With the recognition that mental health issues are the leading cause of disability in the Canadian workplace and that the resulting costs to productivity are staggering, much has been written lately about workplace mental health. Recently, the Conference Board of Canada released its report, Building Mentally Healthy Workplaces, and the Mental Health Commission of Canada announced it will be developing Canada-wide psychological health and safety standards for workplaces, to be released in 2012.
However, when it comes to mental health, whether in the workplace or not, there are certain realities that we must acknowledge and address, and numerous individuals and organizations are taking up the challenge—just consider the amount of information and resources available, from online tests for depression to anti-stigma campaigns. Yet, with all this, very significant challenges remain.
Stigma
Is “stigma” really the enormous issue that it was a generation or two ago? Not to under-estimate the importance of de-stigmatizing mental health, but research shows stigma is more of an issue regarding more severe mental illnesses, such as those that cause unpredictable and dangerous behaviours. The stigma associated with more prevalent mental disorders, such as depression and anxiety, is not the big deal it used to be.
Statistics Canada‘s Canadian Community Health Survey (CCHS), released in October 2010, asked for responses to the following statement: “Most people you know would not willingly accept someone who has had depression as a close friend.” Only 17% either strongly agreed or agreed, while 62% either disagreed or strongly disagreed.
When asked to comment on the statement “Most people you know think less of a person who has had depression,” only 17% either strongly agreed or agreed, while 65% either disagreed or strongly disagreed. But when the statement “Most employers would not consider an application from someone who has had depression” was posed, 31% either strongly agreed or agreed, while 36% disagreed or strongly disagreed, indicating a disconnect between how people feel about individuals with depression and how they perceive employers feel about it. It may be beneficial for anti-stigma campaigns to target the workplace, while not ignoring other efforts.
Relatively few seek help
A 2003 CCHS indicated that only one-third of those aged 15 or over, who need mental health services in Canada, actually receive them. Thirty-one percent of those who did not get help reported that they preferred to manage the issue themselves, 19% said they didn’t get around to it and 18% said they were afraid to ask for help or afraid of what others would think.
Since “stigma” appeared to rank third in the 2003 survey, could the lack of help-seeking be more related to a lack of knowledge of the benefits of mental health interventions? The CCHS survey reported that “over 82% of those who were found to have feelings or symptoms consistent with the selected mental disorders and substance dependencies and also consulted a professional reported being satisfied or very satisfied with the treatments and services received by the health professional consulted.”
Do we publicize the positive outcomes of mental health treatment adequately? What about mental health literacy in general?
According the Conference Board of Canada’s report, “… with only one-third of employees (37%) rating themselves as being knowledgeable or very knowledgeable regarding mental health, there is still much they can learn.”
Private vs. public services
The 2002 Romanow Report (Building on Values: The Future of Health Care in Canada) called mental illness the “orphan child” of healthcare in Canada. While it’s estimated that mental illness accounts for over 15% of the burden of healthcare costs, it receives about 5.5% of the public dollars allocated to healthcare in Canada, according to Alberta Health Services, Institute of Health Economics, 2008.
Quite simply, many services, such as those offered by psychologists and social workers, fall outside the public realm and, like dentistry, physiotherapy and many others, are largely in the private health domain, where one-third of health spending in Canada occurs.
Health benefits
While employers do need to better educate themselves and their employees about mental health, one of the biggest challenges relates to employee benefits.
Consider that a course of cognitive behavioural therapy, which has shown to be very effective in dealing with depression and anxiety, can take six to 20 sessions and private psychologists may charge in excess of $200 per hour. A benefits plan that gives $500 per year for psychological services is wholly inadequate.
Unless and until private plans give more balanced coverage between “physical” and “emotional” benefits, we shouldn’t expect a lot to change. In the United States, The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health plans to be no more restrictive regarding mental health benefits than with what they offer for medical/surgical benefits. However, there are a number of items in the legislation to keep MHPAEA from being the panacea it may appear.
Workplace mental health (perhaps something of a misnomer since, as Karen Seward of Morneau Sheppel pointed out in the article Managing mental health good for business, it’s not like issues originating at the workplace or at home are left in their respective places), is a huge problem seeking solutions, but unless seen in the context of larger mental health issues, is not likely to be comprehensively addressed without understanding and taking action on a number of fronts.
David Michaels is the CEO at The Clinic For Emotional Wellness in Vaughan, Ontario.