Proactive management is the best medicine for mental illness in the workplace.
By Dr Ali Hamdulay
Mental illness in the workplace leads to decreased productivity, increased sick-related absenteeism, poor work quality, wasted materials and even compromised workplace safety. Despite the significant financial loss to employers and broad economy, many mental disorders fly below the radar in the workplace. A more proactive approach for managing mental illness in the workplace is a strategic imperative for South African employers.
Most employers tend to completely underestimate the financial impact of mental illness on their bottom-line. Increasing levels of mental illness drive up disability costs and demand more medical scheme spend. There is also a strong correlation between mental health disorders and substance abuse.
The South African Association of Social Workers in Private Practice estimates that 50% of workplace accidents is related to substance abuse. An undetected substance abuser can cost the employer 25% of that person’s wages.
However, in many workplaces, employees choose to suffer their mental illness in silence, fearing stigma should they speak out, while employers avoid asking too many questions, hoping mental health disorders will just disappear on their own.
Nevertheless, the latest Council for Medical Schemes (CMS) Report 2013-14 confirms that the prevalence of mental illness amongst medical schemes beneficiaries is rising. Total benefits per average beneficiary per month (pabpm) paid to psychiatrists increased by nearly 35% from 2011 to 2013. The total benefits paid to psychologists pabpm increased by 26% from 2011 to 2013, while the total benefits paid pabpm to mental health institutions from 2011 to 2013 increased by 58%.
The latest CMS data also shows that treatment for bipolar mood disorder (BMD) – a Prescribed Minimum Benefits condition and one of the top chronic conditions - increased by 173% from 2007 to 2012.
Unfortunately mental health issues in general are still poorly understood and often surrounded by prejudice, ignorance and fear. Many employees would ‘rather die’ than admit they suffer from a mental illness.
Despite increasing evidence of the connection between physical health and mental distress, when both mental and physical problems co-occur, doctors usually tend to focus on the physical problem. This often means the mental health issue remains untreated. Patients also ignore or play down mental illness. According to the South African Depression and Anxiety Group (SADAG), less than 16% of sufferers receive treatment for mental illnesses. However, when mental health issues are addressed, many patients report improvements in their physical health.
With the World Health Organisation (WHO) predicting that depression will be the second highest cause of morbidity in the world by 2020, employers cannot afford to bury their heads in the sand and hope for the best.
A proactive approach for managing mental illness in the workplace is essential and it is heartening to see the increasing focus on proactively addressing the mental and emotional health of employees evident across both medical schemes and employers.
Like any chronic condition, mental illness can be managed successfully through disease management. Many companies have established specific programmes to manage depression, bipolar disorders, post-traumatic stress disorder and substance abuse amongst employees and medical scheme beneficiaries.
Some companies have also established Employee Assistance Programmes (EAPs) to support employees dealing with issues that impact on mental health. To improve the efficacy of these programmes, appropriate linkages between EAPs and other interventions, such as scheme-level disease management, are important.
A company medical scheme’s rising spend on mental illness can also be proactively reduced by encouraging use of the workplace EAP, a valuable preventative tool to address issues fueling stress and impacting on mental health, before more serious mental illness conditions develop.
Mental illness is rising, and incurring high social and economic costs. Soon it could overtake HIV/AIDS as the leading cause of illness in South Africa. It’s time to take proactive action that will help to manage the impact of mental illness in the workplace.
Dr Ali Hamdulay, MBChB (UCT), MFamMed (Cum Laude) (Stellenbosch), Postgraduate Certificate in Health Technology Assessment (Stellenbosch), Senior Leader Programme (UCT), is the General Manager: Health Provider and Policy Unit at Metropolitan Health, www.mhg.co.za.