes concrete, measurable steps that we will take to transform mental health services. Our action agenda is an evolving document. Each year, as we make progress, we will develop a new agenda and identify new priorities. This is our strategy for change—to continuously reassess how we can improve service delivery.
The EAP field faces many of the same challenges confronting the broader behavioral health community . . . and many of the same opportunities to transform the services you offer. Goal 1 of Achieving the Promise, for example, calls for an end to the stigma and discrimination that prevents many individuals from seeking treatment. SAMHSA has responded by launching a national public education program to change the way Americans view mental health problems. Mental illnesses are treatable and recovery is a very real possibility! We are going to spread that message across America until all those who need treatment can seek care—willingly, openly, and with hope in their future.
The EAP community can create their own strategy to end stigma in the workplace. Central to stigma is a myth shared by employees and employers alike, which is that people with mental illnesses cannot work. Because of this myth, many adults with a mental disorder who could work and want to work are unemployed. In fact, there is a higher rate of unemployment among those with a mental disorder than for any other group of people with a disability.
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 even can become life-threatening.
One of your small-group sessions will deal with outreach and marketing of EAP services. Your challenge is to identify steps to ensure that both agency decisionmakers and agency personnel understand the value of the EAP. Another objective should be to examine new options for getting individuals needing help through your door. Because mental and substance use disorders still carry a heavy stigma, you may need to look more closely at work-life issues affecting a person’s productivity. Issues such as absenteeism or marital problems sometimes are an early warning sign of a mental or substance use disorder. How can you positively educate and influence employees and supervisors to consider that possibility? How can you sensitively encourage employees to reveal the source of personal problems? What steps can you take to correct the person’s work performance before punitive action becomes a possibility?
Another one of your small-group sessions deals with applying evidence to the delivery of EAP services. Greater use of evidence-based practices is a goal for improvement proposed by both Crossing the Quality Chasm and Achieving the Promise.
One of the most fundamental lessons of EAP practice is this: People respond to adversity in different ways. Two people can experience the same life challenge. One will move on with life and work. The other may suffer from lingering depression or begin abusing substances and be unable to function adequately in the work environment. The EAP professional has to make sense of it all and recommend services that are most appropriate for bringing a person back to full productivity.
As I mentioned at the beginning of my remarks, the most appropriate services will be affected by the characteristics that make each person unique. Services for all employees must respect age, gender, culture, faith, and other individual characteristics. These differences demonstrate what is meant by consumer-driven care, which is the foundation of mental health transformation. Consumer-driven care ensures that each individual has access to the full range of services he or she will need to work toward recovery.
[SLIDE 10. Recovery definition]
By recovery, I mean a process—sometimes lifelong—through which a person achieves independence, self-esteem, and a meaningful life in the community.
Research and practice are helping to identify which services are most effective for different populations. Your challenge is to identify how the EAP community can turn this knowledge into widespread application of best practices. I’m talking about more than the services you provide directly. You also have a responsibility to refer individuals to services that are evidence based. Both you and the service provider should be accountable for producing positive outcomes for consumers. This is the bottom line for all professionals involved in mental health care—
[SLIDE 11. Toolbox statement]
The more cutting-edge ideas, concepts, guiding principles, and best practices we have in our mental health services toolbox, the more effective we will be—both for our organizations and for all the people we serve. The purpose of this summit is to help you develop new strategies for filling your EAP toolbox.
Yogi Berra, the baseball player, once said, “If you don’t know where you’re going, you might end up someplace else.” His remark describes the current status of EAPs. If you don’t know where EAPs should be in the future, then you’re going to have a difficult time heading your programs in the right direction. Even if you’re on the right path, you’re going to get run over if you don’t move fast enough.
This meeting gives you an opportunity to address the questions and concerns that transforming EAPs will present. Use your combined talent and commitment to envision the ideal form and function of Federal EAPs. The key to a successful vision is to move beyond what you think is possible. Instead of limiting your vision to what you think an EAP can be, think about what an EAP should be! Think about how EAPs can be proactive—rather than reactive—in addressing mental health concerns in the workplace. Think about how to balance the policy of zero drug tolerance with compassion and understanding for those who have a substance abuse disorder. The greatest risk of program 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.
We hope that this Federal summit will set an example for the entire EAP community. For transformation to be successful, EAPs nationwide must apply the concepts of mental health transformation to the services offered in the workplace. We want this effort to begin with you, and at this summit. Originally, the private sector led the way in developing EAP services. This meeting is your opportunity to be the role model and to offer leadership to others.
Let this summit be the beginning of a new Federal EAP community that works toward a common vision. And let this summit be the beginning of a stronger, more collaborative partnership between EAPs and the larger behavioral health community. Together, we can accomplish our most basic mission. What is this mission?—to help the people we serve achieve their greatest potential in life through sound mental health. Thank you.
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