OECD presentation of the publication "Mental Health and Work: Netherlands"

1. MENTAL HEALTH AND WORK: NETHERLANDS
OECD conclusions and recommendations
Christopher Prinz, PhD
Directorate for Employment, Labour and Social Affairs
OECD
Dissemination Seminar – 28/10/2014 – The Hague

2. MENTAL HEALTH AND WORK
Why is this such an important topic?
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Mental disorders are very costly for society
Estimated costs of mental disorders as a percentage of the country’s GDP, 2010
=> More than half of these costs are indirect costs, including productivity losses and benefit spending
Source: OECD (2014), Mental health and Work: Netherlands

3. 3
HOW THE NETHERLANDS COMPARE?
Reduction in new disability benefit claims
New disability claims have fallen to the OECD average
New claims per 1 000 of the working-age population (inflow rates)
Source: OECD (2014), Mental health and Work: Netherlands

4. 4
HOW THE NETHERLANDS COMPARE?
Relatively good labour market outcomes
Labour market outcomes for people with a mental disorder are relatively good
Employment-population ratios based on national health surveys, latest available year
90
80
70
60
50
40
30
20
10
0
Mental disorder late 2000s No disorder late 2000s
SwitzerlandNetherlands Norway United
States
Source: OECD (2014), Mental health and Work: Netherlands
Australia United
Kingdom
Sweden Denmark Austria Belgium
%

5. DEVOLUTION OF GOVERNMENT RESPONSIBILITIES
• Unparalleled series of reforms, in two waves
• First, shift of responsibilities to employers & workers
– Better incentives, significant success
• Second, successive decentralisation to municipalities
– Potential: concentration, incentives, service integration
– Risks: funding, competence, scale issues, inequality
• The Netherlands: a laboratory for structural reform
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6. BUT SOME IMPORTANT POLICY CHALLENGES REMAIN
• Lack of attention in all policy domains for people
with mild-to-moderate mental disorders
• Little attention for the prevention of poor outcomes
due to mental ill-health at schools and the workplace
• Limited public support to help sick people reliant on
public support return to work
• Lack of better co-ordinated and integrated health and
employment support in both sectors
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7. 7
1) Early action is needed for vulnerable youth
35
30
25
20
15
10
5
0
Youth with mental ill-health are at a higher risk to leave school early
Share of people who stopped full-time education before age 15, 2010
Severe disorder Moderate disorder No mental disorder (↗)
Denmark Netherlands Sweden Belgium United
Kingdom
EU-21 Austria
Source: OECD (2012) Sick on the Job:? Myths and Realities about Mental Health and Work.

8. 8
1) Early action is needed for vulnerable youth
• Many primary/secondary/vocational schools work with
internal and external care teams
– But: huge caseload; reactive not proactive
– 95% of primary schools indicate a lack of preventive measures
• Early school leaving successfully reduced
– But: problems of invisible mental illness unaddressed
• School-to-work transition support with disability
– But: no focus on those with mild-to-moderate mental illness

9. 9
2) Employers need to focus more on prevention
Sickness absence has dropped considerably but remains above the OECD average
Incidence of sickness absence of employees in OECD countries, 2003 and 2013
8
7
6
5
4
3
2
1
0
NOR
FIN
SWE
DEU
FRA
NLD
PRT
SVN
BEL
AUT
LUX
Source: OECD (2014), Mental health and Work: Netherlands
GBR
CZE
DNK
ISL
CHE
ESP
USA
POL
IRL
SVK
ITA
EST
AUS
HUN
TUR
GRC
2013 2003 OECD 2003 OECD 2013

10. 2) Employers need to focus more on prevention
Incidence of sickness absence and reduced productivity (in percentage) by mental health status, 2010
Netherlands EU-21
Panel A. Sickness
absence incidence
Panel B. Reduced
productivity incidence
80
70
60
50
40
30
20
10
0
Severe Moderate No disorder
100
90
80
70
60
50
40
30
20
10
0
Severe Moderate No disorder
Source: OECD (2014), Mental health and Work: Netherlands
10
Sickness absence is high for Dutch workers with mental ill-health

11. 2) Employers need to focus more on prevention
Share of employers seeing different aspects as a barrier to address workplace risks, 2009
60
50
40
30
20
10
General risks Psychosocial risks
Source: OECD (2014), Mental health and Work: Netherlands
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Barriers to address psychosocial risks are high, also in the Netherlands
Netherlands EU-27
0
60
50
40
30
20
10
0

12. 3) Better UWV support is needed for sick people
Mental ill-health is very frequent among unemployed people in all OECD countries
Prevalence of severe or moderate mental disorder among the unemployed (in %), latest available year
60
50
40
30
20
10
Source: OECD (2014), Mental health and Work: Netherlands
12
0
Australia Austria Belgium Denmark Netherlands Norway Sweden Switzerland United
Kingdom
United
States
Severe Moderate

13. 13
3) Better UWV support is needed for sick people
Very few Vangnetters on long-term sick leave resume work
Work resumption after 10, 18 and 27 months by vangnetters and employees on
long-term (9 months) sick leave
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Panel A. Vangnetters Panel B. Regular employees
Works fully Works partially Does not work
10 months 18 months 27 months
Source: OECD (2014), Mental health and Work: Netherlands
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
10 months 18 months 27 months

14. 4) Mental health care needs to be linked with
employment support
Share of people who sought treatment for their mental illness in the past three
months, by severity of the disorder and type of treatment, 2010
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 Under-diagnosis by GPs; waiting times; compulsory own risk clause of €360; stigma
 Of those who visit the general practitioner, only 16% is referred to mental health care
Source: OECD (2014), Mental health and Work: Netherlands

15. 15
4) Mental health care needs to be linked with
employment support
• Mental health support in general practice
– POH-GGZ support in diagnosing, treating, referring
• No workplace support in general practice
– Poor link with occupational health and psychologists
• No employment focus in the mental health system
– Employment and health sector separated
– Guidelines? GGZ Nederland-UWV covenant?

16. Thank you for your attention!
Further information can be found on:
www.oecd.org/els/disability
Please note that the report is still under embargo;
it will be officially released in late November 2014
when it will be presented to parliament
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