Category: State Talk

Mental illness includes mental, behavioral or emotional conditions. According to the National Institute of Mental Health 57.8 million adults in the U.S. lived with a mental illness in 2021, yet only 26.5 million received mental health services. Effective treatment for mental health conditions can often lead to reduced workplace accidents and injuries; lower absenteeism and turnover; improved productivity; and decreased disability costs.

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Of the 167.9 million workers across the nation, many are impacted by some level of work-related stress daily. According to a survey by The American Institute of Stress, 83% of U.S. workers experience such stress, which can affect a person’s health, relationships, productivity and job performance. Poor workplace environments where discrimination, inequality, excessive workloads, low job control and job insecurity exist can contribute to mental health conditions. As a result, employers may face absenteeism, low employee productivity and an increase in stress-related worker injuries. The impact on U.S. employers is more than $300 billion in losses annually. Conversely, workplaces that prioritize mental health often contribute to recovery and inclusion, improve confidence and social functioning and improve worker productivity. State governments and other employers can implement a range of strategies designed to mitigate negative impacts, boost employee well-being and build a more inclusive workforce.

These issues were a focus of the Mental Health Matters: National Task Force on Workforce Mental Health Policy convened by The Council of State Governments and the National Conference of State Legislatures, in collaboration with the State Exchange on Employment & Disability (SEED), which is a unique state-federal collaboration funded by the U.S. Department of Labor Office of Disability Employment Policy. The task force engaged state policymakers and subject matter experts from across the country to explore policy options and actions taken by states to address major workforce challenges and barriers to employment for people with mental health conditions. Four task force subcommittees explored specific issues. 

The Workplace Care and Supports Subcommittee identified inclusive workforce strategies state governments can use to foster worker well-being. These include developing employee wellness programs and drug-free workplace initiatives as well as providing reasonable accommodations for employees with mental health conditions.

Workers stand to benefit significantly from employee wellness programs. These programs are proven to reduce disease risk factors and increase healthy behaviors among employees and can lead to lower health care costs and utilization. According to a study by the Society for Human Resource Management (SHRM), the SHRM Foundation and Otsuka Pharmaceutical Co., Ltd., 78% of organizations in the U.S. offered workplace mental health resources in 2022 or planned to offer them in 2023. Many states offer wellness programs for public sector employees, but some have taken additional steps to incentivize private employers to adopt or expand services under these programs. For example:

• In 2009, North Dakota launched a Worksite Wellness Program initiative in partnership with the Dakota Medical Foundation, Blue Cross Blue Shield North Dakota and the Department of Health to improve employee engagement with worksite wellness programs. The initiative provides implementation resources and training to organizations across the state.
• Pennsylvania Executive Order 1996-10 (1996) establishes its State Employee Assistance Program to provide its employees and their family members with free, confidential assessments and referral services. The program includes:
  • Financial, legal and emotional support services.
  • Six free counseling sessions per year.
  • Resources for individuals with substance use disorder (SUD).
• Wisconsin SB 73 (2013) provides an income and franchise tax credit to small businesses that offer workplace wellness programs. The credit equates to 30% of the amount spent by the employer to provide the program in a taxable year.

Another strategy for supporting employee mental health is implementing ready-recovery workplace programs. According to the U.S. Department of Labor, such efforts encourage treatment and support recovery for employees with SUD. Approximately 13.6 million adults with SUD are employed in the U.S., comprising nearly 9% of the adult workforce. Drug-free workplaces improve productivity, decrease absenteeism and reduce the risk of workplace accidents or injury. These programs range from providing treatment options to those who fail drug screenings to establishing court diversion programs.

• New Jersey SB 524 (2023) creates the Mental Health Diversion Program to divert eligible individuals with SUD away from the criminal justice system and into appropriate case management and mental health services.
• Kentucky SB 191 (2020) permits employers to hire and retain individuals who fail a drug screening if the employee completes a drug education and addiction treatment program. The bill also provides legal liability protections to employers that implement the Kentucky Transformational Employment Program in their workplaces.

Employees with mental health conditions may be negatively impacted by certain factors in an office setting. Helpful accommodations may include flexible or modified work schedules and remote work. As of 2023, 12.7% of full-time employees worked from home, and 28.2% participated in a hybrid model. States are supporting telework in a variety of ways, such as expanding broadband access and granting remote options to public employees.

• Vermont HB 99 (2013) allows public and private sector employees to request intermediate or long-term flexible work arrangements, such as telework, job-sharing or changes in work schedules.
• In 2016, Tennessee’sDepartment of Human Resources issued Policy 14-001 to provide guidance on Alternative Workplace Solutions (AWS) for state employees. AWS allows certain employees to have flexible schedules and workspaces and has been used as a model for other states. The legislature also appropriated grant funding to improve broadband access in underserved areas.

Additional examples of state telework policies can be found in The Council of State Governments brief Disability-Inclusive Telework for States: State Approaches to Increasing Access & Inclusion. For more information about these findings and others, visit the “Mental Health Matters: Framework on Workforce Mental Health Policy.” This resource outlines policy options to recruit and retain qualified mental health providers; increase access to workplace care and supports; address the unique needs of underserved communities; and enhance mental health parity. Such practices are vital to solve the mental health crisis — and build a stronger, more inclusive workforce and economy.

According to research from the U.S. Department of Health and Human Services, a strong correlation exists between social determinants of health — the conditions and environments in which people live and work — and health outcomes. Social drivers, such as employment, access to insurance and health care and quality of care can profoundly impact a person’s health and well-being.

Data shows underserved groups have less access to mental health services and are less likely to experience high-quality care due to a lack of culturally competent providers and implicit bias among health care professionals, among other factors. Similarly, rural residents often face greater behavioral health workforce shortages, transportation barriers and social stigma than those in urban areas. The reciprocal relationship between health and employment also means that individuals with unaddressed mental health conditions experience a higher rate of employment instability further exacerbating adverse mental health effects. To reverse these negative outcomes, state policymakers can work in their communities to adopt equitable policies that reduce barriers to employment and increase access to mental health services.

These issues were a focus of the Mental Health Matters: National Task Force on Workforce Mental Health Policy convened by The Council of State Governments and the National Conference of State Legislatures, in collaboration with the State Exchange on Employment & Disability (SEED), funded by the U.S. Department of Labor Office of Disability Employment Policy. The task force engaged state policymakers and subject matter experts from across the country to explore policy options and actions taken by states to address workforce challenges and employment barriers for people with mental health conditions. Four task force subcommittees explored specific issues. 

The Underserved Rural, Racial and Ethnic Communities Subcommittee identified strategies to increase access to mental health services and treatment. These include:

• Collecting data to better understand care disparities across populations.
• Engaging underrepresented community members.
• Expanding telehealth and broadband infrastructures.

Understanding quality of care, assessing where health disparities exist and effectively allocating resources requires appropriate data collection. Although most hospitals collect some data, across the U.S. collection methods and data quality related to underserved or underrepresented groups varies widely. According to 2019 information, Medicaid programs face similar data challenges. Most states reported missing, inconsistent or unusable race and ethnicity data for their Medicaid programs. However, some states are beginning to require more stringent and standardized data collection practices in their health systems. For example:

• Maine LD 274 (2021) directed the Maine Health Data Organization to determine the best methods and definitions to use when collecting data to understand and analyze health care disparities.
• Massachusetts Chapter 277 (2020) Section 4513-2020 appropriated funds for the Office of Health Equity to conduct a study assessing the availability of culturally competent behavioral health providers in the state.
• Washington HB 2755 (2020)requires health care data reports to include specific demographic information such as income, language, health status and geography.

Some states are also attempting to mitigate mental health inequities for multiple marginalized populations by including representatives from these communities in state advisory groups. Engaging communities in the decision-making process can help build trust, increase collaboration and hold governments accountable. It can also lead to improved accessibility and quality of services. Members from these communities can leverage their lived experience to provide valuable input on policy and programing. States can use legislation or executive orders to create commissions, task forces, councils, advisory groups and offices that incorporate the voices of underserved populations. For example:

• Kentucky SB 10 (2021) established the Commission on Race and Access to Opportunity to conduct studies and research where disparities may exist across sectors. The goal is to identify opportunities for improvement in providing services, especially to underserved communities.
• Michigan Executive Order 2020-55 (2020) created the Coronavirus Task Force on Racial Disparities to study the causes of disparities and recommend actions to address systemic inequities. The task force is responsible for developing and improving systems that support long-term economic recovery, as well as physical and mental health care, following the COVID-19 pandemic.
• Vermont H 210 (2021) established an office and advisory committee focused on health equity to eliminate health disparities and promote health equity among Vermonters. The committee advises the Department of Health and General Assembly on funding decisions related to improving health care for underserved populations.  

Lack of access to care is one of the most substantial barriers to health equity that can be alleviated through the expansion of telehealth and broadband access. Though the behavioral health workforce shortage is not unique to rural areas, the distribution of the workforce is significantly uneven. Rural counties are more likely to lack psychiatrists and psychologists than urban areas. Underserved groups also find it difficult to locate culturally and linguistically appropriate care. Furthermore, underserved groups, including people living in rural areas are less likely to have access to broadband. Several states are taking steps to expand access to broadband and telehealth services. For example:

• Arkansas HB 1176 (2021) ensures that Arkansas Medicaid reimbursements for certain behavioral and mental health telemedicine services continue now that COVID-19 public health emergency has ended.  
• Colorado HB 21-1289 (2021)codified the Colorado Broadband Office in the Office of Information Technology and created the digital inclusion, broadband stimulus and interconnectivity grant programs to increase community broadband deployment.

For more information about these findings and others, visit the “Mental Health Matters: Framework on Workforce Mental Health Policy.” This resource outlines policy options to recruit and retain qualified mental health providers; increase access to workplace care and supports; address the unique needs of underserved communities; and enhance mental health parity. Such practices are vital to solve the mental health crisis — and build a stronger, more inclusive workforce and economy.

The COVID-19 pandemic and its aftermath prompted a surge in demand for mental health care, as many Americans faced increased isolation, loneliness, job loss, financial instability and grief. The demand surge exacerbated a two-part challenge that predated the pandemic: a lack of access to mental health services and a shortage of mental health providers.

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After the Medicaid Policy Academy concluded on Aug. 28, CSG welcomed a second group of leaders for the Medicaid Leadership Academy (MLA). This event convened long-serving committee chairs from Medicaid-relevant legislative committees and high-ranking executive branch officials to discuss the latest developments with the program.

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