Outside-the-Box Mental-Health Strategies

In an age when celebrities’ familiarity make them feel like distant cousins, I was taken aback when–over a 10-day period in July–Michelle Williams of Destiny’s Child fame admitted herself into an inpatient program to treat her ongoing depression; singer Demi Lovato suffered a near-death overdose; and Ellie Soutter, a rising star on Great Britain’s snowboard team, took her own life on her 18th birthday.

Depression, substance abuse and suicide are recurring themes covered by the media, yet while awareness is increasing, we seem to be making little progress in actually taking on the problem.

I, for one, am frustrated by my seeming inability to effectively address these trends. As I wrote last year after musicians Chester Bennington and Chris Cornell committed suicide: “I doubt I’ve saved or comforted a single soul by posting the phone number for the suicide-prevention hotline on my Facebook wall or in my Twitter or LinkedIn feed, and something similar can be said about companies that simply offer an employee-assistance program and consider the topic addressed.”

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And now we know there is even greater reason to become serious about our collective mental health. According to recent research published in the Journal of Abnormal Psychology (a publication whose very name suggests an outdated understanding of the prevalence of mental illness, notes a reference in Scientific American) only 17 percent participants in a long-term study did not develop a mental-health disorder–even briefly–between birth and middle age.

The scientists conducted prospective research where they closely followed one generation of New Zealanders from birth to midlife (Note: Think of it as the Framingham Heart Study for mental health). They performed in-depth check-ins every few years to assess any evidence of mental illness having occurred during the preceding year. The investigators found if you follow people over time and screen them regularly using simple, evidence-based tools, the percentage of those who develop a diagnosable mental illness jumps to well more than 80 percent.

The outcomes of this study indicate you are more likely to experience a bout of mental illness than you are to acquire diabetes, heart disease or any kind of cancer.

So, what can we do to help ourselves and our employees work through these mental-health trials that’s different than anything we’ve tried in the past? The answer for some may lie in playing a game.

Jane McGonigal is the director of game research and development at the Institute for the Future. Her research focuses on how games can transform the way we lead our real lives, and how they can be used to increase our resilience and well-being.

I briefly met McGonigal when I attended TED2010, where she presented on the topic of harnessing “gamer power” to solve real-world problems. Her presentation intrigued me because I had already participated in crowdsourcing solutions to problems posed by the scientific community. But I wasn’t convinced by McGonigal’s appeal for everyone to spend more time playing games.

That shifted in 2012 when McGonigal presented at TEDGlobal. This time her presentation was personal: She was diagnosed in 2010 with an intractable concussion that required her to stay in bed for three months to assist her recovery. McGonigal started to experience a less common side effect from her situation–suicidal ideation. By day 34, the researcher realized: “I am either going to kill myself, or I’m going to turn this into a game.” Her choice was not surprisingly the second option, and Jane, The Concussion Slayer was born. After a few days of gameplay, McGonigal’s “fog of depression and anxiety went away.” She found she still had to cope with the other concussion symptoms for more than a year, but she stopped suffering.

McGonigal turned her condition-specific game title into one called “SuperBetter.” Soon people from around the world were adopting their own secret identities and recruiting personal allies while fighting their unique health challenges.

At this point, more than 1 million people have spent 6 to 6.5 minutes a day playing SuperBetter. While this number may seem astonishing to you (as it did to me) McGonigal says that 2.7 billion people– approximately one-third of the world population–play games for one hour every day.

SuperBetter now has a workplace version called SuperBetter At Work. The product employs a methodology that uses game science and language to help employees with everyday problems. Given that workers play the game in a closed environment, a company-specific social aspect allows coworkers to take advantage of clever features such as establishing ally squads and ally goals.

After hearing McGonigal present at a Conference Board meeting, a Fortune 250 company piloted SBAW. The company was facing a potential merger and the employer “needed our employees to be healthier.” Eighty-seven percent of the eligible employees signed up after McGonigal kicked off the launch, and 59 percent played the game regularly.

While the outcomes from the pilot are not publicly available, chances are the results were similar to several research studies in which SuperBetter increased four protective factors known to increase resilience (greater optimism, more social support, and high self-efficacy and life satisfaction) and reduced all three known primary obstacles to resilience (less anxiety and hopelessness, and fewer symptoms of depression).

For me, SBAW takes advantage of positive psychology professor Martin Seligman’s theory of post-traumatic growth and resilience where, to quote Seligman: “[T]he normal response to very bad things is not going under. It’s not post-traumatic stress disorder. It’s resilience and, not infrequently, growth.”

If you want to go down a more traditional route to address mental health, I recently became aware of a company that was founded on helping individuals find centers of excellence to treat substance-abuse disorders. It now uses a risk-stratification algorithm (developed with Microsoft) to help employers and their employees cope with behavioral-health challenges.

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What impressed me about AiR Healthcare Solutions is this disease-management company not only works with employees with identified behavioral-health issues. It also uses its 34 proprietary algorithms to find workers who have mental-health diagnoses and are not in treatment (or are receiving inadequate treatment), as well as employees who have no indications of behavioral-health diagnoses but report physical symptoms that are often associated with mental illness.

The company contacts employees in the last two categories to discuss issues that may be impacting them but are not directly related to mental health. For example, an employee was regularly driving a significant distance so her child could receive treatment for a health condition. The AiRCare case manager provided the employee with information about an expert who was part of the worker’s insurance network and close to home. Such actions build trust with the employee, who may open up about how this situation is affecting her mental status as a result of this initial contact.

AiRCare ultimately seeks to change employee behavior over a long period of time. As such, the worker (and often the worker’s family) engages with care managers once he or she is in the program for a one-year period. The company learned in its early days focusing on substance-abuse clients that recidivism following a 30-day treatment program was unacceptably high and that helping clients over the long term is important.

As HR leaders, no matter what we choose to do to address mental health, post-traumatic growth and resilience, we must do something. Our employees and our companies’ success depend upon it.

Carol Harnett
Carol Harnett is HRE’s Benefits columnist. She is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily. She can be emailed at [email protected].