Back when companies were flush with cash and the recession was just a cloud on the horizon, progressive managers crafted impressive benefits packages for their employees, with mental health care as a centerpiece.
But the recession became a reality, and corporate profits shrank. Employees began to worry and fret. Problems such as substance abuse and stress-related disorders began to increase.
Now mental health care costs are swelling at twice -- sometimes three times -- the rate of standard health costs, which themselves are increasing 10 percent a year, say mental health care experts.
"It's an area of low technology and overhead costs, but it's been leading health care costs," said Dr. Paul Shoffeitt, president of Green Spring Mental Health Services, a subsidiary of Blue Cross & Blue Shield of Maryland.
Michael Powichroski, a certified professional counselor and manager of mental health programs with the Sheppard Pratt Employee Assistance Program, said company executives feel stymied. They want to give their employees good benefits but wonder how they can afford them.
While they can't keep mental health care costs from rising, some corporations have found they can at least keep them in check by using outside agencies to manage their programs. Through such programs, an independent organization helps find the specific type of mental health care or substance abuse program that will help individual employees, as quickly as possible and at the lowest cost.
Dr. Shoffeitt said managed mental health care is the best approach in difficult economic times, when more people need the services and companies find it harder to pay for them.
"Mental health and substance abuse care is at the heart of all health care," he said. "If we don't have real good services here, we see costs go up in other areas of care. In times like this, during a recession, it's critical that these services be preserved.
"Managed care is a benefit preserver and helps people get the care they need in a very efficient fashion," he added. "You have more people getting more care more affordably." Executives at managed mental health care organizations say those who go their own way may spend too much time searching for help, wasting money and not getting well.
"Typically what someone might do is go to the Yellow Pages," said Wayne Feest, vice president of sales and marketing at CMG Health, an Owings Mills-based provider of managed mental health care programs. "Maybe the person needs a psychiatrist who can prescribe drugs, but they go to a therapist and months later wonder why they are not getting better. They spend lots of money without benefit."
Mr. Powichroski described three employees from one company who entered a substance abuse treatment center, knowing help there was covered under their company's insurance policy. All were accepted for expensive inpatient treatment, though not all needed it.
"If you present yourself at the door, they're going to help you. That's their job," Mr. Powichroski said. "But of the three, I would have placed only one in the treatment center." He said the second patient could have received inpatient treatment at a less expensive center, and the third didn't need inpatient help at all.
"Had there been some kind of incentive or requirement for them to come through an employee assistance program first,the organization would have saved about $20,000 on those three people."
Mr. Feest said case managers at managed mental health care companies can direct individuals to the most appropriate type of care. An employee looking for help might be referred to a social worker, a psychologist or a psychiatrist who may prescribe medication, depending on the employee's needs.
As efficient as a managed mental health program may be, company benefits managers and employees themselves wonder: Is the care offered to them through a managed program as good as care they might find on their own?
Dr. Shoffeitt says it is. Managed mental health care and substance abuse care companies work with providers that use goal-oriented, brief therapy. Dr. Shoffeitt says the therapy is more focused and more scientific than past treatment methods and provides the best care in the least intensive manner. Some problems are chronic and don't lend themselves to brief therapy, he admitted. In those situations, patients get the help they need through longer-term methods.
Mr. Powichroski says the primary goal of companies struggling with their programs should be to help people get better, not to reduce mental health care costs.
"We need to be careful what we're grabbing for," he says. "If it's to reduce costs, you are almost creating a situation where care can be denied. Maybe all you can do is [hold] growth in costs to 5 percent. But it's real important that the process is care-driven, not cost-driven."