Mental Health and Work SWEDEN Mental Health and Work Contents SWEDEN Executive summary Assessment and recommendations Chapter 1. Mental health and work challenges in Sweden Chapter 2. Youth in Sweden, mental ill-health and the transition into the labour market Chapter 3. Productivity, sustained competitiveness and the Swedish work environment Chapter 4. Facilitating early return to work in Sweden Chapter 5. Integrating mental health and employment services in Sweden Further reading Sick on the Job? Myths and Realities about Mental Health and Work (2012) Mental Health and Work: Belgium (2013) Mental Health and Work: Denmark (2013) Mental Health and Work: Norway (2013) www.oecd.org/els/disability M e n t a l H e a lt h a n d W o r k Please cite this publication as: S OECD (2013), Mental Health and Work: Sweden, OECD Publishing. W http://dx.doi.org/10.1787/9789264188730-en E D This work is published on the OECD iLibrary, which gathers all OECD books, periodicals and E N statistical databases. Visit www.oecd-ilibrary.org, and do not hesitate to contact us for more information. ISBN 978-92-64-18870-9 -:HSTCQE=V]]\U^: 81 2013 07 1 P Mental Health and Work: Sweden This work is published on the responsibility of the Secretary-General of the OECD. The opinions expressed and arguments employed herein do not necessarily reflect the official views of the Organisation or of the governments of its member countries. This document and any map included herein are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. Please cite this publication as: OECD (2013), Mental Health and Work: Sweden, OECD Publishing. http://dx.doi.org/10.1787/9789264188730-en ISBN 978-92-64-18870-9 (print) ISBN 978-92-64-18873-0 (PDF) Series: Mental Health and Work ISSN 2225-7977 (print) ISSN 2225-7985 (online) The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law. Photo credits: © Inmagine ltd. Corrigenda to OECD publications may be found on line at: www.oecd.org/publishing/corrigenda. © OECD 2013 You can copy, download or print OECD content for your own use, and you can include excerpts from OECD publications, databases and multimedia products in your own documents, presentations, blogs, websites and teaching materials, provided that suitable acknowledgement of OECD as source and copyright owner is given. All requests for public or commercial use and translation rights should be submitted to [email protected]. Requests for permission to photocopy portions of this material for public or commercial use shall be addressed directly to the Copyright Clearance Center (CCC) at [email protected] or the Centre français d’exploitation du droit de copie (CFC) at [email protected]. 3 FOREWORD– Foreword Tackling mental ill-health of the working-age population has become a key issue for labour market and social policies in many OECD countries. It is an issue that has been neglected for too long despite creating very high and increasing costs to people and society at large. OECD governments increasingly recognise that policy has a major role to play in improving the employment opportunities for people with mental ill-health, including very young people; helping those employed but struggling in their jobs; and avoiding long-term sickness and disability caused by a mental disorder. A first OECD report on this subject, Sick on the Job? Myths and Realities about Mental Health and Work, published in January 2012, identified the main underlying policy challenges facing OECD countries by broadening the evidence base and questioning some myths around the links between mental ill-health and work. This report on Sweden is one in a series of reports looking at how these policy challenges are being tackled in selected OECD countries, covering issues such as the transition from education to employment, the workplace, the institutions providing employment services for jobseekers, the transition into permanent disability and the capacity of the health system. Other reports look at the situation in Australia, Austria, Denmark, the Netherlands, Norway, Switzerland, and the United Kingdom. Together, these nine reports aim to deepen the evidence on good mental health and work policy. Each report also contains a series of detailed country-specific policy recommendations. Work on this review was a collaborative effort carried out jointly by the Employment Analysis and Policy Division and the Social Policy Division of the OECD Directorate for Employment, Labour and Social Affairs. The report was prepared by Shruti Singh under the supervision of Christopher Prinz. Statistical work was provided by Dana Blumin and Maxime Ladaique. Valuable comments were provided by Stefano Scarpetta and Mark Keese. The report also includes comments received from experts and various Swedish ministries and authorities, including Dr. Tony Klein MD (Uppsala), the Ministry of Health and Social Affairs, Swedish Social Insurance Inspectorate, Swedish Social Insurance Agency, Ministry of Education and the Swedish Work Environment Authority. MENTAL HEALTH AND WORK: SWEDEN © OECD 2013 5 TABLE OF CONTENTS– Table of contents Acronyms and abbreviations ................................................................................. 9 Executive summary ............................................................................................... 11 Assessment and recommendations ....................................................................... 13 Chapter 1. Mental health and work challenges in Sweden ................................. 19 Introduction: definitions and objectives .................................................................. 21 The outcomes: where Sweden stands ...................................................................... 23 The context: systems and institutions ...................................................................... 32 Conclusion ............................................................................................................... 37 Notes ....................................................................................................................... 38 References .............................................................................................................. 38 Chapter 2. Youth in Sweden, mental ill-health and the transition into the labour market .......................................................................................... 39 The role of the education system in tackling mental ill-health ................................ 40 Mental ill-health, school drop-outs and NEET ........................................................ 48 Transition into the labour market ............................................................................ 51 Tackling the issue of young people on disability benefits ....................................... 55 Conclusion and recommendations ........................................................................... 60 Notes ....................................................................................................................... 62 References .............................................................................................................. 63 Chapter 3. Productivity, sustained competitiveness and the Swedish work environment ................................................................................................. 67 Mental health problems at work .............................................................................. 68 Prevention strategies ................................................................................................ 72 Retention strategies ................................................................................................. 74 Conclusion and recommendations ........................................................................... 80 Notes ........................................................................................................................ 81 References ............................................................................................................... 82 MENTAL HEALTH AND WORK: SWEDEN © OECD 2013 6 –TABLE OF CONTENTS Chapter 4. Facilitating early return to work in Sweden ..................................... 85 Tackling labour market exclusion via sickness and disability benefits ................... 86 Addressing mental ill-health in other working-age benefits ................................. 100 Conclusion and recommendations ......................................................................... 105 Notes ..................................................................................................................... 108 References ............................................................................................................ 109 Chapter 5. Integrating mental health and employment services in Sweden .. 113 Treatment, access and utilisation of mental health services .................................. 114 The health and employment interface ................................................................... 120 Conclusion and recommendations ......................................................................... 126 Notes ...................................................................................................................... 128 References ............................................................................................................. 129 Figures Figure 1.1. Economic costs of mental disorders in Sweden are enormous ............. 20 Figure 1.2. Sickness and disability benefit recipiency is falling but remains very high .................................................................................................................. 24 Figure 1.3. Sickness absence and disability benefit recipients remain high by international standards ........................................................................................ 25 Figure 1.4. Most new disability benefit claims in Sweden are now due to mental illness ........................................................................................................... 26 Figure 1.5. Many persons with mental disorders also rely on unemployment and social assistance ................................................................................................ 27 Figure 1.6. Employment-population ratios and unemployment rates, by mental disorder, mid-1990s and late 2000s ........................................................ 28 Figure 1.7. Most persons with mental health problems are struggling at work ....... 29 Figure 1.8. People with a mental disorder have a much higher poverty risk ........... 29 Figure 1.9. Disability benefit claims due to mental disorders among young adults have increased the most in Sweden ............................................................... 31 Figure 1.10. In-patient and out-patient care in Sweden has grown considerably among young adults ................................................................................................. 31 Figure 1.11. The costs for psychiatric care increase at a lower speed than costs for somatic care .............................................................................................. 37 Figure 2.1. Mental disorders among pupils in schools are high .............................. 41 Figure 2.2. Access to school nurse, doctors and psychologist are astoundingly low ........................................................................................................................... 44 Figure 2.3. Co-operation between school and other youth services is low.............. 45 Figure 2.4. Social disadvantages increase the risk of mental ill-health ................... 47 Figure 2.5. Fatigue and illness are the main determinants in school drop-out ........ 48 Figure 2.6. Mental health problems among jobseekers at the PES are growing ..... 53 MENTAL HEALTH AND WORK: SWEDEN © OECD 2013 7 TABLE OF CONTENTS– Figure 2.7. Disability benefit trends for youth deviate drastically from the overall trend ....................................................................................................... 56 Figure 2.8. A strong positive correlation between youth unemployment and disability across Swedish regions ............................................................................ 57 Figure 3.1. Stress and mental strain are the most common cause of work-related disorders ......................................................................................... 68 Figure 3.2. Workers with a mental disorder work in jobs of slightly poorer quality ...................................................................................................................... 70 Figure 3.3. Job strain has increased in professional and service workers in Sweden ............................................................................................................... 71 Figure 3.4. Occupation-specific causes of sickness reflect higher job strain in those occupations ................................................................................................ 72 Figure 3.5. Productivity losses have increased more among persons with mental disorders ................................................................................................................. 74 Figure 3.6. Assessments by the OHS do not reflect the dominance of stress-related work problems ............................................................................... 76 Figure 4.1. Mental disorders increase sickness benefit duration considerably ........ 89 Figure 4.2. The chances to return to employment fall sharply with the duration of sick leave ......................................................................................... 92 Figure 4.3. Very few people move into employment after completion of the Work Introduction Programme ..................................................................... 94 Figure 4.4. New disability benefit claims are decreasing for all disorders and claims are very often rejected ........................................................................... 96 Figure 4.5. Mental disorders are frequent in recipients of unemployment and social assistance benefits ................................................................................ 100 Figure 5.1. Under-treatment is potentially very large............................................ 115 Figure 5.2. Primary care has a main role to play in treatment of mental illness ..................................................................................................... 116 Figure 5.3. Sweden has fewer GPs than most other OECD countries ................... 117 Figure 5.4. The number of non-medical specialists is increasing while there are fewer specialist nurses ............................................................................ 119 Tables Table 1.1. Economic and labour market indicators for selected OECD countries, 2008 and 2011 ......................................................................................................... 24 Table 1.2. Characteristics of the Swedish unemployment insurance ...................... 34 Table 2.1. Little attention is given to mental health conditions in guidelines for selected school medical staff ............................................................................. 43 Table 2.2. Waiting times to consult a school psychologist are very long ................ 44 Table 2.3. The NEET group is at a higher risk of facing mental health problems .. 49 Table 2.4. Indicators for youth aged 16-24, 2000, 2007 and 2011 .......................... 52 MENTAL HEALTH AND WORK: SWEDEN © OECD 2013 8 –TABLE OF CONTENTS Table 3.1. OHS in Sweden offer a wider array of measures than in other countries ......................................................................................................... 76 Table 4.1. Unemployed sick persons are more likely to remain in the social system, especially if suffering from a mental disorder ............................................ 91 Table 4.2. PES clients with a mental disorder tend to be placed into subsidised work ..................................................................................................... 104 MENTAL HEALTH AND WORK: SWEDEN © OECD 2013