Carter Symposium addresses mental health in the workplace

Addressing some of the major issues facing both the business and mental health communities regarding mental health and mental illness in the workplace, Richard Frank, professor of health economics at Harvard Medical School, delivered the keynote address at the 12th Annual Rosalynn Carter Symposium on Mental Health Policy.

The symposium, titled "Mental Health and Mental Illness in the Workplace: Healthy Employees/Healthy Companies," took place Nov. 20 and 21 at The Carter Center. The purpose of the event, which was attended by more than 200 participants from across the nation, was to consider how employers' decisions regarding mental health policies affect businesses, employees, families and communities.

The topic for the symposium was based on three points: the large number of Americans who have employer-based health coverage; documentation indicating that numerous "sick days" taken annually by employees are due to depression; and recent and intensive debates in Congress about the need for equal coverage for both mental and physical disorders.

Frank said that common ground between the business and mental health communities may be "elusive," but he believes it does exist. He offered three tenets to support his theory: markets matter and they don't always work right; that "the new marketplace alters who makes health policy" or influences the restructuring of health insurance; and that reaching common ground would require a "win-win situation."

In the 1970s and 1980s, Frank said, "the most valuable coverage protected against high losses." Insurance for low maintenance events was good, but for catastrophic situations it was bad due to two factors: moral hazard and adverse selection.

The idea of moral hazard has been "historically problematic," Frank said. "If people have insurance, they use it. The national response is to raise costs." Adverse selection works on the theory that "invalids know more about themselves than insurance companies do," Frank said. "Therefore, they pick the plan that is best for them." These two factors worked against each other, Frank said, in facilitating a win-win situation.

Frank mentioned several studies showing that psychological illnesses in employees resulted in an average of 31 days reduced productivity per year. "The implication from these facts is that it is in the employers' self-interest to have better mental health plans...the labor market will be better."

With the development of managed care health systems, new factors were added to the treatment of mental illness. While it "successfully addressed the moral hazard issue," the "abundant worry is over-treatment ... the best incarnation for managed care would be to shift treatment from hospitals to the community, deliver a better bargain for the prices and to treat illnesses earlier." Frank said both the public and the private sectors are consistent with these incarnations.

Adverse selection continues to be important, Frank said, and is "more complicated than before." New tools are used in determining who signs up for health care plans.

"If managed care wants to deliver, it needs to be a win-win situation," Frank concluded. He stated three conditions that need to be met to create this situation: employers need to share their savings with other partners; providers need to keep the care levels high while purchasers play the watchdog role; and adverse selection needs to be minimized.

--Danielle Service

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