Deb Krause has two words for the results of mental health care in Minnesota: "They're horrible."

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Krause is vice president of the Minnesota Health Action Group, which was formed by some of the state's major employers to improve health care in the state and help their bottom lines.

"It's very practical because they spend millions of dollars on benefits," Krause said. "They're not satisfied with the status quo."

For the past two years, the group's focus has been on mental health, and it's an area where they definitely are not satisfied, Krause said.

Krause cites data from MN Community Measurement, an independent nonprofit that tracks medical care in the state. The data show that only 8 percent of Minnesotans show improvement six months after being diagnosed with depression.

"Employers look at that data, and they say that's just horrifying," Krause said. "We're not giving up on this depression because when only 8 percent of the people get better after six months, that's not acceptable."

It also affects employers' bottom lines. The National Council for Behavioral Health reports that 35 million workdays are lost each year because of mental illness. The cost of untreated mental illness, it reports, is $105 billion annually, mostly from lost productivity.

'Bright spots'

But there are "noteworthy bright spots," said Julie Sonier, president of MN Community Measurement. "And Essentia Health is one of them."

In its "Depression Care in Minnesota" 2018 report, the nonprofit singled out 15 clinics from Minnesota or nearby that achieved top ratings for depression remission at 12 months. Eight of the 15 were Essentia clinics, including those in Superior, Hibbing, Ashland and the Lakeside neighborhood.

Krause cites Best Buy as another bright spot.

The Richfield, Minn.-based retailer has aggressively focused on mental health this year, said Liz Beckius, a senior manager on its human resources team. That included redefining her job. Previously, she had been managing eight programs. Now it's three, one of which is mental health benefits.

"It's an everyday priority, not just for a campaign or a period of time," Beckius said.

One of Best Buy's initiatives relies on high-ranking executives who have been willing to share their stories of battling depression and other mental illnesses with employees, she said. That helps dispel the myth that "if you have depression you can't be successful or you're some kind of loser."

Storytelling sessions take place at Best Buy's 5,000-employee corporate headquarters, Beckius said. For the 100,000 employees spread out over 50 states, there are webinars, and employees post their stories on the company's internal news channel.

'F' for equity

But Minnesota employers need to do a better job of ensuring their benefit plans cover mental health care, said Sue Abderholden, executive director of the National Alliance on Mental Illness in Minnesota.

This year was the 10-year anniversary of the Paul Wellstone and Pete Domenici Mental Health and Parity and Addiction Equity Act, designed to provide comparable coverage for mental and behavioral treatment as for physical health treatment.

The legislation was a hallmark of Sen. Wellstone's career, but compliance in his home state has been abysmal, Abderholden said. She cited a report this year from the Kennedy-Satcher Center for Mental Health Equity at the Morehouse School of Medicine. It gave Minnesota an F. Minnesota was not alone; 43 states got a D or an F, and only Illinois got an A.

The absence of parity plays out in a number of ways, Abderholden said. For example, most private insurance plans will pay for rehabilitation for a knee or hip, she said; many won't pay for residential mental health treatment.

"We have one large employer that decided not to pay for family therapy for children," she said. "That's like saying you won't care for diabetes."

Krause agreed that equity hasn't been achieved.

"When that law went into place, employers removed all the limits that used to be in place on mental health care," she said. "What we see now is looking at it in a more sophisticated fashion, there's no parity because the (provider) networks aren't as broad. ... You might not be able to get in. You might not have the access."

Best Buy focuses less on its health plan than on its employee assistance plan, Beckius said, because it's available to all employees, full time and part time, as well as to their families. As the company stepped up its efforts to increase awareness of mental illness, it expected its costs from offering the plan would go up, she said. They have.

What effect improvement in employee mental health has on the bottom line is difficult to measure, Beckius said, although employees say they can better serve the company when they're feeling better.

When it comes to employee health, the bottom line isn't her goal, she said.

"It's about them being healthy, strong and productive human beings," Beckius said. "It's great. It's great for our stores. It's great for our customers. It's great for our communities."

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‘Make it OK’ raising awareness in Duluth

The “Make It OK” campaign that began in Duluth this year after starting in six other Minnesota communities in 2017 is an effort to remove the stigma about mental health.

By the end of May, 36 employers with 26,000 employees in Duluth and the surrounding area were involved in the effort, said Shannon Sweeney Jorgenson of Northland Healthy Minds, which coordinates the work locally.

The results have been relatively encouraging, Jorgenson said. In survey results released last month, 46 percent of Duluth area residents said they were aware of programs or campaigns to raise awareness of mental health, compared with 33 percent across the other communities. It was 37 percent in Hennepin and Ramsey counties.

In Duluth, 74 percent of respondents said they would be comfortable talking to someone about their mental illness. In the other communities, that ranged from 63 to 69 percent.

As Northland Healthy Minds gears up for another campaign next year, more employers are signing on to “Make it OK,” Jorgenson said.

“It’s showing employees that their employers care about this,” she said. “It makes sense not just from the standpoint of the bottom line but because it’s the right thing to do.”

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Course teaches mental health first aid

Many employees have been trained in what to do if a colleague stops breathing or goes into cardiac arrest.

Do they know what to do if a colleague experiences a mental health crisis?

Deb Krause, vice president of the Minnesota Health Action Group, said the agency brought in a trainer this year to teach about mental health first aid at work.

The training was created in Australia in 2001 and brought to the U.S. in 2007 by The National Council for Behavioral Health, said Betsy Schwartz, the nonprofit’s vice president for public education and strategic initiatives.

It’s taught in an eight-hour course for certification in mental health first aid, but there’s also a four-hour version for corporations, Schwartz said. The agency has trained “about 30” companies across the country.

The training  relies on the acronym ALGEE:

A - Approach, acknowledge risk, assist.

L - Listen nonjudgmentally.

G - Give reassurance and information.

E - Encourage professional help.

E - Encourage self-help.

It’s intended as triage for a situation, not a cure, Schwartz said. “CPR is not training anyone to be a cardiologist,” she said. “Mental health first aid is not training anyone to be a therapist.”

The agency trains more than 1,000 people in the U.S. every day, Schwartz said. “The training is saving lives every day.”