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

Working Together: The Business Case

October 23, 2007
Washington, DC

Good afternoon. It is my distinct privilege to be here this afternoon with Helen [Darling], Dr. Johnson, and eachl of you…as distinguished leaders of business and industry.

Today we are here to honor the leadership of several companies that recognize both the importance and the economic value of proactively addressing the mental health of their employees and their families by awarding them the National Business Group on Health’s 2007 Behavioral Health Award.

You may be wondering why someone like myself, from an agency of the federal government, joins you in honoring these award winning companies. Some of you may wonder why an agency of the federal government has chosen to sponsor the awards that are given today. The answer is quite simple. We at the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services recognize that partnership with the private sector is an essential element of our mission to support the mental health and well-being of all Americans. We recognize that working with organizations such as the National Business Group on Health and its member companies provides us all with a way to leverage our resources to support our mutual goals of having a healthy and productive workforce, successful and stable families, and intervening early as mental health issues emerge.

We seek to partner with you to promote a transformation in the approaches taken to promote and renew mental wellness in our workplaces and in our communities. SAMHSA’s relationship with the National Business Group on Health is not new. It began in January 2004 when 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 was the publication of a 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. Clearly, today’s honorees took its recommendations to heart and have done a stellar job in bringing them to fruition. The public sector can and will 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.

Members of the National Business Group on Health and many employers around the world have transformed their way of thinking about their employees…the people that work in their organizations. Enlightened employers now are looking 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 status is an investment. After all…people, not organizations, are our most valuable assets. People create. People innovate. In the places we work, it is the individual efforts and the relationships that people form that ultimately determine whether businesses succeed or fail. As the costs of healthcare have risen over the last few years enlightened employers and health management companies have recognized three key truths about mental health:

The first truth is that mental illnesses are common in society and common in the workforce. Contrary to popular belief, most individuals with mental illnesses and substance abuse disorders work. Of the 20.2 million adults who abuse or are dependent on alcohol or drugs, 15.5 million (76.7%) are employed. According to the 2006 National Survey on Drug Use and Health, 6.6% of full-time employed adults and 7.6% of part-time employed adults experienced a mental illness in the past year. The National Survey on Drug Use and Health recently reported that an annual average of 7.0 percent of full-time workers aged 18 to 64 experienced a major depressive episode in the past year. A full 14.8% of full-time female workers in some occupations experienced a major depressive episode in the last year.

The second truth is that addressing the mental health needs of one’s employees is good for the individual and good for the bottom-line. To illustrate this point we must first look at the costs: 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. Depression is one of the most pervasive and debilitating of the major chronic diseases, and 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 due to this cause. Mental illnesses causes more days of work loss and work impairment than many other chronic conditions such as diabetes, asthma and arthritis. And, if that were not enough, 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.”

Research on costs 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, and especially those who we honor today are taking a systems approach, and are beginning to assess total costs related to employee health. We also must demonstrate that effective treatment produces tangible results that more than offset the cost of care and the loss of productivity. Today’s honorees have begun to show these tangible results. I encourage you to read these case studies and to consider adopting or adapting these approaches to meet the needs of your companies.

The bottom line is that 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 this brings us to the third truth. There currently exists a large gap between what needs to be done and what is being done: In spite of the fact that a range of effective treatments exist for most mental illnesses, less than half of those individuals 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 business and industry, I know that the business case for improving behavioral health care is equally compelling to you.

Creating and implementing policy change works best when there is an alignment of interests. We at the Center for Mental Health Services believe that it makes good policy sense to address mental health needs comprehensively and at the earliest possible time. We recognize that such a policy makes good financial sense as well. SAMHSA’s resources will never be sufficient to “serve” all those with serious MH/SA disorders. In order to maximize our effectiveness, we are taking a balanced public health approach to addressing these needs. Our public health approach involves working “upstream” as well as “downstream.” This is best explained by thinking about how we would deal with people falling into a dangerous river. Clearly, our goal should be to balance use of resources between services to “rescue drowning individuals” (the downstream approach) and also to try to keep people from “falling in” in the first place (the upstream approach).

A public health approach also involves changing the system by promoting evidence-based practices—we can’t pay for all of the services, but by encouraging (and, where we have the appropriate authority, requiring) the use of effective practices, we provide critical leadership to the field and to you in developing and paying for services. Those who we honor today with these awards have taken a large step in that direction. We look forward to partnering with them and with you collectively to leverage our resources to get the job done.

Before closing, I also want to comment on what each of us can do, as leaders to make a difference. We can transform the way we think about and address issues related to mental health and substance abuse in our businesses. In doing so, we can provide a model for our employees and for other business leaders…and help advance a wholesale transformation of our behavioral healthcare system that will change the face of care for generations to come. The need for vision with action is critical. What specifically can we do today? We can commit to opening more jobs to people that might have behavioral health issues. We can volunteer to serve as mentors. We can respect the mind/body inseparability and reflect it in our practice.

We look forward to partnering with you in supporting the best and most cost effective mental health care possible. It will make our companies and our nation stronger and more competitive. CMHS congratulates today’s award winners for making a difference, showing us that it can be done, that it makes good business sense to do so, and that the transformation process is moving forward. Thank you.