Mental Health and Work

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STRENGTHS AND WEAKNESSES
IN DANISH POLICIES: LESSONS FROM OECD’S
MENTAL HEALTH AND WORK REVIEW
Christopher PRINZ
Employment Policy Division
Directorate for Employment, Labour and Social Affairs
OECD
www.oecd.org/els/disability
Seminar “Transforming Disability into Ability”
05/11/2014 - Copenhagen
OECD POLICY REVIEWS: 2000-2015
(i) Disability and Work; (ii) Mental Health and Work
•
Transforming Disability into Ability: 2000-2002
– Review of disability benefit and employment policies
– Conclusion: Systems everywhere in need of reform
•
Sickness, Disability and Work: 2006-2010
–
–
–
–
•
Review of policies in 13 countries, incl. Denmark
12 major conclusions for Denmark; two-thirds implemented
High-Level Policy Forum in Stockholm in May 2009
Synthesis report in November 2010
Mental Health and Work: 2011-2015
–
–
–
–
Report on key policy challenges in December 2011
Review of policies in 9 countries, incl. Denmark
Report on policy approach for the future in early 2015
High-level Policy Forum in The Hague in March 2015
THE DISABILITY PROBLEM
Disability beneficiary rates are high and rising fast
Disability benefit recipients in % of the population aged 20-64 in 15 OECD countries,
three points in time: 1980, 2000 and 2012 (or latest available year)
1980
2000
2012
14
12
10
8
6
4
2
0
NOR
ISL
NLD
FIN
SWE
DNK
BEL
USA
AUS
IRL
ISR
Source: OECD (2010), Sickness, Disability and Work: Breaking the Barriers (updated to 2012).
LUX
AUT
NZL
CAN
THE DANISH CASE
Strengths and potential
•
•
Benefit systems and employment services
–
Municipal job centres as one-stop-shop centres, providing services
for sick and unemployed people and social assistance clients
–
Strong activation-oriented financial incentives for municipalities
–
Adaptable flexjob system to compensate people with partial capacity
–
Disability assessment from resource profile to return-to-work tool
–
New rehab process with multidisciplinary service for under 40s
Other systems (workplace, youth policy, health system)
–
Growing focus on the prevention of psychological workplace risks
–
Competent Youth Guidance Centres in every municipality
–
Highly accessible public health care system free of charge
MAKING LABOUR MARKET REFORMS A SUCCESS
The challenge: Previous reforms have failed
The number of people on health-related benefits has changed very little in the past few years
Recipients of different working-age benefits in Denmark, 2004-2011
Unemployment benefit
Social assistance
Rehab & pre-rehab
Sickness benefit
Flexjob & waiting allowance
Disability benefit
300
250
200
150
100
50
0
2004
2005
2006
2007
2008
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
2009
2010
2011
MAKING LABOUR MARKET REFORMS A SUCCESS
Possible ways forward
•
Understand the reasons for the failure of previous reforms
•
Why success for people with a mental disorder is critical
•
Policy recommendations
•
–
Flexjob reform: rigorous implementation to ensure that the “right”
group of people access the system
–
Disability reform: clear roles and adequate incentives for the key
actors to ensure that the new rehab model can deliver
–
Reform of reimbursement of municipal spending: monitor and
evaluate the impact on different client groups
Initial outcomes?
–
New disability benefit claims have fallen; flexjobs continue to increase
–
Shift to rehab process? Increase in employment?
HELPING CLIENTS OF MUNICIPAL JOB CENTRES
The challenge: Many clients have a mental illness
The majority of recipients of social assistance and long-term sickness benefits have a mental disorder
Proportion of beneficiaries with severe or moderate mental disorder, by type of benefit, 2005
Severe mental disorder
Moderate mental disorder
60
50
40
30
20
10
0
Long-term
sickness
Disability
benef it
Unemployment
benef it
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
Social
assistance
HELPING CLIENTS OF MUNICIPAL JOB CENTRES
Possible ways forward
•
Access to mainstream employment services for everyone is
not good enough to reach people with a mental disorder
•
The match-group approach used by job centres (with three
broad match groups) can be refined
•
Policy recommendations
–
Develop better instruments to identify clients’ mental illness and
the resulting mental health-related labour market barriers
–
Make clients with a mental disorder a new target group for job
centres (regional/national targets) and intervene earlier for them
–
Pay attention to clients (i) moving from unemployment to sickness,
(ii) on social assistance at risk of moving onto disability benefit
–
Invest resources in (i) lowering caseloads for clients with a mental
disorder and (ii) psychological training for caseworkers.
FEATURES OF THE DISABILITY BENEFIT SYSTEM
The challenge: Not designed to tackle mental illness
Most disability benefit claimants with a mental disorder were out of work for a very long time
Share employed in the five years prior to a disability benefit claim, by health condition, 2009
80
70
60
50
40
30
20
10
0
Neoplasms
Circulatory
Injury,
poisoning
Nervous,
eye, ear
Musculoskeletal
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
Respiratory
Mental
disorder
Congenital,
chromosomal
FEATURES OF THE DISABILITY BENEFIT SYSTEM
Possible ways forward
•
Work capacity assessment through the resource profile is
ineffective, especially for those with a mental illness
•
Claimants with a mental illness are different but there work
capacity is highly underestimated
•
Policy recommendations
–
Use the experiences from the return-to-work trial for improving the
rather ineffective resource profile
–
Extend the new rehabilitation model with integrated employment,
social and health service to all age groups (provided it is effective)
–
Rigorously and systematically reassess disability benefit entitlements,
including of long-term clients who rarely seek voluntary supports
–
Evaluate the impact of the high level of disability benefit payments
especially for low-wage earners
CONCLUSIONS
•
Mental ill-health creates considerable labour market
disadvantage and generates high costs for the economy
•
The Danish system is in a good position in principle to
tackle mental health issues forcefully
•
Strong setup does not deliver: systems under-resourced
and actors lack the means to identify mental disorders
•
A number of steps can be taken to improve outcomes
–
related to ongoing labour market reforms that need to deliver
–
related to services not adequate for characteristics of mental illness
–
related to better integration of health and employment services
Thank you for your attention!
For more information and OECD publications on the topic:
www.oecd.org/els/disability
Including free access to the tables and charts of all reports
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