Managing Psychiatric Disability at JPMorgan Chase

“In the financial services business we need the cognitive and interpersonal skills of our employees above all—their ability to think quickly and creatively, to make good judgments, to remember a good deal of information and then to deal smoothly and attentively with our customers—and that’s precisely what depression takes from its patients,” Daniel J. Conti, Ph.D., Vice President and EAP Director for JPMorgan Chase, told the Midwest Business Group on Health this winter. “For any knowledge-based workforce such as ours,” he emphasized, “depression is the number one occupational malady.”

Given this reality, it’s easy to understand why JPMorgan Chase and before them Bank One (which merged with JPMorgan Chase in 2004) have invested time and money in learning more about the impact of depression and other psychiatric disorders on their workforce and how best to manage them. Conti gave a brief run-down of what his company has learned about depression in the workplace and then described the strategies used by JPMorgan Chase to counteract its effects, particularly in the area of psychiatric disability.

Impact of Depression on the Workplace

About 60% of the employees of JPMorgan Chase are covered by the company’s pharmacy plan, and in that group, antidepressants currently rank third in the amount of money spent—a phenomenon that’s not uncommon in corporate pharmacy spending today. (Antihypertensives rank first; antihyperlipidemics rank second.)

Conti and the corporate Medical Director, Wayne N. Burton, M.D., have also looked at the effect of depression on productivity. One self-report study showed that depression had by far the most negative impact on employees’ productivity. Another study, which looked at health risks, found that risks based on perceptual or stress factors had the greatest negative impact on workforce productivity.

By including depression, anxiety, and substance abuse screening in its health risk assessment process, JPMorgan Chase learned that 24% of the participants had scores indicating the need for mental health follow-up. These employees were advised to see a mental health specialist or the employee assistance program (EAP). Interestingly, 14% of these respondents reported a history of being diagnosed and treated for depression.

Psychiatric Disability Is Rising

Since the 1990s, most companies have experienced a rise in psychiatric disability. In a similar increase, psychiatric disability cases are now the number one reason for ADA (Americans with Disabilities Act) charge activity at the EEOC (Equal Employment Opportunity Commission). Only about one-third of the companies that have disability management plans report any kind of specialized treatment for the employees on disability due to psychiatric illness.

Since 1995, JPMorgan Chase/Bank One has been experiencing about a 6% year-over-year growth rate in psychiatric disability cases compared with a relatively flat 1% year-over-year growth rate in medical-surgical disability cases.

In 2005, depression accounted for 70% of psychiatric disabilities at JPMorgan Chase. As a percent of total disability caseload, mental health cases make up between 10% and 12% of the cases if only primary diagnoses are considered. Most non-manufacturing companies are experiencing this same sort of case distribution and finding that, outside of pregnancy and childbirth, mental health disability makes up their largest or second largest category.

The number of non-psychiatric cases that either represent a missed psychiatric diagnosis or include some comorbid psychiatric overlay is unknown. However, Conti presented data from an earlier study that showed that these “mixed” cases produce the longest disability durations. Therefore, considering the “carving in” of behavioral health interventions for cases without a primary psychiatric diagnosis makes good sense in good disability case management.

Psychiatric Disability Is Different

“Employees on psychiatric disability have a particularly difficult time coming back to the workplace,” Conti observed. For one, psychiatric disorders, particularly depression, have a powerful depleting effect on the motivation of an individual. In addition, these employees often fear stigma in returning to the workplace. And finally, unlike employees with other illnesses, these employees seem to struggle to stay on the job as long as they can, frequently increasingly the likelihood of problems between themselves, their co-workers, and their managers before they go out on disability.

“I can assure you,” Conti said, “you have to have a different disability case management process if you want to bring these employees back to work successfully, otherwise there is a good probability that they will return to disability or lose or leave their job.”

JPMorgan Chase Strategies

Here are some of the approaches JPMorgan Chase uses to manage psychiatric disabilities.

• Anyone on psychiatric disability is managed by a mental health clinician who uses a very aggressive front-end assessment to find out two things: how is the employee’s condition affecting his or her work and what kind of treatment is the employee receiving.

• The company requires that these employees be in active mental health treatment. Here is an example of what Conti regards as a worst-case scenario, which is frequently the case in disability management programs without specialized mental health management.

  • Employee: I saw my doc. The doc says I’m depressed. I need to be off from work. He gave me a prescription and said to come back in six weeks.

  • Employer: What are you going to do for the next six weeks?

  • Employee: I don’t know—just stay at home I guess.

  • Employer: OK.

  • “This is not a plan for getting well and getting back to work,” Conti said.

• JPMorgan Chase establishes a dialogue with all treating professionals and medical plans. All efforts are made to get the patient in the care of a psychiatrist. If a psychiatrist is not available, however, primary care physicians become part of the treatment picture, albeit with the inclusion of some mental health provider.

• Conti noted that medication alone will not completely remotivate or revitalize the employee, nor will it address the psychosocial and interpersonal conditions affecting the employee before he or she left work. “In our experience, some sort of psychosocial intervention is necessary in nearly all psychiatric disability cases in order to have a successful return to work,” he stated.

• “It’s important to separate true disability issues from workplace issues, such as facing the stigma of illness or dealing with escalating interpersonal conflicts at work. To help in that regard, the EAP plays an integrated role in disability management by facilitating return-to-work interventions with the employee and management and by providing follow-up supportive counseling.

• The EAP is also integrated with non-psychiatric disability cases in which comorbid psychiatric issues exist or in which behavioral medicine approaches may be helpful.

• Wherever possible, short-term disability is managed within the company. “By bringing disability inside the company, JPMorgan Chase is better able to monitor cases, understand the interplay of work and health, and assure that people have follow-up and support in the workplace,” Conti noted.

Outcomes/Observations

Although the duration of psychiatric disability has remained relatively constant at the company from 1989 to 2005 (about 40 days), returning employees to work on a part-time basis has had significant positive outcomes. Employees who return to work on a part-time basis are returning to work about one week earlier than they would if they had returned on a full-time basis.

“But even more important than the early return to work,” Conti said, “we are more successful in keeping these employees at work.” JPMorgan Chase has reduced the recidivism rate in this group by nearly one-half—from 17% in 1989- 1992 to 9% in 2003.

Some educational efforts have worked; some haven’t. JPMorgan Chase makes a lot of information on depression, bipolar disorder, and anxiety available on its EAP and Work-Life Web site and also distributes printed materials at its outpatient occupational health clinics.

Conti noted, though, that the company gets a very large bang for its buck by educating managers about how to recognize depression and anxiety disorders and how to refer to the EAP. “Our goal is not for managers to start diagnosing employees,” he said, “but to teach them how to intervene appropriately and effectively and how to get the employee to the right workplace resource before problems reach the threshold of disability.”

The company has also conducted seminars but has learned not to hold seminars on a single disease subject, such as depression. “Few employees want to attend a seminar in which a laundry list of symptoms are laid out,” Conti said, “but we fill the room for seminars on ‘Improving Your Ability to Manage Stress’ or ‘How to Manage Difficult People’ during which we can talk about mental hygiene and how to take good care of yourself.”

Good Follow-Up Saves Psychiatric Disability Costs

Research confirms the necessity of good follow-up for patients with a psychiatric disability. Conti participated in a study recently reported in The American Journal of Managed Care that looked at the association between antidepressant adherence and short-term disability.

Researchers found that patients who adhered to either an acute treatment regimen or a continuation treatment regimen were 30%-40% less likely to file a short-term disability claim than those who did not adhere to the treatment regimen.

Furthermore, studies have shown that when depressed patients follow recommended treatment guidelines, they have a lower risk of the depression recurring and lower total medical costs, (The American Journal of Managed Care, February 2007).
The authors calculated that a company of 70,000 employees would save about $1 million— $1,044,000 to be exact—if employees would adhere to their antidepressant medication for the prescribed period.

“This means,” Conti emphasized, “that it is very important to follow these people when they come back to work and to provide education and support as to why they should take their medications and follow their provider’s treatment plan.”

Last Updated: January 2007