Providing mental health benefits for employees with ongoing mental illnesses is expensive, but letting these conditions go untreated can be far more costly for a business due to increased medical costs and the impact on performance, productivity, and morale.

Care Stack Level 2: Chronic Mental Health Conditions

As more employers add mental health coverage for their workers, health insurance expenses will have an increasing impact on the balance sheet, especially with demand for services surging amid the current mental health crisis. However, the costs of covering employees who experience chronic mental health conditions like depression, panic disorders, anxiety, and substance use, must be weighed against the alternative of letting these conditions go untreated. Research shows employers can play an important role in reducing the overall healthcare costs for individuals with these conditions and suggests companies may realize additional returns from these investments.

In day two of Mentera’s Care Stack Summit, Dale Cook, co-founder and CEO of Learn to Live, a mental health service providing digital Cognitive Behavioral Therapy (CBT), discussed some important questions employers should ask when choosing a provider to address chronic mental illnesses.

Questions to ask when choosing a provider:

• Is the therapy provided backed by peer-reviewed research?
• Are tools available to track ROI?
• What are the metrics for program engagement and how are they defined?

The Cost of Mental Illness in the Workforce

The World Health Organization reports that 1 in every 8 people in the world live with a mental disorder. Whether HR leaders are aware of it or not, these conditions are likely to have an impact on a company’s workforce. This may show up as absenteeism, substance use, presenteeism, decreased productivity, or increased turnover. Despite the passage of mental health parity laws, it may be difficult for employees to find service through an employer’s insurer. While this may put employers on the hook for paying for additional benefits, several studies show that providing support for employees struggling with mental health conditions has significant upside potential. A behavioral health study by Evernorth found that treatment of behavioral health conditions can reduce medical costs by up to $3,109 per person over a two-year period.

“If people diagnosed with a behavioral health condition, such as anxiety, depression or substance use disorder, receive outpatient care, costs are reduced by up to $3,109 per person over a two-year period.” 

— “Impact of Behavioral Health Treatment on Total Cost of Care” Evernorth Analysis, November 2021

Other behavioral factors associated with mental illness can have a significant impact on a company’s culture and performance. Absenteeism, substance use, and low productivity are some of the potential problems associated with untreated mental health conditions. When the costs of these events are factored in, the savings may be even greater. A May 2022 report by Deloitte estimated the return on investment for employers investing in care for mental health problems to be an average of £5.30 for every £1 invested.

How to Choose the Right Provider

The evidence shows these investments will pay off in the long run, but what can benefits leaders do to make sure that the solutions they choose are making a difference? Cook shared some of the insights he has gained over the past decade as co-founder and CEO of Learn to Live, helping companies implement strategies to address chronic mental health conditions.

Learn to Live was started in 2012 by Cook and Dr. Russell Morfitt, a psychologist who uses CBT to treat a variety of anxiety-related conditions. The two saw an opportunity to expand the reach of Morfitt’s practice after learning about research that showed remote, or “computer-based CBT,” could be just as effective as in-person CBT. Learn to Live was an early pioneer in what is now known as digital CBT, which uses a combination of recorded lessons and telehealth therapists and coaches to help individuals examine and change the thoughts and behaviors at the root of their mental health disorders. Cook has a personal connection to CBT, having recovered from insomnia related to anxiety in college thanks to a school counselor who introduced Cook to some of the principles of CBT.

Evidence-Based Therapy

Cook believes it is essential for digital health companies to base their products on evidence-based therapies, and credits Learn to Live’s growth in large part to its adherence to providing quality CBT treatment.

“As we talked with employers and other organizations, there was a concern about ‘how can we make sure that our employees and their families are getting consistently effective treatment?’… We took that very seriously when we started, and that’s why our programs are grounded on over two decades of research.”

Easy Access to Care

Another key element in Learn to Live’s growth has been its focus on overcoming barriers to accessing mental health care. The company has a full staff of therapists and coaches who serve individuals and organizations through the company’s telehealth platform. This helps to fill the need for clients in many locations with limited in-person service providers.  Learn to Live also makes an explicit effort to address the stigma and fear that prevents many from seeking mental health care by offering confidential 24/7 access to therapists and coaches as well as its library of content.

“The understanding we have with an employer is: we can get a lot of people to engage with us and we can help them improve their own mental health… but part of the trade-off is that we’re not going to share their identity with you. They need to be able to come to us in privacy, in confidence.”

Tracking Engagement and ROI

To make sure clients have a clear understanding of how Learn to Live is making a difference in their employees’ lives, it offers clients tools for tracking engagement and outcomes anonymously. Clients have access to dashboard metrics on usage and other performance data, while each individual monitors their own progress including an ongoing assessment of their condition.

Sample User Assessment

Engagement statistics for digital health providers are often opaque. It’s common to see bold percentages and figures on a website or brochure, but the criteria for what constitutes an engaged user may not be clearly defined. Cook says that Learn to Live makes it clear in their reporting that engagement means ongoing engagement:

“What we mean is it’s great if you come visit our website, it’s great if you download a PDF or two, but we don’t count you for engagement. You’re in a program of eight lessons, each lesson is about an hour of seat time, and then in between, there’s CBT activities… if you’re doing the things that move you forward to improve your mental health from a clinical standpoint, we count you.”

Reducing the Risk of Chronic Mental Illness

In addition to treatment of known mental illnesses, there are some measures that can play an important role in reducing the impact of these illnesses. One effective practice is screening for signs of potential mental health issues. When symptoms or risk factors are identified early, intervention can be effective in controlling the onset and severity of many disorders. Similarly, preventative and restorative practices can also play a role in reducing the impact of these conditions.

Cook says Learn to Live is expanding its resources on mental health maintenance, based on feedback from users asking for programs focused on building resilience. Currently, the company is adding tools that can help users build the reserves they need to handle life’s stressors and challenges.

“We recognize that just like your physical fitness, mental health is an ongoing daily maintenance issue for all of us. So, whether you’re clinically diagnosed with depression or not, there are going to be days when you’re sad. And we believe we all need the skills to deal with that.”

Investing in Your Employees Makes Sense

As employers weigh the costs and benefits of mental health coverage, it is important they understand the downstream effects of their choices. With the right provider as a partner, investment in a comprehensive plan for employee wellbeing can help a company build the kind of supportive and productive workplace culture that will attract and retain the best talent.

Mentera’s Care Stack is a useful framework that can help you identify the important issues and questions about every component you need to support the mental health of each of your employees. Check out the Care Stack Playbook for steps you can take to build a Care Stack for your employees, and watch the videos from The Care Stack Summit for additional insights from our speakers.