The Balance program provides resources and information on a variety of behavioral health topics including:

• Effects of stress
• When is it depression?
• How to get a good night’s sleep
• Relaxation exercises
• How to boost your mood with exercise

Did You Know?

• 20% – 30% of employees and their dependents struggle with a behavioral health condition such as stress, depression and substance abuse.
• 30% – 40% of the U.S. population experiences behavioral health and substance misuse disorders at some point.
• 50% of these individuals require professional care.
• Only 40% of adults who have a behavioral health condition reported receiving any sort of service for their condition in the prior 12 months.
• 10% of workers are classified as heavy alcohol users.
• Behavioral health conditions and substance abuse frequently co-occur with chronic medical conditions like diabetes, which can double if not triple an individual’s health care costs.
• 60% – 80% of workplace accidents are attributed to stress, and it’s estimated that more than 80% of doctor visits are due to stress.

Behavioral Health Costs by the Numbers

• $811 per month – the average cost of treating a person with diabetes (w/out complications).
• $1,775 per month – the average when that person has a serious and persisting behavioral health condition.
• $1,848 per month – the average cost for that person with co-morbid substance use disorders.
• 500 million – estimated workdays lost annually due to alcohol abuse.
• 2x as likely – employees who use drugs are twice as likely to request early dismissal or time off.
• 2.5x as likely – employees who use drugs are two and half times more likely to have 8 or more absence days.
• $2.5 trillion – estimated cost of behavioral health conditions globally.

Impact on Work

• Unlike costly physical illnesses like cancer, where expenses are largely hospital-based, behavioral health costs are often indirect, such as not being able to work.
• More days of work loss and work impairment are caused by behavioral health conditions than by other chronic health conditions, including arthritis, asthma, back pain, diabetes, hypertension and heart disease.
• Behavioral health issues can account for 30% or more of the disability burden for the typical employer.
• 53% of employers found that return to work is more difficult for employees suffering from psychiatric disorders than for general medical disability.

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Sources:
• 2014 Milliman, Inc. report Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychology
• Journal of Occupational and Environmental Medicine

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Medical Directors

Matthew E. Peters, M.D., is an assistant professor at the Johns Hopkins University School of Medicine with appointments in the Department of Psychiatry and Behavioral Sciences and the Department of Neurology. He completed a neuropsychiatry fellowship and has an active clinical practice and research group focused on cognitive and other psychiatry symptoms following brain injury. He has a particular interest in symptom occurrence in older adults and the underlying brain circuitry involved.

Dr. Paul Kim is an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. He serves as attending physician on the Young Adult Inpatient Unit and Mood Consultation Clinic at the Johns Hopkins Hospital. He also conducts basic science research studying the role of neuroinflammation and neurodevelopment in neurological and psychiatric disorders. He is a managing editor of and contributor to the Johns Hopkins POC-IT Psychiatry Guide.

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The Mind-Body Connection

• Behavioral health problems are common in people with health conditions such as heart disease, diabetes, muscle and breathing problems.
• Stress can increase your chances of getting certain types of cancer and heart disease.
• Depression has been linked to several common health issues, including heart disease, type 1 and 2 diabetes, obesity and asthma.
• Psychosocial factors—such as work environment and whether you’re married—play a key role in high blood pressure.
• ADHD and depression have been associated with obesity.

Impact on the Workplace

• Stress and anxiety are more likely to keep you home from work than a cold or stomach bug.
• It’s going to be tough to do your job if you’re feeling down or blue. Depression causes people to function at lower level—at only 70 percent of peak performance.
• Stress can cause job dissatisfaction and increase job turnover.
• People often wait years before seeking treatment and suffer needlessly. Often this is due to the stigma around mental health issues. But it doesn’t have to be that way.

ABOUT BALANCE

About Balance

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The Johns Hopkins Balance program provides employees experiencing a behavioral health condition with a comprehensive approach to care through early identification and comprehensive care coordination.

HOW IT WORKS

ASSESS:  Employees take a confidential behavioral health questionnaire online. Their results are available immediately and help determine where they are on their path to behavioral health.

IDENTIFY: Based on the questionnaire results, a Balance Care Concierge may contact the employee to confidentially discuss the results and what support they may need and want. Together, they create an action plan to help the employee get in good behavioral health.

REFER/TRIAGE:  The Care Concierge also connects the employee to the resources that will help them get in good behavioral shape.

CHECK/FOLLOW UP/RE-EVALUATE:  The Care Concierge follows up with the employee to make sure they are getting the right care, at the right time, from the best resources for them.

*Balance is a Johns Hopkins Medicine worksite program in collaboration with emVitals and BHS. This service is confidential and follows all federal and state privacy laws.

When speaking to a Care Concierge, the conversations and information collected is not shared with the employer.

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Clicks on the topics below to learn more about these topics.

EFFECTS OF STRESS

WHEN IS IT DEPRESSION?

GET A GOOD NIGHT’S SLEEP

RELAXATION EXERCISE

BOOST YOUR MOOD

The Effects of Stress

Everyone experiences stress in daily life.  And, the very real effects of stress impact our overall health and wellness in a number of ways that can affect every system of our bodies—from the heart and cardiovascular system to the digestive system.  Stress can negatively affect sleep, our moods, and even interfere with relationships and our jobs.

Symptoms of stress include a wide range of physical issues, everything from headaches, heartburn and insomnia to increased colds and infections.  And while it’s important to remember that everyone experiences stress as part of life, it’s also important to know that help in dealing with stress is available.

Tips for Managing Stress

While we can’t always avoid stress in our lives, we can learn to bring those stresses under control. Here are a few tips to help get you started:

• Take direct action to solve the problem. First, identify the problem, then consider possible solutions and evaluate the pros and cons of each. This will help you determine the best course of action.

• Get regular exercise. In general, moderate levels of physical activity help relieve stress—aim for 30 minutes a day of moderate-intensity exercise (such as brisk walking) at least 5 days a week.

• Get enough sleep. When stressed, some people have trouble sleeping.
  Remember that exercise during the day can help with insomnia. Making a list may also help, or try writing down your thoughts about what’s troubling you early in the evening, then keep activities prior to bedtime restful and relaxing.

• Practice relaxation techniques. These include such things as deep breathing, meditation, and listening to soft, soothing music. Experiment with these and find what’s best for you.
• Make time for fun. Sports, hobbies, and socializing offer ways to unwind. Try something new and see which activities appeal to you most.

WHEN IS IT DEPRESSION?

When is it Depression?

Everyone has their ups and downs in life. That’s only natural. But clinical depression is different from the occasional bout of feeling down. If you are clinically depressed, your sadness will be profound for weeks at a time, almost without relief.

Here are a few questions that can help you tell if this is truly depression:

• Do you feel deeply sad or hopeless most of the day?
• Are you much less interested in things that used to interest you?
• Do you have trouble paying attention or concentrating?
• Do you feel guilty and bad about yourself?
• Do you think you’d be better off dead?
• Do you think about hurting or killing yourself?

If you answered yes to more than one of these questions, or if you answered yes to the last two, you should talk to your doctor as soon as possible about how you are feeling.

Depression can be treated with medication and psychological counseling. Even some lifestyle changes, such as diet and exercise, can help. And while it’s important to know that depression can be a serious disease, it’s also good to know that help is available.

GET A GOOD NIGHT’S SLEEP

Nine Ways to Get a Good Night’s Sleep

If your sleep is disturbed more than three times a week, and the trouble has gone on for at least a month, discuss it with your doctor; he or she might recommend a sleep specialist. If, however, your sleep problems are not too severe, or are the result of poor sleep habits, read on.

1. Make your bedroom a haven.
Is your mattress as soft or as firm as you like? Are your bedclothes comfortable? Temperature and humidity OK? Is the room quiet and dark enough for you? (Wear earplugs or a mask if need be.)

2. Come up with a bedtime routine.
Go to bed at about the same time every night, and follow the same routine so your body will know you’re ready to bed down. Dim the lights, drink a cup of herbal tea—or take a bath, read or listen to music to smooth the way from wakefulness to sleepiness.

3. Get up at around the same time each morning, weekends too.
Such constancy will reinforce your biological clock’s sleep-wake cycle.  Use your bed for sleeping. Move the TV (computer, tablet or smartphone) out of the bedroom; also don’t read, talk on the phone, or snack in bed.

4. Don’t lie in bed and stare at the ceiling.
If you can’t fall asleep after a while, or if you wake up in the middle of the night, get up and read, listen to music or do some deep breathing to encourage sleep. (But do not exercise!)

5. Eliminate daytime naps.
Some people get quite drowsy in the afternoons and doze off for a while. But if they do take a nap, they may have trouble sleeping that night—and so the following day, they’ll have to take another nap to make up for the previous night’s lost sleep.

6. Exercise regularly.
Exercising in the daytime can help you feel tired and relaxed in the evening. If you’re not already exercising, ask your doctor to help you devise a workout. Avoid exercising within three hours of bedtime, since vigorous activity at that time can drive away sleep.

7. Avoid caffeine, nicotine and alcohol.
All three of these drugs can cause poor-quality sleep, particularly if consumed late in the day. Smokers often experience troublesome withdrawal symptoms while trying to sleep; caffeine stays in the body for many hours before it can be eliminated; and alcohol is actually a stimulant that can also disrupt sleep.

8. If your partner snores loudly or thrashes around while asleep . . .
either move to a different room or ask him or her to see a doctor. Snoring can often be due to some treatable medical condition like a sinus blockage, thyroid imbalance, sleep apnea or obesity. Jerking and thrashing may be due to restless leg syndrome.

9. Use sleeping pills only as a last—and temporary—resort.
In certain circumstances, hypnotic medications may be useful for sleeplessness but they’re not a replacement for good sleep habits. If your insomnia has gotten to the point where sleeping pills are sounding like a good solution, talk with your doctor.

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RELAXATION EXERCISE

Relaxation Exercise: Deep Breathing

This technique can result in both better emotional and physical health.

• Lie on your back to help shift your breathing to a deeper, abdominal breath.
• Put your hands on your belly and take a deep breath through your mouth or nose. Each time you breathe in, try to push your belly out as much as possible—feel your hands rise as the belly rises. (As opposed to the popular notion that when you take a deep breath you suck in your gut.)
• Hold that breath for a few seconds and then slowly exhale through your mouth. Try to imagine you’re exhaling through a straw.
• After that deep breath, take three or four normal breaths.
• Then take another deep breath.
• Continue this for 5 to 10 minutes.

At least while you’re still learning, try to practice this form of relaxation during an already quiet time when you’re least stressed.

To learn more about relaxation and meditation, visit the National Institutes of Health website: http://nccam.nih.gov/health/meditation/overview.htm.

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BOOST YOUR MOOD

Boosting Your Mood with Exercise

• Regular exercise has effects that can boost mood, relieve depression and stress, and increase your self-esteem.
• Repetitive movements like those used in walking, running, swimming, or cycling increase production of serotonin (the chemical in the brain whose decline is linked to depression). You don’t have to be a marathon runner…all you need is a regular program of aerobic exercise.
• Regular exercise is an effective way to decrease blood levels of stress hormones such as cortisol. High levels of these hormones have been linked to depression and anxiety symptoms.
• Intense exercise triggers endorphins—“runners high” comes from the release of endorphins, which produces a sense of well-being and suppresses sensations of pain. Endorphin production usually begins about 15 to 20 minutes into an exercise session, and tends to peak after about 45 minutes.

RESOURCES

Additional Resources

Center for Workplace Mental Health
http://workplacementalhealth.org/

National Institute of Mental Health
https://www.nimh.nih.gov/health/find-help/index.shtml

National Alliance on Mental Illness (NAMI)
http://www.nami.org/

Substance Abuse and Mental Health Services Administration (SAMHSA)
https://findtreatment.samhsa.gov/

Mental Health.gov
https://www.mentalhealth.gov/

National Suicide Prevention Lifeline
https://suicidepreventionlifeline.org/

National Council for Behavioral Health
https://www.thenationalcouncil.org/

Veterans & Families – Mental Health Resources
https://www.mentalhealth.va.gov/

National Institutes of Health (NIH)
National Center for Complementary and Integrative Health (NCCIH)
https://nccih.nih.gov/health/stress

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During times of uncertainty, it’s more important than ever to have the tools and resources to maintain a healthy workforce and do our part to help keep our global community safe. To support those efforts, we are sharing Johns Hopkins-developed and curated information and resources to share within your organization and beyond.

As the new coronavirus (COVID-19) continues to spread and impact our daily lives, so do our anxieties. Joseph McGuire, Ph.D., M.A., a child psychologist at Johns Hopkins Medicine, shares some tips for you, your employees and their families on how to manage coronavirus-related stress.

In light of the COVID-19 pandemic, many people are working from home these days. Under normal circumstances, telecommuting can offer a pleasant break from your daily routine. But this situation is far from normal.

Harpreet Gujral, program director of integrative medicine at Johns Hopkins’ Sibley Memorial Hospital, offers suggestions on staying centered and healthy while you’re working at home during the pandemic.

Adversity. We all are facing it in one way or another as we try to adjust to the drastic disruption of our lifestyle and routines caused by the coronavirus pandemic. And many of the challenges and changes we are experiencing now will be with us when we begin to navigate “America 2.0.”

Johns Hopkins psychologist George Everly Jr., Ph.D., has spent much of the past 40 years helping people all over the world deal with the psychological impact of natural and man-made disasters. He offers five ways we can not only minimize the impact of adversity on our mental health but also turn it to our advantage.