The high cost of depression among employees in the workplace – as much as R4,2-billion annually – is being addressed by South African health tech Signapps.

As part of its contribution to Mental Health Awareness Month, the Cape Town-based business recently hosted a webinar on Mental Health and Functional Rehabilitation in the Workplace, attended by more than 60 delegates, representing a variety of organisations including medical schemes, managed care organisations, insurers, employers and health care providers. The Signapps care co-ordination platform was shown to be central in preventing a key problem in workplace mental health – relapse.

The webinar explained the difference between absenteeism – where a person is not at work due to mental illness – and presenteeism, where the worker is physically at work but their performance is negatively impacted by their condition. These workers do not deliver what is required while enjoying all the benefits of being employed. Both categories have significant impacts on the individual, the employer and the economy.

Cost of presenteeism

Panellist Professor Stoffel Grobler explained: “Consider absenteeism: A study by Johnson in 2002 has shown that ‘Once a person commences on sick leave, they start down a slippery slope leading to long term worklessness. The longer someone is off work, the less likely they are to return to work. If the person is off work for 20 days, the chance of ever getting back to work is 70%, for 45 days this reduces to 50% and after 70 days of sick leave, the chance of ever getting back to work is 35%’.

“Another study by Waddel and Burton in 2006 on the impact of not working points to a number of possible negative outcomes for the individual, including an increase in medical consultations, hospitalization and the consumption of medicines. The American Medical Association puts it like this: 50% of people out of work for eight weeks will not return to work, while 85% of people out of work for six months or more, are likely never to return to work.”

Grobler continued: “Presenteeism results in another set of problems. Because the person is at work but operating below capacity, their productivity, and hence the effectiveness of the organization, is compromised. It has been estimated that, in South Africa, 49% of clinically depressed people will keep working despite their illness. Alarmingly, it has been estimated that 4,2% of South Africa’s GDP is lost due to presenteeism related to depression.”

The Covid-19 tsunami

The Covid-19 pandemic and the impact it has had on employment, pressure on corporate profitability and general anxiety and depression in the population has been enormous. The levels of depression in both working and non-working people have increased significantly this year compared with previous years. One of the panellists called it “a tsunami of cases”.

At a practical level, the role of Signapps starts when the medical team around the patient, back at work after being treated for mental illness, relapses. Panellist Dr. Kim Laxton, a psychiatrist in private practice, explains: “Typically, an employee suffering from a mental illness is given sick leave and is treated, either in hospital or as an outpatient. Very often, when the employee returns to work, there is a relapse due to a breakdown in his or her managed care. There exists a gap between the initial return to work phase and successful reintegration of the patient into the workplace, fully rehabilitated. Failure to ‘close the gap’ potentially results in dire consequences for the person, the employer and the insurer.”

Team effort is the answer

Successful treatment is a co-ordinated team working together to see the patient successfully rehabilitated. Dr Laxton explained: “Typically, this is a big team. On the administrative side we have the person’s line manager, HR department, legal representative and the case manager representing the health insurance company.

“On the medical side, there is usually the patient’s GP, a psychologist to give psychotherapy, a psychiatrist for medication, often a dietician and finally the key person, the Vocational Occupational Therapist, who is essentially the core around which the whole team operates. Logically in such a big team, data collection and care co-ordination is difficult.

“To prevent relapse, the team needs to communicate – often. We must stop working in silos. This is exactly where Signapps comes in.”

Signapps CEO Andrew Davies says: “Signapps is a suite of patient-centric care-coordination tools. The CoVID-19 pandemic has accelerated the use of digital healthcare services and data to deliver better outcomes more efficiently.

“Our platform is secure, simple, safe and cost-effective for our customers. It enables a large team to communicate effectively in real time without having to be present with one another or the patient. In addition, all the paperwork, results and forms are in the cloud and can be accessed immediately.”

The webinar concluded that, to address this “gap”, a number of role players need to engage and collaborate.

“Signapps is not the end solution. Our platform is only one piece of the puzzle with the potential to drive efficiencies in the care coordination process,” stressed Davies.

“Right now we are actively looking to engage service providers in the industry to put our technology and the expertise of our team to work in the area of corporate mental health. In the end, a successful partnership will make a dramatic and positive impact on the lives of the patients, the effectiveness of their organizations, a reduction in medical claims and, ultimately, a more productive economy in South Africa.”