The 2008 rankings from the United Health Foundation show that Indiana faces several health challenges. Nearly one-quarter (24.1 percent) of Hoosiers smoke and 27.4 percent are obese. The overall indications are that healthiness will decline over time rather than improve. Not a pretty picture.

Many people are receiving health care assistance from the workplace—both medical health care in the form of insurance, and wellness benefits and mental health care which often are provided by employee assistance programs (EAPs).

“Recently we have seen a number of EAPs that have branched out to the wellness arena and are working to expand their services,” says Mike Campbell, president of the Wellness Council of Indiana. “They have figured out ways to reach out proactively to the population they work with, and they have services to offer that have some teeth in them to help people change their lifestyles. My response is kudos to them for doing that. This problem is a huge problem and we need as many conscientious, credible, passionate organizations as we can lay our hands on to help solve it.”

What employees need now

“The biggest reason people seek treatment [from an EAP] is more of the mental health spectrum with stress, depression, marital problems and occasionally a work-related issue like conflict with a co-worker or supervisor,” says Debra LeRoy, EAP therapist for LaPorte Regional Health System’s IMPACT EAP, which provides care for hospital employees and employees of local companies. LeRoy, a trained intrinsic coach, also provides smoking cessation and weight loss counseling when that is requested.

Current issues getting a lot of attention from Northwest Indiana EAPs include job loss or fear of job loss, financial issues and marital issues.

“People like certainty,” says Bob Franko, vice president of development and marketing for Porter-Starke Services Inc., a community mental health center in Valparaiso. “Over these last 18 to 24 months, that’s really been taken away from them. If an employee doesn’t know that they are going to have a job tomorrow or next month, that’s causing a host of other issues. Obviously stress and anxiety is one. Sometimes that stress and anxiety comes out in the form of depression. Sometimes it will come out in the form of substance abuse. People are looking for coping skills or they are not coping well.”

Porter-Starke offers a wide breadth of services including outpatient counseling, a chemical dependency and addiction unit, psychiatric staff for in-depth diagnosis and treatment of the chronically mentally ill, a 17-bed psychiatric inpatient unit and a methadone clinic. The center also offers drug testing—urine drug screens with same-day reports, hair fiber testing and blood tests. It creates “customizable” EAPs based on a company’s needs and payment structure.

Barbara Bullock, LCSW and employee assistance program therapist for all the Sisters of St. Francis Health Services facilities in Northwest Indiana, Indianapolis and Lafayette, has begun to see the trend toward financial anxiety within the last four to six months. “I’m hearing people experience a lot of anxiety about keeping their job,” she says, “and about not having enough hours in the day to get all the things done that they need to do because we are doing more with less. I think that’s probably here to stay for a little bit.”

St. Francis’ EAP is a robust program, providing services for all employee-related problems from substance abuse to getting along with others—serving hospital employees and their spouses and dependents, as well as area schools, banks and small business and industry clients. “The root of the problem almost always involves some personal issues that hamper employees’ productivity,” she says.

Another trend Bullock is hearing about is people borrowing from their retirement plans to pay for medical expenses because they are “tapped out.” She hopes the new health care reform will allow for more comprehensive coverage so people won’t feel the “pinch” like they do now.

Sue Heaton, director of the employee assistance program for Methodist Hospital, says anxiety runs high even in organizations or departments that haven’t been impacted by layoffs. “They just wonder how long before it’s going to touch them,” she says. Methodist provides substance abuse, chemical dependency and mental health services to its own employees as well as those who work for U.S. Steel, the City of Gary, Portage and other smaller businesses and municipalities in Northwest Indiana.

Providing financial information, which many EAPs now do, is just part of the picture, however. “Emotionally, we believe that we are our credit scores,” Heaton says. “When our credit scores go down or we feel we can’t meet our financial responsibilities, that brings us down. We have started to understand that people don’t just need financial counseling, they need the emotional support to go with it. We have been working with individual or couples counseling to prepare them and getting them in the right frame of mind so they can be successful when they go to Consumer Credit, and understand that it is not going to be a quick turnaround.”

Job insecurity and financial stress have led to an increase in requests for marital counseling and the need for conflict resolution in the workplace. “With the changes in the different organizations that we provide services for, we’ve begun doing ‘debriefings’ to give them the opportunity to voice and process what they’re going through,” Heaton says.

Concerns about proposed health-care reform

No one has a crystal ball and can tell what will happen with the new health-care reform. “All the health-care reform that we are looking at right now is conceptual,” Franko says. “It changes literally day to day. We are waiting to see what it is going to be before we can adjust to it.”

He does say that what he is hearing is that there will be more preventive measures, something he considers “very positive.”

The Mental Health Parity Bill is a big boon for EAP programs. It will help to equalize medical and mental health visits. “People who have behavioral health issues and addiction issues traditionally have had a hard time getting those services covered,” Franko says. “Mental health and addiction services haven’t been treated equally as physical health issues by funders. This bill levels the playing field a little. We are happy to see it.”

LeRoy isn’t as optimistic, and points out that both medical and mental health coverage, even if increased by the Mental Health Parity Bill, could in fact be threatened by health-care reform measures. “There are two sides to it,” she says. “Company-based EAPs that are separate from insurance will probably increase.”

Campbell says many wellness vendors are afraid that national health care—a third-party payer system—will put them out of business because there won’t be any incentive for employers to be as involved in wellness. “For a vendor who has been dealing in wellness based on health-care costs alone, that’s probably true,” he says. “They should have been dealing with all the things a holistic wellness approach could have an impact on. Those who have been doing that, in the unlikelihood that national health care comes about, will probably still be standing.”

While the health-care community awaits the final decision, Bullock remains hopeful. “We hope that it will provide more comprehensive coverage so people can get the care they need,” she says. “The emotional stress that people go through, it takes a toll on them psychologically as well as physiologically. It’s mind, body and spirit, all connected.”