MENTAL HEALTH AND WORK: SWEDEN

OECD conclusions and recommendations

Stefano SCARPETTA and Shruti SINGHDirectorate for Employment, Labour and Social AffairsOECD

www.oecd.org/els/disability >Sweden

Dissemination Seminar- 5/03/2013 - Stockholm

MENTAL HEALTH and WORKPrevalence , definition and characteristics of mental disorders

• Mental ill-health is frequent (20% of the population)

• Mental-ill health can get better

• Mental ill-health includes range of illnesses, e.g. depression

• Problems are often hidden and start early in life

• No indication that prevalence has increased

MENTAL HEALTH: A KEY LABOUR MARKET ISSUEAn overview

• Mental ill-health generates very high personal, social and economic costs (2.8% of GDP)

• People with mental ill-health face considerable labour market disadvantage

– 15 percentage points lower employment rates

– Double the overall unemployment rate

• Mental ill-health is now the main driver for long-term sickness absences and disability benefit claims

• Policymakers can do more to address this previously neglected and highly stigmatised issue

MENTAL HEALTH SERVICES IN SCHOOLSThe challenge: A highly under-resourced system

Access to school nurses, doctors and psychologist is astoundingly low and improved only littleMedical school support staff in 1997 and 2009

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 2.2 page 44.

0

500

1,000

1,500

2,000

2,500

1997 20090

2,000

4,000

6,000

8,000

10,000

12,000

14,000

1997 2009

Nurse Doctor Social worker Psychologist

Panel A. Number of school medical staff, 1997 and 2009

Panel B. School medical staff to student ratio, 1997 and 2009

MENTAL HEALTH SERVICES IN SCHOOLS The challenge: A highly under-resourced system

Social worker Psychologist

State school 2 10Private school 1 22Primary & secondary school 2 11Upper secondary school 2 16

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Table 2.2 page 44.

Waiting times to consult a school psychologist are very long

(In weeks)

MENTAL HEALTH SERVICES IN SCHOOLS Possible ways forward

• Increase resources for school health services

• Provide systematic guidelines for staff in school health services

• Raise awareness among teachers

• Build strong links with child psychiatric services and schools

HELPING NEETs INTO THE LABOUR MARKETThe challenge: NEET have higher risk of mental ill-health

The group at higher risk of facing mental health problemsProblems of nervousness, worry or anxiety by main activity, persons aged 16-24, 2009

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Table 2.4 page 49.

Men Women

Studying 13.3 26.0Employed (including self-employed) 11.3 27.7Neither employed nor studying(NEET)a

26.6 36.0

Problems of nervousness, worry or anxiety by main activity, persons aged 16-24, 2009

HELPING NEETs INTO THE LABOUR MARKET Possible ways forward

• Better target and strengthen services of Youth Clinics

– Systematic screening for mental health problems

– Outreach with schools, local services and PES

• Co-ordinated employment and health services to vulnerable youth e.g. through Navigator Centres

– Ensure availability across all municipalities

– Evaluate programmes and procedures

DISABILITY BENEFIT DEPENDENCE EARLY IN LIFEThe challenge: Increasing benefit claims among youth

Young age and mental illness drive today’s disability benefit claims New disability benefit claims by age and by health condition, as a share of all claims

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 2.7 page 56.

19-24 25-54 55-64

Panel B. Mental disorder inflows as a % of total claims

Persons Index, 2003 =100

Panel A. Inflows into new disability claims

0

50

100

150

200

250

300

350

400

450

2003 2004 2005 2006 2007 2008 2009 2010 0

10 20 30 40 50 60 70 80 90

100

2003 2004 2005 2006 2007 2008 2009 2010

DISABILITY BENEFIT DEPENDENCE EARLY IN LIFE Possible ways forward

• A more active approach with greater focus on employment measures.

• More comprehensive screening of pupils entering special schools.

• Reform current system of benefit payments for those in special schools.

PRODUCTIVE AND HEALTHY WORKPLACESThe challenge: Mental health affects productivity

Incidence of absenteeism and presenteeism (in percentage) by mental health status, 2010

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 3.2 page 70.

0

10

20

30

40

50

60

Severe disorder Moderate disorder No disorder0

102030405060708090

100

Severe disorder Moderate disorder No disorder

Sweden EU-21 Average (Sweden) Average (EU-21)

Panel A. Sickness absence incidence

Percentage of persons who have been absent from work in the past four weeks (apart from holidays)

Percentage of workers not absent in the past four weeks accomplishing less than they would like as a

result of an emotional or physical health problem

Panel B. Reduced productivity at work

PRODUCTIVE AND HEALTHY WORKPLACESRemaining challenges

• Occupational Health Services (OHS) focus on ‘traditional’ workplace problems

• Monitoring risk factors is difficult for small and medium enterprises (SMEs)

• Managing sickness absence is a challenge for SMEs

• Relatively weak employer incentives

PRODUCTIVE AND HEALTHY WORKPLACESPossible ways forward

• Issue clear guidelines to OHS to focus on mental health

• Provide easily accessible service and support to SMEs

• Raise awareness among line managers and employees

FACILITATING EARLY RETURN TO WORKThe challenge: Particularly long sickness absence

0102030405060708090

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45

Months

Mental disorder Other health conditions

At 90 days At 180 days

Share of persons remaining on sickness benefits

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 4.1.A page 89.

FACILITATING EARLY RETURN TO WORKThe challenge: Particularly long sickness absence

Share of persons remaining on sickness benefit

0102030405060708090

100

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44

Months

Employed mental disorder Unemployed mental disorder

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 4.1.B page 89.

FACILITATING EARLY RETURN TO WORK Remaining challenges: Lacking early intervention

• Absence of systematic intervention is a problem

• Participation in ‘contact’ meetings with Public Employment Service (PES) is low

• Incentives for PES to intervene early remain weak

FACILITATING EARLY RETURN TO WORK The challenge: Difficult to move people into work

Few people move into employment after completion of the Work Introduction ProgrammeTransition rates after completion of the three-month Work Introduction Programme in 2011

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 4.3 page 94.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

End of Programme After 90 days After 180 days After 270 days

Has left the PES without work At the PES without activity supportIn a programme with activity support Openly unemployedWork

SICKNESS ABSENCES WITH A MENTAL DISORDERPossible ways forward

• Mandatory participation in PES interviews with the PES during the first six months

• Offer mandatory support to long-term sick much earlier, not after 2.5 years

• Follow-up workers who return to their jobs

• Increase competence of caseworkers in SIA and PES

• Provide medical rehabilitation for mental disorders early on

FACILITATING EARLY RETURN TO WORK The challenge: Difficult to move people into work

Few people move into employment after completion of the Work Introduction ProgrammeTransition rates after completion of the three-month Work Introduction Programme in 2011

Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 5.1 page 115.

0

10

20

30

40

50

60

70

80

Severe Moderate None Severe Moderate NoneSweden EU-21

Non-specialist Specialist

LINKS BETWEEN HEALTH AND EMPLOYMENT SERVICE The Challenge: need to promote employment

• Inclusion of depression in sickness absence guidelines is a step forward but lacking return to work programmes

• National Action Plan established but does not include employment aspirations

• Rehabilitation Guarantee is good initiative; but take up is low and lack of capacity in mental health system to deliver services.

LINKS BETWEEN HEALTH AND EMPLOYMENT SERVICE Possible ways forward

• Increase mental health care capacity in primary care

• Disseminate and promote evidence-based treatment for return to work.

• Build in outcome based payments in the Rehabilitation Guarantee

• Develop effective ways of integrated health and employment services (in both the health and the labour field)

CONCLUSIONS

• Mental ill-health creates considerable labour market disadvantage and generates high social and economic costs

• Policy maker in Sweden recognise the challenge but current action is still insufficient

• Biggest barriers are lack of resources, lack of awareness and tools to identify and hence help those with mental health problems

• Systematic and sustained effort is required across different Government Departments

Thank you for your attention!

For more information and OECD publications on the topic:

www.oecd.org/els/disability

Including free access to the Executive Summary and all tables and charts of “Mental Health and Work: Sweden”