Stressed Out: Health care system comes up short in responding to need for early treatment

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Physical and mental health problems caused by the brain's overreaction to daily challenges and conflicts have yet to register fully on health care radar.

But if stress were a recognized medical condition or diagnosis, the United States would be experiencing a pandemic.

Those overburdened by stress still have trouble finding help because stress isn't a recognized illness. Only when it leads to mental or physical disorders, including depression, heart disease, diabetes, among many others, do doctors treat it and health insurance providers pay.

Medical clinics exist for cancer, heart disease and diabetes but not for stress. For now, the main oases of aid for stress are nonprofit community centers such as Squirrel Hill Psychological Services, where clinicians help people to manage stress and improve lifestyle for a fee.

UPMC Health Care and Highmark offer stress-management assistance online or by telephone, with UPMC now deploying health coaches to client companies to assist employees. Few people use or are even aware of insurance-based programs, while the uninsured are on their own.

PG graphic: Stress and your body
(Click image for larger version)

In the January report, "Stress in America," the American Psychological Association found a gap exists between what Americans want from the health care system and what they're getting in terms of stress management and wellness.

"Results showed that the U.S. health care system is not meeting specific patient needs related to behavioral health that could aid in the prevention and management of chronic illness," according to the report. "While Americans think it is important that health care focuses on issues related to stress and living healthier lifestyles, their experiences do not seem to match up with what they value.

"This year's survey also finds that people living with chronic illness are less likely to receive health care that is focused on helping them make the lifestyle and behavior changes needed to improve their health."

Malady of the millennium

Science warns that high stress in pregnant women can affect the fetus. A child can face a life of chronic stress from sexual, physical or mental abuse, or if a parent dies, among other early-life traumas. Prospects don't improve with age. Teenagers and young adults are the nation's most stressed-out age group due to social and relationship issues, educational costs and demands, and the challenges of finding a job or launching a career.

G. David Sivak, who teaches stress management at California University of Pennsylvania, says stress is "the malady of the new millennium" because it is "taking a toll on everyone, both young and old."

But there's no national strategy to deal with stress and its health effects. The U.S. Centers for Disease Control and Prevention group it in with anxiety disorders that it identifies as a common problem in American life. Currently, however, "no surveillance efforts at the national or state level are directed toward documenting anxiety disorders."

In its report, the APA says the number of people reporting high stress has been declining with continued public discussion of its harms. Still, it says stress isn't being addressed adequately by government, the health care system nor health insurance companies, with doctors often avoiding discussions with patients on the topic.

The UPMC Health Plan and Highmark have programs to help members manage stress but acknowledge they are works in progress. UPMC says it's pursuing a broad-spectrum approach for members with an online program and telephone coaching with follow-up sessions.

Because such a small percentage of members use these programs, UPMC took its "MyHealth Less Stress" program to the next level. In the past 18 months, it has deployed health coaches to member companies and those subscribing to the program. Companies are assigned on-site health coaches to help employees deal with stress and improve their lifestyles.

"Across the board, about 2 percent of employers' populations will be engaged at any one time [with online or telephone programs] regardless how good the programs are. Two years ago, we scratched our heads and said we need something to break through that barrier in a big way," said Tim Cline, senior director of clinical training and development at UPMC Health Plan.

On-site health coaches raised participation from 2 percent to 50 percent at member corporations, with early results revealing the potential to reduce health impacts and health care costs.

But most people have no access to such programs.

"I think there's a lot more out there [to deal with stress], but it's kept under a blanket and can be difficult for a person to find," the UPMC director said.

In 2006, two years before UPMC's program, Highmark determined that stress was affecting members' health with an impact on insurance premiums. It launched its Daily Steps to Less Stress program, which is free for Highmark members. Those who participate online or over the phone can learn stress-management techniques or speak with health coaches. Highmark also sponsors free public programs.

"Everyday stressors that turn into bigger problems? That's what we want to prevent," said Art Kusserow, Highmark director of specialty health management. "For several years, our accounts have been identifying increased levels of stress among employees and have seen health care costs related to stress and other behavioral health issues go up. They are looking for ways their health plan can mitigate costs."

Highmark member companies found that stress causes absenteeism and what Mr. Kusserow described as decreased "presenteeism," in which an employee is not focused or lags in productivity. "Clearly just about everyone these days recognizes that stress has some level of behavior health component in it, whether it's mild anxiety all the way up to clinical depression," he said.

Because primary care physicians have limited time with patients, Mr. Kusserow said Highmark recommends referrals to its Blues On Call program so patients can get help and speak to health coaches.

Highmark and UPMC officials also point to gymnasiums, yoga and tai chi classes as activities that reduce stress. UPMC and West Penn Allegheny Health Systems also have integrated medicine programs where patients also can find help.

What is lacking is a formal way to incorporate stress treatment into in-patient and out-patient medical services, said Betsy Blazek-O'Neill, medical director of the Integrated Medicine Program at Allegheny General Hospital.

"Insurance companies have programs you can go through," she said. "They understand the importance of it but don't prioritize it -- not only health insurance providers but also medical providers.

"Most people understand it has a role in health, but they don't understand what size a role and the priority in addressing its impact on illness or general health."

Personal responsibilities

Adopting a tough-love philosophy, Bruce S. Rabin, a University of Pittsburgh immunologist and stress expert, says those burdened by stress must learn to manage it without relying on doctors and health insurance. People can reduce stress by interacting with friends and family, participating in religious or spiritual activities, meditating, exercising, eating a better diet, ceasing to smoke, and drinking less alcohol.

Other proven stress-management techniques include deep breathing, humor, mindfulness and meditation, guided imagery, and expressive writing, all of which help to reduce the response of the brain to stress.

But people say they are too busy or their lives are too complicated to take time to manage stress, avoid bad habits or focus on lifestyle improvements.

"To this I can only say that when someone has died and is being eulogized, no one will say that they were a special person because they worked themselves to death and didn't take care of their health needs," Dr. Rabin said. "No one will say that they were a special person because they didn't take vacations or find time to read a book or just look at the trees.

"Remember," he said, "death is inevitable; a life of ill health is not."

Parents, he said, should feel obligated to be lifestyle models for their children. Coping with stress is fundamental to the quality of one's mental and physical health. "When children start life using healthy lifestyle behaviors, these will become their default behaviors and the likelihood is high that they will maintain these behaviors throughout life," Dr. Rabin said.

Libraries, schools, places of worship and gymnasiums also can sponsor public programs to help people improve lifestyle and cope with stress.

Some community programs, including the Squirrel Hill Psychological Services, are available to help people deal with relationship, family, financial and employment issues. "Having a place to go to is a step in the right direction," said Jordan Golin, director of SHPS clinical services. "Prevention is something society should look at to save money and in the short run save people" who are experiencing stress.

The need to deal with stress and improve lifestyle is paramount, Dr. Rabin said, because "the current quality of health and longevity in Western Pennsylvania is nothing to be proud of."

Those unwilling to improve their health and lifestyle should take action simply to prevent loved ones from the stress and burdens of caring for them when they develop an illness that could have been prevented.

"For motivation," Dr. Rabin said, "become a meaningful, healthy-lifestyle role model for those you love and who love you."

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David Templeton: or 412-263-1578. First Published March 11, 2013 4:00 AM


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