European countries are reporting emerging evidence that mental health problems are becoming more prominent in the overall incidence of disability. In a study of programs aimed at youth with mental health and disability issues, Eurofound (see reference below) reports that:
In many countries, a growing number of new disability pension claimants report …mental health conditions, most notably in the Scandinavian countries: in Denmark, from over 25% in 1995 to over 45% in 2007, and in Sweden, from 20% in 1995 to well over 40% in 2007. The numbers are equally high in other European countries, including the Netherlands, Switzerland and the United Kingdom. (p 21)
Almost 40% of new entrants into the new Wajong benefits system annually in the Netherlands were diagnosed with mental health or behavioural/communicative conditions in 2008 and 2010 (see Figure 5). In most cases, they had severe behavioural problems that make it hard to go to school or find employment. Only 14% had a disability diagnosis on the basis of a sensory or physical impairment.
In Finland, according to the authors, 75% of women 25-29 who receive disability pensions, do so because of mental illness, especially depression.
According to the OECD, the majority of mental health conditions emerge during adolescence and early adulthood. About three-quarters of people diagnosed as being mentally unwell are identified before they are 25 years of age. Anxiety conditions and substance abuse are particularly common in young people (OECD, 2011). There is also evidence that new disability benefit claimants with mental disorders are considered to be further from the labour market than those with other health conditions.
Source: Eurofound (2012), Active inclusion of young people with disabilities or health problems, Publications Office of the European Union, Luxembourg. http://www.eurofound.europa.eu/pubdocs/2012/26/en/1/EF1226EN.pdf
There are also likely to be many “hidden” cases among disability, social assistance and unemployed benefit groups who are not identified as mental health cases because the benefits are triggered by other factors. The increases in identified mental illness are of course not all related to increased incidence, as much as to more effective diagnostic services, greater willingness to identify mental illness and overall increased awareness. The report points out, with some lament, that this has also led to lowered work expectations. They note that the OECD has recommended that member countries develop more rapid responses to mental health conditions to prevent them becoming chronic or disabling, and also that rehabilitation to employment be a high priority.
“Active Inclusion” in Europe
The European Union is promoting the concept of “active inclusion” as a guide for national policies:
The main aim of the research is to see how the policy has been implemented to move young people with health problems or disabilities from inactivity into employment. Forty-four diverse and innovative case studies of good practice are analysed to distil the characteristics of service providers, their experiences and the success factors underlying their projects to formulate conclusions that are applicable across the EU.
The concept of active- as opposed to passive – policies and programs (passive tending to mean income support without assistance or requirement to be in the labour market) has infused European and OECD policy recommendations for at least two decades, but was slow to be picked up in programs dealing with disability, and especially with mental illness. The reasoning is fairly clear – other population groups, such as displaced workers, employable social assistance recipients, youth in general, women and lone parent families, appeared to be closer to the labour market – more employable. Investment in activation – education and training, employment incentives and contingent benefits, placement and counseling services, job creation, job sheltering, job sharing, job rotation, mentoring, social economy initiatives, employer incentives and quotas, etc. – could be more cost-effective with the other groups.
This Eurofound study examines the situation of young people with health problems or disabilities in 11 countries (Denmark, Finland, France, Germany, Ireland, the Netherlands, Poland, Portugal, Slovakia, Spain and the United Kingdom) and at EU level, with an emphasis on assessing the implementation of active inclusion policy at national level. Active inclusion policy seeks to integrate measures in relation to three pillars – adequate income, inclusive labour markets and access to quality services – for people furthest from the labour market.
Some notable observations:
Germany has made a major shift in how disability is viewed by policy. Not only are they seeking active integration as program objectives, but they identify the obligations of all societal actors to promote and achieve an “inclusive society.”(p29)
A number of countries operate quota levy systems to stimulate the employment of people with disabilities. These measures are highly sophisticated in Germany for people classified as severely disabled and include a requirement that in enterprises with a staff of 20 people or more, at least 5% of their workforce are people with disabilities. Enterprises that fail to meet their requirements under the quota system have to pay a compensatory levy. A similar system is operating in France, where the quota of people with disabilities is 6% of the workforce of a company. However, young people with health problems or disabilities are underrepresented among the beneficiaries of the system. (p32)
In Finland, inclusive policy means that every young person, including people with severe disabilities, has the right to secondary education. (p30)
Ireland provides flexible income supports for people with disabilities to work, including a wage subsidy which compensates employers if the person with a disability has a lower level of productivity. People receiving disability benefits benefit from an “income disregard” which permits them to earn some 432 Euros per month before their benefits begin to be reduced. (p31)
Young people who are not able to work under normal conditions in Denmark are offered work in special employment schemes, which have the aim of providing work under as normal conditions as possible. Options include ‘flex jobs’ for people who are able to work if their working conditions are flexible, such as allowing for reduced time, reduced speed or more frequent breaks. People can receive a full salary regardless of hours and productivity in ‘reduced-demands jobs’, which cater to those who cannot handle a job under normal conditions. The system also includes financial incentives for employers to encourage them to employ people with disabilities as well as productivity-related wage subsidies. Young people under 25 are required to participate in secondary or further education in the mainstream or to attend secondary education for young people with special needs. (p32)
The study pointed out that while most countries identify active inclusion in policy objectives, the service systems which implement the policies are not always well-integrated or coordinated.
Many services continue a practice or bias of keeping people with disabilities out of mainstream society. (p47) In many country reports, the transition of young people to adulthood was highlighted as a point where the fragmentation of services was very likely to occur. (p48) …..In a number of cases, the positive impact of national policies was reduced by fragmentation between different levels of authority (regional and local actors) or by the institutionalised responses within the relevant sectors. Demarcation issues arose between social protection and employment agencies and between education and social protection administrations. This led to ineffective sharing of information between agencies and a requirement on individuals to approach a range of providers in order to access the services they required (p82)
In relation to NGO’s, which are responsible for a lot of direct service delivery:
The role of these services is often tied to their source of funding; funding may come from a specific ministry, for example. This may lead to difficulties in supplying a fuller range of services and of collaboration between the services, which is needed for effective active inclusion. (p84)
The problem of service delivery NGO’s being bound by restrictive and fragmented funding arrangements, or in the case of public service delivery organizations, by narrow legislative mandates or institutional information boundaries, seems to often be observed in problem areas of social policy. A subject for a future issue.
The authors discuss the concept of “inclusive growth” (p86) in anticipation of economic recovery as the European economies emerge from the Great Recession. As the financial position of governments improve and job vacancies increase, it may be a good time for making inroads on a very difficult problem area, as historically, periods of growth make it slightly easier, politically and economically, for introducing program improvements which bring vulnerable or “excluded” population groups into the mainstream.
Source: Eurofound (2012), Active inclusion of young people with disabilities or health problems, Publications Office of the European Union, Luxembourg.