GAPS IN MENTAL HEALTH ECOSYSTEM - An Illustrative Example

Mental Health care is not a luxury instead it is a need

In today’s competitive business environment, maintaining employee satisfaction is paramount. With the number of anxieties, depression and stress, the good news is an increased number of companies are focusing directly on employee mental well-being.

Mental health care ecosystem consists of Employers, Primary care physicians, Education system, Policy makers/government, Wellness providers/Mental Health providers, Insurance brokers, Insurers, broader health care system/hospitals and Family/community.

However, the sad part is most companies do not review the outcome of the implemented solution throughout the year and due to the fragmented nature of the ecosystem, many care seekers don’t know where to begin.

Most employers struggle to set clear benchmarks, KPIs, and measure the success of these wellness programs and benefits.

During one of Corporate Wellness consultations, in a casual conversation with employees I heard the story of Mr. A which I feel is the typical story of many employees, in many companies. This is brought for, to put into perspective the end number of Gaps found in Mental health support which needs to be filled by various parties involved.

Illustrative Example: Mr. A's search for mental health

Mr. A is a 45-Year-old employee working as a B-level manager in a MNC company. This company is known to have the best employee benefits like Insurance plans, EAP, Wellness app, other wellness initiatives etc. He has been working in this company for the past 8 years. He has a family with his wife and two kids.

He reports to a manager who he feels is micromanaging him due to which he is unable to use his talent and capabilities. He also faces constant conflicts within the department and interdepartmental which demotivates him.

Though his work hours are from 8 AM to 5 PM, most days he works till ten in the night. Most weekends, he is unable to have quality time with friends and family due to work pressure.

He started having arguments with his colleagues and spouse. He was no longer interested in any kind of work or family get-together events. His manager gave him an official warning letter for the increased number of sick leave.

He spoke to some of his colleagues about his concerns, but they couldn’t help and suggested measures like Yoga, Mindfulness sessions etc. on the app provided by the employer. He was not able to be consistent with these due to his nature of work. To support and offload the employee from work pressure his manager takes him out of upcoming projects without giving the reasoning behind his action.

He was also experiencing sleeplessness, fatigue, and constant heart burn. He went to the nearby GP. GP prescribed some antacids and did the diagnostics which were found to be normal.

The symptoms have persisted for a few months now. While talking to John, the doctor felt that he was stressed, and he suggested he visit a psychiatrist.

Mr. A reviewed his insurance plan and found that psychiatry benefit is covered. After the consultation, based on the counselling the doctor said his stress is due to work pressure and recent loss of his family member. He gave him some medicines to relax and therapies.

Later that evening, he got a call from the Insurance Team at Hospital that his claim cannot be covered as it is not a diagnosis and causing factors of stress falls into the exclusion list. Based on this John, discontinued his therapy.

He also tried the EAP program he has from the Employer however the process to get through the Psychologist was cumbersome which he couldn’t manage along with his busy work pressure.

A few months back, a medical specialist diagnosed him with diabetes and blood pressure. He is now on regular medicine.

Gaps found in this Case study.?

Manager/Leaders/Employer

1. A survey was never done among employees before designing the Employee Benefits.
2. While the employee benefits were provided, an analysis of the employees log in and log out timings to understand the time invested on work and find better measures to manage work without compromising on the work-life balance of employees could have been done.
3. While the manager takes actions to offload the employee there is no proper communication which makes the employee think otherwise and worsens his condition.
4. Did an analysis on the sick leaves taken however the manager could have considered talking to the employee to understand the reason.
5. Didn’t have trained in-house personnel to address issues related to Mental health and route the person to the right direction, right person and in the right time.

Insurer

1. Psychiatric benefits under the Insurance plan can cover mental health issues only if diagnosed as a disorder under ICD coding.
2. Exclusion clauses of the Insurance plan stand as a barrier to get care at the most stressful situations like bereavement, workplace stress etc. which eventually can lead to mental disorders.
3. Claims related to Chronic conditions (End product of constant Stress) increased the cost to the employer as the causing factors were not taken care from the start.

Wellness Vendors (EAP providers & Wellness app providers)

1. The providers were unable to engage the employees enough for them to be consistent with the usage.
2. Informative sessions and Flyers on usage and benefits of the app/EAP was not provided to the employees.
3. Engagement/Utilization report was not regularly brought to the attention of the Company

Mr. A

1. Mr. A didn’t try to understand his benefits as he was not aware of the employee benefits his employer is investing in, for him.
2. Didn’t pay attention to the Mental health awareness sessions which his employer arranged for him, or he was unable to attend the session, or he forgot what the speaker said the day after 3 months.
3. Mr. A was not aware of how EAP works and that he can have a relationship consultation and financial consultation free of cost under his EAP program. He could also regularly talk to a specialist from the EAP on his most stressful days, which could have saved him from accumulating all the stress.?

Friends & Family of Mr. A

1. Was unable to support Mr. A during a stressful situation. They also lacked awareness of mental health and available resources. Community plays a vital role in helping to navigate through such stressful situations.

If gaps in mental health support access are filled, it could profoundly impact on individuals and society with potential outcomes such as Improved well-being, prevention of crisis, Increased productivity, stronger communities, decreased stigma and cost savings.

This is a Wakeup call to all parties involved that let’s focus on more comprehensive and outcome-based programs than check box activities. Scientific approach should be considered while designing the programs and Employees should be involved in each stage of designing.

Physical and Mental health are not stand alone so Wellness programs must be integrative. Improving the mental health journey requires mapping key players and relationships in the mental health ecosystem. Each touchpoint in this ecosystem presents challenges and opportunities for improvement.