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Addressing the Mental Health Crisis with Primary Care Integration

May 18th, 2023 | 4 min. read

By Amber van Niekerk

group gathered talking about mental health

“Integrating care can improve early intervention, ensure that providers treat co-occurring physical conditions, reduce stigma and, in some cases, save lives.” -The National Alliance on Mental Illness (NAMI)

While the COVID-19 pandemic contributed largely to worsening mental health outcomes for Americans, consider that mental health has been on a decline since before the pandemic began.

  • The number of adults who report having serious thoughts of suicide has increased every year since 2011-2012 
  • Rates of substance use have increased for both youth and adults both before and during the pandemic
  • In 2019—prior to COVID-19—nearly 50 million Americans experienced a mental illness

While these rates of mental decline are concerning on their own merit, the crisis is exacerbated by the very real mind-body connection as it relates to health. In short, unmanaged mental health increases the risk of unmanaged physical conditions, and vice versa. In any given workplace population:

  • Those with a mental health problem are more likely to have a preventable health condition like heart disease 

  • The mortality rate from cancer and heart disease is higher among those with a mental health condition 
  • Depression is found to co-occur in more than 40% of individuals with cancer and 27% of patients with diabetes

And when a once-in-a-century global pandemic is added to the mix? It's no wonder that better mental health support and access is top of mind for America's employers and unions.

“The pandemic has functioned like a magnifying glass for vulnerabilities.”

Gabriela Sehinkman, Licensed Clinical Social Worker, Ohio 

The cost of poor mental health

As the link between mental and physical health has become more clear, so too has the related costs of unmanaged mental health. Whether it's related physical illnesses being aggravated by unmanaged mental health or frequent absenteeism and productivity loss, the price of ignoring mental health makes up a large chunk of employers' bottom line.

  • The National Alliance on Mental Health estimates that untreated mental illness costs the US up to $300B every year due to losses in productivity 

  • An analysis from the National Safety Council found that employers spend over $15,000 on each employee experiencing mental health issues every year 

  • The cost of days lost averages $4,800 per employee per year 

  • From 2015 to 2019, mental health spend increased twice as much as overall medical spend 

And data from Everside Health finds the impact of mental and physical comorbidities on per member per month (PMPM) spend is: 

  • 82% higher than the average patient 

  • 44% higher than those with just a physical condition 

From 2015 to 2019, mental health spend increased twice as much as overall medical spend. 

The role of employers and orgs in providing support

A report from the New York Times found that nine of out ten therapists report clients seeking care is on the rise. That means more members of a workforce or union than ever realizing they need support. The question is: are employers offering it to them?

A recent Kaiser Family Foundation (KFF) report indicates nearly half the country receives health insurance from their employer. This places employers and organizations that provide health benefits as key contributors toward better, more accessible mental health care. 

What's important for employers to understand, as well, is that many of the "characteristics" of mental health are used to describe moments-in-time that occur most often in the workplace.

Nine of out ten therapists indicate clients seeking care is on the rise.

An upcoming presentation may provoke anxiety. A labored conversation with a coworker may feel fatiguing. Hitting a daily production quota may induce stress. But these moments of feeling unwell are simply the tip of the chronic stress, anxiety, and fatigue "iceberg" that millions of Americans experience every day. While these terms are often used in passing, consider whether their frequency in workplace conversations indicate a more pressing concern not readily visible.

Early intervention and integration matters

A study published by the Journal of Clinical Psychology in Medical Settings examined the cost effectiveness of integrating behavioral health services into a primary care setting. The project found that mental care integration was associated with $860.16 in per member per year savings.

Additionally, an analysis from the National Academies of Sciences, Engineering and Medicine found that every $1 invested in prevention and early intervention for mental illness and addiction programs yields anywhere from $2 to $10 in savings, including in health costs.

...mental care integration was associated with $860.16 in per member per year savings.

And finally, a systematic review from medical journal PLOS Medicine found that:

...most studies consistently found that interventions for mental health prevention and promotion were cost-effective or cost saving. The review found that targeted prevention was likely to be cost-effective compared to universal prevention...workplace interventions had good evidence in mental health promotion.

In short, when mental health care is integrated with primary care, it results in healthier employees, reduced costs, and a lower risk of costly downstream health events that feature multiple comorbidities.

One union's goal to offer better care

Indiana Teamsters, an Everside Health client since 2014, found a concerning pattern with their employees using their onsite health center: growing instances of anxiety, depression, sleep problems, and requests for stress management. The union, serving 6,500 members and their families, realized an unmanaged mental health crisis was only just beginning.

Together with Everside, Indiana Teamsters added two dedicated mental health providers to their suite of services to close the gap between what their members were missing from traditional local models. By integrating mental health care directly into Everside's primary care model, union members could access a truly holistic model in one place.

Both in-person and virtual access to these providers resulted in:

  • >94% patient satisfaction 
  • 100% follow-up compliance (vs. 4.5% average in employee assistance programs, or EAPs) 
  • 89% rolling 12-month member participation 

“Mental health was a significant issue...Our members are very appreciative of the ease of access they now have.”

Patricia Wilson, Indiana Teamsters Health Benefit Fund 

Consider your workers' mental needs

If you're an employer, union, or other worker organization, consider the structure of your current mental health benefits. Do members have access to a licensed therapist? Is mental health support covered in their benefits? Are their healthcare providers trained in mental and physical care integration that directly addresses costly comorbidities?

addressing the mental health crisis through primary care ebook