Workplace Approaches to Addressing Mental Health Problems: Service Use in EAPs and Integrated Behavioral Health Plans

The impact of mental health problems such as depression is increasingly recognized in the workplace. Employee assistance programs (EAPs), specialty behavioral health benefits, and behavioral health benefits that include EAP access (integrated product) are widely available in the private sector. However, little is known about differences in mental health treatment access and utilization within each of these private insurance arrangements. We used 2004 insurance claims and other data from a national managed behavioral health care organization including approximately 5 million privately insured enrollees. Bivariate analyses showed that the percent of enrollees (weighted for duration of enrollment) with any behavioral health service use was significantly higher in the integrated product (5.2%) than in the behavioral health benefits-only arrangement (3.7%). About 1% of enrollees utilized the EAP-only product for clinical behavioral health services including assessment. Multivariate models examined the effects of product type in the context of variables from other key domains such as individual-level characteristics, employer and provider characteristics, utilization management procedures, and consumer cost sharing. We also examine and contrast access rates by diagnostic category and prior use of services, and compare utilization patterns including treatment engagement/retention across three approaches to behavioral health in the workplace (separate EAP, separate behavioral health, integrated). The results will further the development of multifaceted models of mental health treatment access and engagement in the private sector. Results will also help to inform practitioners, employers, insurers, policymakers, consumers and others concerned with understanding and improving access to mental health services through employer-sponsored programs.