hacking mental health: how employers can … · hacking mental health: how employers can overcome...

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Hacking Mental Health: How Employers Can Overcome the

Four Largest Barriers to Success

Chris CutterCEO

LifeDojo, Inc.San Francisco, California

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The Four Major BarriersWhat stands in the way of employers effectively addressing mental health?

Utilization CostStigma Access

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Depression

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Generalized Anxiety Disorder(Chronic Stress/Burnout)

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Acute Mental Illness(Panic, Bipolar, Psycho-Somatic, Trauma)

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Tier 1: Primary Prevention

Tier 2: Secondary Prevention

Tier 3:High Risk Treatment

Tier 4:Mental Illness Treatment

Tier 5:Catastrophic Treatment

Major Depressive Disorder (MDD)

• Occasionally sad• Occasionally lonely• Lower energy• Fair life satisfaction

• Life circumstances are hard

• Some feelings of isolation

• Feelings of low self worth

• Low resilience to events

• Score 'mild’ - Beck's Inventory

• Prolonged sadness• Prolonged loneliness• Still enjoy elements of

life• Significant impact on

work

• Score 'moderate' -Becks

• Prolonged sadness• Prolonged loneliness• Feeling trapped• Medication important

• Harm to self orothers

• Psychotic symptoms• Score 'severe' –

Becks• Long road to

improvement

Generalized Anxiety Disorder (GAD)

• Occasional worry• Some trouble

sleeping• Some trouble

relaxing• Fair life satisfaction

• Occasionallyoverwhelmed

• Frequent trouble sleeping

• Frequent trouble relaxing

• Poor life satisfaction

• Score ‘mild’ – GAD SS

• 8+ weeks chronic worry

• 8+ weeks chronic anxiety

• Moderate decline in desire to engage in regular activities

• Significant impact on work

• Score ‘moderate –GAD SS

• 3+ months chronic worry

• 3+ months chronic anxiety

• High decline in desire to engage in regular activities

• Harm to self orothers

• Score ‘severe’ –GAD SS

• 6+ months chronic worry

• 6+ months chronic anxiety

• Unable to care for self

Prevalence 80% 45% 18.5% 5% .9%

Population of 5,000 4,000 2,250 925 250 45

Acute Mental Illness .3% (15) .2% (10) .1% (5)

Total 4,000 2,250 940 260 50

Overview: 5 Tiers of Mental Health

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Low Utilization of Early Interventionsleads to more acute care or required treatment

Major depressive disorder Tier 1: Primary Prevention

Tier 2: Secondary Prevention

Tier 3:High Risk Treatment

Tier 4:Mental Illness Treatment

Tier 5:Catastrophic Treatment

Symptoms

• Occasionally sad• Occasionally lonely• Lower energy• Fair life satisfaction

• Life circumstances are hard

• Some feelings of isolation

• Feelings of low self worth

• Low resilience to events

• Score 'mild’ - Beck's Inventory

• Prolonged sadness• Prolonged loneliness• Still enjoy elements of

life• Significant impact on

work

• Score 'moderate' -Becks

• Prolonged sadness• Prolonged loneliness• Feeling trapped• Medication important

• Harm to self orothers

• Psychotic symptoms• Score 'severe' –

Becks• Long road to

improvement

Intervention(s)

• Exercise• Healthy eating• Stress

management• Resilience training• Help from

friend/coach

• Brief CBT with LCSW, MA Counseling, EAP counselor

• Focus on primary prevention

• Work through life events

• Extended therapy with Psychologist or LCSW

• Focus on CBT treatment

• Include primaryprevention

• Work through life events

• Extended therapy with Psychiatrist or Psychologist

• Focus on CBT,Medication

• Include primary prevention

• Work through negative cycles

• Inpatient psychiatric care

• Likely inpatient medical care

• Extended therapy with Psychiatrist and care coordination team

• Intensive recovery process

Utilization Low Low Medium High High

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The cost of later stage care is exponentially higher

Major depressive disorder Tier 1: Primary Prevention

Tier 2: Secondary Prevention

Tier 3:High Risk Treatment

Tier 4:Mental Illness Treatment

Tier 5:Catastrophic Treatment

Intervention(s)

• Exercise• Healthy eating• Stress

management• Resilience training• Help from

friend/coach

• Brief CBT with LCSW, MA Counseling, EAP counselor

• Focus on primary prevention

• Work through life events

• Extended therapy with Psychologist or LCSW

• Focus on CBT treatment

• Include primaryprevention

• Work through life events

• Extended therapy with Psychiatrist or Psychologist

• Focus on CBT,Medication

• Include primary prevention

• Work through negative cycles

• Inpatient psychiatric care

• Likely inpatient medical care

• Extended therapy with Psychiatrist and care coordination team

• Intensive recovery process

Utilization Low Low Medium High High

Cost PEPY(Per Employee Per Year) $100 average PEPY $1,000 average PEPY

(10 sessions + primary)$6,000 average PEPY

(30 - 40 sessions + primary)

$14,000 average PEPY (30 - 40 sessions + medication

+ outpatient care + primary)

$50,000 average PEPY(Inpatient treatment +

medication + outpatient treatment + medical treatment)

/ /// ///////

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A big part of low utilization is due to stigma

Major depressive disorder Tier 1: Primary Prevention

Tier 2: Secondary Prevention

Tier 3:High Risk Treatment

Tier 4:Mental Illness Treatment

Tier 5:Catastrophic Treatment

Symptoms

• Occasionally sad• Occasionally lonely• Lower energy• Fair life satisfaction

• Life circumstances are hard

• Some feelings of isolation

• Feelings of low self worth

• Low resilience to events

• Score 'mild’ - Beck's Inventory

• Prolonged sadness• Prolonged loneliness• Still enjoy elements of

life• Significant impact on

work

• Score 'moderate' -Becks

• Prolonged sadness• Prolonged loneliness• Feeling trapped• Medication important

• Harm to self orothers

• Psychotic symptoms• Score 'severe' –

Becks• Long road to

improvement

Intervention(s)

• Exercise• Healthy eating• Stress

management• Resilience training• Help from

friend/coach

• Brief CBT with LCSW, MA Counseling, EAP counselor

• Focus on primary prevention

• Work through life events

• Extended therapy with Psychologist or LCSW

• Focus on CBT treatment

• Include primaryprevention

• Work through life events

• Extended therapy with Psychiatrist or Psychologist

• Focus on CBT,Medication

• Include primary prevention

• Work through negative cycles

• Inpatient psychiatric care

• Likely inpatient medical care

• Extended therapy with Psychiatrist and care coordination team

• Intensive recovery process

Utilization Low Low Medium High High

Stigma-influencedperception “This is normal.” “I don’t need help.” “I’ll figure it out myself.” “Maybe I need help…” “How did I get here?!”

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And with high barriers to access, the effort required is high

Major depressive disorder Tier 1: Primary Prevention

Tier 2: Secondary Prevention

Tier 3:High Risk Treatment

Tier 4:Mental Illness Treatment

Tier 5:Catastrophic Treatment

Symptoms

• Occasionally sad• Occasionally lonely• Lower energy• Fair life satisfaction

• Life circumstances are hard

• Some feelings of isolation

• Feelings of low self worth

• Low resilience to events

• Score 'mild’ - Beck's Inventory

• Prolonged sadness• Prolonged loneliness• Still enjoy elements of

life• Significant impact on

work

• Score 'moderate' -Becks

• Prolonged sadness• Prolonged loneliness• Feeling trapped• Medication important

• Harm to self orothers

• Psychotic symptoms• Score 'severe' –

Becks• Long road to

improvement

Intervention(s)

• Exercise• Healthy eating• Stress

management• Resilience training• Help from

friend/coach

• Brief CBT with LCSW, MA Counseling, EAP counselor

• Focus on primary prevention

• Work through life events

• Extended therapy with Psychologist or LCSW

• Focus on CBT treatment

• Include primaryprevention

• Work through life events

• Extended therapy with Psychiatrist or Psychologist

• Focus on CBT,Medication

• Include primary prevention

• Work through negative cycles

• Inpatient psychiatric care

• Likely inpatient medical care

• Extended therapy with Psychiatrist and care coordination team

• Intensive recovery process

Utilization Low Low Medium High High

Accessibility Easy Medium Difficult Very difficult Easy – but expensive

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The Four Mental Health Barriers: How can employers overcome?

Major depressive disorder Tier 1: Primary Prevention

Tier 2: Secondary Prevention

Tier 3:High Risk Treatment

Tier 4:Mental Illness Treatment

Tier 5:Catastrophic Treatment

Symptoms

• Occasionally sad• Occasionally lonely• Lower energy• Fair life satisfaction

• Life circumstances are hard

• Some feelings of isolation

• Feelings of low self worth

• Low resilience to events

• Score 'mild’ - Beck's Inventory

• Prolonged sadness• Prolonged loneliness• Still enjoy elements of

life• Significant impact on

work

• Score 'moderate' -Becks

• Prolonged sadness• Prolonged loneliness• Feeling trapped• Medication important

• Harm to self orothers

• Psychotic symptoms• Score 'severe' –

Becks• Long road to

improvement

Intervention(s)

• Exercise• Healthy eating• Stress

management• Resilience training• Help from

friend/coach

• Brief CBT with LCSW, MA Counseling, EAP counselor

• Focus on primary prevention

• Work through life events

• Extended therapy with Psychologist or LCSW

• Focus on CBT treatment

• Include primaryprevention

• Work through life events

• Extended therapy with Psychiatrist or Psychologist

• Focus on CBT,Medication

• Include primary prevention

• Work through negative cycles

• Inpatient psychiatric care

• Likely inpatient medical care

• Extended therapy with Psychiatrist and care coordination team

• Intensive recovery process

Utilization Low Low Medium High High

Accessibility Easy Medium Difficult Very difficult Easy – but expensive

Stigma “This is normal…” “I don’t have a problem.” “I’ll figure it out myself…” “Maybe I need help…” “How did I get here?!”

Cost $100 average PEPY $1,000 average PEPY (10 sessions + primary)

$6,000 average PEPY (30 - 40 sessions + primary)

$14,000 average PEPY (30 - 40 sessions + medication

+ outpatient care + primary)

$50,000 average PEPY(Inpatient treatment +

medication + outpatient treatment + medical treatment)

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A new mentalhealth paradigm

S o l v i n g t h e 4 F u n d a m e n t a l B a r r i e r s

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Traditional EmployerMental health

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The “Wide Net”Solution

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Tier 4: Mental Illness Treatment

Tier 5: Catastrophic Treatment

Tier 2: Secondary Prevention

Tier 3: High Risk Treatment

Tier 1: Primary Prevention“Wide Net” Program

Dynamic Screening + Coaching + Concierge

Total Population

The “Wide Net” solution

5,000 (100%)

2,500 (50%)

400 (8%)

40 (.8%)

10 (.2%)

100 (2%)

Decrease Stigma

IncreaseUtilization

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Tier 4: Mental Illness Treatment

Tier 5: Catastrophic Treatment

Tier 2: Secondary Prevention

Tier 3: High Risk Treatment

Tier 1: Primary Prevention“Wide Net” Program

Dynamic Screening + Coaching + Concierge

Total Population

The “Wide Net” solution

DecreaseUtilization

Drive Down Cost

Improve Access

5,000 (100%)

2,500 (50%)

400 (8%)

40 (.8%)

10 (.2%)

100 (2%)

Four Fundamental Solutions

Decrease Stigma

IncreaseUtilization

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Tier 1: Primary Prevention

Tier 2: Secondary Prevention

Tier 3:High Risk Treatment

Tier 4:Mental Illness Treatment

Tier 5:Catastrophic Treatment

Intervention(s)

• Exercise• Healthy eating• Stress

management• Resilience training• Help from

friend/coach

• Brief CBT/Talk Therapy with LCSW, MA Counseling, EAP

• Include primary prevention

• Manage negative life events

• Extended therapy with Psychologist or LCSW

• Focus on CBT treatment

• Include primaryprevention

• Manage negative life events

• Extended therapy with Psychiatrist or Psychologist

• Focus on CBT,Medication

• Include primary prevention

• Work through negative cycles

• Inpatient psychiatric care

• Likely inpatient medical care

• Extended therapy with Psychiatrist and care coordination team

• Intensive recovery process

Cost PEPY(Per Employee Per Year) $100 average PEPY $1,000 average PEPY

(10 sessions + primary)$6,000 average PEPY

(30 - 40 sessions + primary)

$14,000 average PEPY (30 - 40 sessions + medication

+ outpatient care + primary)

$50,000 average PEPY(Inpatient treatment +

medication + outpatient treatment + medical treatment)

Without Wide Net N/A 150 200 150 50

Total Cost $0 $150,000 $1,200,000 $2,100,000 $2,500,000

With Wide Net - Targets 2,500 Increase 300% Reduce 50% Reduce 30% Reduce 50%

Step 1: Set Specific Targets

Employee #1

Employee #2

Employee #3

Employee #4

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Tier 4: Mental Illness Treatment

Tier 5: Catastrophic Treatment

Tier 2: Secondary Prevention

Tier 3: High Risk Treatment

Tier 1: Primary Prevention“Wide Net” Program

Dynamic Screening + Coaching/Concierge

Total Population

• Licensed Clinical Social Workers• MA Counselors (Brief CBT)• EAP Counselors, Telehealth Counselors

• Employee wellbeing programs • Onsite facilities/events/social groups• Yoga/Meditation Studios• Fitness Centers • Cooking classes, social groups, etc.

• Psychologists• Licensed Clinical Social Workers• Specialist Therapists

• Psychiatrists• Specialist Psychologists• Psychiatric Inpatient

• Specialist Psychiatrists• Psychiatric Inpatient• Psychiatric Outpatient

Mental Health Resources

Step 2: Map out your company’s mental health resources

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Tier 4: Mental Illness Treatment

Tier 5: Catastrophic Treatment

Tier 2: Secondary Prevention

Tier 3: High Risk Treatment

Tier 1: Primary Prevention“Wide Net” Program

Dynamic Screening + Coaching/Concierge

Total Population

Step 3: Design the right “Wide Net” intervention(s)

Highly Recommended:

1. Stress Management2. Building Resilience

Key Components:

1. Companywide prevention program2. Person-centered coaching3. Warm hand-offs4. Short, med & long-term measures

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Tier 4: Mental Illness Treatment

Tier 5: Catastrophic Treatment

Tier 2: Secondary Prevention

Tier 3: High Risk Treatment

Tier 1: Primary Prevention“Wide Net” Program

Dynamic Screening + Coaching/Concierge

Total Population

Step 4: Implement, Evaluate, and Improve over time

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Month 1

Month 2

Month 3

Month 4

Month 5 Month 6 Month 7 Month 8 Month 9 Month

10Month

11Month

12Month

13Month

14Month

15Month

16

Review Data + Set Targets

Resource Network Mapping

Wide Net Program Design

EvaluationDesign

Wide Net Enrollment

Wide Net Program

Active

ReferralsProgram

Active

Evaluation & Reporting

What would a rollout timeline look like?

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An ounce of prevention works

The Value On Investment (VOI) is substantial

Employers are uniquely positioned to help

Final Thoughts

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Thank youQuestions?

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