Current mental health study estimates as many as 700,000 Americans are homeless on any given night. An estimated one-fourth of these people have serious mental illnesses, and more than one-half have an alcohol and/or drug problem (National Resource Center on Homelessness and Mental Illness, 2001). People who are homeless and have mental illnesses need a broad range of services.

Until recently, workers' compensation and employee benefit claims were looked at in a very concrete manner, focusing on traditional medical/disability cost reduction programs, i.e., case management, managed care, disability management, and prevention programs, such as loss control/safety and wellness.

Today, in any given work force, more than 30 percent of employees can be classified as "troubled employees," suffering from issues ranging from short-term family crisis, drug/alcohol, and depression, up to acute psychiatric issues. In fact, 47 percent of industrial injuries are linked to alcohol and 70 percent of all adult drug users are employed, while stress costs employers more than $200 billion a year.

Employers are now more aware of how behavioral/mental health issues contribute to: workers' compensation claims; employee benefits claims; lengthy lost time/disability claims; higher absenteeism; loss of productivity; and violence, sexual harassment, diversity, and many other issues.

But in many cases, mental health issues are still addressed in a very limited way (see "Can Your Business Pass the Stress Test?" on page 24). EAPs (employee assistance programs) have existed for many years and have been the behavioral/mental health solution of many employers (primarily via employee benefits).

EAPs traditionally provide confidential counseling to employees in crisis and are included as part of an employee benefits package.

There are two general types of EAPs:

* The smaller regional EAP, utilizing counselors to see employees. Services and territory are usually limited to basic counseling, referrals, and training issues. Capitated rates can be higher, but provide more personal service.

* Large national EAP services, which generally are highly automated, serve large areas and large employers primarily by telephone, i.e., counseling and managed care. Capitated rates are lower, but service and results can be marginal and not hands-on.

I would like to mention an organization I have observed that has devised a new, fully integrated model for today's multilevel behavioral/mental health care services that should be used to judge what can be done to address problems in today's employer/employee environment. Menninger Care Systems is a division of the world renowned Dallas-based Menninger Clinic, which is ranked as the top psychiatric care provider in the world.

Menninger has established a for-profit division specifically to offer employers a state-of-the-art multi-functional approach to dealing with and reducing the cost of behavioral/mental health issues in the workplace.

The state-of-the-art model includes:

* A multi-level EAP program broken into regional components to provide national scope and regional sensitivity and control. EAP can be provided via Internet, telephone, or in person depending on employer needs. They also offer a full range of work/life services.

* A leadership training center where highly skilled mental health professionals can provide behavioral training ranging from executives to line employees on issues including: violence in the workplace; corporate productivity agendas; stress management; downsizing and M&A issues; drug/alcohol issues; sexual harassment; and motivation and behavior.

* A managed behavioral health sytem that provides behavior networks and consulting programs that access needs evaluation assessments; psychiatric preferred provider (PsyPO) international network; TPA services for behavioral/mental health claims; drug-free workplace; behavioral policies and procedural criteria; catastrophic mental health issues; and behavioral benefits plan design.

* International capabilities for behavioral issues on the international front, including new employee evaluation; family support for international moves; and crisis intervention/counseling.

Menninger approaches employer behavioral/mental health issues in a new integrated way and has set the bar higher for other vendors to follow.