It can sometimes feel like mental health issues are an entirely modern problem; in truth they have probably been around as long as we have. People just didn’t talk about them before and those affected suffered alone, in silence and in shame.
Today, we can celebrate some progress but there is still a way to go in terms of acknowledging issues around mental health and providing proper support to those affected. The immediate financial, emotional and social costs are usually borne by individuals and their families. However, there is a knock-on effect on a wider group of stakeholders, including employers, health providers, the risk industry and the wider economy.
The short and long term costs of mental health issues to the South African family and to the fiscus are pretty sobering. That is before taking account of mental health conditions that go undiagnosed because of many hurdles, including lack of resources, lack of understanding, shame and stigma.
Mental health problems are a key underlying factor in the dual plagues of absenteeism and presenteeism across workplaces in South Africa. Estimates on the costs of absenteeism vary. Occupational Care South Africa recently put the costs of absenteeism to the economy at around R12-R16 billion per year, whereas the Human Capital Review estimated the cost at R19.144 billion. This equates to about 15% of employees being absent on any given day, a productivity killer that affects both large and small companies.
And then there is presenteeism, where employees who are not in a fit state for work drag themselves to their workplace. This introduces a new set of risks and costs for all involved. Sick workers often underperform while making their conditions worse. Their work might reflect badly on the employer and they will introduce new risks for fellow workers and customers.
Undiagnosed mental health issues are an obvious cause of presenteeism. How can you stay away from work if you have no words or reference points for what you are feeling or experiencing. You are not sneezing or coughing. You have no doctor’s note. Many people don’t know they can ask for help, or where to start. There is a huge knowledge gap in our society, and in our industry, that is leaving individuals feeling isolated and in a worsening cycle of emotional and financial insecurity.
In an article published in advance of South African Corporate Mental Health Week, which ran from July 1 to 5 this year, Professor Renata Schoeman the head of Healthcare Leadership at Stellenbosch Business School, said: “Health economists estimate that unaddressed mental health conditions cost the South African economy R161 billion per year due to lost days of work, presenteeism (being at work but unwell), and premature mortality.”
Burnt out but still burning through the work
According to the latest Gallup State of the Global Workplace report, 36% of the South African workforce experience excessive daily stress. Also, more than 71% of those polled are either disengaged or actively disengaged at work, which Prof Schoeman describes as “some of the more alarming signs of burnout”.
Employers, who often stand accused of not doing enough to prevent the condition, should be aware that their dedicated and most committed staff members are particularly prone to burnout.
Burnout, which is classified as an occupational phenomenon by the World Health Organization (WHO), is a state of emotional, mental and often physical exhaustion brought on by prolonged or repeated stress. The condition has a debilitating impact on productivity and on the overall health of those affected. Not to be confused with anxiety caused by stress in a normal life, burnout is a workplace phenomenon that often leads to pessimism and disengagement from work.
Financial stress can add another level of pressure when someone struggling with mental illness worries that it will impact their ability to support their family. Products that offer therapeutic interventions as well as financial relief can be a game changer here.
Lack of awareness about cover
Often people with mental illness do not know what is wrong with them or, in fact, that they have a diagnosable condition for which help is available. They may feel demotivated or lethargic or might be acting out in ways that can easily be confused with anti-social behaviour.
A lack of awareness of medical cover or other assistance that is available under employee benefits adds to resistance to report feelings that are often difficult to articulate.
The lack of a proper understanding of mental illness among sufferers is often mirrored among employers and society at large, even sometimes among insurance providers. The array of conditions is vast and complex, including anxiety, depression and burnout as well as delusions, psychosis, schizophrenia, bipolar disorder and many other conditions, including those related to substance abuse.
In South Africa, mental health services are often underfunded and understaffed with a shortage of mental health professionals such as psychiatrists, psychologists and social workers.
South Africa’s high disease burden adds another layer of complexity since individuals with comorbidities are significantly more likely to suffer depression. People already struggling with HIV/Aids or TB are prime candidates for anxiety-related disorders.
Changes to the workplace since the height of the COVID pandemic in 2020 also take their toll. The increase in remote working adds to social isolation for many, which has a knock-on effect both in terms of increasing the chances of a mental disorder manifesting and decreasing the chances of early detection.
Medical schemes and mental health
All medical schemes in South Africa are required to cover 271 Prescribed Minimum Benefits (PMB) conditions, which include certain mental health conditions. Major medical aids prioritise mental health and offer comprehensive coverage, including outpatient psychotherapy sessions and group therapy, but treatment depends on the member’s plan as well as a variety of other factors. Unfortunately, members’ awareness of coverage and benefits is often as patchy as their understanding of the conditions. This is a significant hurdle to patients’ uptake of the services that are available. ASISA guidelines on minimum benefits and prescribed payments for specific conditions do allow insurers to standardise critical illness benefit payments. These are managed to global and WHO standards.
A determined effort to educate South Africans about mental health is required to improve access to care. The group risk market can offer significant benefits that can assist with providing much needed support post diagnosis. Better screening and early detection, for example, could significantly reduce the trauma and financial burden on individuals and their families. There would no doubt be a knock-on effect on employers, too.
More detailed campaigns by employers, medical aid funds and healthcare providers could be focused on awareness and understanding of what support services are available, and how to access them.
Tackling the mental health plague and the related issues of absenteeism and presenteeism will require input from a variety of stakeholders. A first, necessary step is to raise awareness. The more that organisations focus openly on the realities and the risks affecting their workforce or their policy members, the sooner we will start to properly tackle the problem.
Increased awareness and an open feedback loop between affected individuals their employers and insurers will also help risk managers to develop more appropriate responses to this epidemic of mental health problems impacting employee wellness and, ultimately, our economy.
Group risk products have an important role to play here. Education to members and intermediaries about the products and services available to them is absolutely key.
