The document summarizes policies and results regarding psychosocial risk management in the Netherlands over the last two decades. It discusses how the country shifted from managing risks to reducing absenteeism and disability through work and health covenants from 1998-2007. Evaluation found these covenants reduced various psychosocial risks by 10-20% and sickness absence trends declined. Current policy focuses on participation and inclusion to build an all-inclusive labor market.

1. Psychosocial risk management: The Dutch case Irene Houtman

2. This presentation Psychosocial risk exposure in the Netherlands Active policies in the last two decades and their results The policy shift: from managing risks towards reducing absenteeism & disability and increasing participation  Towards sustainable employability & an all inclusive labour market

3. Working conditions profile NL against EU

4. Trends in EU-data on psychosocial risks covering 1990-2005 Source: EWCS

5. Period of 1990 - 1998 1990  National legislation on OSH was implemented with specific attention to ‘well being at work’  1990-1998 Handbook(s) on management of work-related stress Description of good practices Guidelines for maintenance (‘objective’, expert opinion: WEBA method) Research: Monitor on Stress and Physical Load Priority program on mental fatigue

6. Some findings of the Monitor on Stress and Physical Load –linked survey on + 1000 companies- Companies who are active in ‘Psychosocial RIsk MAnagement’ (PRIMA) characterize themselves by (multivariate): Employers: OR Work-related stress recognized as a problem 3.1 Large size 2.1 Employees: Low on autonomy 1.8 Many short cycled work 1.5 Low physical load 2.1

7. 1998 – 2007: Work and Health Covenants Characteristics & aim: Sector wise approach Ministry subsidizes (50%) Large scale OSH interventions: psychosocial risks in NL highly prevalent … so psychosocial risk management often ‘core’ Aim: 10 % risk reduction in three years Proper (quantitative) evaluation

8. An example: the police favourable <------------ difference compared to reference group -------------> unfavourable

9. Changes in risk exposure High quantitative demands - 12% Problems with time autonomy - 11% Problems with opportunity for contact - 12% Problems with feedback - 17% Problems with emotional load - 10% Problems with supervisor and colleagues - 20% High emotional exhaustion - 11% High depersonalisation - 20% Dissatisfaction with work - 20%

10. Effectiveness of the measures I (imputation)

11. Effectiveness of measures II (imputation)

12. After the Work and Health Covenants In 2007 the Working Conditions Act was updated Employers obligated to make a risk assessment (RIE) Well being as specific issue was skipped from the act . Companies <25 employees can use a RIE at sector level, approved by social partners Employers are encouraged to compile a ‘Health and Safety Catalogue’ at sectoral or organisational level  This catalogue is often a digital instrument including e.g.: What are (e.g. psychosocial) the risks present Legislation (demands to meet) Measurement (general & specific tools) Good practice (what worked?)

13. Amidst the Covenant period: a shift towards absence and disability reduction –’the Dutch worker is sick’ Self reported long term absence > 30 days in Europe Source: EWCS

14. Sickness absence trend in the Netherlands

15. Absolute figures on disability in The Netherlands – until 2004 steady rise 100.000 a year -> legislative change Source: NEA 2009 Source: UWV

16. Disability inflow by diagnosis

17. Estimated costs of work-related drop out (for 2001) Costs of drop out from work Euro % of total x1000) Work-related costs of absence 3.785 29,8 Work-related costs of disability 4.371 34,4 Costs on operational management unknown Costs of health care, Legislation & enforcement 2.869 35,8 Total (work-related costs) 12.690 100 For work-related mental health: 5.457 43% Source: Zwinkels et al, 2004)

18. Research directed at determinants of, and intervening effectively in drop out because of ill mental health Lessons learned from that research: Early contact occupational health physician facilitates return to work Partial work resumption is instrumental to return to work Employers who facilitate partial return to work obtain a lot higher (up to 9 times higher) return to work after drom out from mental health reasons In NL depression appears to be a major factor prehibiting return to work

19. Final conclusions for the Netherlands -1 In NL there were relatively high levels of psychosocial risks and drop out for reasons of mental health  Costs were high. The high work pace appears to have been addressed quite effectively  Work & Health Covenants? The Work and Health Covenants have stopped. Now the Work and Safety Catalogue (is hoped to) maintain the gains and experiences from these Covenants – no explicit monitoring Attention shifted to counteract the high drop out (for large part) due to mental health problems  this is mirrorred by legislative changes Now the policy attention is mainly directed at participation and inclusion, particularly of specific groups at risk (e.g. elderly, women)  towards an ‘all inclusive labour market’

20. Take home message Conditions for psychosocial risk management to be effective: Participative approach (both employer AND employee involvement) Use a stepwise approach (inventory –passive-active-, plan, act, evaluate) Employer has to ackowledge psychosocial risks to be a problem Acknowledge workers/employees as experts Management has to act on changes in the organizational structure If many companies are small, try to organize sector wise When employees become absent: individual approach necessary : Early contact with (occupational health) physician discussing R2W Partial work resumption is instrumental to a full return to work Employer should temporarily and activily lower the threshold for (partial) return to work (adjustment in tasks, working times etc).

21. Results: RTW per country (Time 2) Percentages after excluding full RTW at Time 1

22. Results (continued): RTW and social security system