The 5 Stages of Behavioral Health and How They Can Impact Both Employees and Employers

By: | December 17, 2018 • 5 min read

Terri L. Rhodes is CEO of the Disability Management Employer Coalition. Terri was an Absence and Disability Management Consultant for Mercer, and also served as Director of Absence and Disability for Health Net and Corporate IDM Program Manager for Abbott Laboratories.

Dr. Dan Jolivet, Workplace Possibilities℠ practice consultant, Standard Insurance Company

For this Risk Insider contribution, Terri Rhodes is accompanied by Dr. Dan Jolivet, the Workplace Possibilities practice consultant at The Standard, where he previously led the Behavioral Health Case Manager team and managed the psychiatrist and psychologist peer consultants. He is a clinical psychologist licensed in Georgia and Oregon and has worked in behavioral health since 1981. Dan is also the practice leader for Motivational Interviewing and goal-directed case management at The Standard. Prior to joining The Standard, Dan worked in managed behavioral health care organizations for 20 years in a variety of management roles and was in clinical practice as a child psychologist until 2003.

Nearly 1 in 5 U.S. adults lives with a mental illness. These illnesses are like any other — they can impact the employee and employer. And because of the interplay between mental and physical health, mental health issues also raise the risk of even greater direct and indirect costs. These costs include absence, disability and lower employee productivity.

The good news is that employer attitudes toward mental health and substance abuse are changing. While the stigma has not disappeared, there is a growing awareness that the “whole person” comes to work — and that whole person needs to be well to perform well. Employers have a role to play in programs and management techniques that address the two largest mental health issues: stress and depression.


More employers than ever want to provide the support their employees need to treat and even prevent undue stress and other mental health issues that reduce productivity and increase costs. For example, financial wellness programs have joined physical wellness programs as employers have come to understand how money worries can impact performance and absence.

To most effectively address the full range of mental and behavioral health issues, employers need to understand and be able to identify the stages in which symptoms manifest.

Stage 1: Emergence of mental health and substance abuse conditions

Whatever the cause — from job-related stress to the loss of a loved one — symptoms are often mild at their onset. Not always recognizing the potential seriousness of a situation and wanting to avoid stigma, employees tend to try to handle things on their own.

The responsibility of identifying and managing any medical condition ultimately falls to employees. But employers can provide support or find help for an employee at this stage. Employee assistance programs (EAPs) are helpful — but often underutilized — resources.

Employers should communicate regularly with employees about the support EAPs provide. Part of that communication includes messages of support for those seeking necessary medical treatment and the importance of mental wellness in addressing or even preventing behavioral health conditions.

Employers can also provide information about programs that indirectly impact mental health. Physical and financial wellness programs, employee affinity groups and work-related social activities are just a few programs that can help employees find supportive and positive experiences.

Stage 2: Early clinical symptoms

At this stage, symptoms increase. Fearing stigmatization or other negative reactions, employees may continue to conceal their behavioral health issues, which means symptoms greater in number and severity may go unnoticed. However, work performance usually suffers more at this stage, so a noticeable decline in performance can alert employers to possible issues.

Referrals to EAPs are still appropriate at this point. However, absence management and stay-at-work disability management strategies can be more effective. By providing these options, employers can help employees address issues proactively and help them stay at work or return to work quickly.

Stage 3: Severe conditions

At this stage, severe symptoms directly impact an employee’s ability to work. This may require accommodations or even disability leave.

This can be a difficult stage to manage, with specific risks for employers. Supervisors may interpret these symptoms negatively, including constant complaining from colleagues, unreliability, difficulty working in teams and general dissatisfaction. This can lead to mismanagement of an employee’s health situation.

To prevent this, and the potential legal risks it can cause, it’s important at this stage to provide employees with outside resources and other assistance. This includes referrals to an EAP, reasonable accommodation strategies under the ADAAA, support of the employee’s FMLA application and help to identify in-network health care providers. It’s important that supervisors understand the restrictions or limitations imposed by the condition so they can be supportive.

Stage 4: Chronic impairment

This stage involves severe or chronic symptoms, which greatly increase the risk of significant costs. At this stage, employees may see themselves as disabled. This could lead to use of the Americans with Disabilities Act accommodations and long-term disability benefits.

To assist employees at this stage, employers should look to goal-directed case management and return-to-work strategies. It’s important to keep in mind these interventions are useful but potentially limited in their effectiveness when employees come to see a condition as chronic. The earlier the intervention, the better the chances are that an employee will return to work.

Stage 5: Recovery

Recovery can occur at any stage in the behavioral health journey. This can be the result of effective interventions and assistance. Or a condition could simply run its course. Early recovery, before severe or chronic symptoms develop, usually depends on employees receiving timely and effective care and support.


During recovery, stay-at-work and return-to-work strategies can have a positive impact on limitations and restrictions. It is also very important that managers and supervisors receive training, so they can help employees remain well. This includes knowledge of and communication about EAPs, wellness and HR support. And, of course, training in basic management techniques that promote all forms of individual and team wellness.

There was once a time when cancer and other serious illnesses were discussed in whispers. There’s still too much whispering with illnesses that affect the mind. All the whispering does is increase employee anxiety and employer cost and risk. The first step in reducing these downsides is to promote awareness of mental and behavioral health issues and ensure employers have the tools to effectively address them. Understanding the five stages is a big step in that direction.

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]