The Mental Health Commission of Canada attributes nearly one-third of short- and long-term disability claims to mental-health illnesses. As many employers grapple with helping employees receive the treatment they need so they can return to work, the Health Benefit Trust of Alberta has piloted a program that simplifies the process.
The trust, a multi-employer plan covering more than 350,000 health-care employees and their dependants, saw its disability and drug claims for mental illness reach $25.8 million in 2017/18. As a result, it started looking for an approach that would mitigate the duration of claims, minimize absenteeism and presenteeism and, ultimately, foster recovery.
Mental illness made up 28 per cent of open short-term disability claims and 33 per cent of long-term disability claims across all of the trust’s plans between July 2017 and June 2018, says Gayle Shurvell, its director of policy and governance. For non-union members, 45 per cent of new claims stemmed from a primary diagnosis of mental illness in 2017, she adds.
“It became a bit of a problem a couple of years ago, in that the costs were getting fairly significant. As well, we weren’t seeing the return to work happening.”
The trust also found that a referral to a psychiatrist in Alberta could take anywhere from five to 12 months. In the meantime, patients would often be seen by non-specialists.
Indeed, 500,000 Canadian employees are unable to work every week due to mental illness, and accessing treatment isn’t always straightforward, according to the Mental Health Commission of Canada. And in 2017, the Fraser Institute found the total wait time in Canada for psychiatry services was 19.4 weeks, though it varied by province.
To address the issue, the trust redesigned its mental-health approach, creating a centralized model for all plan members with its insurer, Great-West Life Assurance Co., and Medaca Health Group, an early intervention service that delivers access to a national network of psychiatrists in consultation with the employee’s family physician.
In early 2017, the trust launched a one-year pilot project aimed at providing plan members with access to psychiatrists within days, so they could receive an accurate diagnosis, first-line treatment and ensure a healthy return to work.
Through the initiative, plan members who didn’t already have a treating psychiatrist were taken through an initial screening process, which led to an assessment with a psychiatrist in person, by phone or through an app within 15 business days. The process has been averaging eight days for the trust’s plan members, says Shurvell.
The psychiatrist then shares the assessment with the plan member’s physician to discuss and consult on recommended treatment. Case managers follow up with the treating physician for updates or to engage rehabilitation services, provide access to cognitive behavioural therapy or support the employee and employer with return-to-work strategies.
Carolyn Chapman, an organizational health consultant at Great-West Life, says the dialogue taking place between the physician and the specialist helps to implement the recommended treatment.
“It’s a more collaborative approach then, say, an independent medical assessment, where we’re provided with recommendations but that conversation piece between the two physicians doesn’t take place,” she says. “We’re able to then confirm that that recommended treatment is in place.
“This approach ensures that, from the very start, the diagnosis is correct and that appropriate treatment is recommended early,” adds Chapman.
Indeed, early intervention is a crucial component in ensuring employees receive the right diagnosis and the appropriate treatment, ultimately helping to foster a safe and sustainable return to work.
“I think, fundamentally and intellectually, we all know that by getting involved earlier on claims, and helping people recover and make sure they have the right diagnosis to begin with and the right treatment, that they will go back to work. So that was the driver for us,” says Shurvell.
The next level
Chris Anderson, president of Medaca, says the trust’s situation leading up to the new approach wasn’t dissimilar from other organizations.
“A lot of employers have a good wellness program, they’re implementing the national strategy on mental health, they have an [employee assistance program]. But for a lot . . . you’re always going to have a certain percentage of your employees on disability who have a clinical mental illness that requires a psychiatrist. And a lot of organizations have not been able to manage that, simply because there’s not a lot of access available. So the treatment piece has been sort of left off the table in many cases.
“HBTA is the first one I’ve seen that has taken it to this level in terms of not just focusing on the cost of mental illness, but focusing on ‘what are the benefits for the productivity of our entire organization from a strategic perspective of having very good mental health,’” he adds.
There’s been an attitude shift in recent years as Canadian employers realize the value of a mental-health strategy, both with a view to helping employees and in terms of the positive impact on the bottom line, says Julie Holden, principal of workplace health consultancy Holden and Associates.
“There has been this shift as people have increased their awareness, and so they are looking for programs to help them with that. There’s some great work being done, but there’s still a long way to go. It’s a little over one-third of Canadian employers that have a formal mental-health strategy, so there’s still a lot of employers out there that are looking for the right program for their employees.”
In March 2018, at the end of the one-year pilot project, the trust’s new program had 658 referrals, with almost all expected to close, and only four recurrences, says Shurvell. At the same time, the organization is working on shifting away from measuring success simply in terms of closed files.
“For us, it’s about measuring things like recurrence. How many employees go back to work and stay back at work, where we are not seeing them come back on disability in the future,” she says.
The project’s first year has been very positive, she adds. “It feels like the approach we’re taking is the right one.
“Has it reduced all of our costs? No. Have we seen higher incidences of return to work? Yes, absolutely we have, throughout all of our plans within the trust.”
Helen Burnett-Nichols is a freelance writer based in Hamilton, Ont.