24 November 2017

Mental ill health is today the most important cause of employee sick leave, but in the workplace, it’s not clear who is responsible for treating it. Réka Andersson has studied the organisations that handle this growing problem.

Medicinska journaler
Réka Andersson’s doctoral thesis investigates how a complex problem is managed by the healthcare services, and how delineations are made between the organisations that are involved. Work-related mental ill health has an ambiguous definition and the allocation of responsibility between the healthcare providers who manage the problem is unclear.

“Work-related mental ill health is difficult to define, and it’s a very complex problem where many factors play a part. As a result there is a huge amount of flexibility in how it is interpreted,” says Réka Andersson.

There are a number of different professional groups from different healthcare providers managing the problem. But there is also a huge variation in how work-related mental illRéka Andersson has studied the organisations involved in handling mental ill health at the workplace.Réka Andersson has studied the organisations involved in handling mental ill health at the workplace. health is defined in the healthcare system. A result of the unclear allocation of responsibility is that the definition of such a multi-facetted problem has consequences for how it is handled within the healthcare system.

“It became clear that the professionals at the various healthcare organisations faced different challenges when handling a case of work-related mental ill health. For instance, in primary care some professionals feel an organisational pressure when making a diagnosis, because certain types of diagnoses are rewarded within the Swedish welfare system. In occupational health, there was a lot of discussion about dependence on the employer,” says Réka Andersson.

Lack of contact between organisations

Today, work-related mental ill health is managed by different healthcare providers, mainly from primary care and occupational health. In her study, Réka Andersson interviewed doctors, psychotherapists, social workers, psychologists, behavioural scientists, occupational therapists and rehab coordinators. To gain a better understanding of the organisational contexts, observations were also made. In Sweden, occupational health was privatised in 1993, which means the employer is both the contractor and the client, in relation to the occupational health services. Starting off with this complex system, Réka Andersson has investigated and shown how different control forms and organisational factors affect how cases are handled.

“The biggest problem is that primary care and occupational health services have essentially no contact with each other, and this is an issue that both organisations have highlighted and want to change.”

Since occupational health was privatised, it is no longer a part of the public healthcare system, which means that primary care normally cannot send a referral to occupational health. Instead, a system emerges where the only way that many healthcare professionals can present their assessment to the employer is by an informal letter, where they state their case for why the occupational health services should take on individual. Because the healthcare professionals in primary care are aware that occupational health has been commissioned by the employer, many feel a need to send a letter to the employer, who in turn makes a decision whether to forward the case to occupational health.

“Suddenly you have a middleman who isn’t a care provider, a situation that doesn’t exist anywhere else in the care chain,” says Réka Andersson.

A letter contains a recommendation from a healthcare professional, but it cannot force the employer to send the individual to occupational health, because this is private. The privatisation of the industry has also led to competition between the various companies that provide occupational healthcare, so these companies also have very little contact with each other. If the privatisation itself is good or bad is another question, but Réka Andersson maintains that the lack of contact between the healthcare-providing organisations is a problem. In the end, it is the individual who is seeking help who falls between two stools.

“There are several reasons why it’s important to shed light on how work-related mental ill health is handled today, and that there are multiple definitions of the problem within the healthcare system. Firstly to be able to offer better care, and secondly to give the professionals who have the knowledge the chance to work with the problems, and not to limit them in a system that is organisationally inflexible. It’s not that people don’t want to work together, what we’re lacking today are structures for supporting this collaboration.”

Réka Andersson defended her doctoral thesis on 15 September 2017.

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