Estonia: Call for measures to help prevent work-related mental health issues

Measures to identify and prevent mental health problems among workers in Estonia have been recommended by a new report. About one-third of people with an occupational disability in Estonia have mental health problems. Labour market policies, however, have so far neglected this group.

Background

A study on measures to help people with mental health problems find work (in Estonian) was commissioned by the Ministry of Social Affairs in 2013, when it was pointed out that government proposals to help workers with occupational disabilities overlooked those with mental health problems.

Methodology

The Praxis Centre for Policy Studies in Estonia carried out the study, combining different sources of information and methods.

The study involved:

• a literature review of existing measures to overcome barriers to labour market participation;
• analysis of Estonian administrative statistics and European surveys, including Eurostat’s EU Labour Force Survey, to study determinants and contingencies of labour market participation;
• analysis of policy documentation to determine gaps in the current policies and in the way they are implemented;
• in-depth qualitative personal interviews with people with mental health issues;
• qualitative interviews with employers and other groups that implement policies.

Main findings

Many workers in the Estonian labour market have mental health problems. According to statistics from the Estonian Health Insurance Board, in 2013 there were 87,288 people of working age (10.6% of population aged 16–62 years) whose bill for treatment indicated a mental disorder; 51,538 of them had bought prescribed drugs to treat a mental health problem. At the beginning of 2014, the board identified 32,498 people of working age whose incapacity to work was mild to total because of a mental health problem.

People with mental health problems are one of groups at high risk of non-participation in the labour market. Their unemployment rate is higher and their activity rate is lower than the rest of the labour force. Their lower motivation and fewer opportunities to work is influenced by several factors, including:

• access to treatment and rehabilitation;
• skills and competencies;
• work experience;
• access to suitable employment and working conditions;
• stigma – misconceptions and false beliefs about mental health problems.

Recommendations

To comply with the International Labour Organization's Convention on the Rights of Persons with Disabilities, to enhance the social inclusion of people with mental health problems and to prevent a shortage of workers due to an ageing and declining population, the state needs to improve employment opportunities for people with mental health problems.

Prevention is crucial. Stressful working conditions can cause mental health problems or exacerbate them. The study suggests that policymakers ensure that employers and employees are well informed and consulted on psychosocial risk factors, mental health problems, possibilities for improving working conditions and methods for coping with stress. Substantial assistance could be given here by occupational physicians and psychologists.

Early identification of mental health problems is also crucial to prevent incapacity and reduce the need for treatment and rehabilitation. The study recommends that policymakers increase public awareness of mental health issues to enable early identification, to end the idea that poor mental health is shameful, and to encourage those seeking help and those providing assistance to act early. Proposals have also been made to improve the availability of psychiatric treatment and psychological assistance, which up to now has been scant.

Employment service providers, employers and those providing social rehabilitation services have to evaluate ways to avoid loss of performance and productivity and to support people in their efforts to work. The study suggests service providers advise employers on ways of developing and implementing workplace mental health policies, and on how to tailor work and working conditions to employees’ mental health needs so that they can stay at work or return to work after sickness leave.

Participation in the labour market depends on education and work experience. The study suggests that policymakers improve the opportunities and equal access to formal education for people with mental health problems. It proposes:

• the provision of vocational education and training both within and outside the workplace; 
• sheltered employment;
• employment schemes to help people with mental health problems to increase their activity in the labour market and to acquire work-specific skills so that they can gradually move into the open labour market.