Employer medical claims likely miss 75% of employee mental health issues

Woman sitting on stairs Health insurance companies, self-funded employers, and the health care community cannot catch all the cases of mental illness. (Photo: Shutterstock)

We have deduced that we had a mental health epidemic in the US before the pandemic. And employer medical claims likely miss more than 75% of employee mental health issues. Our mental health epidemic starts long before people are adults.

As a reference, before the pandemic in February 2019, the University of Michigan reported that about one in seven teens and children “have at least one treatable mental health disorder, including depression, anxiety or ADHD.”

Related: A new framework: Mental health benefits in the post-pandemic workplace

The report further cited that half of those children went without needed treatment from a mental health professional in 2016, according to the University of Michigan study published in JAMA Pediatrics. Post-pandemic, a JAMA Network article of a “meta-analysis of 29 studies including 80,879 youth globally” revealed clinically elevated child and adolescent depression was 25.2%, and anxiety was 20.5%. It noted that during COVID-19 the prevalence of depression and anxiety symptoms doubled compared to pre-pandemic estimates.

Further, the mental illness epidemic seems to carry into adulthood. According to 2020 data reported by the National Institute of Mental Health, “one in five US adults live with a mental illness (52.9 million in 2020). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate, to severe.”

More data from the National Institute of Mental Health defines Any Mental Illness (AMI) as “a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment.”

  • In 2019, an estimated 51.5 million US adults 18+ had AMI, equating to 20.6% of all US adults Females had a prevalence rate of 24.5% versus 16.3% for males
  • By age, the prevalence rate of AMI was 29.4% for adults aged 18-25, 25.0% for those 26-49, and 14.1% for those 50+.
  • Prevalence of AMI was 31.7% amongst adults reporting two or more races, followed by white adults at 22.2%, and Asian adults at 14.4%)

With that said, at the Health Transformation Alliance (HTA), our medical claims data shows a rise in claims related to anxiety (+19.6%) and depression (+7.4%) from 2019 to 2021. Further, Anxiety medical claims rose (+7.5%), and depression was up (+5.4%) from 2020 to 2021.

While we at the HTA are experiencing rising mental health claims, the number of claims is relatively small. For anxiety, in 2021, the HTA saw 43.5 reported claims per 1,000 people or 4.35%; and depression reported claims were 39.6 per 1,000 or 3.96%.

The bottom line is that medical health claims are grossly underreported compared to mental health rates reported. In fact, medical claims on the rise only indicate that the issue is more prevalent. But, health insurance companies, self-funded employers, and the health care community cannot catch all the cases of mental illness.

Uncaptured claims include patients that pay for services with cash in a doctor’s office, and employee assistance programs, where reporting is either spotty or nonexistent. In addition, 45% of Americans with clinical-level mental health problems do not seek care, according to the Mental Health Million Project launched by Sapien Labs. The reasons for not seeking help by individuals included:

  • A preference for self-help (36%)
  • A lack of knowledge of what kind of help to seek, or where to get it (34%)
  • Non-confidence in mental health treatment (28%), including respondents who felt it wouldn’t help (19%), and feared being forced to take medication or being committed(13%)
  • 22% did not seek help because of stigma/fear of people knowing
  • 17% did not act due to lack of affordability

In the United States, according to the Kaiser Health Foundation, as of 2020, nearly 164 million Americans received health insurance via their employer. If 20.6% of Americans have Any Mental Illness, it indicates that 33,729,162 with employer health care coverage are suffering from AMI. Most are not captured in data but more importantly, not dealt with by the individual nor the employer.

It adds up to an epidemic of mental illness long before the pandemic. So, how can employers address this to assure their employees are happy and effective? Further, how can employers help those working parents address the mental health needs of their children?

The answers are not obvious nor easy. But next-generation Employee Assistance Programs can and are making a difference by giving employees a pathway for help. These programs, such as Lyra or Spring Health, provide employees up to same-day access to mental health services with

EAPs go beyond mental health. While they can help with emotional and substance use issues, and interpersonal relationships – they can extend to legal problems and financial difficulties. Of importance is that EAP services are typically provided at no cost to the employee on a limited basis.

In addition, the US government is pushing the issue via the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). In the 2022 report, it underscored the epidemic citing that “Recent data from the Centers for Disease Control and Prevention indicate that between August 2020 and February 2021, the percentage of adults exhibiting symptoms of an anxiety, or a depressive disorder increased significantly, from 36.4 percent to 41.5 percent.”

The MHPAEA is designed to ensure equal and increasing access to mental health and substance use disorder coverage.

Employers can lead the way to assure that employees have access, continual reminders, and open sessions to encourage employees to reach out. Some employers are offering unlimited use of the EAP to help patients get the help they need. Others are offering special programs to target causes of widespread stress, such as special programs to avoid burnout, seminars on dealing with racial stress, and webinars on coping with substance use/abuse disorder.

The bottom line is that it is likely that few employees medically treat mental health issues through their employer-sponsored health care plans. In addition, data shows there is still a stigma with mental health issues that are swept under the rug. The deduction that employer medical claims likely miss 75% of employee mental health issues is just a data point that underscores mental health may be an epidemic in America.

Lee Lewis is chief strategy officer & GM Medical Solutions at Health Transformation Alliance.

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