MENTAL HEALTH AND WORK Policy challenges and policy developments in OECD countries Shruti Singh, Labour Market Economist Directorate for Employment, Labour and Social Affairs Global Healthy Workplace Awards Florianopolis - Brazil, 18-19 May 2015
Outline of the presentation Background:OECD reviews What is mental ill-health? Why do we care? Links between work, working conditions and mental health Policy responses and examples Conclusions
OECD policy reviews on (i) Disability and Work and (ii) Mental Health and Work Sickness, Disability and Work: 2006-2010 Review of policies in 13 Member countries High-Level Forum in Stockholm in May 2009 Conclusion: Mental health biggest unresolved challenge Mental Health and Work: 2011-2015 Analytical report to build evidence base Identified 4 key policy areas: Education; Workplace; Benefit systems; Health system Review of policies in 9 countries Fit mind, Fit Job: 2015 High-level Forum in the Netherlands in March 2015 Ministers of Employment and Health from 30 OECD countries
How do we define mental ill-health and who is affected by it? People with mental illness reaching clinical threshold (mostly depression and anxiety) Identified by validated mental health instruments used in population health surveys as a proxy for in-depth clinical interviews Prevalence of mental ill-health is very high
THE CASE FOR POLICY ACTION
Economic costs of mental ill-health are enormous Costs of mental disorders as a percentage of the country s GDP, 2010 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Austria Belgium Denmark Netherlands Norway Sweden Switzerland United Kingdom Source: OECD (Mental Health and Work review)
Most people with a mental disorder are in work but the employment gap is significant Employment rate (in %), latest available year Severe disorder Moderate disorder No mental disorder 90 80 70 60 50 40 30 20 10 0 Source: OECD (2012), Sick on the Job? Myths and Realities about Mental Health and Work. For more information: www.oecd.org/els/disability
and the risk of becoming unemployed is high Unemployment (in %), latest year available Severe disorder ( ) Moderate disorder No disorder 30 25 20 15 10 5 0 Source: OECD (2012), Sick on the Job? Myths and Realities about Mental Health and Work.
Mental ill-health is a key driver of inactivity New disability benefit claims due to mental disorders (in % of total claims) Mid 1990s Latest year 70 60 50 40 30 20 10 0
Productivity losses at work are large Measures of productivity loss: Sickness absence incidence and duration and proportion of workers accomplishing less than they would like because of a health problem, 2010 Sickness absence incidence Average absence duration Presenteeism incidence 45 40 35 30 25 20 15 42 28 21 19 8 7 6 5 4 3 7.3 5.6 5.2 4.8 90 80 70 60 50 40 30 88 69 35 10 2 20 26 5 1 10 0 Severe disorder Moderate disorder No disorder 0 Severe disorder Moderate disorder No disorder 0 Severe disorder Moderate disorder No disorder Source: OECD (2012), Sick on the Job? Myths and Realities about Mental Health and Work. For more information: www.oecd.org/els/disability
WORKING CONDITIONS AND WORK-RELATED STRESS: WHY DO THEY MATTER?
Have working conditions changed over time? 6 5 Percentage-point change in selected labour market outcomes and working condition indicators in the period 1990-2010 (16.6) 4 3 2 1 (12.4) (46.2) 0-1 (57.2) (57.8) -2 (84.8) -3 Temporary work Part time work Work Intensity Complex tasks Low autonomy Job satisf action Note: Values within parenthesis are the OECD average in the last year Source: OECD database on Labour Force Statistics and the European Working Conditions Survey (EWCS).
Links between working conditions and work-related stress 12 10 8 6 4 2 0-2 -4-6 -8-10 -12-14 -16 DEU GBR Association between percentage-point change in exposure to selected working conditions and change in perceived work-related stress, 1995-2005 Low job satisfaction FIN ITA IRL SWE HUN ESP NLD DNK AUT FRA POL CZE PRT SVK BEL LUX Correlation: 0.44 * GRC -2 0 2 4 6 8 10 12 14 Change in perceived work-related stress 12 10-10 -12-14 -16 12 10 8 6 4 2 0-2 -4-6 -8-10 -12-14 -16 GBR DEU Low autonomy at work CZE PRT ESP NLD SVK POL AUT HUN ITA FIN DNK BEL FRA SWE IRL LUX Correlation: -0.69 *** GRC -2 0 2 4 6 8 10 12 14 Change in perceived work-related stress * significant at 10%; *** significant at 1%. Source: OECD Employment Outlook 2008 (based on European Working Conditions Survey).
Work-related stress can worsen mental health Some stress can translate into job strain, i.e. a situation of high demands and low control Job strain can translate into mental ill-health Mental ill-health results almost always from a combination of personal characteristics, nonwork factors and workplace factors
Having a job is important for mental well-being Persons with a mental disorder by labour market status, relative to the overall prevalence in the working-age population, latest year available Employed Unemployed Inactive 2.5 2.0 1.5 1.0 0.5 0.0 Australia Austria Belgium Denmark Netherlands Norway Sweden Switzerland United Kingdom United States Source: OECD (Mental Health and Work review)
but the quality of work is also critical Mental health suffers when individuals move from employment to unemployment or inactivity But the type of employment has a substantial impact on the person s mental health A change from standard to non-standard employment tends to reduce mental well-being e.g. temporary contract, long working hours, shift work, low job security.
WHAT CAN EMPLOYERS DO? POLICY RESPONSES AND EXAMPLES
Elements for good workplace policies Attention to psychosocial workplace risks, e.g. work pressure, working hours etc. Multidisciplinary support at the workplace - e.g. occupational health + psychological services Addressing stigma and discrimination Raising awareness and competence among management and employees Systematic monitoring of sick-leave behaviour with return-to-work support
Interesting workplace policies: Belgium, Denmark, Netherlands and the UK Belgian labour law on dealing with mental health risks Psychosocial risk assessments; occupational doctors and psychosocial prevention advisors In Denmark, Sector and job-specific guidance tools Describe (i) risk factors; (ii) ways to prevent problems; (iii) consequences of unawareness Employer responsibility for sick workers in Netherlands Two-year sick-pay by the employer; mandatory reintegration plans; significant sanctions; OHS Supporting line-managers Mental health first aid kit in the UK Training for line managers
Conclusion Topic neglected for too long due to widespread stigma, fears and taboos Countries increasingly recognising this as an issue for public policy Policy action calls for an integrated response to improve outcomes.
THANK YOU For further details and OECD publications: www.oecd.org/els/disability https://twitter.com/oecd_social