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 Seminar “Transforming Disability into Ability” 05/11/ Copenhagen

OECD POLICY REVIEWS: (i) Disability and Work; (ii) Mental Health and Work Transforming Disability into Ability: – Review of disability benefit and employment policies – Conclusion: Systems everywhere in need of reform Sickness, Disability and Work: – 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: – 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 PROBLEM Disability beneficiary rates are high and rising fast Disability benefit recipients in % of the population aged 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).

THE DANISH CASE Strengths 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 SUCCESS The challenge: Previous reforms have failed The number of people on health-related benefits has changed very little in the past few years Recipients of different working-age benefits in Denmark, Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.

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 CENTRES The 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.

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 SYSTEM The 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.

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

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