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