OECD report on Mental Health and Work in Denmark - 2013 www.oecd.org/els/disability - Denmark

1. MENTAL HEALTH AND WORK: DENMARK
OECD conclusions and recommendations
Christopher PRINZ
Directorate for Employment, Labour and Social Affairs
OECD
www.oecd.org/els/disability >Denmark
Dissemination Seminar- 25/02/2013 - Copenhagen

2. 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

3. MAKING LABOUR MARKET REFORMS A SUCCESS
Possible ways forward
•
Reasons for the failure of previous reforms (of the
disability benefit system and the flexjob scheme)
•
Why success of reforms for people with a mental illness is
critical for the success of the reforms more generally
•
Policy recommendations
–
Flexjob reform: rigorous implementation to do away with the many
weaknesses of the system; ensure that the “right” group of people
access the system (significant but not permanent work incapacity).
–
Disability reform: clear roles and adequate incentives for the key
actors to ensure that the rehab model can deliver; evaluation of the
factors responsible for success and/or failure of the reform.
–
Reform of reimbursement of municipal spending: monitor and
evaluate the impact on different client groups of any changed but
also simplified funding mechanism.

4. SCHOOL SUPPORTS & SCHOOL DROP-OUT
The challenge: School drop-out remains high
Early school-leaving is frequent in Denmark partly because of high drop-out from vocational education
Proportion of youth aged 20-24 (i) not in education and without upper-secondary diploma (early
school leavers) and (ii) not employed and not in education (NEET), 2009
Early school-leaving rate
30
25
20
15
10
5
0
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
NEET rate

5. SCHOOL SUPPORTS & SCHOOL DROP-OUT
Possible ways forward
•
Youth Guidance Centres – a good-practice model with
enormous potential
•
Possible explanations for the high rate of drop-out from
vocational schools: limited evidence
•
Policy recommendations
–
Schools and teachers need sufficient resources and competencies to
deal with common mental disorders, and work together with better
resourced municipal educational-psychological advisory services.
–
Youth Guidance Centres could be more effective with better ways
and more resources to identify and help young people with mental
disorders, and they should also be responsible for those aged 25-29.
–
School drop-outs with a mental disorder need help quickly to be
able to access the labour market (including demand and supply
measures; mandatory enrolment in an education programme).

6. MENTAL HEALTH RISKS IN THE WORKPLACE
The challenge: Mental health impacts productivity
Performance problems at work seem massive also for those with a common mental disorder
Share of workers not absent in the past four weeks who accomplished less than they would
have liked as a result of an emotional or a physical health problem, 2005 and 2010
2005
2010
100
90
80
70
60
50
40
30
20
10
0
Severe
disorder
Moderate
disorder
No mental
disorder
Denmark
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
Severe
disorder
Moderate
disorder
EU-21
No mental
disorder

7. MENTAL HEALTH RISKS IN THE WORKPLACE
Possible ways forward
•
Promising attempts to address the psychosocial working
environment (PWE)
•
How forceful and effective are measures and agreements
of the social partners?
•
Policy recommendations
–
Increase resources for PWE risk assessment and inspections and
monitor employer actions and responsibilities on preventing PWE
risks; with special support to small and medium-sized enterprises.
–
Work environment consultants could play a role as independent
workplace conflict managers and work accommodation facilitators;
to promote job retention and prevent sickness absences.
–
Monitor and support employers’ sickness absence management
actions, involve job centres and doctors as early as necessary (not
only after 8 weeks); and promote a gradual return to work.

8. 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

9. HELPING CLIENTS OF MUNICIPAL JOB CENTRES
Possible ways forward
•
Open access to 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 particular attention to clients moving from unemployment onto
sickness benefit, and those on social assistance and at risk of
moving onto a permanent disability benefit..
–
Invest resources in (i) lowering caseloads for clients with a mental
disorder and (ii) psychological training for caseworkers.

10. FEATURES OF THE DISABILITY BENEFIT SYSTEM
The challenge: A system not designed for new issues
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

11. 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, also to achieve swifter decisions
agreed by different systems (e.g. health system and benefit system).
–
Extend the planned 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.

12. STATE-OF-THE-ART MENTAL HEALTH CARE
The challenge: Lack of adequate treatment
Moderate mental disorders are rarely treated and if so only by non-specialists
Share of people who sought treatment for their mental illness in the past three months,
by severity of the mental disorder and type of treatment, 2005
Specialist treatment
Non-specialist treatment
Panel A. Severe mental disorders
0
10
20
30
40
Panel B. Moderate mental disorders
50
60
0
Denmark
Denmark
OECD-21
OECD-21
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
10
20
30
40
50
60

13. STATE-OF-THE-ART MENTAL HEALTH CARE
Possible ways forward
•
Does mental health care supply match the demand? How
many (more) people need treatment?
•
A poor link between health and employment services: from
cooperation to integration of services
•
Policy recommendations
–
Increase mental health care capacity at all levels (psychiatrists;
specialist nurses; authorised psychologists) to reduce waiting times.
–
Further improve mental health knowledge of general practitioners
and facilitate systematic mental health screening in their practices.
–
Promote shared-care models to facilitate a better connection
between primary and specialist mental health care.
–
Develop effective ways of integrated health and employment
services (in both the health and the labour field).

14. 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
•
But the strong setup does not deliver because structures
are under-resourced and the relevant 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 various individual tools, structures and services
–
…related to the integration of health and employment services

15. 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: Denmark”