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Hacking Mental Health: How Employers Can Overcome the
Four Largest Barriers to Success
Chris CutterCEO
LifeDojo, Inc.San Francisco, California
8A-1
The Four Major BarriersWhat stands in the way of employers effectively addressing mental health?
Utilization CostStigma Access
8A-2
Depression
8A-3
Generalized Anxiety Disorder(Chronic Stress/Burnout)
8A-4
Acute Mental Illness(Panic, Bipolar, Psycho-Somatic, Trauma)
8A-5
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
8A-6
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
8A-7
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)
/ /// ///////
8A-8
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?!”
8A-9
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
8A-10
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)
8A-11
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
8A-12
Traditional EmployerMental health
8A-13
The “Wide Net”Solution
8A-14
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
8A-15
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
8A-16
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
8A-17
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
8A-18
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
8A-19
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
8A-20
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?
8A-21
An ounce of prevention works
The Value On Investment (VOI) is substantial
Employers are uniquely positioned to help
Final Thoughts
8A-22
Thank youQuestions?
8A-23