April 16, 1999

APA President Rodrigo Muņoz, M.D., believes that psychiatrists and corporate leaders have paid far too little attention to their common bonds and to the ways in which they could provide each other with valuable expertise.

In an effort to strengthen these links, Muņoz scheduled two events in conjunction with the March meeting of the Board of Trustees in Chicago that brought together leaders from psychiatry, the business world, and individuals who have worked at the juncture of these two realms.

He invited two Canadians, psychiatrist Edgardo Perez, M.D., and Bill Wilkerson, a consultant and former business executive, to address the Board about concepts in their book, Mindsets

, which emphasizes that fostering good mental health among employees is an effective, though overlooked, "weapon" that corporate officials can use to increase productivity and improve their company's bottom line.

They focused in particular on the way in which the late 20th-century economies in the U.S. and Canada have often left workers with extremely high stress levels and little job security as corporations rush to maximize profits at all costs. They also noted that by heeding nonmedical factors that can improve employees' mental health, corporate executives can, despite misconceptions by many business leaders, actually reduce health care costs, boost productivity, and more than reward the investment.

"Investing in human resilience, flexibility, and decision-making capacity is a business issue," Wilkerson told the Trustees.

An effective approach psychiatrists and other mental health advocates can take in dealing with business leaders is to frame the issues in terms of "their legitimate self-interest" rather than calling on these corporate decision makers "to do the right thing" on behalf of their workers, Wilkerson said. A critical step is to convince CEOs that "investing in mental health is a sound business practice," he added. "The work climate has a definite impact on financial performance."

The challenge for psychiatrists, mental health professionals, and the business community, pointed out Pierre Beausejour, M.D., past president of the Canadian Psychiatric Association, is to "develop a common language" that will foster rather than hinder communication about the interface of work and mental health. Beausejour attended the Board meeting at Muņoz's invitation.

Early the next morning more than a dozen of the Trustees boarded a bus to attend a meeting of the Midwest Business Group on Health (MBGH) at the group's offices near O'Hare Airport in an effort to, as Muņoz said, "look for common goals, go beyond misunderstanding, and find constructive ways to work together."

The MBGH is a nonprofit coalition of more than 100 large employers concerned with getting the best value in the health insurance they purchase for their workers. Member companies are in 11 Midwestern states.

The primary goal of MGBH members is "to improve the quality and the cost-effectiveness" of health insurance for both employers and employees, said MBGH President James Mortimer. One project the MBGH has undertaken to achieve this goal is a search for "best practices," that is, what policies or decisions by health plans, providers, and insured workers appear to be working well to improve employees' health and keeping employers' costs down. The project is focusing on methods for better identifying and treating depression.

"We believe that quality improvement doesn't just happen at the clinical level," Mortimer said. "It happens in the way employers do their work, the way they design their [health] plans, and the way they communicate" with their workers. "It also happens in the way health plans operate, in the way they interact with health care providers, and certainly in the way health care practices such as diagnosis, treatment, and follow-up care bring people back to a high level of health status," he added.

The greatest challenge facing employers who purchase health insurance is how "to add value for the money they spend as well as extracting it," pointed out Raymond Werntz, a health care consultant and board member of the Washington Business Group on Health (WBGH). (The president of the WBGH is former APA president Mary Jane England, M.D., who chaired the meeting with its Midwestern counterpart and the APA Board members.)

The strategy the WBGH encourages employers to follow revolves around arriving at "a better definition of the health care delivery system," he said. The goal is to ensure that employers buy health care based on certain principles, the most important of which are "best practices, integration of services, and patient-centeredness," Werntz explained.

"We are seeing a much greater awareness of the role of consumers" in the health care system, but this needs to move beyond the view of patients as "victims," he said. Progress in this area involves developing a better understanding of factors such as the dynamics of the doctor-patient relationship, the psychosocial forces that drive consumer behavior, and the role of patients' preferences and expectations about their medical care.

"This leads to an understanding of the forces that influence good 'patienting' that have meaning in the workplace," Werntz stated.

He and his colleagues are searching for a way "to shift emphasis from the cost of services to the value of people who undergo the right kind of health experiences" and the resultant influence on productivity and economic growth.

In the mental health arena, Wayne Burton, M.D., first vice president of BancOne, which is a MGBH member, noted that more employers are realizing that there is a substantial indirect cost of failing to help employees recognize when they might need psychiatric care and helping them understand how to access it.

Employers have not been able to address these indirect costs adequately, he said, but the evidence for their impact continues to appear in worker disability and absence statistics.

Muņoz later commented to Psychiatric News, "Relationships with employees belong in companies' strategic planning and strategies for enhancing performance. As the business community increases its use of psychiatric strategies to control absenteeism, productivity losses due to physical illness, and workplace stress, we expect to see increased productivity as the result."

The meeting with the MBGH, he added, "shows that we have strong allies in the business community who are prepared to work with us."

At its meeting the previous day, the APA Board of Trustees authorized the creation of a task force whose charge is to recommend a strategy for enhancing APA's relationship with the business community. It is to provide the Trustees with a plan at their July meeting.