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! 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