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

1. MENTAL HEALTH AND WORK: SWEDEN
OECD conclusions and recommendations
Stefano SCARPETTA and Shruti SINGH
Directorate for Employment, Labour and Social Affairs
OECD
www.oecd.org/els/disability >Sweden
Dissemination Seminar- 5/03/2013 - Stockholm

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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”