BOX 5-4: DEPRESSION Awareness, Recognition, and Treatment in the Workplace

In addition to its support for rehabilitation services and employment research, the National Institute of Mental Health (NIMH) has been working with the business community to promote mental health and combat depression in the work place. Organized as a public/private partnership, the DEPRESSION Awareness, Recognition, and Treatment (D/ART) program is a national public and professional education campaign aimed at reducing the prevalence of depressive disorders. The D/ART National Worksite Program is the first to address a specific mental disorder in the work place. A little more than $100,000, 10.6 percent of the total D/ART budget, was spent on the Worksite Program in fiscal year 1993. Initial activities began in 1989 as a collaborative effort with the Washington Business Group on Health (WBGH). The goals of the work site program, which harmonize with the ADA's mandate include: informing employers about depression and its impact on costs, productivity, employees and their families; initiating multifaceted and integrated approaches to managing depression at the work site; assisting employers in implementing depression-related activities in their companies; and, disseminating employers' experience among other major U.S. companies.

Advised by members of the Corporate Leadership Council (CLC)--an employer advisory group composed of human resource and health management professionals from more than 15 Fortune 500 companies--NIMH and WBGH staff developed a six- part comprehensive approach for managing depression in the work place: Employee education about symptoms and treatment of depression; management training to identify employees whose work may be affected by depression; employee assistance services for on-the-job support for employees experiencing depression; proper benefit design and management; and data collection and analysis on prevalence, cost, treatment outcomes and attitudes about depression, and the integration of health programs.

D/ART has produced a slide presentation for businesses that describes its "Management of Depression" approach. In addition, D/ART publishes posters and informationalbrochures targeted to employees and their families, management personnel, and employers. The publications have been distributed to Fortune 500 employers, business coalitions, and national business, employee assistance, wellness programs, and human resource management organizations. Currently, members of NIMH, WBGH, and the CLC are developing a program to educate employee assistance professionals about depression so that they can perform roles in education, management training, crisis intervention, recognition and appropriate referral, case management, and on-the-job support.

Recently, some D/ART Community Partners also have begun to provide work site education programs about depression. Located in 23 States and the District of Columbia, Community Partners are networks of community mental health groups coordinated under the leadership of a single nonprofit mental health agency, usually a local affiliate of the National Mental Health Association, or the National Alliance for the Mentally Ill. Most of the Community Partners receive around $3,500 a year in NIMH funding to conduct D/ART programs. During the spring of 1993, OTA interviewed 23 of the 32 Community Partners. Fifteen of the 23 groups indicated that they--albeit infrequently--conducted work site programs about depression. Of those 15, six--in Indiana, Missouri, New Jersey, Ohio, Oklahoma, and Virginia--explained that work site education activities had been infrequent because they chose to concentrate on other aspects of D/ART's public education campaign. What is particularly significant is that the remaining nine--in Alabama, California, Colorado, Georgia, Maryland, Texas and Utah--said that employers generally were not interested in workplace discussions about mental illness. Many of the partners found that companies may avoid discussions about "AIDS, alcohol, and mental illness--for fear they may offend or make people uncomfortable." In addition to the issue of stigma, some D/ART Community Partners have found employers reluctant to use the D/ART program because they are concerned that: the demand for services will exceed the supply of affordable resources; treatment of depression will be a costly drain on medical insurance benefits; or acknowledging that depression exists in the work place will expose employers to workers' compensation suits.

On the other hand, eight of the Community Partners--in California, Florida, Kansas, New York, North Dakota and Virginia--conducted work site depression education programs frequently and found them to be well received by employers and employees. Many groups combine D/ART educationalmaterials with those of other organizations, such as the National Mental Health Association, the United Way, and the Wellness Councils of America. At least one, in California, conducts programs for employers about the ADA and reasonable accommodations for people with psychiatric disabilities. These groups generally report an increase in calls requesting additional information about depression after presentation of work site programs. While some groups found that working through a company's employee assistance program (EAP) is an effective way to establish a presence in the workplace, others--in Alabama, California, Texas, Utah, and Washington--note that in some companies EAPs are: A bureaucratic response to employees' problems; typically deal with short term, situational problems; do not have sufficient personnel; carry out certain designated duties and are not innovative enough to expand their role to educate people about mental illness. Several of the groups asserted that the success or failure of a work site education program depended on the support it received from CEOs and other company officials.

SOURCE: Office of Technology Assessment, 1994.
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