• Does a recommendation to take antidepressants constitute taking action on mental health issues?

It is no exaggeration to say that the financial toll of mental health issues is truly staggering. 2010 estimates put the global direct and indirect costs of mental health disorders at US $2.5 trillion; by 2030 these costs are expected to double, making the economic loss comparable to that of cardiovascular diseases, and greater than the costs of cancer, chronic respiratory diseases and diabetes. Compounding this economic burden are the costs associated with diminished productivity in the workplace–not to mention the reduction in the quality of life of those who suffer from mental health issues.  Clearly, steps must be taken to address this challenging and long-standing issue.

Sadly, progress has been inadequate. The “illness” industry is thriving, yet legislators, caregivers, advocates and medical professionals are stymied because they do not know how to tackle this issue. The fact is, being “aware” of a problem and “understanding” it does not get it solved.

In the literature, this lack of action has been justified based on the assertion that “[a]ccess to mental health care is generally restricted owing to the lack of personnel and infrastructure, and effective evidence-based treatments are not provided”; furthermore, researchers note that “specific prevention is almost completely lacking.”

This does not justify inaction, of course, yet the escalation from “awareness” of the issue to actual solutions has been notably lacking. This is not due to a misunderstanding of the causes of mental illness, as researchers have told leaders of corporations how and why mental health issues arise, and it is no mystery that mental health issues arise in response to different stressors and circumstances and experiences over time; still, this appears to have been glossed over in the literature.

So if the answer is known and there are programs out there to at least commence the long journey back to corporate wellness, why is there such hesitation?

One of the issues here appears to be that if one can’t see the manifestation of a “disease” as a physical issue such as cancer, diabetes or heart disease, then perhaps it isn’t a real disease. Even workers who are afflicted with mental health issues oftentimes do not really believe that these types of issues are real diseases, especially when the issue relates to self-inflicted substance abuse.

As a study in contrast, let’s look at an affliction that, regrettably, many of us might be familiar with. Cancer is prevalent worldwide and new strands seem to be developing yearly, with people being diagnosed with this somatic disease at younger and younger ages.

Around this “disease industry” a multitude of organisations have sprung into being, including hospitals, wellness centres, care facilities, hospices, doctors, specialist surgeons and nursing staff, not to mention the thousands of foundations dedicated to conducting research to find a cure. Along with this, we can bear witness to the increase in the numbers of drugs, drops, pills and potions, treatments, diets, mindfulness techniques, exercise programs and the like to help alleviate this disease (or at least the symptoms).

Wanting to make a contribution, thousands upon thousands of volunteers donate time, money and energy to increase awareness and understanding, as well as to raise money for the cause. The money generally goes towards research or the building of new facilities for prospective new patients.

Now, what would happen if a universal cure were proclaimed and it worked for each and every type of cancer, were freely available, and could not only cure but prevent the onset of cancer? What would happen to the infrastructure, the structures, the jobs of those specialists, doctors, nurses, the researchers and the volunteers if this were the case?

Pretty much everyone would be out of a job!

The enormous amount of time, effort and dollars spent on, in and around cancer would suddenly be freed up. What would happen globally?

There would be an outpouring of grief, loss and sadness even though individuals who had the disease would suddenly all be cured and they would be rejoicing. Those who had a vested interest in “maintaining the disease” in some way, would be the losers. What would everyone do, then?

Is there a parallel case in the mental health industry worldwide?

Returning our focus to mental health, let’s consider, as a case in point, a “solution” promoted by the American Psychiatric Association (APA), through Right Direction, (www.RightDirectionForMe.com), which prompts employers to include regular screening for depression in their EAP’s (Employee Assessment Plans) and health-care plans. The recommended treatment plan goes something like this:

• Hire a mental care health professional.
• Assess the worker.
• Diagnose the issue as per the DSM-5, specifically by a mental health-care professional (usually a psychologist or a psychiatrist registered with the APA).
• Prescribe medication (typically antidepressants).
• Instigate CBT (Cognitive Behavioural Therapy), a “talking” therapy.
• If all else fails, implement ECT (electroconvulsive therapy) or some other mind-altering treatment.

So, the basis of this treatment plan is primarily to get the patient onto some antidepressant medication. It is pretty much, “Pop a pill and make it go away. We’ve helped the depressed worker in some way. We are covered and we have been seen as doing the ‘right’ thing.”

Tellingly, the results of the Survey of US Workers indicating the impact of depression on productivity demonstrate the vital need for employers to provide support and resources for those living with the effects of these diseases. Yet, they fall short of delineating what “resources” these might be.

Thus, the current treatment path seems to be drugs first, and not a practical stress-reduction training program. What, then, can a company do to do the right thing by their workers and for the workers to gain access to real treatment plans that don’t rely on drug therapy?

1. Take mental health issues as seriously as any disease. After all, solutions can only be found when we’re actively looking for them.
2. Move beyond the “awareness” phase and into a more results-oriented approach. Raising awareness is fine, but it shouldn’t be the endgame.
3. Seek input from all tiers of the corporate hierarchy, including the workers themselves.
4. Offer alternative treatments to drugs. One example would be HeartMath, a program that uses simple tools and technology, such as breathing exercises, to measure, monitor and manage stress (the research indicates that this type of program actually works, without the unwanted side effects of medication).
5. Incorporate current research into any program, but check the source of that research; be wary of conflicts of interest (for example, if a research study were conducted by a pharmaceutical company).
6. Make access to mental health care more convenient and affordable. Inform employees of the options available to them.
7. So as not to exacerbate the problem, reduce stressors in the workplace environment as much as possible.

However we choose to approach the ever-pressing issue of mental illness, it is time to move past “awareness” and “understanding,” and towards real action that changes lives. Sufferers of mental illness, and those of us impacted by this disease (and that would include every one of us), deserve nothing less.