Mental Health and Work in Sweden - 2013


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  • Good Morning Minister, Ladies and Gentleman, Let me begin by thanking the Swedish authorities for participating in ‘Mental Health and Work’ review and for the enthusiastic and committed support we have received. Let me also thank all of the other individuals and organisations who are present here today and who gave their time and effort to meet with the review team and to respond to their many requests for information. >>How come that the OECD is addressing the relationship of mental health and work? Interest of Government in sickness and disability field mainly resulted from very high and fast rising cost of disability schemes across the OECD.As a result, we conducted in-depth country reviews on sickness and disability policies. The project concluded with a high-level Forum with Ministers in 2009, which in fact was held and funded by the Swedish Authorities (the same government as today's); and parts of which took place in the very same conference room that we are in today ("Aulan")Most importantly, it was during this forum that ministers and state secretaries from 15 OECD countries agreed and concluded that one big area remains unaddressed and unresolved: mental health. Back then and ever since then Sweden has been one of the greatest supporters of our work on disability & mental health. Our first cross-country analytical report on Mental Health and Work: Sick on the Job? Myths and Realities about Mental Health and Work was released in 2012. Two purposes of this report: Identifythe main underlying policy challenges by broadening the evidence base, (ii) Raise awareness about impact of this issue on the labour market and economy and especially among stakeholders who are not always and not fully aware of their importance e.g. GPs, teachers and caseworkersWe are now in the phase of producing country-specific policy studies. Sweden is one in a series of nine country reports that we are currently preparing. Therefore, the discussions we will have here today will not only be important for Sweden, but also for other countries and the remainder of our project. We will synthesis our knowledge at the end of the project, for a better mental-health-and-work policy framework in OECD countries.
  • Why is mental ill-health a key issue? Who is affected by it and how are they defined?Mental-ill health is a key issue both because mental illness concerns a large proportion of the population and because of the large costs it imposes on individuals and our societies. Mental-ill health 20% at any moment and double of this in a lifetime. Mental illness can and will get better for many if not most people; if rightly addressed and treated.Mental ill-health is highly diverse, varies considerably in severity, and includes a range of illnesses, and in particular three broad and widespread categories: mood disorders (depression), anxiety disorders, substance abuse disorders. They pose a particular challenge because mental-ill health is often hidden; and while mental illness jus as any other illness can develop at any age, most mental health problems early in life. According to epidemiological and international research, there is no indication that prevalence has increased; the policy relevance arises from fact that the prevalence of mental ill-health is so high and we are much more aware of this today than we were in the past.
  • Let me start with some facts about mental health and work in Sweden. In Sweden, the estimated total cost is Euro 8 billion equivalent to 2.8% of GDP ( N.B: This is comparable to other OECD countries).Around 50% of the costs account for direct medical costs i.e. to treat and support people with mental health problems. The other 50% is attributable to lost productivity and additional spending on health care, sickness and disability benefits. The very high cost are an immediate consequence of the very high prevalencePeople with mental disorders experience poor labour market outcomes. In Sweden, their employment rates are 16 percentage points lower than those of people without mental disorders and their unemployment rates are double the overall rate. It is becoming the leading cause of labour market exclusion among the working-age population and especially so for young people.Policymakers can do and should do more to address this issue, which was previously neglected for too long due to widespread stigma, fears and taboos. Our new report “Mental Health and Work: Sweden” looks in detail into how policy challenges are being tackled in Sweden. The report includes a set of recommendations on how Sweden can improve the situation, which my colleague (Shruti Singh author of the report) and I, will now present. In particular, the report identified four key policy challenges: (1) mental ill-health among youth, (2) productive and healthy workplaces, (3) social benefits that facilitate return to work, (4) a health system that helps workers maintain and regain their work capacity.We will focus on each of them in turn.
  • Let me begin with the first policy area: Addressing mental ill-health among youth. Evidence from a wide range of countries suggests that around 50% of all mental disorders have their onset during childhood and adolescence (around the age of 14). Mental health problems, if left unaddressed and untreated at this stage are likely to have an adverse impact on educational attainment, weaken chances of labour market participation later in life and increase risk of labour market exclusion at a very young age.Schools provide an ideal setting to prevent mental health problems arising in the first place and to intervene quickly when they do occur. Are Swedish schools in a position to do this? Access to school health services, in particular to school psychologists is a major problem in Sweden:Panel A shows that the number of staff working in school health services has increased but overall resources remain insufficient.Panel B shows that student-to-staff ratios remain too high to provide adequate services. On average, a school nurse is responsible for 800 students, a school doctor for 10 000 and a psychologist for 2000 students.
  • One consequence of limited resources is long waiting times to see specialist staff in schools. In state (municipal) schools, waiting times to see a school psychologist are on average more than two months. Access is even more difficult for pupils in private and upper secondary schools.
  • What can we do improve access to mental health services in schools?Increase resources to reduce waiting times and to ensure rapid access to see school psychologists. However simply increasing staff resources is not sufficient. Need to also review how services are provided. For instance;Municipalities should provide systematic guidelines to school nurses, social workers & psychologists on i) how to identify mental health problems ii) when to refer pupils to more specialist services. Teachers have direct day-to-day contact with pupils and thus potentially have good knowledge of pupils problems. But they need better training to spot early signs of more serious problems and understand various risk factors. School health services need to be better linked with psychiatric services to ensure timely treatment and minimise time away from school.
  • Particular attention is needed for young people not in education and employment as poor mental health is significantly more common among the NEET than young people studying or employed. Addressing needs of this group is particularly important in times of high unemployment to avoidlabour market exclusion.(N.B In 2012, youth unemployment rate in Sweden was as high as 23.9% which is above the OECD average (16%)) NEET are also at a much higher risk of not receiving support and treatment for mental health problems as they are less likely to be in contact with various authorities.
  • How can we ensure that youth not in employment and education are being connected to the right services? A number of models in Sweden already exist which have potential in addressing mental health problems among youth. For instance, Youth Clinics currently play an important role in general health promotion of teenage population. These services can however be better targeted and strengthened to help young people with common mental health problems. This can be achieved in two main ways; First, evaluations of anxiety and depression could become a standard routine among adolescents visiting Youth Clinics. Second, the Clinics can promote access to their services by actively reaching out to schools, local services and PES.Navigator Centres (one-stop-shops for youth) in some municipalities offer employment support to early school leavers and vulnerable youth.These centres should also offer health services to treat youth with mild mental disorders. They should be made available across municipalitiesSystematic evaluation and sharing of experiences can help identify best practice models.
  • As in other countries, one of the biggest challenges facing Sweden is early withdrawal from the labour market among young people. Unless mental health problems among youth are tackled, there is a risk that increasing numbers of young people drift into long-term benefit dependence and labour-market exclusion.This chart (Panel A) reveals that increasing numbers of young people are relying on benefit support. The number of new disability benefit claims for young people have quadrupled during 2003 -2007 and remain at a very high level, while the number of new disability claims of the older population has dropped markedly. Among young people, mental-health accounts for more than 80% of all new disability benefit claims. The substantial drop in the older population is related to the comprehensive reforms of the disability benefit system for this group. (NB: Inflows among young people went up from 1,133in 2003 to 4,341 in 2010).(NB: We argue that the rising inflows is not due to greater prevalence of mental-health problems, but due to increased awareness and reduced stigma.)
  • For those with partial work capacity, policies should focus on improving employability and support pathways into work.A more active approach can include an obligation to participate in employment-support measures (e.g., as in DK disability benefit being replaced with rehabilitation benefit for under 40 year olds).As in other OECD countries, a general problem in Sweden is an increasing number of young benefit claimants coming directly from special education/schools.Sweden has recently improved assessment procedures used to determine eligibility for the special school system. These reforms are promising. But currently, assessments are far from comprehensive for graduates of special schools. Benefit entitlements for those leaving special schools should be based on a work-capacity assessment, rather than being quasi-automatic.
  • Let me now turn to the second policy challenge identified in our report: Productive and healthy workplaces. Work plays an important role, both as a contributor to well-being and as a risk factor for mental health. With up to 60% of persons with mental health problems in employment, mental health is an issue for Swedish employers – as well as for the individuals concerned. In fact, failure to tackle mental ill-health creates huge costs for employers. Sickness absences are one crucial factor. As in other OECD countries, persons with mental health disorders are more likely to be off sick from work (Panel A).But there is also clear evidence of lost productivity among those who stay in work (Panel B).Employers are best placed (i) to prevent mental-health problems by ensuring a healthy work environment, (ii) to help people to stay in work if mental-health problems do occur, and (iii) to facilitate a swift return to work for those returning from a sickness absence. >> Are Swedish employers doing enough in each of these areas?
  • OHS have a critical role in retaining persons with mental health problems at work as well as helping those returning from sickness absence. But despite the fact that mental health problems have large cost for employers, the reality is that most workplaces in Sweden still focus on traditional health problems at workResults from assessments carried out by OHS in Sweden in 2010 reveal that around 23% of the assessments were related to working postures or heavy work while only 14% were related to workload or stress (even though stress and mental strain are the most common cause of work-related disorders). All employers are legally obliged to monitor health and safety of their workers including their mental health. However, small-medium enterprises often encounter problems in carrying out risk assessments due to lack of knowledge, expertise and capacity. Unlike large employers, SMEs do not have resources to offer OHS to employees. This is a barrier for managing sickness absence (both prevention and reintegration into work). One overarching challenge is whether employers have the right incentives to prevent mental health problems and the subsequent move into sickness benefits. This is one of the most controversial challenge in many OECD countries. In Sweden, employers only have to pay 14 days of sickness absence (relatively low in international comparison).
  • Clear guidelines should be provided to OHS to pay particular attention to mental health problems. This in turn requires that OHS are made up of multidisciplinary teams e.g. including psychologists .Provide support to SMEs by establishing independent OHS as done in other OECD countries. For instance, the UK has set up a dedicated phone line to help small companies dealing with sickness absence issues and mental health problems. However, offering services to employees to better deal with their conditions will not be sufficient. Stigma attached to mental health problems means that often employees are reluctant to take-up services and seek treatment due to fear of being dismissed. Simple steps, such as raising awareness among managers and employees are therefore critical to provide a supportive environment. In addition, managers can be trained to spot early signs of emerging mental health problems and to address them appropriately. Let me now hand over the presentation to Shruti who will present two remaining policy areas i) the social benefit system and ii) the health system.
  • Stefano, has just illustrated some of the policies needed to keep people in work. But of course some people loose their jobs. For them the benefit system needs to provide adequatesupport while facilitating rapid return to work. High degrees of benefit dependence and long benefit spells have been a problem in Sweden. In recent years a number of reforms have been introduced. Despite being very successful in reducing overall benefit caseloads, a number of challenges remain. Helping persons with mental health problems on sickness benefit is one of them. The current procedure and process i.e. the rehabilitation chain can be improved for these people. This chart illustrates why people with mental health problems need greater attention and require further policy changes. It basically shows the share of claimants remaining on benefit after a given number of months.What we observe is that among those with no mental disorder, 75% have left sickness benefit within three months. Among those with a mental disorder, only 50% have left at that point. The simple message is that those with a mental disorder have longer benefit spells than those without.And as a consequence, persons with mental health problems make up the biggest group in long-term sickness absences.
  • What we also observe is that among those with mental disorders, unemployed persons stay longer on sickness benefits than employed persons with mental disorders. This could be partly explained by the fact that these people do not have a job to return.
  • What are the weaknesses in the current system?Absence of systematic early intervention continues to be a problem during the first months of sickness spells. Early intervention is critical as the chances to return to employment fall sharply with duration of sick leave. For instance, available administrative data on destinations show that initially (with in 3months), some 90% of all sick leaves end in employment. This proportion falls to 50% after one year. There are still two key structural problems in the system which impede early intervention. First, participation of sickness beneficiaries in meetings with the PES remains low. This is largely attributed to the fact that participation is not mandatory. This is a missed opportunity as these meetings are an important way for beneficiaries to stay in contact with the labour market. Second, there are also concerns that the PES does not have the right incentives to intervene early as they do not bear the cost of paying sickness benefits. In other words, the fact that employment services are separated from the benefit agency undermines the desired effect of the rehabilitation chain. We are aware that since last year, the SSIA and PES have launched a new co-operation model which aims to be more flexible. In other words beneficiaries can get support as soon as possible depending on their needs. This new model moves in the right direction. But there are concerns whether the new rules will be enforced properly in the absence of hard financial incentives.
  • The next slide reinforces the importance of intervening early on in the sickness spells. Sweden has implemented a strong employment programme knows as the Work Programme for people reaching the end of their benefit. The slide shows the transition rates of persons completing the three month. There two important lines to focus in the chart. The bottom blue area, shows that less than 5% of people find a job at the end of the programme, 270 days later still less than 15% are in work. Overtime, the share of people leaving the PES without work also increases (illustrated in by the top area)The message is, if intervention comes in too late, even a ‘very strong’ programme like the work programme that has the right elements will not deliver adequate employment outcomes.
  • What can be done to ensure that sickness beneficiaries with mental health problems get the right support?First, incentives for individuals need to be changed. Contact meetings should become obligatory for sickness beneficiaries. Second, systematic vocational and rehabilitation measures should come earlier, instead of 2.5 years. There are improvements already being made on this front. But will need to be careful that the new rules are enforced properly. Third, SIA should actively follow-up those returning back into work. This is particularly important for those with mental health problems, as for many of them the root cause of their illness is related to their work. This will ensure that people do not return back to sickness system especially because people can qualify within 3 months of leaving the sickness benefit system. Fourth, increasing awareness, knowledge and competence of caseworkers both in SIA and PES s fundamental to both assess capacity of persons with mental health problems as well as to give appropriate support. And last but not the least, it is important to give the right medical rehabilitation to persons with mental health disorders early on in their sickness spell for people to manage their disorder and improve capacity to facilitate early return to work. This nicely brings me into the last part of the presentation which is on the Health system – an important player which is too often ignored when discussing employment prospects.
  • As Stefano highlighted at the beginning of the presentation, most common mental disorders have the potential for improvement if treated quickly and effectively. And with the right support and treatment, we are much more likely to prevent people moving into sickness and disability benefits, shorten sickness absences for those that do fall out of work, reduce productivity costs borne by employers and importantly life the burden of mental health problems on individuals and their families. However, despite the very high prevalence of mental health disorders, evidence based on Eurobarometer suggests that under-treatment treatment is large. i) Some 50% of all Swedes with a severe mental disorder and over 70% of those with a mental disorder do not receive an treatment for mental health services in Sweden, as in other OECD countries. ii) When people do receive treatment, this is often by a GP rather than a specialist. I should add a caveat here that we need to be careful when interpreting these figures. It is very difficult to measure whether the Swedish mental health system treating everyone who needs treatment? This is because not everyone needs treatment, or the same type of treatment etc.
  • However, the biggest challenge from our perspective is the lack of integration of treatment and rehabilitation on one side and employment services in another. There is plenty of evidence showing that work is good for mental health in general and moving back to work can improve mental health. Therefore, there is a strong case for integrating work in a broader treatment strategy. Traditionally, focus on employment matters in mental health system has been very limited in most OECD countries. But we have already started to see changes in the Swedish health system. For example, the sickness absence guidelines produced by the National Board of Health and Welfare have played a very important role in the sickness reforms. These guidelines are now also covering depression. However, the Board does very little in advocating the benefits of being in work and promoting evidence based return to work programmes that combine therapy and occupational interventions together. The latest National strategy for Mental health ‘From vision to Action’ also emphasises on municipalities paying greater attention to occupational therapy. This is a very promising step, it does not include tangible goals in regard to employment. There are also very good initiatives starting from social security end, that is increasingly recognising the role of treatment. The ministry of health and Social Affairs has introduced a Rehabilitation Guarantee for people on sick leave or at risk of long-term leave as a result of psychological problems.
  • National Board of Health and Welfare (NBHW) to promote employment as part of treatment.
  • Mental Health and Work in Sweden - 2013

    1. 1. MENTAL HEALTH AND WORK: SWEDEN OECD conclusions and recommendations Stefano SCARPETTA and Shruti SINGH Directorate for Employment, Labour and Social Affairs OECD >Sweden Dissemination Seminar- 5/03/2013 - Stockholm
    2. 2. MENTAL HEALTH and WORK Prevalence , 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
    3. 3. MENTAL HEALTH: A KEY LABOUR MARKET ISSUE An 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 longterm sickness absences and disability benefit claims • Policymakers can do more to address this previously neglected and highly stigmatised issue
    4. 4. MENTAL HEALTH SERVICES IN SCHOOLS The challenge: A highly under-resourced system Access to school nurses, doctors and psychologist is astoundingly low and improved only little Medical school support staff in 1997 and 2009 Panel B. School medical staff to student ratio, 1997 and 2009 Panel A. Number of school medical staff, 1997 and 2009 Nurse Doctor 2,500 Social worker Psychologist 14,000 12,000 2,000 10,000 1,500 8,000 1,000 6,000 4,000 500 0 2,000 1997 2009 0 1997 Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 2.2 page 44. 2009
    5. 5. MENTAL HEALTH SERVICES IN SCHOOLS The challenge: A highly under-resourced system Waiting times to consult a school psychologist are very long (In weeks) Social worker State school Private school Primary & secondary school Upper secondary school Psychologist 2 1 2 2 10 22 11 16 Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Table 2.2 page 44.
    6. 6. 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
    7. 7. HELPING NEETs INTO THE LABOUR MARKET The challenge: NEET have higher risk of mental ill-health The group at higher risk of facing mental health problems Problems of nervousness, worry or anxiety by main activity, persons aged 16-24, 2009 Problems of nervousness, worry or anxiety by main activity, persons aged 16-24, 2009 Men Studying Employed (including self-employed) Neither employed nor studying(NEET)a Women 13.3 11.3 26.0 27.7 26.6 36.0 Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Table 2.4 page 49.
    8. 8. 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
    9. 9. DISABILITY BENEFIT DEPENDENCE EARLY IN LIFE The 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 19-24 Panel A. Inflows into new disability claims 25-54 55-64 Panel B. Mental disorder inflows as a % of total claims Persons Index, 2003 =100 450 100 400 90 80 350 70 300 60 250 50 200 40 150 30 100 20 50 10 0 2003 2004 2005 2006 2007 2008 2009 2010 0 2003 2004 2005 2006 2007 2008 2009 2010 Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 2.7 page 56.
    10. 10. 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.
    11. 11. PRODUCTIVE AND HEALTHY WORKPLACES The challenge: Mental health affects productivity Incidence of absenteeism and presenteeism (in percentage) by mental health status, 2010 Panel A. Sickness absence incidence Panel B. Reduced productivity at work Percentage of persons who have been absent from work Percentage of workers not absent in the past four in the past four weeks (apart from holidays) weeks accomplishing less than they would like as a result of an emotional or physical health problem Sweden EU-21 60 50 40 30 20 10 0 Severe disorder Moderate disorder No disorder Average (Sweden) 100 90 80 70 60 50 40 30 20 10 0 Severe disorder Average (EU-21) Moderate disorder Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 3.2 page 70. No disorder
    12. 12. PRODUCTIVE AND HEALTHY WORKPLACES Remaining 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
    13. 13. PRODUCTIVE AND HEALTHY WORKPLACES Possible 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
    14. 14. FACILITATING EARLY RETURN TO WORK The challenge: Particularly long sickness absence Share of persons remaining on sickness benefits At 90 days At 180 days Mental disorder 100 90 80 70 60 50 40 30 20 10 0 Other health conditions Months 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 4.1.A page 89. 37 39 41 43 45
    15. 15. FACILITATING EARLY RETURN TO WORK The challenge: Particularly long sickness absence Share of persons remaining on sickness benefit Employed mental disorder 100 90 80 70 60 50 40 30 20 10 0 Unemployed mental disorder Months 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 4.1.B page 89. 38 40 42 44
    16. 16. 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
    17. 17. FACILITATING EARLY RETURN TO WORK The challenge: Difficult to move people into work Few people move into employment after completion of the Work Introduction Programme Transition rates after completion of the three-month Work Introduction Programme in 2011 Has left the PES without work In a programme with activity support Work At the PES without activity support Openly unemployed 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% End of Programme After 90 days After 180 days Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 4.3 page 94. After 270 days
    18. 18. SICKNESS ABSENCES WITH A MENTAL DISORDER Possible 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
    19. 19. FACILITATING EARLY RETURN TO WORK The challenge: Difficult to move people into work Few people move into employment after completion of the Work Introduction Programme Transition rates after completion of the three-month Work Introduction Programme in 2011 Non-specialist Specialist 80 70 60 50 40 30 20 10 0 Severe Moderate Sweden None Severe Moderate EU-21 Source: OECD (2013), Mental Health and Work: Sweden, Paris: OECD Publishing. Figure 5.1 page 115. None
    20. 20. 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.
    21. 21. 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)
    22. 22. 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
    23. 23. Thank you for your attention! For more information and OECD publications on the topic: Including free access to the Executive Summary and all tables and charts of “Mental Health and Work: Sweden”