We sat down with Charles Alberts, Senior Consultant at Aon Employee Benefits to explore the most common pathways for employees to access mental health care and some of the obstacles they may face in getting that care.
Can you tell me a bit about PMI as a pathway to mental health services?
The ability to access treatment faster is one of the primary reasons people purchase Private Medical Insurance, and mental health is one of the areas where private healthcare excels. Prompt treatment of a mental health problem helps prevent the condition deteriorating; left untreated it can lead to potentially devastating consequences.
And whilst this is acknowledged in the NHS, with new waiting time standards for mental health that came into effect from 1 April 2015, there is significant inconsistency throughout the UK (a 'postcode lottery') and in some parts patients can wait for up to 50 months to see a clinical psychologist, that's more than four years!
Waiting to access treatment is a serious concern. The We Need to Talk coalition reports that one in six patients said they had attempted suicide, four in ten said they had self-harmed, and two thirds said their condition had deteriorated before they had a chance to see a mental health professional.
The majority of Private Medical Insurance policies in the UK are purchased by employers for their staff and it's easy to see why - with one in four people experiencing a diagnosable mental health condition in any given year, poor mental health alone is estimated to cost employers £1,035 per employee per year (according to a 2007 report by the Sainsbury Centre for Mental Health).
Private Medical Insurance policies offer prompt access to the most appropriate psychological therapy at a place and time of the member's choosing. In contrast, in the public sector only eight per cent of those surveyed by the We Need to Talk coalition had a choice in the therapy they received and only 13 per cent had a choice in where they received therapy.
Traditionally members had to obtain a GP referral to access mental health treatment via their private medical insurance policy, but a number of insurers now offer direct access to treatment, allowing the member to refer themselves for a clinical assessment of their condition, and an immediate onward referral to the most appropriate level of care. As many delay seeing their GP at the early stages of a problem and mental health remains an area people tend to be more hesitant to discuss with their GP, direct access to treatment via private medical insurance has the potential to be transformational for many people who suffer with a mental health problem.
Whilst there was initially some concern that bypassing the GP may inflate claims costs, insurers have operated a similar model for musculoskeletal disorders for many years with positive results - fast access to treatment reduces the impact on the individual, helping them achieve a faster recovery, and reduces the total episode cost - all parties win.
Yet despite barriers to accessing treatment being removed, mental health is an area that I would argue remains under-utilised in private medical insurance. Whilst we know that approximately 25% of people would have a need to access care, on average, utilisation of mental health benefits remains below 5%. This is in stark contrast to Group Income Protection policies where mental health is a top reason for submitting a long-term absence claim - we could be inclined to conclude that mental health is far too often left untreated for too long.
The development of mental health pathways in private medical insurance presents a fantastic opportunity for employers and insurers alike to promote the benefits of fast access in a proactive and positive manner.
Check the fineprint
In utilising Private Medical Insurance to reduce the impact of poor mental health on business it is important to review the fineprint with your employee benefits consultant to ensure you are aware of where the limitations lie. For instance, at the date of writing, not all insurers provide direct access to mental health treatment, still requiring a GP referral. And where the service is offered, there may be differences in: how the service is funded (e.g. the clinical assessment may attract a charge), who delivers the clinical assessment and triage (e.g. in-house or outsourced), whether or not an excess applies to the clinical assessment charge, whether you are also required to purchase the provider's Employee Assistance Programme for the service to fully operate, and what level of therapy members will be able to access (e.g. some may only refer to Cognitive Behavioural Therapy (CBT)). Direct access is not always automatically included; it may be an option that the employer has to actively select. Other issues to consider include whether mental health cover is a separate benefit or whether it is combined with the out patient benefit limit; and how the provider determines when a mental health condition is 'chronic' and therefore (most often) no longer eligible for cover.
A Gold standard of cover?
It is not always feasible to provide uncapped benefits in private medical insurance policies, often due to financial constraints. This is an area where your employee benefit consultant can advise on the most appropriate design, balancing cost versus benefit. For instance, a balance could be achieved by providing full access on an out patient basis, reaching a greater number of people through early intervention, whilst capping in patient treatment at a market-standard level.
Research conducted by Aon has identified inconsistent approaches by insurers when it comes to providing cover for addiction. Mental health problems can lead to problems with addiction and vice versa, and it is an issue that is prevalent in certain industries. It is important to review the terms of your policy and consider what action the business would take in the event that someone is denied cover for addiction.
What are the different types of pathways and services/products in place for mental health issues other than PMI?
Employee Assistance Programmes (EAPs) are the most common mental health benefit offered by employers. The cost of EAPs has drastically reduced over the past decade and many employers now avail themselves of free-of-charge EAPs included in insurance products such as Group Income Protection. However, increased prevalence has not been matched by increased utilisation, and there remains much more work to do to promote and fully embed EAPs in the workplace.
It is important to recognise the limitations of EAPs as these are designed to provide short-term
counselling for issues typically resolved within 5-6 sessions. Some EAPs provide access to CBT - either online only, or with a face to face option, if clinically indicated.
EAPs are an invaluable service for many employees, but are not designed to treat more serious or complex mental health problems. Pathways can be established whereby following initial contact with an EAP and a clinical assessment, the EAP provider refers the employee direct to the private medical insurer to access treatment without the need for a GP referral.
Similarly, some employers establish direct links between other services such as Occupational Health and Private Medical Insurance. Integrating healthcare benefits is an efficient approach to ensure employees access the best service for their particular needs, and their pathway to treatment and recovery is as smooth as possible. Integrating healthcare is a positive objective to support employees during a time when they are most vulnerable, helping them to navigate what can feel like a complex suite of benefit options when they need it most.
An alternative way to access private healthcare is via new-generation entry-level Private Medical Insurance policies designed to offer cover for issues that have the greatest impact on the workplace at a lower cost. These policies typically cover higher-volume and lower-cost treatment of musculoskeletal disorders and mental health, but may exclude in patient treatment and other conditions such as cancer.
A newer development in workplace health and wellbeing is employers providing staff with access to GP consultations via telephone / video ('telemedicine'). These significantly reduce waiting times to see an NHS GP, reduce time away from the office to attend GP appointments, and in turn provide earlier access to treatment. It is an evolving market and to-date there are numerous variations - the most advanced allowing the GP to authorise treatment on behalf of the insurer and referring the employee direct to a treatment provider, thus minimising the number of steps to care. Telemedicine is an area we are watching with great interest - it has the potential to be transformational in not only in how we access mental health treatment, but healthcare as a whole.
What might the data from these pathways be able to tell employers?
Employee Assistance Programmes commonly report on the impact their service has had on employees, assessing for instance the level of psychological morbidity at the start of counselling and again at the end, and whether employees absent at the start of the counselling had returned to work by the end of the programme.
And whilst private medical insurers often report on the utilisation of their direct access pathways, there is an opportunity for insurers to become more sophisticated in their reporting, illustrating not only volumes but also outcomes. This type of data will certainly be good for the insurance industry and help employers illustrate the value that the product has delivered to their business.
Having examined the most common pathways for employees to access mental health care it is evident that:
- There is a significant disparity in speed of access between public and private care
- Direct access to care, bypassing the need for a GP referral, delivers benefits to all parties
- It is important to review the fineprint of policies as there can be material differences
- Benefits offered by employers is arguably under-utilised, and we should aim to promote and embed these
- There is often a range of benefits and services that employees have access to, some duplication within those, and it's not necessarily easy for the employee to decide what is most appropriate whilst they are faced with a difficult time personally
Aon works with employers to strategically design their approach to employee health and wellbeing, starting with intelligent analytics to building a bespoke integrated benefit and service programmes.
If you would like to know more, then please get in touch.