DMEC: Welcome to Absence Management Perspectives, a DMEC Podcast.
The Disability Management Employer Coalition, or DMEC as we're known by most people,
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This podcast series focuses on industry perspectives and delves into issues that affect DMEC members and the community as a whole. We're thrilled to have you with us and hope you'll Visit at www.DMEC.org to get a full picture of what we have to offer. From webinars and publications to conferences, certifications, and much more, let's get started and meet the people behind the processes.
Heather Grimshaw: Hi, thank you for joining us. I'm Heather Grimshaw with DMEC and today we're talking about Psychedelic Assisted Therapy. Our guest is Sherry Race, Chief Executive Officer and co-founder of Enthea, whose article From Counterculture to Clinical the Potential of Psychedelic Assisted Therapy was published in DMEC's member publication @Work magazine. This article, which is open to the public, notes the importance of employers staying informed about these emerging treatments for policy development and benefits planning as they become more widely available.
She emphasizes the ways in which this treatment addresses the root causes rather than the symptoms of mental illnesses that can, as she writes, reduce recurrent leaves and disability claims. Race has agreed to provide additional context for us today on this compelling topic. So my first question for you is about a data point in the article that cites the fact that mental health conditions account for a significant percentage of workplace disability costs. I'm hoping that you'll talk a little bit more about this and how it supports a need for different types of treatment. A reference to the $3.7 trillion annual cost of mental health is certainly compelling.
Sherry Rais: Yes, $3.7 trillion does turn heads. So I think some of these Data points to 3.7 trillion, as well as the data we have on workplace disability costs are some of the most compelling data points we have. There were studies done by both Deloitte and Johns Hopkins that show that mental health conditions account for about 30% of workplace disability claims, but up to 70% of the total disability related costs. And that's because mental health related claims tend to be longer in duration,
more complex to treat, and more likely to recur over and over than physical health conditions.
In financial terms, it was Health Canal that put together data from various sources to show that untreated mental health costs US employers $3.7 trillion a year. And that 3.7 trillion looked at three big categories. One was the cost of healthcare spend, the other was the cost of productivity and absenteeism. And the other cost of was retention. And like rehiring as an example, the number one reason that Millennials and Gen Zers quit their job last year was due to mental health. So a lot of work to rehire and retrain. That's where that 3.7 trillion comes from. And what this really tells us is that we really need better solutions to address mental health. This is kind of the crux of why we need new treatment options, especially for the people who haven't responded to standard medications or therapy. And I should note that up to 60% of people are treatment resistant, which means 60% of, sorry, people with mental health conditions don't respond to traditional methods.
And that's where we really need innovative solutions like ketamine assisted therapy, psychedelic assisted therapy, even. There's another therapy called Stella Ganglion Block, but more innovative solutions that get to the root cause of trauma because the traditional methods are not working and ends up costing employers a lot of money.
Heather Grimshaw: You talk about the 60% of people with mental health issues that are treatment resistant and realize that in addition to that employer cost, that whole component of pain and confusion for those people. So that's certainly compelling.
Sherry Rais: Definitely. Imagine, like, most people who have a mental health condition don't get treated either because they can't afford care or access care, or there's like, cultural stigma. So about half of people that have a mental health condition don't get treated. But then the half that do get treated, most of them are not finding relief. So they got over the hurdle, saved money, or they figured out how their benefits work, or they got over the cultural taboo, and they decided to get care, and then it doesn't help them.
And then they might try another medication or another therapist, and nothing is working. So now imagine how hopeless that person would feel. And if we step away from the statistics for a second and just think in our own lives, I'm sure, I'm positive that everyone listening could think of someone they know that has actually gone through this cycle. And maybe that person hasn't been so open about it. But we all know someone who's struggling with mental health and is feeling hopeless because the existing options just haven't helped them. And so, yeah, yeah, I don't really have good words to explain that feeling of despair.
Heather Grimshaw: Oh, I think you do. I think that was very well said. And I think you're right. I think the ability to hear people talking about these issues and recognizing different options hopefully opens up different avenues for hope. So there are references in the article to the comprehensive care model. Would you please share a little bit more information about this and why it's something employers should consider?
Sherry Rais: Yes. Sometimes when talking about comprehensive care in the context of psychedelic therapy, some practitioners or providers might be referring to the fact that when you do psychedelic therapy, you shouldn't just do the psychedelic and there's a container or a protocol that's considered good practice, which is doing sessions of preparation before you even do the psychedelic or the ketamine, which means meeting with a therapist and setting your intentions and reducing fears around what might come up and providing context. That's all the preparation phase. Then there's the actual medicine sessions where a psychedelic or ketamine is administered. And then there are integration sessions, which is when you do follow on therapy sessions to sort of make sense of everything that was realized or epiphanies that were had during the altered state. Experience. Experience. So sometimes when talking about comprehensive care, that is what is referred to. But I say that just for context. When I wrote about comprehensive care in the article, I was actually talking about delivering ketamine assisted therapy and psychedelic assisted therapy in connection with primary care and psychiatric providers, licensed therapists, perhaps like in connection with occupational health and return to work planning. Sometimes you need to loop in your HR or disability management or EAP teams. But I really believe a model that ensures that no part of the care journey happens in a vacuum is what leads to lasting results. You know, we could add even more and talk about like diet and nutrition and meditation and journaling and community. You know, that's all a part of comprehensive care as well. But I think the treating clinician, so that in this case, the psychedelic therapist or the ketamine therapist should coordinate with the employees, existing providers as part of the process and outcomes should be tracked. Various outcomes and indicators should be tracked throughout.
Because sometimes we only track the reduction in your depression symptoms. According to, you know, a depression survey, that might be what your psychiatrist tracks, right? They give you this survey and says, okay, your depression score has gone down. But like, what about your productivity at work? What about your absenteeism? What about your general mood? What about your feeling of purpose? So I think, yeah, that's what I mean by comprehensive care. And I think, sorry to talk so much about this, but fragmented care leads to longer recoveries, higher costs, and because I spend a lot of time looking at claims like leads to claim friction and comprehensive Care ensures more safety, accountability and like real healing outcomes, not just symptom relief.
Heather Grimshaw: Thank you so much for providing the additional context because I think that, that it really pulls the concept full circle, especially for people who don't fully understand the role that it can play. And so I do think that hearing you talk about your focus on claims and also that those different pieces of productivity at work, absenteeism and how you're feeling just holistically is really important and very helpful. So this actually brings me to my next question, which is about eligible conditions for psychedelic assisted therapy. The article references PTSD, depression and anxiety and I'm wondering if there are others and if this definition is evolving.
Sherry Rais: Yes, okay, so definitely evolving. I would say maybe core eligible conditions supported by current evidence and research is really focused on treatment resistant depression,
PTSD, anxiety disorders and suicidal ideation. But the definition is evolving and there's growing research on psychedelic and ketamine therapy for substance use disorders, OCD, neurodegenerative disorders, chronic pain with depression, end of life anxiety, and I don't know if I said eating disorders, but that too, I think I'll highlight a little bit, if I may, where the research is at, you know, for FDA approval, as a lot of these medicines are not FDA approved yet, but they've been given breakthrough status. In order to get FDA approval, you sort of need to get FDA approval for one condition.
That doesn't mean that the psychedelic is or the medicine is only good for that one indication, but it means the bulk of the research will be focused on that one indication to get the FDA approval and then there will be other use cases. So right now, three psychedelics have been given breakthrough status, which means they've been, the FDA recognized how significant they are and how great the outcomes are that they're fast tracking the approval process without compromising safety.
And for LSD, which is commonly known as acid, that compound has been given breakthrough status for the treatment of anxiety. For MDMA, which is also known the street name, which is not as pure, this drug is Molly or Ecstasy, that has been given breakthrough status for PTSD. And then psilocybin, which is also known as mushrooms or magic mushrooms, has been given breakthrough status for treatment resistant depression. That's not to say again that these medicines are not useful for other things. It's just what the FDA approval pipeline looks like. I will highlight like some of my favorite studies. There's a study by University of Exeter that looks at ketamine assisted therapy and heavy drinkers or alcoholics, and it showed that after just six ketamine sessions, 86% of the participants had not touched alcohol even a year later. So completely abstinent from alcohol even at one year follow up, which if you know anyone who is a heavy drinker and you've tried to get them to stop drinking, you might be able to resonate with how, how impactful it would be to like do something six times and then not touch alcohol again. There's another study from Johns Hopkins that looked at heavy smokers. I believe there were people who were smoking like a pack of cigarettes a day or more,
um, maybe for 10 or more years. I could be wrong on the number of cigarettes in the number of years, but it's close to that. And after three psilocybin sessions, 80% of them had not touched a cigarette for a year. So totally quit smoking. Now, if you think about all of the drain on our healthcare system and additional healthcare problems and costs that smoking causes, like, again, this is like years of life gained back and probably trillions of dollars the total cost of smoking on healthcare system.
I haven't done that math. And then last study, because I know I'm giving a lot of data, but the study done on MDMA for PTSD showed that 65% of people that did one to three sessions of MDMA therapy, and these were like vets and victims of sexual assault, 65% of them no longer qualified for PTSD. They no longer had the PTSD diagnosis, diagnosis one year after the three MDMA session. So really groundbreaking results. And then there is a bunch of data and a lot of research again around O C D, eating disorders and other disorders. But those are a few to highlight, I guess. Oh, and one more. Sorry. Ketamine I will always mention is the only medicine that reduces suicidal thoughts in just a few hours, you know, in as little as four hours. So a true life.
Heather Grimshaw: Thank you for sharing those specifics. And I know in the article you referenced the academic institutions that are studying these therapies and mentioned a few now, and I think that that certainly lends a different element to the issue overall. So thank you for sharing that data. And the last piece that you mentioned is that ketamine assisted therapy, and I'm hoping that you'll talk a little bit about eligibility for this ketamine assisted therapy.
Sherry Rais: If an employer decides to offer this to their employees through a third party that knows how to do this, then the employee would first go to an in network provider and do a medical and psychiatric assessment to see if they are a good fit. Often that provider will See if they've tried other treatments before without adequate relief and you know, do an assessment to see if they have one of the indications needed for suitable for ketamine therapy. And then that provider would submit a prior authorization request to the third party provider that the employer has contracted with. And then that third party provider would, you know, either approve or deny the prior authorization request before treatment is administered. If it's approved, the employee is then starts working with that provider and is integrated into that kind of comprehensive care plan we talked about. And that's how I guess eligibility would be determined. So it would be like first with the provider and then with the third party with the prior authorization process. Does that make sense?
Heather Grimshaw: It does. It's really helpful to hear the different steps and it makes me wonder,
you had mentioned in the article actually that there are proactive absence management strategies that can help potentially accelerate recovery timelines and return to work. And this is jumping a little bit, but I'm hoping that you'll talk a little bit about what those proactive absence management strategies are and frankly how pervasive they are.
Sherry Rais: This is where I think a lot of forward thinking employers are focusing their energy.
Proactive absence management means not just reacting to leave requests, but identifying at risk employees early, intervening with the right treatments and potentially preventing a leave altogether. That would be, I guess, a successful proactive absence management if you can prevent the leave in full transparency you mentioned. I'm the CEO of a company called Enthea. So we are a third party that partners with employers and unions to offer these innovative treatments. And we've worked with employers who, well, we'll help them actually get access to their data and we'll review leave patterns,
see who's kind of received EAP referrals, evidence for treatment resistant depression,
see who perhaps hasn't put a leave request, but we look at the data to see who's been, you know, kind of, we look for abscess and TSM pattern. So maybe not they haven't put in a leave request yet, but we see a trend of being absent quite a lot. And then we get data from, we get claims data and we can often get data if we partner again comprehensive care. If we look partner with their existing EAP to see who's been seeking counseling sessions, then we can kind of identify who might be a really good candidate for ketamine assisted therapy and, and focus on educating the employees on the benefits of ketamine assisted therapy to that employee population. So in one case, well in many cases, but in one case an Employee was really on the verge. Like, we ended up telling their provider that they were really just about to put in their request for short term disability, but started ketamine assisted therapy through their plan, never went on leave, stayed at work and sent us a testimonial saying like, they felt like themselves for the first time in years. So I think it can be extremely transformational for a person's healing and for the employer if we cannot just accelerate recovery, but really prevent the full cost of leave from ever materializing. Because, like, taking extended leave is of course, you know,
not great for the company, but very jarring on someone's personal life as well. Right. Like, it doesn't feel great to not be able to work. And so preventing that altogether is a huge success. To summarize, the most important part is the openness to share data. And so if data can be shared kind of in that comprehensive care model between the eap, between the HR department and between and THEA or, you know, whichever other company is doing this with the employer, that's how you can identify people who are at risk. And you know, in terms of prevalence, I, I don't know if I have a number off the top, like offhand memorized. I, I should have maybe analyzed some of that data ahead of time.
But you know, we're seeing, typically we see about 4, 4 to 5% utilization of ketamine to therapy across an employer population. And I think that, again, I'm not looking at the data now, but probably a quarter of that were people who would have gone and leave. But I'm not, I'm not looking at the data now. And we don't actually directly measure that. So that's kind of my estimate.
Heather Grimshaw: That's really helpful. And no need for specifics there. Just it's helpful to hear how many employers are moving in this direction. So that's really helpful. I think you referred to these folks as early adopters. I'm using air quotes here. When you're talking about psychedelic assisted therapies, and you also referenced specialized return to work protocols.
So I'm hoping that you'll share a few specifics. And you did just provide an example of identifying on the front end and preventing a leave. If you can share an example of the specialized return to work protocols, that would be really helpful too.
Sherry Rais: One, I'll share an example of, you know, an early adopter. This was shared in the article as well. But for anyone listening that did not read the article, one of an amazing case study we have is with Dr. Bronner which is the soap company manufacturing company, and I mean soap manufacturing. But they were one of our first customers and their results were outstanding. So after offering ketamine assisted therapy to their employees, they saw a 65% reduction in depression,
a 67% reduction in anxiety, an 86% reduction in PTSD, and 80% of participants that did the ketamine therapy stopped taking their antidepressants and stayed off even for months after the ketamine therapy was finished. But what we're seeing now to your point about return to work protocols and how we're working, especially now with unions, that we're working with large unions where return to work is so important as we are scheduling more integration sessions with a therapist post treatment to quicken the return to work. Also customizing a return to work schedule that's, you know, coordinated with the ketamine therapist and the employee. That's like a clear custom way of like, okay, this, this might make sense of like how, how you should return to work and how quickly and then continuing doing ongoing symptom monitoring and touch points with either the HR, often, not often more just the provider or EAP, but ongoing symptom monitoring and touch points to make sure that that person does feel supported even after they've returned to work. So that way the, all of the clinical benefits of the ketamine therapy translates into, you know, real functional outcomes. And I think doing all of this does make a big difference in both speed and like sustainability of recovery. Because what we don't want is someone does this treatment and you know, they feel good for six months and then they don't feel good again. Unfortunately, that's what we don't see. We, we actually do see people having long lasting, sustaining results that even a year later they don't need to go back into treatment.
Heather Grimshaw: That's really impressive. Thank you for sharing those examples. Hearing you talk more about this and, and reading the article, which I encourage everyone to do, we'll include a link to the piece in the notes section episode. Is there one sticking point or barrier that you found to employers embracing psychedelic assisted treatments? And if so, what, what is it?
Sherry Rais: 100% language. So actually we don't really use the word psychedelic and we have seen a big difference in employers, like traction with employers and unions and interest when we don't use that word. We started the company like really heavily focused on destigmatizing psychedelics and being the first psychedelic healthcare provider and the psych, first psychedelic employee benefits provider. And that was our branding everywhere. And people just Couldn't get over that word. They had ties to it maybe from college experiences or their children's experiences or they heard a story or whatever it is, all these taboos in their head, they couldn't get over that word. And so then we started just saying ketamine because the other psychedelics are not FDA approved, and ketamine is the only one that's, you know, available nationwide. And even that, you know, turned heads. We would get questions of like, do you mean the horse tranquilizer? Is that the thing that Matthew Perry did, you know, is that that party drug? And so we stopped using ketamine as well, and we changed our messaging and just, you know, started with innovative mental health treatments. Sometimes we'll say transformational mental health treatments, cutting edge, evidence based. But usually we say innovative. And of course, you know, it's not that we are being deceptive, because then when we go into talking to employers, we will explain that the treatments include ketamine assisted therapy and we'll share the science. But that opening line, switching it to refrain from using psychedelic or ketamine really did help people get over their stigma. Um, they would buy in, you know, to the data and the outcomes and the ROI that we would share with them, and then, you know, they would learn, oh, this is through treatments including ketamine. Well, they've already kind of bought into this. The outcomes. We've told them like we tell them, 86%. You know, would you want to offer something to your employees that has an 86% reduction in PTSD and will reduce suicidal thoughts in four hours? Who's going to say no to that? Right? And then you're like, oh, by the way, it's ketamine assisted therapy and it's super safe and it's backed by science. So we do use the word still in articles and on podcasts. And I do a lot of speaking engagements now. I'm giving away all my trade checks on this podcast. But we do, we do use the word a lot because it generates maybe buzz in terms of like on. On podcasts or in articles are on stages. But when we're actually having a conversation with an employer and we're talking to the benefits team, we stay away from that word initially.
Heather Grimshaw: At least that makes sense. I love it. And I love to hear you say you're giving away your secrets. That's great for us. We love it. So I know that you've presented at several DMEC conferences and spoken with employers directly. Are there specific questions they've asked you that are or more common than not for employers?
Sherry Rais: Yeah, definitely. People. The first two questions, like, is it safe? And is it legal?
Always comes up with almost every employer. Then after, is it safe, is it legal? Employers often want to know about outcomes, so they'll often ask, like, you know, what's, what can we expect in terms of ROI?
Or what kind of outcomes? Have you seen some of the questions that you've asked today? Like, who's eligible for this? A very common question is, can it be used even if you haven't tried other treatments, like, can somebody do ketamine assisted therapy as a first line of support? And that's an interesting one because that really depends on plan design not to get into like the nitty gritty stuff. Like, some employers want to be a bit more conservative with their offering and want to only offer ketamine assisted therapy once someone has tried something else and it hasn't worked for them.
My personal opinion, and a lot of employers are agreeing that it doesn't make sense to make someone suffer. If there's something out there that could help them that's cheaper than the traditional method anyways, and we know it's more effective, then why not let them do it first? So that's a common question, obviously, how much does it cost? Always comes up. And then they're happy to hear that it's way cheaper than rehab and ongoing therapy and ongoing meds. So that comes up a lot.
Heather Grimshaw: All those very practical pieces. Thank you so much. I appreciate your time and the additional context. Once again, just encourage listeners to read this article in At Work magazine. We will include that link in the notes section. And Sheri, thank you so much for your time today.
Sherry Rais: Thank you so much, Heather. And for anyone listening, if you are curious about ketamine therapy or psychedelic therapy, you can find me, I guess on LinkedIn or anywhere. And I'm happy to be a resource, happy to answer your questions questions, happy to help.
