Assessing the financial return on investment of good management strategies and the WORC Project

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Background The Australian Bureau of Statistics (ABS) estimates that 5.8% of the adult Australian population has depression each year and that depression the leading contributor to the non- fatal disease burden in Australia (1). Depression is both prevalent and disabling with a substantial impact on employee well-being and performance. Additionally the majority of symptomatic individuals do not seek professional treatment within the previous 12- months(1), yet treatments are highly effective. The societal cost of depression in Australia is largely unknown, but is potentially very significant. It not only includes the direct costs of treatment but also the indirect costs including lost productivity, both while at work(2-8) and days absent from work(5;8-14). It is increasingly evident that a decrement in productivity while at work, rather than absence from work, is the principal factor contributing to overall decreased worker productivity. Depression can have the first onset at any age however; highest prevalence for females is in the early to mid 20's whist for males it is in mid-to-late 30's(15;16). This is when people are in the workforce. Many people with depression may not attribute their symptoms to depression, or may be reluctant to seek treatment. Due to the high prevalence of mood disorders, the low treatment seeking behaviour and the disabling nature of these disorders it has been recognised that health policy makers need to develop better programs aimed at increasing the numbers of people seeking treatment and to improve the inclusion and retention of employees. From a humanitarian perspective the evidence supporting the need to facilitate treatment in individuals with mental health disorders is compelling. However, if even 60% of persons with a mood or anxiety disorder were to seek medical or psychological treatment, this would completely overwhelm the available psychological services infrastructure and government expenditure resources. Thus, new and innovative methods of mental health service delivery are required. One possible mental health service delivery method is for employers to screen employees for mental health symptoms and then provide employer funded treatment. For such a program to be widely accepted by employers a couple of key pieces of information are required which are (1) how widespread is the problem? (2) how much are we loosing in productivity? (3) where do I target resources? and (4) what is the return on investment for providing mental health services? The WORC Project aims are to identify employees with symptoms of depression, who are not in treatment for their symptoms then, using cognitive behavioural therapy (CBT) and motivational interviewing techniques to encourage these employees to seek advice from a mental health professional. This project will not only identify the economic burden that depression has on employers and the nation but also determine the return on investment for early identification and treatment for depression.

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... Primarily, this plan should set-off to identify people in need of developing mental conditions and proactively target highrisk individuals. 10 High-risk individuals include people who lost their jobs, people who are disproportionately burdened by crisis and ensuing austerity measures, such as the elderly, people with comorbidities and multi-child families. An intervention aiming to identify people suffering from or at risk of developing depression and/or anxiety disorders through a screening questionnaire was proved to be effective in curbing productivity loss and tackling depression. ...
... Published research provides positive evidence on the financial returns from health management programmes. For example, the results of an Australian programme of early diagnosis and intervention for employees with depressive symptoms indicate annual financial benefits in terms of higher productivity which are nearly five times the annual costs of the programme (Hilton, 2005). A similar programme in the US shows annual financial benefits of $1,800 per employee compared with costs of only $100 -$400 a year (Wang et al., 2007). ...
... Dealing with the second question, published research provides increasingly strong evidence on the financial returns from mental health management programmes. For example, research on an Australian programme of early identification and treatment for employees with symptoms of depression indicates annual financial benefits in terms of higher productivity which are nearly five times the annual cost 30 . A similar programme in the US shows annual financial benefits of $1,800 per employee compared with costs of only $100-$400 a year 31 . ...
... In terms of societal and economic burden of disease, depression is ranked second only to ischemic heart disease. In Australia alone it has been estimated that undiagnosed depression costs the economy $4.3 billion in lost productivity each year (Hilton 2004). The most common coping mechanisms for depression, such as smoking, alcohol consumption and over-eating, have their own serious health consequences, regardless of depression, which adds to the burden of disease (Pretty 2004;Pretty et al. 2005). ...
Technical Report
This report, commissioned by Beyond Blue, provides a review of existing Australian and international literature on the links between mental health and wellbeing and contact with nature, especially through green spaces.
... Economic analyses indicate that workplace interventions addressing depression and ! 16! anxiety through screening and cognitive behavioural therapy courses are cost-saving due to a reduction in both absenteeism and presenteeism (lost productivity while at work) [12,96] ! There is a paucity of evidence from LMICs on the effectiveness of mental health policies and interventions in the workplace. ...
Technical Report
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Introduction Good mental health is an integral component of population health and wellbeing and contributes to the functioning of individuals, families, communities and the social and economic prosperity of society [1,2]. Promoting mental health and wellbeing will deliver improved health and social outcomes for the general population and for people with mental health problems. Despite the recognition of the importance of mental health, it remains a neglected aspect of public health, especially in low- and middle-income countries (LMICs). People living in poverty and other forms of social disadvantage bear a disproportionate burden of mental disorders [3-5]. Addressing the social determinants of mental health is central to the global development agenda and affects progress towards the achievement of the Millennium Development Goals [6-8]. Mental health promotion and prevention needs to be integrated into population health improvement and development strategies, together with primary and secondary health care delivery [9]. This paper provides a briefing for policy and decision-makers on the evidence for mental health promotion and primary prevention interventions that can be implemented and sustained at a reasonable cost, whilst generating clear health and social gains in the population. Evidence from high, middle and low income countries clearly show that there are effective and feasible interventions for promoting mental health and preventing mental ill-health that represent a cost-effective use of resources and a strong case for policy investment [1,2,11-14]. This paper provides a guide, based on best available evidence, to support decision making in identifying priority areas and “best buys” for implementation.
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There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions. Since a large proportion of lifetime mental illness starts before adulthood, such interventions are particularly important during childhood and adolescence. Prevention is important for the sustainable reduction of the burden of mental disorder since once it has arisen, treatment can only reduce a relatively small proportion of such burden. The challenge for clinicians is to incorporate such interventions into non-clinical and clinical practice as well as engaging with a range of other service providers including public health. Similar strategies can be employed in both the European and global contexts. Promotion of mental well-being can prevent mental disorder but is also important in the recovery from mental disorder. This guidance should be read in conjunction with the EPA Guidance on Mental Health Promotion. This guidance draws on preparatory work for the development of England policy on prevention of mental disorder which used a wide range of sources.
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