Leading Together to Address Inequitable & Affordable Access to Mental Health in the Workplace

Background: There continues to be widespread concern across the country among purchasers and regional coalitions on issues impacting access to behavioral health treatment and the quality and management of patients with mental health and substance use issues by both primary care and behavioral health specialists. Concerns include consistent and timely access to care, evidence-based diagnosis and treatment, the stigma and related silence associated with mental health conditions, and the limited evidence-based strategies available to employers to support employees in their efforts to receive care for mental health conditions.

Mental health disorders are one of the most burdensome and costly illnesses in the United States and have a higher cost burden than stroke, cancer, and obesity. In addition, the cost burden for mental health in the workforce results in lost productivity, including lower work performance, disability, and unemployment. Unfortunately, while employers recognize the important role mental health plays in the workplace, they have been challenged with the lack of evidence-based strategies available to support employee and their family’s mental health in the workplace and community.

In addition to the existing barriers and challenges, the pandemic has exacerbated these concerns and played a role in the increased prevalence of mental health conditions, causing an urgent need to take action. Yet, one stakeholder cannot do it alone; it will take all  stakeholders—employers, regional coalitions, health plans, providers, behavioral health providers, patient advocates, community leaders and community organizations —working together to address the issues related to mental health.

Proposed Solution: The National Alliance of Healthcare Purchaser Coalitions (National Alliance) developed a collective agenda in 2019 that worked to support all stakeholders (employers, health plans, behavioral health organizations, and providers) in taking action on the issues related to assessing, addressing, and supporting employee mental health. This agenda led to the creation of The Path Forward for Mental Health and Substance Use (The Path Forward), which highlighted five priority areas: Network Access, Collaborative Care, Measurement-based Care, Tele-behavioral Health and Mental Health Parity. In addition to identifying high-priority areas, The Path Forward initiative brought together eight RESET Regions to collaborate with other regional stakeholders and communities to work on local change related to mental health. Over the last two years, this initiative has reached out across all stakeholders to create partnerships and explore mental health issues.

To address the challenges and barriers identified through The Path Forward work, the project team proposes to bring together the Path Forward Steering Committee, engaged partners, the eight RESET regions, and community partners to share challenges, promising practices, successes, and lessons learned at a full-day stakeholder convening event in June, 2023. At the event, key themes and promising practices/polices will be shared to engage the community and workplace in mental health. In addition, resources and tools developed through the Path Forward initiative and prior PCOR work funded by PCORI will also be shared. In addition, the event will identify evidence gaps to support future PCORI work in addressing mental health in communities and the workplace.

Objectives:

1. Development and deployment of the Stakeholder Convening Meeting – that brings together key stakeholders for the full day event geared to highlight key progress to-date for RESET Regions across the country and highlight evidence-based strategies to address workplace and community mental health
2. Identify challenges and promising practices in addressing workplace and community mental health in the RESET Regions to inform the Stakeholder Convening Meeting
3. Identify PCOR work funded by PCORI that could be used during the meeting as tools and resources to addressing workplace and community mental health
4. Share meeting learnings with regional coalitions across the country, and communities within each RESET Region - to create awareness of the resources and opportunities available to address mental health in the community and workplace
5. Utilize learnings and feedback to inform a patient-centered outcomes research (PCOR) agenda focused on addressing mental health in the workplace and the community

Methods: The National Alliance has extensive experience convening and engaging stakeholders to facilitate working together on broad overarching health issues. Through these past experiences the following methods have been identified as promising practices.

• The goal of convening RESET Region stakeholders to identify promising practices/policies and address challenges can be accomplished through the following key activities:
  • Prework Landscape Survey/Research Review: prior to the convening event, the National Alliance team will review and summarize the current Reset Region activities. In addition to the RESET Region landscape survey, current PCORI-funded research will be reviewed that could support strategies to address barriers and challenges. Researchers associated with relevant research will be contacted and offered an opportunity to be a part of the Convening Event and potentially present their work. These summaries will inform the convening event agenda and will be sent to attendees prior to the event to inform the discussion and support the event goals of identifying promising practices/policies and barrier strategies.
  • Event Planning Advisory Committee Convening: a Steering Committee comprised of the HR Policy Association, American Health Policy Institute, American Psychiatric Association, APA Center for Workforce Health Bowman Foundation, Meadows Mental Health Policy Institute, and the JED Foundation will virtually convene along with employer and community representatives from each RESET Region to plan the event and set the event goals, agenda, and speaker roster.
  • Developing Convening Event Agenda and Materials: from this event planning meeting, regional presentations will be identified, subject matter expert speakers will be identified, and an agenda will be developed with companion learning materials that will include tools and resources.
  • Host Stakeholder Convening Event: RESET region employer and community representatives along with subject matter experts will convene to discuss current RESET Region efforts, identify promising practices, and discuss barrier strategies which will include the role of PCOR. Subject matter experts could include PCORI-funded researchers whose research has been identified as a potential strategy to address barriers and challenges. The meeting will be a hybrid event. Attendees will have the option of attending in person or through a virtual platform.
  • Develop and Deploy National Communication Strategy: output from the convening will include comprehensive promising practices/policies and strategies to address challenges. Communication tools from these learnings such as podcasts and infographics will be developed and distributed across all RESET Regions, partners, and the National Alliance network.
  • Develop Summary Report: all insights gained from the initial landscape survey through the convening event learnings will be developed into a summary report submitted to PCORI.

Projected Outcomes and Impact: The outcomes of the Stakeholder Convening Event focused on mental health in the workplace and community will be broad-reaching and will enhance both employer and community efforts to support mental health for all employees and their families. Specific outcomes and impact include:

Short-Term Outcomes (during the project period)

• Develop a landscape survey and summary of promising practices/policies, barriers, and potential solutions to addressing mental health through workplace and community partnerships
• Highlight shared learnings from employers, community leaders, and subject matter experts that identify promising practices/policies and strategies to address mental health through workplace and community partnerships
• Resources that distill the shared learnings distributed to partners and networks across the country

Medium-Term Outcomes (zero to two years post project period)

• Develop communications that highlight resources that include shared learnings distributed to partners and networks across the country
• Highlight tools and resources that could be utilized by employers and communities in efforts to create a mental health plan
• Develop and share insight into areas to be addressed through PCORI-funded research
• Potential use of existing PCORI-funded research to address identified barriers and challenges
• Engaged cross-sector stakeholders empowered to work together to address mental health in the workplace and community

Long-Term Outcomes (three and more years post project period)

• Expanding topics to be addressed through workplace and community partnerships
• Insights into future PCOR/comparative clinical effectiveness research (CER) topics related to mental health and engagement with PCORI to determine next steps

Connection to PCOR/CER: Through this proposed multi-sector convening event promising practices and challenges to addressing access and quality through mental health services for the workplace and community will be discussed. These discussions will expand the capacity of the employer and partnering community to engage and inform patient-centered outcomes and comparative clinical effectiveness in future research agendas related to mental health.

In addition, this convening event will also support employer and community stakeholder understanding of the impact of evidence in addressing mental health in both the community and the workplace that could be utilized in plan design and individual employee outreach and engagement. This deeper understanding of the connection between evidence and action will energize and engage the employer community in the role PCOR/CER can play in supporting efforts to address mental health in the community and workplace.

Evaluation Plan: The evaluation plan for the proposed stakeholder convening event will be conducted through a series of surveys and assessments including:

• Post-event survey for feedback on the event content, its relevance, and potential uptake by the multi-sector attendees
• Post-event survey check-in with attendees for general feedback on the event activities and how this may be improved for future convening events
• Dissemination tracking tool six months post-event to determine use of materials disseminated as part of the convening event
• Use of the PCORI Evaluation Tool will be completed as part of the full submission

Sustainability: This multi-sector convening event on addressing access and quality through mental health services for the workplace and community will help build on the work of The Path Forward initiative, which is rooted in achieving measurable improvements over the course of five years. Key metrics are anchored by the Milliman Mental Health & Substance Use Disparities Assessment. A convening summary report will be shared that highlights key learnings from the RESET Regions and highlights other resources and tools employers can use to enhance their individual efforts. As this event is meant to expand the opportunity for engagement and change, this event can be the seed for additional convening events across the country on mental health. In addition, through this event, new workplace/community partnerships will be built that can be used to expand into other areas, such as health equity and health access.

In addition, the convening event will result in tools and resources highlighting promising practices/policies and strategies to address mental health through workplace and community partnership. These tools and resources will support short- and long-term efforts to address mental health and will be updated regularly through the RESET Region work that brings together workplace and community leaders to address mental health across the country.

Patient and Stakeholder Engagement Plan: The National Alliance has successfully engaged healthcare stakeholders across the country over the past several years. With their 45 regional employer coalitions, they represent more than 45 million Americans who live and work in communities across the United States. The launch of The Path Forward initiative brought together various industry stakeholders including HR Policy Association, American Psychiatric Association’s Center for Mental Health, Meadows Health Policy Institute, The Bosman Foundation, the JED Foundation, and others to create regional stakeholder engagement teams that includes a multi-sector and community lens. Through the Path Forward and the launch of the RESET Regions, the National Alliance has expanded its engagement to include other national and community leaders who will come together during the proposed Stakeholder Convening Meeting to address the systemic issues of access quality and equity in mental health in the workplace and communities. The agenda will also offer national and regional insights into the challenges employers and communities face when addressing mental health and look to solutions and approaches to address the chronic systemic issues across stakeholders.

Specific engagement by stakeholder group includes:

• Through the landscape survey and research review, the National Alliance project team will be reaching out to RESET Region workplace and community representatives to understand current efforts. In addition, researchers conducting PCORI-funded work that is identified as relevant will be engaged to better understand the role the work could play in strategy development to address barriers and challenges.
• Through the event planning committee convening, RESET Region advisory committee members and RESET Region representatives will be engaged to plan the event and develop the agenda and meeting materials.
• Through the event implementation, community and workplace leaders and subject matter experts will be engaged to discuss current work, promising practices/policies, and strategies to address barriers and challenges.
• Through the dissemination of the tools and resources developed from the convening event learnings, a broad network of stakeholders will be engaged in efforts to address mental health through workplace and community partnerships.