“The problem is that it is not just a simple off the shelf package; it needs to be locally tailored and that doesn’t exist,” says Dr Doug Wright, head of clinical governance at Aviva UK Health. He argues that local employers need to understand local provision of mental health treatment and to integrate benefits with it. Furthermore, he feels that some insurers have yet to deliver the right model of care.
“The employer does not understand the health needs of the workforce, so you tend to go for generic solutions like private medical insurance (PMI) and EAPs,” he says. “That’s a very crude tool.”
Dr Wright would like to see something comparable to Back Up – the programme Aviva developed to manage back and neck pain PMI claims – developed for mental health. Designed with rehabilitation provider HCML, Back Up combines an in-depth assessment with dedicated case management and a personalised rehabilitation plan. Where the customer is part of a group scheme, the case manager can also work with their line manager to advise how they can be helped at work.
Dr Wright also sees close parallels between mental illness and musculoskeletal problems and compares the traditional model for managing the latter – GP referral to a physiotherapist or to a specialist – with the “crude tools” of EAP access and PMI psychiatric cover. “It’s about individual assessment and case management,” he argues.
While there are signs that PMI providers are starting to address mental ill-health – CIGNA HealthCare promotes cognitive behavioural therapy to its members, who can claim for it providing it is recommended by a GP or occupational health professional – it does not appear to sit as comfortably within the PMI arena as it does within income protection (IP).
“The employer does not want to provide a service that is fixing something that might not have anything to do with them,” says Dr Wright.
Alistair Sclare, director of healthcare at Groupama Insurances, believes that there are “a significant proportion of employees who can take advantage of the law and the employer,” arguing that the latter can be a “soft target” when it comes to identifying the cause of mental ill-health. Nevertheless, it is “increasingly common” for Groupama to receive requests for referral to a counsellor (which it will consider providing that a consultant makes the recommendation). Sclare has also noted requests from brokers to add a facilitation service to schemes, whereby Groupama will arrange access to counselling for members on an ad-hoc basis, a “more selective and cost effective way of purchasing that treatment”.
Of course, EAPs often include access to face-to-face counselling and this is welcomed by intermediaries. Dave Middleton feels that EAPs have been poorly communicated and have been pigeon-holed as “just a stress line”. He also suggests that smaller companies may benefit from arranging better access to broader occupational health.
For smaller companies, perhaps unable to afford IP, Steve Ellis of Premier Choice Group suggests putting a cash plan in place, including access to an EAP and face-to-face counselling.