I. THE COSTLY EFFECT OF MENTAL ILLNESS AND SUBSTANCE ABUSE ON WORKPLACE PRODUCTIVITY IS WELL DOCUMENTED.

• Six out of the top ten health problems chosen by over 400 corporate leaders as most seriously affecting their companies' workforces can be treated appropriately and effectively by practicing psychologists. The problems, along with their ranking, were: Cigarette Smoking (#2), Alcohol Abuse (#4), General Mental Health Problems (#5), Stress (#6), Drug Abuse (#9), and Depression (#9) (Yanson, 1991).

• In 1985, a government report estimated that mental illness and substance abuse cost the American non- institutionalized population $77.2 billion dollar in lost income (Rice/ADAMHA, 1990).

• The National Council of Compensation Insurance estimated that 1989 payments for stress-related disability claims totaled $380 million in California alone (Walker, 1991).

• 43% of CEOs surveyed claimed alcohol misuse and abuse cost their firms 1-10% of payroll in lost productivity (William M. Mercer Meidinger Hansen Inc., 1988).

• In 1990, major depression alone was estimated to cost $23 billion in lost work days (Kamlet, 1990).

• The Mental Health Policy Resource Center claims mental illness is the third most limiting health condition, in terms of being able to prefrom major daily activities, and is preceded only by cancer and stroke. In terms of being unable to work, mental illness is the most limiting health condition (Database, 1990).

A. Mental lllnesses and Substance Abuse Can Impair Employees' Ability to Function Productively.

• 87% of the Medical Directors, Personnel Directors and Employee Assistance Program Directors surveyed claimed stress, depression and anxiety impair their employees' ability to function effectively on the job (Warshaw/NYBGH, 1989).

• 57% of Ohio small business executives surveyed claimed their companies have suffered productivity losses due to emotional or personal problems of their employees. 34% claimed their companies' overall efficiency dropped due to substance abuse (Belden and Russonello/APA and OPA, 1989).

• Substance abusers were found to be 25-33% less productive than non-substance abusers (Kronson, 1991).
• 84% of individuals with panic disorder surveyed reported a decline in their quality of work due to panic attacks or associated phobias (Edlund and Swann, 1987).

B. Mental Illness and Substance Abuse Increase the Chance of Employee Injury.

• Stress accounts for 10% of all worker compensation claims ('Managing Mental Health...', 1990).

• Researcher Jansen (1986) claimed that 80% to 90% of all industrial accidents are likely related to personal problems and employees' inability to handle stress.

• Substance abusers were found to be 4-6 times more likely to have an on-the-job accident (Kronson, 1991).

• The National Institute for Drug Addiction (1987) found chemically-addicted employees almost 4 times more likely to have an accident, and 5 times more likely to file a worker's compensation claim.

• Medical Directors, Personnel Directors, and EAP Directors surveyed noted that employees suffering from stress, anxiety and depression suffered an average of 16 lost work days per year (Warshaw/NYBGH 1989).

• In a 3 year study of a large corporation, 60% of employee absences were found to be due to psychological problems (Jansen, 1986).

• Panic disorder patients are over 3 times more likely than an asymptomatic individual to be unemployed or on welfare at any given time (Markowitz et al., 1989).

• In one study, a group of individuals with panic disorder were unable to work an average of more than 2 1/2 years per person. In terms of 1983 average wages, this disability period cost an income loss of over $44,000 per person (Edlund and Swann, 1987).

• Individuals with major depression were found to be over 4 times more likely to take disability days than non- depressed employees, and 3 times more likely to miss time from work. Due to its higher prevalence in the workforce, minor depression with mood disturbance may account for 51% more disability days than major depression (Broadhead, et al., 1990).

• Patients suffering from major depression were over 1 1/2 times more likely than asymptomatic individuals to be unemployed or on welfare at any given time (Markowitz, et al., 1989).

• Those testing positive for drug use were 2 1/2 times more likely to be absent than workers who did not test positive (Kronson, 1991). Substance abusers were 2 1/2 times more likely than non abusers to have absences of 8 days or longer (NIDA, 1982).

• In 1980, alcoholism alone cost the nation 500 million lost work days (Harwood et al., 1984).

D. Many Mental Disorders are Comorbid with Substance Abuse.

• In a sample of 254 patients with panic disorder, 32% also had major depression and 44% had substance abuse problems (Klerman, et al., 1991).

• Those suffering from panic attacks (sample size = 667), a more common and milder illness similar to panic disorder, also suffered from major depression 21% of the time, and substance abuse problems 30% of the time (Klerman, et al., 1991).

• Research based on a nationwide, prospective database (Epidemiological Catchment Areas- ECAs) shows that people with panic disorder, compared to asymptomatic people, are 4 times as likely to abuse alcohol and almost 5 times as likely to abuse other drugs (Markowitz, et al., 1989).

• ECA research has also revealed that major depression strongly correlates with substance abuse. People with major depression, when compared to asymptomatic individuals, are 2 1/2 times more likely to abuse alcohol and 3 times as likely to abuse other drugs (Markowitz, et al., 1989).

  
  

A. The Effectiveness of Psychological Services in Treating Productivity-Impairing Disorders is Well Documented.

1. Efficacy of Panic Disorder Treatment
   • 70% to 90% of patients with panic disorder, a disease affecting millions of Americans, can 'obtain significant relief' through psychological services (Office of Scientific Information, 1992).

   • A review of clinical trials of 11 panic disorder treatments and combinations of treatments (mostly for Panic Disorder with agoraphobia), including both pharmacotherapies and outpatient psychotherapies, found cognitive- behavioral therapy and cognitive therapy with graduated exposure to be the most efficacious. These two treatments had 90% and 87% success rates, respectively, and also had the lowest relapse rates, of 10% and 5%, respectively (Michelson and Marchione, 1991).

2. Efficacy of Depression Treatment
   • A review of 58 studies of the effectiveness of psychotherapy for depression found that 77% of depressed patients treated scored significantly better on post-treatment evaluations than depressed patients with no treatment. 80% of the treated group scored better than wait-listed controls. On the average, treatment was completed in only 9 sessions (Robinson et al. 1990).

   • Another meta-analysis showed that cognitive therapy is an extremely potent intervention for depression. Cumulative data indicated that the depressed patients undergoing cognitive therapy had better outcomes than 98% of the patients in the no treatment condition. Further, the average cognitive therapy patient scored better on post-treatment measures than 70% of the pharmacotherapy patients (Dobson, 1989).

   • A meta-analysis of 56 studies of five types of psychotherapy revealed that 89% of psychotherapy patients improved more than those in the no treatment group. Mean treatment length was only 4 weeks (Steinbrueck et al. 1983).

3. Efficacy of Substance Abuse Treatment
   • Of 754 patients entering inpatient substance abuse treatment, 40% reported working under the influence. However, one full year after treatment, that number had dropped to 4% (Harrison and Hoffmann, 1989).

   • In a study of 742 substance abuse patients undergoing a variety of treatments, including inpatient and outpatient psychotherapy and methadone treatment, alcohol abusers showed a 67% decrease in number of days intoxicated, and a 150% increase in earned income. Drug abusers showed a 67% decrease in opiate use, 50% decrease in stimulant use and a 390% increase in earned income (McLellan et al., 1982).

   • A study of alcoholism treatment efficacy (Holder et al., 1991) found, by review of clinical trials, that out- patient mental health treatments were the most cost-effective. Brief motivational counseling, self control training, social skills training and marital behavioral therapy were among the types of treatment found both most inexpensive and most effective in eliminating or reducing alcoholism. By contrast, Alcoholics Anonymous, residential treatment, and many types of pharmacotherapy showed little or no evidence of efficacy.

   • A study comparing inpatient and outpatient alcohol detoxification found significant improvement at 6 months after treatment for both groups overall, but with no significant difference in outcome between the two groups. However, the inpatient treatment costs were 10-20 times higher than outpatient treatment costs, and out patient treatment took only an average of 6.5 days (Hayashida et al., 1991).

C. Reducing Existing Mental Health Benefits can be Harmful to Employee Psychological Health and Workplace Productivity.

• 32% of employees suffering a significant drop in benefits claimed stress caused them to miss at least one day of work. In contrast, only 15% of employees with stable benefits missed a day due to stress (Northwestern National Life, 1991).

D. Psychological Services Accomplish More Than the Reduction of the Primary Effects and Symptoms of Mental Illness and Substance Abuse: By Eliminating the Causes of Productivity Loss, They Also Increase a Company's Productive Capacity and Quality of Products and Services.

• The Stress Management Program at Safeway's Bakery Division has reduced lost work days due to employee injury from 1,740 days in 1977 to 0 days in 1990 (Spotlight: Managing stress in the Workplace, 1991).

• Prior to inpatient substance abuse treatment, 42% of individuals studied reported absences due to drugs, and 39% reported tardiness. One full year after treatment, these numbers dropped to 5% and 7% respectively (Harrison and Hoffmann 1989).

• Over a four year period, the McDonnell Douglas Corporation's (MDC) Employee Assistance Program reduced termination for those in substance abuse programs by 42%, and for those in mental illness treatment by 28%, when compared to those in the traditional health plan (McDonnell Douglas Corporation, 1990).

• Over a 5 year period, the same MDC program reduced absenteeism by 29% for those in substance abuse treatment, and 25% for those in mental illness treatment, compared to those in the traditional health plan. Full implementation is projected to reduce absenteeism by 7,761 days over the next 4 years. (McDonnell Douglas Corporation, 1990).

• According to the insurer Northwestern National Life, the average cost per person in lifetime disability payments for stress-related illness is $73,270. However, the average cost to rehabilitate a disabled employee is only $1925-- a savings of over $71,000 per employee (Walker, 1991).

References

Belden and Russonello, (1989). Degree of and Responses to Employee Psychological Problems Among Small Businesses in Ohio: A Report of Findings from a Survey of Small Business Executives. A report prepared for the American Psychological Association and the Ohio Psychological Association.

Broadhead, W.E., Blazer, D.G., George, L.K., Chiu, K. T., (1990). Depression, disability days, and days lost from work in a prospective epidemiological survey. Journal of the American Medical Association, 264 (19) 2524-2528.

Database, Policy in Perspective, Mental Health Policy Resource Center, July, 1990.

Dobson, K.S., (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414-419.

Edlund, M.J., Swann, A.C., (1987). The economic and social costs of panic disorder. Hospital and Community Psychiatry, 38 (12) 1277-1279.

Harrison, P.A. and Hoffmann, N.G., (1989). CATOR report: Adult inpatient completers one year later. St Paul: Ramsey Clinic.

Harwood, H.J., Napolitano, D.M., Kristansen, P.L., Collins, J.J., (1984). Economic Costs to Society of Alcohol and Drug Abuse and Mental Illness: 1980, Research Triangle Inst.

Hayashida, M., Alterman, A.I, McLellan, A.T., O'Brien, C.P., Purtill, J.J., Volpicelli, J.R., Raphelson, A.H., and Hall., C.P., (1989). Comparative effectiveness of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. Journal of the American Medical Association, 320 (6) 358-365.

Holder, H., Longabaugh, R., Miller, W.R., and Rubonis, A.V., (1991). The cost effectiveness of treatment for alcoholism: A first approximation. Journal of Studies on Alcohol, 52 (6) 517-540.

Jansen, M., (1986). Emotional disorders in the labour force: prevalence, costs, prevention and rehabilitation. International Labour Review, 125 (5) 605-615.

Kamlet, M.S., (1990). Depression in the workplace: Issues and answers. Baltimore; NIMH/DART.

Klerman, G.L., Weissman, M.M., Oullette, R., Johnson, J., Greenwald, S., (1991). Panic disorders in the community, social morbidity and health care utilization. Journal of the American Medical Association, 265 (6) 742-746.

Kronson, M.E., (1991). Substance abuse coverage provided by employer medical plans. Monthly Labor Review, April, 3-10.

'Managing Mental Health and Chemical Dependency Expenses,' (1990). William M. Mercer Meidinger Hansen, Inc., 1990.

Markowitz, J. S., Weissman, M.M., Oullette, R., Lish, J.D., Klerman G.L., (1989). Quality of life in panic disorder. Archives of General Psychiatry, 46 (Nov) 984-992.

McDonnell Douglas Corporation and Alexander Consulting Group, (1990). Employee Assistance Program Financial Offset Study 1985-1989. McDonnell Douglas Corporation.

McLellan, A.T., Luborsky, L., O'Brien, C.P., Woody, G.E., Druley, K.A., (1982). Is treatment for substance abuse effective? Journal of the American Medical Association. 247 (10) 1423-1428.

Michelson, L.K., and Marchione, K., (1991). Behavioral, cognitive, and pharmacological treatments of panic disorder with agrophobia: a critique and synthesis. Journal of Consulting and Clinical Psychiatry, 59 (1) 100-114.

National Institute on Drug Abuse, (1987). 'Strategic Planning for Workplace Drug Abuse Programs,' Department of Health and Human Services.

Northwestern National Life, (1991). Employee Burnout:America's Newest Epidemic. Northwestern National Life Insurance Company.

Office of Scientific Information, (1992). Panic Disorder Fact Sheet, National Institute of Mental Health.

Response Analysis Corporation, (1991). Corporate Mental Health Benefits, Phase Two: A comparison of Boston Area Companies with Companies Nationwide. A study conducted for the American Psychological Association and the Massachusetts Psychological Association.

Rice, D. R., Kelman, S., Miller, L. S., Dunmeyer, S., (1990). The Economic Costs of Alcohol and Drug Abuse and Mental Illness: 1985. Report Submitted to the Office of Financing and Coverage Policy of the Alcohol, Drug Abuse, and Mental Health Administration, U.S. Department of Health and Human Services. San Francisco, CA: Institute for Health and Aging, University of California, 1990.

Robinson, L.A., Berman, J.S., and Neimeyer, R.A, (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcomes research. Psychological Bulletin, 108, 30-49.

Spotlight: Managing stress in the workplace, (March 1991). Prevention Report, US Public Health Service, p.7.

Steinbrueck, S.M., Maxwell, S.E. and Howard, G.S., (1983). A meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults. Journal of Consulting and Clinical Psychology, 51, 856-863.

Walker, C.K, (1991) Stressed to Kill. Business and Health, Sept. p. 42.

Warshaw, L.J., (1989). Stress, Anxiety and Depression in the Workplace: Report of the NYBGH/Gallup Survey. Presented at Conference on Stress Anxiety and Depression in the Workplace, 10/18/89, New York, NY.

William M. Mercer Meidinger Hansen, Inc., (1988). Substance Abuse in the Workforce, Marsh and McLennan Co: New York.

Yanson, J., (1991). The 1991 national Executive Poll on Health Care Costs and Benefits. Business and Health, Sept. 1991 61-71.

Marketing Department
APA Practice Directorate
June 1992