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Strengths and weaknesses in Danish policies: Lessons from OECD’s Mental Health and Work review. Christopher PRINZ Employment Policy Division Directorate for Employment, Labour and Social Affairs OECD www.oecd.org/els/disability. Seminar “Transforming Disability into Ability” - PowerPoint PPT Presentation
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STRENGTHS AND WEAKNESSES
IN DANISH POLICIES: LESSONS FROM OECD’S
MENTAL HEALTH AND WORK REVIEW
Christopher PRINZEmployment Policy DivisionDirectorate for Employment, Labour and Social AffairsOECDwww.oecd.org/els/disability
Seminar “Transforming Disability into Ability”
05/11/2014 - Copenhagen
OECD POLICY REVIEWS: 2000-2015 (i) Disability and Work; (ii) Mental Health and Work
• Transforming Disability into Ability: 2000-2002
– Review of disability benefit and employment policies– Conclusion: Systems everywhere in need of reform
• Sickness, Disability and Work: 2006-2010
– Review of policies in 13 countries, incl. Denmark– 12 major conclusions for Denmark; two-thirds
implemented– High-Level Policy Forum in Stockholm in May 2009– Synthesis report in November 2010
• Mental Health and Work: 2011-2015
– Report on key policy challenges in December 2011– Review of policies in 9 countries, incl. Denmark– Report on policy approach for the future in early 2015– High-level Policy Forum in The Hague in March 2015
THE DISABILITY PROBLEMDisability beneficiary rates are high and rising fast
Disability benefit recipients in % of the population aged 20-64 in 15 OECD countries, three points in time: 1980, 2000 and 2012 (or latest available year)
Source: OECD (2010), Sickness, Disability and Work: Breaking the Barriers (updated to 2012).
0
2
4
6
8
10
12
14
NOR ISL NLD FIN SWE DNK BEL USA AUS IRL ISR LUX AUT NZL CAN
1980 2000 2012
THE DANISH CASEStrengths and potential
• Benefit systems and employment services
– Municipal job centres as one-stop-shop centres, providing services for sick and unemployed people and social assistance clients
– Strong activation-oriented financial incentives for municipalities
– Adaptable flexjob system to compensate people with partial capacity
– Disability assessment from resource profile to return-to-work tool
– New rehab process with multidisciplinary service for under 40s
• Other systems (workplace, youth policy, health system)
– Growing focus on the prevention of psychological workplace risks
– Competent Youth Guidance Centres in every municipality
– Highly accessible public health care system free of charge
MAKING LABOUR MARKET REFORMS A SUCCESSThe challenge: Previous reforms have failed
The number of people on health-related benefits has changed very little in the past few yearsRecipients of different working-age benefits in Denmark, 2004-2011
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
0
50
100
150
200
250
300
2004 2005 2006 2007 2008 2009 2010 2011
Unemployment benefit Social assistance Rehab & pre-rehab
Sickness benefit Flexjob & waiting allowance Disability benefit
MAKING LABOUR MARKET REFORMS A SUCCESS Possible ways forward
• Understand the reasons for the failure of previous reforms
• Why success for people with a mental disorder is critical
• Policy recommendations
– Flexjob reform: rigorous implementation to ensure that the “right” group of people access the system
– Disability reform: clear roles and adequate incentives for the key actors to ensure that the new rehab model can deliver
– Reform of reimbursement of municipal spending: monitor and evaluate the impact on different client groups
• Initial outcomes?– New disability benefit claims have fallen; flexjobs continue
to increase
– Shift to rehab process? Increase in employment?
HELPING CLIENTS OF MUNICIPAL JOB CENTRESThe 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
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
0
10
20
30
40
50
60
Long-termsickness
Disabilitybenef it
Unemploymentbenef it
Socialassistance
Severe mental disorder Moderate mental disorder
HELPING CLIENTS OF MUNICIPAL JOB CENTRES Possible ways forward
• Access to mainstream 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 attention to clients (i) moving from unemployment to sickness, (ii) on social assistance at risk of moving onto disability benefit
– Invest resources in (i) lowering caseloads for clients with a mental disorder and (ii) psychological training for caseworkers.
FEATURES OF THE DISABILITY BENEFIT SYSTEMThe challenge: Not designed to tackle mental illness
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
Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.
0
10
20
30
40
50
60
70
80
Neoplasms Circulatory Injury,poisoning
Nervous,eye, ear
Musculo-skeletal
Respiratory Mentaldisorder
Congenital,chromosomal
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
– Extend the new 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
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
• Strong setup does not deliver: systems under-resourced and 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 services not adequate for characteristics of mental illness
– related to better integration of health and employment services
Thank you for your attention!
For more information and OECD publications on the topic:
www.oecd.org/els/disability
Including free access to the tables and charts of all reports