Christopher PRINZ Employment Policy Division

1. Strengths and weaknesses in Danish policies: Lessons from OECD’s Mental Health and Workreview Christopher PRINZ Employment Policy Division Directorate for Employment, Labour and Social Affairs OECD www.oecd.org/els/disability Seminar “Transforming Disability into Ability” 05/11/2014 - Copenhagen

2. 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

3. THE DISABILITY PROBLEM Disability 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).

4. 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

5. 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 years Recipients of different working-age benefits in Denmark, 2004-2011 Source: OECD (2013), Mental Health and Work: Denmark, Paris: OECD Publishing.

6. 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?

7. 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.

8. 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.

9. 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.

10. 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

11. 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

12. 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