This past April marked a meaningful gathering of minds about workplace mental health. The National Alliance of Healthcare Purchaser Coalitions (the National Alliance), formerly named the National Business Coalition on Health, brought together experts, researchers, and panels of employers to share high-level thinking about current issues related to mental health and wellbeing with other employers and employer coalition representatives.

Employer coalitions are powerful mechanisms for effecting change. There are more than 50 coalitions across the country and, together, they represent 45 million people.

The American Psychiatric Association Foundation’s (APAF) Center for Workplace Mental Health has collaborated with employer coalitions over the years, starting with the Mid-America Coalition on Health Care (MACHC) and its Community Initiative on Depression in 2001-2005. Since that time, we’ve worked with coalitions to provide educational sessions for employer members in Philadelphia, New Mexico, Montana, Ohio, Maine, South Carolina, and Virginia, to name a few. Our understanding of the power of employer coalitions informed our decision to collaborate with the Ohio-based employer coalition, Employers Health, to develop Right Direction, our depression awareness initiative for the workplace.

The MACHC’s Initiative on Depression, one of the best examples of the power of employer coalitions, was led by William L. (Bill) Bruning, a longtime co-chair of Workplace Mental Health’s Advisory Council. We asked Bill, and our other co-chair, Alan Axelson, for their thoughts on the National Alliance’s summits, the last fifteen years of progress, and the path forward to advance workplace mental health.

Reflecting Back and Moving Forward: Q&A with Bill Bruning and Alan Axelson

Question: Bill, what did you see as some of the highlights of the meetings?

Answer: “First of all, it was really gratifying simply to see hundreds of people coming together to talk about workplace mental health. When we first launched the Community Initiative on Depression, Kansas City’s employers were true pioneers in rolling out discussions on a mental health topics. We were just beginning to capture the attention of employers about the business case for focusing on depression. We began by looking at participating employers’ drug costs, since mental health-related prescriptions were, and still are, at the top of employers’ health care costs. We quickly moved beyond the pharmaceutical focus to depression’s effect on absenteeism and presenteeism, what we termed “the fully loaded costs of depression.” So, hearing the panels at the National Alliance meeting and some of the great examples of how others are rethinking the total burden of depression, finding ways to be innovative, both in breaking down the stigma of seeking care and re-thinking care entirely was a great experience.”

Question: Alan, what are some examples of the panelists’ messages?

Answer: "One interesting example was Sandra Turner, director of EY’s employee assistance program (EAP), who shared how their executives were prepared and coached to talk very openly about their own experiences with mental health issues or the experience of a family member, friend, or colleague. They’ve seen increased EAP use as a result. Another example, Kim Hauge, a manager at Kent State, shared how they’ve used the materials from the Right Direction program on their eight campuses to communicate about depression. They are now offering EAP services to all family members of employees, including parents and in-laws!

Several people spoke very openly about the broken mental health care system and the challenges in improving it. Jurgen Unitzer, M.D., University of Washington, and the APA’s Chief of Policy, Programs, and Partnerships, Kristen Kroeger Ptakowski, discussed traditional but underdeveloped solutions. For example, improving integrated and collaborative care and behavioral health care networks are two possible ways of addressing the problem. It is important for employers to advocate for this with their health plans. Hyong Un, M.D., Chief Psychiatric Officer at Aetna, however, went so far as to say the care delivery model "is the same as in the late 1800's" and that Aetna is taking major steps to shake things up. Greater use of digital and tele-mental health will be important, as will enhanced supports for members. Some other speakers described the tools they were using in these areas and the positive effects of early intervention and improved user access.

Our own panel from the APAF’s Center for Workplace Mental Health, led by then-director Clare Miller, brought up some important points about changing the culture in workplaces and accepting people with mental health challenges. Panelists used personal stories and emphasized the importance of ethics, values, diversity, and inclusion."

Question: Day Two of the summits focused on “well-being.” How are mental health and well-being connected?

Answer from Bill: "This well-being concept represents some evolution in thinking about mental/emotional health and about the concept of wellness. While we have been somewhat focused, and rightly so, on improvements in the mental health care system and on getting people into effective care, the shift to well-being does several things. It encourages us to pay equal attention to mental health and somatic illness."

Answer from Alan: "The well-being focus emphasizes what employers can do preventively – we can start much earlier to help people learn mental/emotional skills, and we can do that in innovative learning formats, like the communication programs available through the APAF. The Millennial workforce is helping with that, since they have grown up with digital devices in their hands, and they seem much more accepting of self-care and self-improvement in general. It just seems more main stream now to talk about mental health as one component of the whole picture of well-being, and that’s a good thing."

Question: Any final thoughts?

Answer from Bill: "I’m very proud of our early work on the Community Initiative on Depression. Many Kansas City employers continue to support mental health for their employees and their families. It’s exciting that other employers across the country are moving the conversation along, playing the important role of convener, and facilitating discussions about mental health."

Answer from Alan: "It will take strong collaboration among employers, health plans, private and public health care providers, and employer coalitions to solve the ongoing challenges concerning access to value-focused quality health care. Hats off to the National Alliance for choosing to address mental health and well-being, and congratulations to all who participated in the summits."

The Path Forward

There are many takeaways from the National Alliance meetings and the MACHC’s Initiative on Depression that help employers and coalitions chart strategies for advancing mental health.

If you are an employer, join a coalition. If you are already a member of a coalition, use your voice to encourage your organization to focus on mental health. While mental health deserves a dedicated focus, it should not appear in a silo. Review the coalition’s current activities, and look for opportunities to include mental health. For example, if the organization is focused on diabetes and asthma, then depression should also be addressed, because those conditions frequently occur with and are worsened by depression.

Here are some ways that employer coalitions can address mental health:

• Convene educational events focused on mental health. For example, the Northeast Business Group on Health convenes regular workplace mental health summits. The sessions have focused on specific topics such as stigma and quality of care. This work led to two CEO summits on mental health and the development of a toolkit for employers interested in addressing mental health.

• Don’t forget about your annual meeting! By including mental health topics at your annual meeting, you will likely reach some employer representatives who might not participate in a session dedicated to mental health.

• Identify common challenges. Use your power to convene employers, health plans, and other agencies to discuss how mental illnesses are addressed at the workplace and within your communities. (The Northeast Business Group on Health’s summit surfaced a frequent challenge among many employers -- lack of access to psychiatrists. Now they are working on an agenda to identify solutions to this issue.)
• Use eValue8 to inform your work. The National Alliance of Healthcare Purchaser Coalition’s eValue8 tool provides a common set of metrics to work from. This can help identify areas for improvement that coalitions can use to address a common area of concern.
• Enhance communication links with psychiatrists. Respond to local psychiatrists who reach out to business coalitions.

The following employer and organizational partners were also panelists at the National Alliance meetings:

• Aetna
• EY
• HERO
• Integrated Benefits Institute
• JP Morgan Chase
• Northwest Business Group on Health
• Prudential
• Sprint
• University of Michigan
• Zappos

About the Author

Nancy Spangler, PhD, OTR/L, president of Spangler Associates, Inc., and consultant to the Center for Workplace Mental Health, is an organizational health and effectiveness specialist in the Kansas City, Missouri, area.