Mental health disorders are among the costliest health concerns for employers in the United States. According to the National Institute of Mental Health, nearly one in five adults live with a mental illness. Depression and anxiety are among the most common mental health disorders but often go undiagnosed and untreated.¹

Many factors may contribute to mental health issues, including traumatic or abusive life experiences, biology, and family history of mental health problems. Unfortunately, social stigma and fear of discrimination prevent many people from seeking help.

Employee mental health impacts the bottom line

Poor mental health and stress can negatively affect employee job performance, productivity and relationships. In addition, as physical health is inextricably linked to mental health, many people with mental health disorders are at high risk for chronic physical conditions such as heart disease, diabetes and respiratory illnesses.²

The reverse is also true; physical illness, such as cardiovascular disease, may cause or worsen mental health issues, particularly symptoms of depression.³ Healthcare costs to treat people with both mental and physical disorders can easily be two to three times higher than for people without co-occurring illnesses.⁴

Employers have a unique opportunity to improve employee mental health

Investing in mental health treatment in general has proven to be cost-effective. Employers can reduce health care costs for their businesses and their employees by addressing mental health issues in the workplace. Many evidence-based treatments can save $2 to $4 for every dollar invested in prevention and early intervention.⁵ An effective approach is not one-size-fits-all but takes into consideration generational differences and employee diversity.

A recent study published in the Harvard Business Review called “People want their employers to talk about mental health” indicated that millennials (the cohort of people born between 1981 to 1996) were three times more likely to experience anxiety than baby boomers.⁶ Gen Zers (those born between 1997 to 2012) report even higher rates of anxiety and depression. Millennials and Gen Z employees are the largest demographic in the workforce, and those who took part in the survey indicated an expectation that mental health be addressed in the workplace openly and without stigma.

Develop a customized approach to promoting mental health resources

The Harvard Business Review study recommends a multi-faceted approach that includes a more accepting culture starting from the top, with training and support, as well as clear information about employee resources such as availability of mental health benefits, wellness programs and employee assistance programs.

Employers should be cognizant of where their different employee groups seek information and use those channels (whether it’s the intranet, staff meetings, one-on-one meetings, employee resource groups, digital signs and posters, instant messaging platforms, or other social media venues) to provide needed information. Virtual mental health counseling and the availability of mental health apps offer convenient and mobile-friendly emotional support, particularly for younger employee groups accustomed to using their smart phones for everything from texting to shopping.

Dislodging stigma and experimenting with different communications channels to meet the needs of a diverse workforce can be challenging for human resources departments and managers. But the end result will be worth the effort: a healthier work environment that supports healthier employees and enhanced productivity.

Learn more about how your organization can benefit from an EAP solution.

1 “Facts & Statistics.” Anxiety and Depression Association of America, ADAA, https://adaa.org/about-adaa/press-room/facts-statistics.

2 “Chronic Illness & Mental Health.” National Institute of Mental Health, U.S. Department of Health and Human Services, https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml.

3 “Chronic Illness & Mental Health.” National Institute of Mental Health, U.S. Department of Health and Human Services, https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml.4 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748662?

5 Lerner D, Lyson M, Sandberg E, & Rogers W.H. (2018). The High Cost of Mental Disorders- Facts for

Employers. Retrieved from https://onemindinitiative.org/at-work/the-business-case/

6 Greenwood, Kelly, Bapa, Vivek, Maughan, Mike (2019). Research: People want their employers to talk about mental health. Retrieved from https://hbr.org/2019/10/research-people-want-their-employers-to-talk-about-mental-health

In 1989, one survey of the general public found that more than half of respondents believed lack of discipline was a possible cause of mental illness. The survey found that, at that time, Americans were more likely to receive information about mental illness from mass media than from medical providers or psychologists. Thirty years later, with the availability of information on the internet, the public should theoretically have a more accurate and balanced perspective of mental illness. But is the public obtaining their information from science-based sources? While there is still much to learn about mental illness, scientists have identified several factors that can play a role in mental health, including genetics, environmental exposure, altered brain chemistry, significant stress, and comorbid medical conditions. With the availability of misinformation on the internet and on social media websites in particular, are we really any better educated on mental health than we were 30 years ago?

The National Institute of Mental Health (NIMH) reports that approximately 1 in 5 adults experiences mental illness annually, with approximately 1 in 25 experiencing mental illness that substantially interferes with or limits 1 or more major life activities. Based on data from the 2018 National Survey on Drug Use and Health, approximately 19% have an anxiety disorder, 2.8% live with bipolar disorder, and fewer than 1% have schizophrenia in the United States (US) adult population. In addition, 7.2% of adults have experienced at least 1 major depressive episode in the last year. Unfortunately, only about 43.3% of adults with a mental health condition received mental health services within the past year, and of those with a serious mental illness, only 64.1% received mental health services within the past year. Even the indirect costs of mental health have a significant impact. Serious mental illnesses have been estimated to cost over $193.2 billion in lost earnings per year in the US, and mental illness has been predicted to cost the global economy $16 trillion by 2030.

Much has changed in the treatment of mental illnesses in the past 30 years. Key treatments for depression, such as selective serotonin reuptake inhibitors (SSRIs) and newer serotonin-norepinephrine reuptake inhibitors (SNRIs), have mitigated some of the limitations of earlier antidepressants (e.g., drug-food interactions or select adverse effects). Even in the past year, novel approvals for treatment-resistant depression (TRD) and postpartum depression (PPD) have emerged. For those with schizophrenia, the availability of newer generation antipsychotics has significantly altered care as well. Although testing for genetic alterations to better identify the best medication choice for a patient is in its relative infancy, the role of pharmacogenomics is rapidly expanding, too. These advances offer promise for individuals with mental illness, but no medication is without risks, and a discussion with a licensed medical provider is essential to establish an appropriate treatment regimen. In addition to medications, the role of nonpharmacologic treatment has expanded in the past 30 years as well, with additional treatment modalities beyond the advancements in psychotherapy alone (e.g., modern cognitive behavioral therapy, interpersonal therapy). A more holistic approach, incorporating lifestyle changes (e.g., diet, exercise) and non-traditional medicine (e.g., meditation, acupuncture), is also gaining in popularity; however, it is critical to understand that herbal or “natural” treatments can have adverse or toxic effects and drug interactions. These should only be used in consultation with a healthcare provider.

Mental illness can contribute to the risks for suicide. Unfortunately, the Centers for Disease Control and Prevention (CDC) reports that suicide rates have increased by approximately 30% from 1999 to 2016. Notably, suicide is rarely caused by a single factor, and the National Alliance on Mental Illness (NAMI) reports that approximately 54% of those who die by suicide do not have a diagnosed mental health condition. Regardless, this leaves a significant portion of patients with known mental health conditions where intervention may have been helpful. Moreover, NAMI also reports that approximately 90% of those who die by suicide show symptoms of a mental health condition. The CDC includes several warning signs on their website and offers advice to several groups ranging from laypersons to the government to healthcare providers. One component the CDC emphasizes to healthcare systems is the need for affordable and effective mental and physical healthcare where people live. In addition, the Zero Suicide Institute provides a framework for continuous quality improvement in health and behavioral healthcare systems aiming to prevent suicide.

Of late, the public seems particularly concerned with the risk of violence in those with a mental illness. A 2006 survey found that 32% and 60% of Americans thought people with depression and schizophrenia, respectively, were likely to act violently toward someone else; however, research has demonstrated that there are several factors that contribute to violence, and that when accounting for these additional factors, the presence of a mental illness is only a modest contributor (at best) to violence. According to the 2018 National Survey on Drug Use and Health, approximately 19.4% of those over 12 years of age have used an illicit drug in the past year and 3% had at least 1 illicit drug use disorder. Additionally, 3.7% of adults reported dual diagnosis (both any mental illness and substance use disorder). Studies of patients with substance abuse or dual diagnosis have found higher correlations with violence compared to mental illness alone. Most importantly, adequate treatment has demonstrated improved outcomes.

With the discussion of mental health in the press and the plethora of inaccurate information on mental health online, it is difficult for the public to develop a truthful foundation on mental illness. While public access to information and scientific discovery have advanced in the past 30 years, the most critical component for the proper diagnosis, effective treatment, and safety of those with mental illness remains consultation with a healthcare provider and/or team.

If you or someone you know may be at risk for suicide, contact the free and confidential Suicide Prevention Lifeline at 1-800-273-TALK (8255). It is available to anyone 24 hours a day, 7 days a week.

Some people experience a serious mood change during the winter months, when there is less natural sunlight. This condition is called seasonal affective disorder (SAD). SAD is a type of depression, and usually lifts during spring and summer. Seasonal affective disorder impacts those who live in specific geographical areas, typically those who live in northern or southern hemispheres but is extremely rare in people who live close to the equator.1

SAD symptoms
SAD is a fairly common form of depression that occurs in the winter. During the winter days are shorter. Shortened days increase the chances of someone to develop SAD due to the lack of natural sunlight.

Common symptoms may include:

• Sad, anxious, or “empty” feelings
• Feeling hopeless
• Feeling guilty, worthless, or helpless
• Irritability and restlessness
• Loss of interest in activities
• Loss of energy
• Difficulty concentrating, remembering details and making decisions
• Difficulty falling sleeping or oversleeping
• Changes in weight
• Thoughts of death or suicide

Seasonal changes in bipolar disorder
In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania). This is known as reverse seasonal affective disorder. Signs and symptoms of reverse seasonal affective disorder include:

• Persistently elevated mood
• Hyperactivity
• Agitation
• Unbridled enthusiasm out of proportion to the situation
• Rapid thoughts and speech

There are some measures you can take on your own that may help. You can make your environment brighter by sitting near windows and being exposed to more light. It is also helpful to get outdoors and be exposed to the sun and daylight. Regular exercise can help relieve the stress and anxiety brought on by SAD.

About 4 to 6 percent of people suffer from SAD and an additional 10 to 20 percent may suffer from mild SAD.2

Treatments SAD may be effectively treated with light therapy. But nearly half of people with SAD do not respond to light therapy alone. It is important to speak to your doctor about how you feel and determine the right treatment plan for you.

Here are a few tips on how you can manage SAD. Remember to speak with your doctor at any point about how you feel, and to determine the right treatment plan for you.

• Get enough sleep and practice good sleep habits
• Eat a healthy diet
• Try to exercise more often and find activities that make you happy
• Avoid alcohol and illegal drugs
• Talk with family and friends
• Stay active

When you are struggling with depression, talk about how you’re feeling to someone you trust. Try to be around people who are caring and positive. Volunteer or get involved in group activities.

People who have had repeated seasonal depression should talk to a mental health care professional about prevention methods. Starting treatment during the fall or early winter, before the symptoms of SAD begin, may be helpful.

For additional information, visit MagellanHealth.com/MYMH

1. www.mentalhealthamerica.net
2. American Family Physician, Seasonal Affective Disorder (www.aafp.org/afp/2000/0301/p1531.html) Source: National Alliance on Mental Health; National Alliance on Mental Illness (NAMI)

This document is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

Caring for a family member or friend who has a disability or a chronic illness can be rewarding. But it’s also demanding. One of the keys to being a successful caregiver is to manage stress by seeking support and taking care of yourself. Managing stress is especially important for a caregiver, because stress can weaken his or her immune system. A weak immune system makes the caregiver more likely to get sick.

Think about the kinds of caregiving tasks or situations that trigger stress for you. Then you can focus on one or two things you can do that will help the most to reduce stress. Here are some ideas:

Get support
Ask family members for help. Include them in caregiving decisions.

• Ask family members for help. Include them in caregiving decisions.
• Share the tasks. Make a list of weekly tasks, and share that list with your family. Ask for help with shopping, housecleaning, and errands. You don’t have to do all the work on your own.
• Stay involved. Make time for social activities and friends, even if it’s only a phone call or coffee during the week.
• Join a caregiver support group. Meeting other caregivers helps you know you’re not alone. And it gives you a chance to talk about your worries and concerns with others who understand.
• Find respite care. Respite services provide someone who can stay with your family member while you get away for a few hours or days. Time away can help you manage your stress and be a better caretaker.
• Look up caregiver resources in your community. Hospitals, churches, and other groups may provide transportation or other services that support caregiving tasks. You can reduce stress by planning ahead so you know who to call when you need extra help.

Take care of yourself

• Put your own health first. Be sure to schedule and go to your medical checkups.
• Eat a healthy diet, and get enough sleep. Taking care of yourself will help you deal with stressful situations.
• Get regular exercise. Even a 10-minute walk can relieve stress.
• Take a breath. Try stress reduction techniques like deep breathing and meditation.
• Take a break. It’s important to take time off from caregiving once in a while. Spend some time doing things you enjoy or on things in your own life that need attention.

What to think about
Depression is common among caregivers. It’s emotionally draining to care for a loved one whose health is getting worse. Don’t dismiss your feelings as “just stress.” If you’re having trouble coping with your feelings, it may help to talk with a counselor. If you have symptoms of depression, such as a lack of interest in things you enjoy, a lack of energy, or trouble sleeping, talk with your doctor.

Help is available. For additional mental health information and resources, visit MagellanHealthcare.com.

Source: Healthwise

What is depression in children and teens?

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens have serious depression.

Still, many children don’t get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

• Is irritable, sad, withdrawn, or bored most of the time.
• Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

• Lose or gain weight.
• Sleep too much or too little.
• Feel hopeless, worthless, or guilty.
• Have trouble concentrating, thinking, or making decisions.
• Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

• Both very young children and grade-school children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping. Often they will lose interest in friends and activities they liked before. They may complain of headaches or stomachaches. A child may be more anxious or clingy with caregivers.
• Teens may sleep a lot or move or speak more slowly than usual. Some teens and children with severe depression may see or hear things that aren’t there (hallucinate) or have false beliefs (delusions).

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a milder, ongoing form of depression called dysthymia (say “dis-THY-mee-uh”). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of brain chemicals that affect mood. Things that may cause these problems include:

• Stressful events, such as changing schools, going through a divorce, or losing a close family member or friend.
• Some medicines, such as steroidsor opioids for pain relief.
• Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical exam and ask questions about your child’s past health. You and your child may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how he or she thinks, acts, and feels.

Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

• Encourage your child to get regular exercise, spend time with supportive friends, eat healthy foods, and get enough sleep.
• See that your child takes any medicine as prescribed and goes to all follow-up appointments.
• Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
• Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.

• Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
  • Talking, drawing, or writing about death.
  • Giving away belongings.
  • Withdrawing from family and friends.
  • Having a plan, such as a gun or pills.
• Your child may start to feel better after 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
• A child may need to try several different antidepressants to find one that works. If you notice any warning signs or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child’s doctor.
• Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems

Help is available. For additional information, visit MagellanHealth.com/MYMH

©Healthwise

If you have family, friends or colleagues who live with mental illnesses, you may be unsure of how to speak to them in a respectful way. You want to show you care, but don’t know how to express your concern and not hurt the person at the same time.

Just ask…

1. Can you help me understand what it’s like living with your condition?
2. Is there anything you need from me or something I can do to help you?
3. Can we do something together – get coffee, go for a walk or see a movie?
   Just because the person has mental illness doesn’t mean he/she won’t want to do regular activities
4. What is your diagnosis and how do you feel about it?
5. Do you need to talk?
   Sometimes talking can help make things feel a little better.
6.  What can I do to be there for you, and help you feel supported?
7. How can I support you – can I listen to you, leave you alone, give you a hug?
8.  How has living with this condition shaped who you are today?
9. How are you? You don’t seem like yourself, and I want to know how you’re really feeling because I care about you.

Find Help and More Information Regarding Mental Illness

Help is available. For additional information, visit MagellanHealth.com/MYMH.

For more information on treatment resources, contact:
National Institute of Mental Health
https://www.nimh.nih.gov/health/find-help/index.shtml

NAMI (National Alliance on Mental Illness)
http://www.nami.org/

Substance Abuse and Mental Health Services Administration (SAMHSA) https://findtreatment.samhsa.gov/https://www.mentalhealth.gov/

Mental Health.gov
https://www.mentalhealth.gov/
Help is available. For additional information, visit MagellanHealth.com/MYMH

Read more about Mental Illness from Magellan Health Insights

Holidays are meant to be a joyful time celebrating with family and friends, enjoying time off from work, and indulging in delicious meals. That said, it is also easy to get overwhelmed and anxious as you try to keep up with multiple demands on your personal, family and work life.

Try these sanity savers to help you find the right balance so you can focus on making positive memories this holiday season:

• Keep it simple (and be realistic): Perfection is overrated. Don’t put pressure on yourself by committing to every party or making your own party a gala event. Focus on what makes the holidays special for you.
• Set aside differences: Try to accept family members and friends as they are, even if they don’t live up to all of your expectations. Set aside grievances until a more appropriate time for discussion.
• Stick to a budget: Before you start shopping for gifts, food, and decorations, decide how much money you can afford to spend. Don’t try to buy happiness with excessive gifts or lavish meals.
• Plan ahead: Identify possible challenges that can trigger stress and develop an action plan to feel prepared to deal with them. Set specific days for shopping, cooking, traveling, visiting friends, and other activities.
• Keep healthy habits: Don’t let the holidays become a free- for-all. Overindulgence only adds to your stress and guilt. Get plenty of sleep and make as much time for exercise as you can.
• Take a breather: Pay attention to your own needs and feelings. Spend a little time by yourself if you can. Meditate, do some relaxation breathing, or go for a short walk.
• Control the controllable: As families change and grow, traditions often do as well. Choose a few to hold on to, and be open to creating new ones and finding new ways to celebrate together.

Take steps to prevent stress and find peace and happiness this holiday season.

During National Depression Awareness Month, we wanted to take some time to discuss the very normal stress and mental health challenges working families experience as we are increasingly connected to our jobs. As our connectivity to work has grown – between email, texting, chats, phone calls, video conferencing calls, and a myriad of social networking sites – so has the challenge to separate work from our personal lives. Employees are spending an increasing amount of time both at work and thinking about work. Habits such as checking email during a family dinner or ruminating about that email that you’d forgotten to write in bed at night are common experiences for many. Add on top of that a child who’s acting out and a parent who needs a little extra care both physically and financially, and you have a recipe for stress that affects your own health and mindset, as well as potentially relationships with family, friends or colleagues.

Employee assistance programs (EAPs) have been adopted by many employers to reduce the impact of mental health disorders, workplace stress and other work/life issues on workplace productivity. Despite the ubiquity of this employee benefit, which is offered by 97 percent of large employers, utilization hovers around five percent industry-wide. A primary barrier is the stigma of utilizing EAP programs, which were historically grown from occupational substance abuse programs.

While great strides have been made in reducing stigma, a great opportunity lies in changing the premise that stands in the way of employees tapping into services that might help them move forward and find their best self. What if we were to fundamentally remove the premise that there are people with “issues” and people without? The reality is that every employee is faced with their own brand of “juggle,” and stress and anxiety continue to be on the rise as working families live increasingly busy lives.

As Magellan transforms the EAP benefit for modern day workers and their families, we’re driven to provide resources and tools to help people address their mental health challenges before they severely impact their lives and productivity. The pivot lies in helping employees take care of their mental health as a practice of self-improvement and in helping employers position EAP services in their culture of well-being.

There are three essential components to powering this shift in the transformed EAP:

• Clinically-validated online programs and mobile apps that help employees track and change habits and mindsets
• When employees experience a bump in the road, convenient access to a coach or therapist that can fit into their harried day
• Content that inspires, motivates and helps employees feel validated in the normalcy of their stress and feel connected to others tackling similar experiences

Imagine a world where employees give each other a high five for taking some “me” time, leveraging a convenient method of choice, just as they do for someone sticking to their gym routine or running their first 5k. We certainly do!