Trick or Treatments
At a time when firms are trying to focus on employee mental health, only one-quarter of outreach calls to therapists lead to appointments.
The employee knew that she was depressed, but, like most people experiencing mental-health struggles, she waited for weeks before reaching out. Finally, she gathered the energy to find her health-insurance company’s directory and called five mental-health clinicians. Just one appointment was available—in two months.
A new study suggests that this is the norm for employees seeking mental health care. Researchers called thousands of clinicians listed in insurer directories, and only 23% of outreach attempts resulted in appointments. From single calls, just 12% led to appointments, according to a new study published in JAMA Health Forum. “This is disappointing,” says Dan Stech, senior client partner in the Healthcare Consulting practice at Korn Ferry. “I’m not sure that even people in the industry know it’s this bad.”
The numbers from the study are alarming—and quantify exactly why it’s so hard to find a good therapist: Across 5,822 calls to psychiatrists and psychologists in five states, the majority of calls (61%) yielded no outcome. Over 55% of the listings involved major directory errors, such as an incorrect specialty or phone number. The figures are particularly troubling given how difficult it can be for an employee in the grip of anxiety or depression to pick up the phone. “It’s demoralizing,” says Kendra Marion, vice president of global assessment services at Korn Ferry, who notes that it can take weeks or months for people to reach out to a mental-health professional. If clinicians are unreachable or unavailable, she notes, “people may not bother to try again.”
Corporations care about this kind of failed outreach because mental-health issues are a leading cause of absenteeism and significantly impact productivity: Workers who rate their mental health as “fair” or “poor” report about four times as many unplanned absences as other workers, according to Gallup data. In the UK, mental health accounts for 29% of workplace absences, according to data from the Chartered Institute of Personnel and Development, an HR organization. The risk to firms extends beyond absenteeism: The lack of access is often perceived by employees as purposeful, leading to mistrust of both the benefit program and the employer.
Yet HR leaders are typically unaware of the depth of these access problems, because few employees undergoing mental-health crises are able or willing to make a formal complaint. Though it may appear as if firms are purposely contracting with inexpensive networks, HR experts say that this is usually not the case. CHROs often choose networks with many specialists, and most are under the impression that clinicians listed in a directory are generally available. “It’s discouraging to find that, in fact, the service employees are getting is not acceptable,” says Ron Porter, senior partner at Korn Ferry. He notes that when a patient meets a clinician for the first time, it’s often not a good chemistry fit. “For the employee, the whole exercise can become a waste of time,” he adds.
The underlying problem, say experts, is misaligned incentives. Insurance companies are incentivized to list many clinicians in their directories, because large networks are a selling point to employers. “They’re not incentivized for whether the directory is accurate,” says Stech. Meanwhile, behavioral-health providers are not necessarily keen to work with insurers. “They’re not incentivized to participate in a health plan when they can make more money not participating,” says Stech. The shortage of behavioral-health providers, especially psychiatrists, further exacerbates the issue.
Experts agree that large networks with easy mental health care access are in the best interests of both employers and employees. He advises firms to pressure-test potential networks not only while shopping for insurance plans, but also while contracted. “Really challenge how well the network actually performs in terms of access,” Stech recommends.
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