Depression in the workplace affects 10 million people each year (Value Options, How Depression Affects the Workplace) with 6-8% of the population having a major depressive episode each year (Kessler RC et al., The Prevalence and Correlates of Workplace Depression in the National Comorbidity Survey Replication, 2008). It often occurs during a person’s prime working years – between ages 25 and 44 and 1 employee in 20 can be experiencing depression at any given time (Value Options, How Depression Affects the Workplace). Depression can lead to clinical symptoms which make it difficult to function in the workplace such as poor concentration, low motivation, loss of energy, and even thoughts of suicide. Moreover, depression costs over $51 billion in absenteeism from work and lost productivity and $26 billion in direct treatment costs (Mental health America, Depression in the Workplace). Depression is often co-morbid with other physical and mental health conditions such as heart disease, obesity, diabetes, and anxiety, which contributes to the high medical costs.
Collaborative Care for Depression
Collaborative care is an evidence-based model of depression that treats individuals with depression in a primary care setting. In fact, 70% of all antidepressant prescriptions are written by primary care providers. However, only 20% show improvement with this usual care model. The Collaborative Care Model integrates both medical and mental health care in the primary care setting. Unlike care as usual, which involves a primary care physician treating the patient, the model involves a team-based approach which includes a primary care physician, a care manager and a consulting psychiatrist to provide care. Patients are actively monitored and treatment is adjusted as needed to ensure improved clinical outcomes (AIMs Center: Advancing Integrated Mental Health Solutions).
More than 79 clinical trials have demonstrated that Collaborative Care is more effective than care as usual. The IMPACT study, which is the largest depression trial to date, demonstrated that Collaborative Care more than doubles the effectiveness of usual care. Long-term analysis has demonstrated that $6 is saved in health care costs for every $1 spent, making it cost-effective (AIMs Center: Advancing Integrated Mental Health Solutions). Additionally, Collaborative Care has been chosen as the model of depression care by New York through many initiatives such as the Delivery System Reform Incentive Program (DSRIP) and the Collaborative Care Medicaid Program (CCMP).
How Workplaces Can Use Collaborative Care as a Resource
If employers were to refer their employees to collaborative care programs they would have access to effective depression care treatment that would be efficient and cost effective (Partnership for Workplace Mental Health – A program of the American Psychiatric Foundation, A mentally healthy workforce – it’s good for business, 2011). The following are some of the steps employers can take: (1) Request more information about which organizations are participating in Collaborative Care; (2) Evaluate current health plan and mental health benefits; (3) Evaluate employee assistance programs to utilize collaborative care initiatives for short term effective depression care; (4) Conduct employee awareness program about depression; and (5) Offer depression screenings.
Workplaces Incorporating Collaborative Care as a Resource
Major corporations are providing coverage for the Collaborative Care model in Minnesota where The Institute for Clinical Systems Improvement (ICSI) has launched a program in 2008 called DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction). DIAMOND was established in several primary care clinics and health plans agreed to make monthly payments to participating clinics. More than 1,600 patients have been enrolled and among and results have demonstrated that 43% of patients who have been in the program for at least 6 months have recovered from their depression, which enable employees with depression to contribute productive efforts at work (Institute for Clinical Systems Improvement, ICSI). The value of providing collaborative care models for treating employees with depression).
A variation of the collaborative care model was also used in an intervention in the Netherlands where those with clinical depression received services directly in the workplace. In this study, occupational health case managers facilitate services with primary care providers and mental health specialists and results show this as an effective means of delivering care (Gilbody, Simon et. al, Better care for depression in the workplace: integrating occupational and mental health services, 2012).
Conclusion
As a new model, we are proposing that organizations consider integrating the collaborative care model into their benefit and employee assistance programs and packages. 80% of depressed people can be treated successfully and this model will ensure that employees continue being productive at work and reduce financial costs for employers (Mental health America, Depression in the Workplace).
You may reach Virna Little at vlittle@institute.org or Sudha Sarode at ssarode@institute.org.
