Canadian HR Reporter

By Karen Seward D espite at least two decades of ex- tensive public education cam- paigns, increased workplace supports and advances in health care, mental illness remains a leading cause of disability in Canada. Many people experi- ence a mental illness in their lifetime and the cost to the economy can be stagger- ing. Add to that the devastating personal costs — unemployment, relationship breakdowns, reduced quality of life and, in extreme cases, suicide. e reasons for the lack of progress also re- main the same: limited access to specialist and services, a reluctance to seek help be- cause of the continued stigma about mental illness and the complexities of receiving a diagnosis and access treatment. Not an easy fi x It doesn't help that the assessment and treatment of mental health issues is rarely straightforward. Mental illnesses often de- velop in conjunction with physical illness or chronic pain. For example, the symptoms of depression, the most common mental ill- ness, can include physical complaints such as headaches, stomach aches and joint pain. Conversely, many chronic pain suff erers also experience severe levels of depression. Diffi cult life events such as job stress, di- vorce, fi nancial diffi culties or trauma can also have a negative impact on physical and mental health, as do unhealthy coping be- haviours like overeating, smoking or alcohol abuse. A lack of resiliency directly infl uences a person's ability to cope, resulting in anxiety. e real need is to have both a diagno- sis and treatment plan for mental illness in order to simultaneously address physi- cal and environmental issues. e assess- ment requires suffi cient time for a proper mental health diagnosis, according to the white paper Mental Health Treatment: Changing Perceptions and Changing Needs by SCM Health Solutions, which includes an examination with diagnostic testing, as appropriate, as well as a review of relevant scientifi c literature, and the individual's life circumstances and health history. More integrated approach needed For treatment, a more integrated psycho- educational approach is also needed, one that ensures collaboration and co-ordina- tion between primary physicians, special- ists, psychiatrists, government agencies, employers, insurers, private providers and, if required, case managers. Currently, this is not what's happening. Diagnosis of mental health conditions is often left to family doctors, with treatment often involving medication alone. e med- ication is to stabilize, not resolve, mental health issues. Even when patients obtain treatment, the results can be mixed. When treatment is prescribed, about one-third of patients never fi ll the prescription, and another third fi ll it but do not take the medication, ac- cording to a 2006 report from the National Community Pharmacists Association in the United States. Finally, the last third take the prescrip- tion, but there is no guarantee they are ad- ministering it to themselves properly. is is not so much an indictment of physicians as it is an observation about the stark reality faced by users of the health- care system. e challenge for general practitioners and patients is that accessing and co- ordinating these various supports can be extremely challenging, especially in more remote or rural areas. Accessing treatment through Canada's mental health system can be a diffi cult proposition. e economics of mental health e case for increased investment in pro- viding advanced mental health support can be easily made from an economic standpoint. In any given week, according to a 2010 report in the Journal of Occupa- tional and Environmental Medicine, at least 500,000 employed Canadians are unable to work due to mental health problems — of- ten because of disability cases. In fact, mental health issues continue to represent more than one-third of all short- and long-term disability claims and 70 per cent of short- and long-term disability costs. Many employees suff ering from mental health issues are doing so in silence. Mental health is often not visible. And lost productivity from presentee- ism — where employees are at work but because of an unaddressed physical or mental issue, are less productive — can be considerably greater than productivity loss from absenteeism. In an eff ort to address the rising costs of mental health issues, more and more companies are re-evaluating workplace health programs and policies and turning to private health-care providers for new options and a co-ordinated, multi-faceted approach. This includes managing clinical risk through objective medical consultations for employees at work or just accessing disability to prevent untreated conditions from becoming increasingly severe. Rethinking programs Today's workplace health programs need to include: Emphasis on early identification: Accurate and timely medical diagnosis through mental and physical health assess- ments, online information and support, as well as extensive employee and manager training programs are just some of the op- tions to help individuals identify and proac- tively address mental health issues in order to move toward treatment and recovery. Early interventions: As with physical illnesses, early treatment is essential. De- laying diagnosis and treatment can exacer- bate symptoms and greatly increase costs. When employees have early access to treat- ment, employers save between $5,000 and $10,000 per worker per year in prescrip- tion medication, sick leave and replace- ment workers, according to Mental Health Works. Integration: Integration of traditional and alternative health services within an individual's care pathway through public services, insurer programs, EAPs and dis- ability management providers can enhance recovery, avoid duplication of services and reduce costs. Continuum of care: Workplace health programs need to include an array of health services spanning all levels of care: From education and prevention, physical and mental health risk assessments to medical fi le reviews, and from integrated and co- ordinated treatment with an employee's treating physician, to return-to-work sup- ports and ongoing support. Education programs: ese not only ad- dress physical and mental health risks and resiliency but address stigma surrounding mental illnesses. All levels of management should also be included to help them deal with mental health issues in the workplace and guide employees to the appropriate help. Ease of use: Even the best programs are of no use if employees don't, or can't, ac- cess them. Resources should be available through a variety of platforms to meet gen- erational and cultural needs: by phone, in- person and especially electronically. Embracing new technologies Above all, programs need to be adapt- able and fl exible. Canada has a multigen- erational and culturally diverse workforce and a one-size-fi ts-all approach no longer works. Programs must be continually as- sessed and adjusted to meet changing The real need is to have a diagnosis and treatment plan to address physical and environmental issues. BARRIERS > pg. 14 FEATURES MENTAL HEALTH Rethinking care care care care The assessment of mental health issues requires sufficient time for a proper mental health diagnosis, along with a more integrated psycho-educational approach

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