While it is known that psychiatric illness and subclinical psychiatric illness 
can be very disabling, their impact on workers' productivity has been little 
appreciated or appropriately addressed. Complex variables are involved in 
fashioning an appropriate policy to ameliorate the impact of mental illness on 
productivity including the identification of effective treatments and potential 
negative effects of controlling patients' access to them. The cost-effectiveness 
of such treatments is considered from the differing perspectives and goals of 
the various stakeholders involved, including employers, insurers, and workers 
with psychiatric illness. Depression in workers leads to significant 
absenteeism, "presenteeism" (diminished capacity due to illness while still 
present at work), and significantly increased medical expenses in addition to 
the costs of psychiatric care. In addition to the specific usefulness of 
psychotropic medication, there are a variety of studies on the 
cost-effectiveness of different psychotherapeutic treatments that improve health 
and productivity in psychiatrically ill workers. Research indicates the 
usefulness of approaches including employee assistance programs, specialized 
cognitive-behavioral treatments, and brief and longer term psychodynamic 
interventions. It is clear that substance abuse disorders and especially 
depression and subsyndromal depression have a profound negative effect on work 
productivity and increases in medical visits and expenses. The current system of 
mental health care suffers from ignorance of the negative effects of psychiatric 
illness in workers, from a lack of subtle awareness of which treatments are most 
appropriate for which diagnoses and from the reluctance by payers to invest in 
them. Access to evidence-based appropriate treatment can improve the negative 
impact on productivity as well as workers' health. This article considers these 
issues and argues for a role of psychotherapy in the treatment of mental illness 
and substance abuse from the perspective of worker productivity.