Young employees with psychological complaints add to growth in disability benefit claimants

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A further influx of people registered as disabled under the Dutch Occupational Disabilities Insurance Act (WAO) has brought the total to more than 900,000. This, coupled with the government's plans to stem the flow by implementing more stringent assessment procedures, has unleashed a heated controversy in spring 1999. The changing composition of the influx of new claimants has also caused comment, since one-third are now individuals with psychological complaints. In addition, many are aged under 35 and the majority are women. Hence the need for preventative measures and active reintegration programmes has reached a crisis point.

The swelling influx of people registered as unfit for work under the Occupational Disabilities Insurance Act (Wet Arbeids Ongeschiktheid, WAO) - now over 900,000 - coupled with the cabinet's plans, announced in January 1999, to stem the flood by introducing more stringent assessment procedures has unleashed a storm of controversy in the Netherlands (NL9902124F). Further concerns have focused on the changing composition of the influx into the WAO system. In 1998, people with psychological complaints comprised one-third of the group, and many are younger than 35 years old. Half of all young WAO benefit recipients experience psychological problems. A plan put forward by the Liberal Party (Volkspartij voor Vrijheid en Democratie, VVD), one of the governing coalition parties, to weed out individuals with "mild psychological complaints" from the WAO is proving a major bone of contention. The Secretary of State for Social Affairs, Hans Hoogervorst, who is also a member of the VVD, has rejected the plan.

Young adults

According to the latest figures from the National Institute of Social Insurance (Landelijk Instituut Sociale Verzekeringen, LISV), incapacity for work has increased since 1995 amongst employees younger than 35, whereas the number of employees older than 35 in receipt of unemployment benefit has dropped. In terms of the total national workforce, the number of young women (under 35) unable to work has risen more sharply than the number of young male employees. However, compared with the growing number of working women, the percentage of female WAO recipients has risen by less. Nevertheless, in 1998 the ratio of women to men in the WAO scheme was two to one.

Another group attracting attention is young WAO claimants who have never been employed. WAO benefits now go increasingly to this group, which comprises half of the WAO recipients under 35. Since 1990, the level of benefits paid out to this group has risen by 25%. Only 7.5% have a pre-existing condition which prevents them from working. Most benefits (54%) go to individuals with psychological problems. Although no research has been conducted into the underlying causes for the increasing size of this group, a number of suggested explanations have been given. Some say that it is due to general population growth, and the fact that people with disabilities now enjoy a longer life. Although the reform of the WAO in the 1990s (including "privatisation" of the Sickness Benefits Act) established stricter disability criteria intended to influence employers and the health and safety services, these measures had no impact on this group of young adults since none had been previously employed and they already received benefits equal to the minimum wage. Cynics note that nobody stands to gain if this group is reintegrated into the labour market - aside, that is, from the tax-payer and the individuals themselves. As a result, it is now clear to commentators that reintegration will require a targeted approach, bureaucracy will need to be trimmed and room will have to be created in the budget to assist this group of individuals who still have a potentially long life of employment ahead of them.

Women

The increased influx of young women into the WAO scheme has, however, been researched and studies show that the influx is not so much a result of gender or the presumed "double burden" borne by working mothers, but instead relates to their sector of employment. Many women are employed in the healthcare sector, which traditionally has a relatively high rate of absence related to illness, with employees are four times more likely to become unfit for work than in any other sector. The increased risk is related to the nature of the work, which is physically strenuous, and the high degree of pressure at work. Over the past decade, cutbacks and efficiency measures have led to sharply increased workloads, whilst staff shortages have served only to accelerate this process over the last few years. Absence due to illness is extremely high, reaching levels of around or higher than 10%. Homecare ranks highest at 14%, but care for people with disabilities and work in the welfare sector are close behind at 13%. The fact that little is invested in improving working conditions (less than half the national average) in the healthcare sector is also noted. It has also been revealed that sick part-time employees (mostly women) receive less supervision than sick full-time employees.

Psychological complaints

Psychological complaints affect one third of all WAO recipients, and consequently increasing numbers of young adults and women. Between 50% and 70% of these cases involve problems arising in the workplace, such as mounting stress and workloads. The number of individuals declared unfit for work as a result of psychological complaints has risen during the 1990s. A study conducted by the LISV revealed that in many cases examining doctors find it very difficult to apply the stricter regulations which now apply. However the fact remains that, compared with other west European countries, the number of WAO recipients with psychological problems in the Netherlands does not exceed the European average.

According to experts, increasing levels of on-the-job pressure and related stress may have resulted from changes in the nature of work. Today, it is claimed, employees are faced with a service-oriented economy in a knowledge-driven society. The "24-hour economy" has become a reality and globalisation has fanned the flames in terms of international competition. On average, psychological complaints are more likely to affect individuals in administrative or sales positions. Nowadays, most people work in offices, dealing with clients, students or patients. Organisations are now flatter and less hierarchical, and terms of employment are more flexible. Work requires both mental and emotional exertion, involving thinking, concentration, planning, making decisions and persuasion. In addition, it is claimed, the lines between work and home life have blurred, with work often taking precedence over other areas of personal responsibility or preference. Increased psychological burdens seem to have become part and parcel of a modern working life. Excessive pressure on the psyche can easily lead to mental overburdening, which manifests itself in nervous exhaustion, burnout and depression. Of all the people who end up in the WAO scheme with psychological complaints, 60% ascribe their problems to mental taxation at work.

Prevention

Over a third of the employees declared unfit for work report that they would have been able to continue working if preventative measures had been taken in time. Doctors indicate that rest is beneficial in cases of nervous exhaustion and burnout; however, individuals granted an open-ended period of rest tend to remain in an inactive state, whereas individuals provided with help in gaining control over their situation take steps towards recovery. With respect to these types of psychological complaint, the implementation of a timely reintegration plan at a relaxing and adapted pace could prove beneficial, according to experts. It is also important because it means that the employee will not simply be "forgotten" at the workplace. In addition, a risk analysis and evaluation of specific functions performed by the Working Conditions Service (Arbodienst) could prove beneficial in formulating optimal preventative measures, such as improved organisation of work, adequate work and rest schedules and different management styles.

Commentary

The suggestions outlined in the previous section seem reasonable to at least one of the social partners, namely the trade union movement. Considerable differences arose between the parties during discussions concerning the plan proposed by Secretary of State Hoogervorst to tighten WAO assessments further. On the one hand, employers championed introducing new guidelines to reduce the volume of claimants, whilst on the other, unions set their sights on a plan favouring prevention. The construction sector (perennially associated with disability) is a good example in this respect: new measures in the form of a policy on improved working conditions have dramatically decreased absence levels due to illness, and, ultimately, reduced the number of WAO recipients. Preventative measures in the workplace appear to be a solution. (Marianne Grünell, HSI)

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