Mental Illness: A Rising Workplace Cost --- One Form, Depression, Takes $70 Billion Toll Annually;

Bank One Intervenes Early

Author: By Elyse Tanouye
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Abstract (Abstract): Even more pronounced was depression's impact on indirect costs, such as productivity
losses from absenteeism. Depressed employees stayed out on short-term disability longer than employees with
other common illnesses, and they suffered a high relapse rate. Another analysis showed Bank One's
employees lost a total of 10,859 workdays over a two-year period because of depressive illnesses. In contrast,
high blood pressure resulted in 947 workdays lost and diabetes, 795 days. Depression also seemed to be
insensitive to status, striking a cross-section of the company's staff, from clerical workers to executives.
Bank One decided to confront employee depression head on. In the belief that early intervention would mean
fewer catastrophic claims later, the bank taught managers to recognize the signs of depression using the
Depression Awareness, Recognition and Treatment program developed by the National Institutes of Health and
the Washington Business Group on Health. It hired a staff psychologist to evaluate the treatment in each mental
health disability case. It also mobilized its employee assistance program to help with employees' transition back
to work. And it ran employee workshops on depression, stress management and managing relationships.
Indeed, Bank One's effort to combat depression created a peculiar anomaly: The number of employees taking
disability leaves for depression has ballooned, to 7.2 per 1,000 employees in 1999 -- four times the 1989 rate.
Last year, about 500 employees went on short-term disability for depression, Dr. [Daniel J. Conti] says.
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Full text: IN A TYPICAL OFFICE of 20 people, chances are that four will suffer from a mental illness this year.
Depression, one of the most common, primarily hits workers in their most productive years: the 20s through
40s. Its annual toll on U.S. businesses amounts to about $70 billion in medical expenditures, lost productivity
and other costs.
And yet most employers don't have a clue.
Even though Prozac has become a household word, few individual companies know the true cost of depression
to their business, says Paul Greenberg, a health care economist at the Cambridge, Mass., consulting firm
Analysis Group/Economics. That's because many of the indirect costs -- such as reduced productivity and
related illnesses like alcoholism -- aren't readily apparent. And unlike those with allergies or appendicitis, people
with mental or emotional problems tend to hide their conditions for fear of stigmatizing their careers.
What companies do see are the ever-rising medical bills to treat psychiatric illnesses among employees. U.S.
antidepressant sales alone have risen more than 800% to $10.2 billion, since 1990, according to IMS Health.
Public awareness of depression has also increased, as have the cost of interventions such as hospital stays
and psychiatrist visits.
Seventy percent of large employers said they were concerned about rising psychiatric claims in a survey
conducted last year by consulting firm Watson Wyatt Worldwide and the Washington Business Group on
Health, an employer group. And companies tend to respond to that rise by trying to control costs. "Companies
view health care, and specifically psychiatric claims, as a cost to be minimized," Mr. Greenberg says.
But depression is a tough disease to manage because its symptoms are largely invisible and subjective -- even
as it affects a person's moods, thoughts and energy levels. While its symptoms and severity can vary widely,
the disease is particularly debilitating for working people: It often causes them to lose interest in their jobs and
other aspects of their lives, to withdraw from social contact and to be overcome by feelings of worthlessness,
guilt and hopelessness.

Sometimes, depression is triggered by an event, such as a death or divorce, but it can also occur without
warning. For many, the disease is mild and transient. But for others, it worsens over time and, left untreated,
can lead to very serious symptoms, such as suicidal thoughts that require hospitalization -- or actual suicides
that may seem to coworkers to come out of the blue.
Even when businesses do acknowledge and try to manage employee depression, it can be a thorny task. Bank
One Corp., a Chicago-based banking and credit-card company, conducted an unusually comprehensive
computer analysis of employee health data in the mid-1980s to determine what was driving its health-care costs
so high. To its surprise, treating depressive disorders cost the company's self-insured health plan $931,000 in
1991 -- nearly as much as the $1.2 million cost to treat heart disease. The actual costs might have been closer,
but the plan reimbursed treatments for mental health at a lower rate than other medical claims.
"The prevalence stunned us," says Daniel J. Conti, a clinical psychologist and director of the company's
employee assistance program.
Even more pronounced was depression's impact on indirect costs, such as productivity losses from
absenteeism. Depressed employees stayed out on short-term disability longer than employees with other
common illnesses, and they suffered a high relapse rate. Another analysis showed Bank One's employees lost
a total of 10,859 workdays over a two-year period because of depressive illnesses. In contrast, high blood
pressure resulted in 947 workdays lost and diabetes, 795 days. Depression also seemed to be insensitive to
status, striking a cross-section of the company's staff, from clerical workers to executives.
Some reasons could be specific to the company: Two-thirds of Bank One's employees are women. Depression
appears to strike women at about twice the rate it hits men, though it could be that women simply seek help
more often than men. The company has also undergone a series of mergers, which can contribute to employee
stress, according to studies.
Bank One decided to confront employee depression head on. In the belief that early intervention would mean
fewer catastrophic claims later, the bank taught managers to recognize the signs of depression using the
Depression Awareness, Recognition and Treatment program developed by the National Institutes of Health and
the Washington Business Group on Health. It hired a staff psychologist to evaluate the treatment in each mental
health disability case. It also mobilized its employee assistance program to help with employees' transition back
to work. And it ran employee workshops on depression, stress management and managing relationships.
As it dug deeper, Bank One realized that many employees with mental illnesses weren't getting adequate
treatment from its self-insured plan or from the several HMOs it offered. So in its self-insured plan, the company
substantially reduced employee out-of-pocket costs for the first 12 therapy visits and stressed early intervention,
which helps avoid hospital costs.
But less than 30% of its employees are in the self-insured plan, and Dr. Conti complains that HMO care is still a
disappointment, despite pressure from Bank One. People treated under HMOs often receive drugs and shortterm therapy, and while they return to work much faster, the relapse rate is much higher. The company figures it
loses many more employee workdays because of the "revolving door" of employees leaving, then returning,
only to leave again, Dr. Conti says.
Indeed, Bank One's effort to combat depression created a peculiar anomaly: The number of employees taking
disability leaves for depression has ballooned, to 7.2 per 1,000 employees in 1999 -- four times the 1989 rate.
Last year, about 500 employees went on short-term disability for depression, Dr. Conti says.
Is that figure abnormally high? It's hard to tell. Most businesses "have no idea what is driving their disability
cost," Mr. Conti says, noting that Bank One's awareness programs probably spurred the jump by making more
employees seek treatment and, ultimately, disability leave.
Still, there remains a deep-seated fear that admitting to mental illness, much less taking a leave for it, will hurt a
career. Workers often ask whether getting treatment will make them uninsurable in the future, and Dr. Conti tells
them they may encounter some difficulty. He also counsels those seeking treatment to be smart about whom

they disclose information to.

The increased disability probably cost Bank One several million dollars in lost wages, as well as pay for
temporary workers. But Dr. Conti believes the rise in disability is an initial blip that will decline in the future. "In
the long run, it will pay off in lower numbers of serious cases and more productive workers," he says. "People
will get help earlier and arrest the disease in earlier stages."
(See related articles: "What Happens When It's the Boss Who's Suffering? --- Paul Gottlieb's Story Shows
Upper Ranks Get Hit Too; Screaming Atop the Cliffs" and "New Medicines, Protective Laws Cut Dismissals" -WSJ June 13, 2001)
(See related letters: "Letters to the Editor: Treating Mental Illness Is a Wise Investment" -- WSJ June 26, 2001)
Credit: Staff Reporter of The Wall Street Journal
Subject: Corporate culture; Mental depression;
Publication title: Wall Street Journal, Eastern edition
Pages: B.1
Number of pages: 0
Publication year: 2001
Publication date: Jun 13, 2001
Place of publication: New York, N.Y.
Publication subject: Business And Economics--Banking And Finance
ISSN: 00999660
Source type: Newspapers
Language of publication: English
Document type: Feature
ProQuest document ID: 398827506
Document URL: http://search.proquest.com/docview/398827506?accountid=2909
Copyright: Copyright Dow Jones & Company Inc Jun 13, 2001
Last updated: 2010-06-26
Database: National Newspapers Premier,ABI/INFORM Complete

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