Crazed and Confused

Every couple of weeks, I find myself writing one of those old-school items: a cheque. Each is for $150 and made out to the same health practitioner. I don’t bother submitting my receipts to my university’s health-care carrier; I know I won’t be reimbursed because the money I’m shelling out – an amount that would buy, say, a substantial library of self-help books – is not for the right kind of treatment. It’s not, for example, for the services of an acupuncturist, massage therapist, naturopath or chiropractor, among others who are covered by my extended health plan at Ryerson University. The recipient is a therapist with a master’s of social work and 25 years’ experience.

True, the current contract for Ryerson faculty includes a provision for up to $3,500 a year in psychologists’ fees. This is a considerable improvement over the old deal, which was $200 annually, or the similar sums most other universities or colleges will pony up – enough, perhaps, to cover two appointments. As far as I can tell, within the academic sphere only York University seems to have a grasp of reality, providing employees losing their own grip with up to $10,000 a year for this service.

Yet York faculty still face the challenge of locating a simpatico psychologist, since there are roughly 3,200 in all of Ontario, or a quarter of a practitioner per 1,000 people. When my long-time therapist – who conveniently was a doctor and hence covered by my provincial health plan – retired earlier this year, I managed to find a psychologist who was taking new patients. I’m not sure whether it was his frequent weeping when talking about his family or the fact that he talked about his family at all – it’s not about you – but I bailed after two visits. Since then I’ve been writing those cheques and, despite the cost, I dare not stop. That way, I fear, lies madness. Literally. And perhaps “The Woods.”

Five years ago, I signed myself into the eight-week Integrated Mood and Anxiety Program at Homewood Health Centre in Guelph, Ontario, joining about 50 other “medically stable adults whose level of functioning has been severely impaired by symptoms of depression and/or anxiety.” My cohort included a one-time Mafia enforcer who was alarmingly familiar with unconventional uses for lead pipes, a psychiatrist, a handful of men and women whose demons prevented them from working outside the home or virtually even setting foot there, a nurse, a mill worker and a grade-school teacher whose art-therapy projects were mostly black.

Also, a lawyer or two, another prof and bipolar me, listing heavily to the depressive side. In other words, the kind of cross-section you get in disaster flicks, or the mix you would expect, given that 20 percent of Canadians will be struck by mental illness in their lifetime. Our group was among the close to 12 percent of workers who each year struggle with mental health or addictions issues and, not infrequently, both.

For a group of anxious, depressed crazies, we were pretty chatty. After we’d tired of kvetching about the food (“Can you believe we got red Jell-O again?”) and comparing suicide attempts, talk often turned to the cost of our stay: who was there on their own nickel, who was lucky enough to qualify for repayment from their insurance plan, who had waited a year and a half for the handful of beds set aside for those relying entirely on the provincial health plan to cover the stay. Most of us, like the majority of employed Canadians, were poorly served – outrageously poorly served – by our work-related benefits.

I, for example, had already learned that Ryerson’s “extended” health plan only extended to sojourns in “real” hospitals, ones that carried out surgery, which is a very common provision, so it seemed I was on the hook for the eight-week program’s “accommodation” cost – more than $200 a day, 30 days’ up front please. (Ryerson ultimately covered the bill, although not without a lot of enervating phone calls and the ultimate impression I was being done a favour.)

Later, properly medicated and less morose, I looked into other universities’ and colleges’ health plans and found the majority, at least as reflected in their human resource policies, are far more concerned about employees’ teeth, eyesight and arches than they are about people quietly, or not, flipping out.  As Peter Mansbridge might say, “What’s up with that?”

It’s a question that a number of influential “Earth people,” as we Woods denizens called them, had been asking in the United States for close to two decades. In 2008, American supporters of what’s been dubbed “mental health parity” marshalled arguments of both a civil rights and personal nature (U.S. House Speaker Nancy Pelosi: “Illness of the brain must be treated just like illness anywhere else in the body”; Patrick Kennedy: “I have a mental illness, and I am fortunately getting the best care this country has to offer because I am a member of Congress”). The famously dysfunctional House of Representatives managed to pull itself together long enough to pass a bill requiring employers to offer comparable benefits for mental and physical ailments, albeit one with large enough loopholes to drive truckloads of Prozac through.

Up here in Canada, where our second-favourite sport is trashing the American health system, the likelihood of our achieving mental health parity anytime soon is about the same as ringette overtaking hockey as the “national game” – despite the powerful arguments supporting the parity concept.

Here are some: More workdays are lost annually due to mental illness than any other condition; one study found that those who take time off because of mental illness don’t come back to work for an average 200 days. At least a quarter of all disability claims arise from mental-health issues, according to Canadian HR Reporter. The most recent estimate of the cost of mental-health disorders, including substance abuse – both direct, for treatment, and in lost productivity – is $51 billion a year, roughly four percent of GNP (K.L. Lim et al in Chronic Diseases in Canada, PDF, 2008). Since that figure dates back to 2003, the annual tab is likely closer to $60 billion by now. By comparison, this year’s grants and scholarships budget of the Social Sciences and Humanities Research Council was $335 million.

SSHRC has doubtless funded a considerable quantity of the research conducted in the past two decades into what the World Health Organization notes is one of Canada’s costliest conditions (PDF). This literature is striking not only for its volume but also for the myriad perspectives from which it originates: medical, psychiatric, economic, sociological, societal, educational, and more. Almost universally, these papers highlight what one calls the “enormously negative impact on performance, productivity, absenteeism, and disability costs” of inadequate attention to mental health.

Which does raise the question: Is no one at the institutions whose faculty are diligently sampling, evaluating data and ultimately publishing actually reading this stuff?

Natacha Joubert doesn’t think so. Now with Health Canada’s Population Mental Health Promotion program, Dr. Joubert in 2001 co-authored with Thomas Stephens “The Economic Burden of Mental Health Problems in Canada,” the first such analysis. She notes that a lot of research and policy papers have been produced in the past two decades: “We’re very good at documenting.” But as for “action, out there, in the community, with people,” her take is an unscholarly and dispirited “Humph.”

What about the possibility that the academy is populated by not only the smartest of the smart but the sanest of the sane? Dr. Joubert merely laughs at the suggestion. So does André Foucault, executive director of labour relations for the Ryerson Faculty Association, who describes the mental-health issue at the university as “significant.”

There is, of course, research that supports their skepticism. One Scandinavian study in 2006 found that a higher education level was a predictor of lengthier disability leave arising from depression or anxiety. A 2008 study, “Sickness Absence to Depressive Symptoms,” in the International Archives of Occupational and Environmental Health reported that men and women in the educational field experiencing depression represented the longest average absence from work: 232 and 242 days respectively (men in the industrial sector had the lowest average, at 189 days). The abstract for this paper concludes with the blunt observation: “Workers with depressive symptoms were absent for a long time.”

As someone who logged two and a half years away from teaching last decade, that sounds about right, particularly since, as yet another paper, this one by Ash Bender and Peter Farvolden, observes, “bipolar disorder [is] associated with more than twice as many lost work days” than garden-variety major depression. The authors also note, “Despite intensive treatment, individuals with bipolar disorder spend as much as one-third of their time depressed.” Unfortunately, that also sounds familiar, if a little low.

It certainly didn’t brighten my mood during those lost years that the amount of assistance the university and the insurance company paying my long-term disability benefits offered to get me out from under the covers and back to the classroom was … none. I was left to devise my own re-entry program, which involved an uncharacteristic amount of exercise, “interning” at a small magazine, auditing a graduate-level course and wangling a referral for a return-to-work program. The latter included a battery of tests, presumably devised to determine where I was on the Earth-person scale. (My favourite had me answering a faux telephone, taking messages for “Mr. Brown” and “Ms. White” and their colourful co-workers, then putting the slips in the appropriate slots.  As a receptionist, it turned out, I was marginally employable.)

Dr. Joubert and others believe that one reason universities, like employers in general, do such a bad job of managing mental illness among their employees is that they don’t really know what to do, since the problem seems so large. I tend to think of this as akin to the depressive’s struggle to get out of bed and take a shower – it just seems too hard.

The most common response is to hand off responsibility to an employee-assistance provider. On the sunny side, at least accessing an EAP is confidential, precluding the necessity of outing oneself to colleagues and administrators in order to seek help. However, most contracts limit the use of EAP services to a handful of visits a year – enough time, perhaps, to cope with a credit crisis or reno meltdown but hardly sufficient for someone who’s started to eyeball high bridges in a speculative manner to receive much more than a referral to a community agency.

This drives Robert Wilson, well, crazy. He’s a psychologist and co-founder of Human Solutions, a company in Vancouver that has been devising EAPs since 1979; he also pioneered inclusion of mental-health provisions in benefit plans. Though recently retired, he remains a forceful advocate for health-benefit reform.

“The thing that’s disappointing to those in the field,” he says, “is the awareness that many – not all, but many – of these problems can be properly treated quite successfully, but the folks who have the problems can ill afford to pay for it out of their own pockets. Unfortunately, EAPs have tended to focus on those with lesser stresses and problems.”

Like many psychologists, he’s a proponent of cognitive behaviour therapy for depression, which has been shown – there are studies! – to be highly effective for many. The catch is that an optimum number of sessions is 10 to 20, at $150 or $175 each, which of course vastly exceeds most benefit plans’ provisions. In a 2006 article for the Canadian HR Reporter, Dr. Wilson said of the false economy involved, “Employers simply can’t ignore the staggering costs attached to depression.”

Four years later, that seems to be exactly what they’re doing, but administrators aren’t the only ones who need to get this message. The addition of benefits to contracts is often driven by faculty associations or unions, which in turn look to their members for gotta-have items to throw on the table at bargaining time. There’s no evidence that we academics are any less motivated by self-interest, and not always enlightened self-interest, than the rest of the Earth people. Cash for the crazies? Higher salary? Pick one. As Ryerson’s André Foucault admits, improved mental health benefits “is not where members’ minds are at.”

Not so for most of the provinces’ and territories’ human rights’ bodies. Almost all their codes address mental disabilities, although P.E.I.’s seems to have been drafted around the time the Anne of Green Gables musical premiered. Perhaps back in 1965, restrictive covenants were still a serious issue; in any case, they get ink in the document, while even the phrase “mental illness” is absent.

By contrast, the Ontario Human Rights Commission seems to mean it when it says it wants to “bring mental illness out of the shadows and remove the stereotypes and discrimination so often associated with it.” Conceivably that could mean therapist-social workers achieving parity with naturopaths in benefits plans. I don’t know whether this is representative of naturopaths’ perspective on bipolar disorder, but one in the U.S. suggests on his website, “If you get hit by a bus, go see your MD. If you just feel like you were, it’s time to see me.”

Personally, I’ll stick with the pharmaceuticals and the counselling, covered by my benefits plan or not. But there’s another old-school activity I’ve been engaging in recently: filling out, by hand, the multi-page Ontario Human Rights Tribunal form to lodge a complaint against Ryerson for discrimination on the grounds of inequity in the benefits plan. As the late American writer and iconoclast Robert Anton Wilson once observed, “Of course I’m crazy, but that doesn’t mean I’m wrong.”