Cross sectoral networks are possible But extremely difficult to build

Transcription

1 Cross sectoral networks are possible But extremely difficult to build Chris Nas 7. Fachtagung Psychiatrie Berlin, February 20 th

2 What will my contribution this morning be about Why are cross sectional networks necessary What can we learn from the recent OECD reports on mental health and work What can we learn from experiences in the Netherlands since 2012 (3 studies from December 2014) Do I have recommendations for professionals and organisations? Do you have questions? 2

3 Mental disorders have a serious impact on the employment of patients Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 30. 3

4 and their income. Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 31. 4

5 Majority of mental disorders do NOT lead to disability, not even SMI Proportion of people with a mental disorder, by severity and co-morbidity, who also report a disability Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page 27. 5

6 competitive work reduces length of psychiatric inpatient stays. Length of stay (in days) of hospitalisations in a psychiatric clinic by employment status and illness severity, Switzerland, a, b Source: OECD (2012), Sick on the job? Myths and realities about mental health and work, page

7 Mental disorders do lead to productivity loss Workers who have not taken sick leave, but show reduced productivity due to an emotional problem (in the previous four weeks) by mental health status and country. Source: OECD (2015) Fit Mind, Fit Job (to be published March) 7

8 The impact of mental health problems on Europe s economy is huge... Annual direct costs (work-related) 610 billion employers (absenteeism and presenteeism) 270 billion economy (lost output) 240 billion healthcare systems (treatment) 60 billion social welfare (disability benefit payments) 40 billion Sources: Matrix (2013), Economic analysis of workplace mental health promotion and mental disorder prevention programmes and of their potential contribution to EU health, social and economic policy objectives; OECD (2014) Mental Health at Work: Netherlands, page 22. 8

9 and translates to the costs of mental disorders for Germany: This amount is based on GDP 2013 of Germany ( billion) and the percentage of 3,7% of GDP as estimated by the OECD. Costs of mental disorders as a percentage of the country s GDP, 2010 Source: OECD (2015) Fit Mind, Fit Job (to be published March) 9

10 At this moment, already many different kinds of professionals are involved. In the Netherlands, if somebody falls ill and is absent from work (s)he will have to deal with 9 12 persons on average: Manager Human resources officer Occupational physician General practitioner/ mental health nurse Psychologist UWV (social benefits) Lawyer Mental health specialist Employment caseworkers And nobody takes the lead Source: Soentken et al (2014) Zorg en participatie bij werkenden en uitkeringsgerechtigden met psychische klachten Verkenning naar mogelijkheden om het systeem van zorg en werk efficiënter te maken TNO,

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12 OECD: there is no single country with a well functioning support system Early identification and intervention needed teachers, family doctors, employers and employment caseworkers they lack knowledge Financial silo s (health, work and income) lead to conflicting policies and incentives Treatment gap Interventions are too late Interventions are not appropriate Source: OECD (2015) Fit Mind, Fit Job (to be published March 2015) 12

13 OECD: mental health care must recognise importance employment Mental health care must recognise importance of employment. Integrate mental health and employment services, they are both needed. Add employment related outcomes into treatment plans (next to clinical outcomes) Make these employment related outcomes part of all pay-for-performance schemes Develop employment support programmes for people with mild/moderate mental health problems (= IPS for CMD) Source: OECD (2015) Fit Mind, Fit Job (to be published March 2015) 13

14 Good practice Fit-4-Work: outflow 40% compared to 13% control group Social assistence beneficiaries with multiple psychosocial problems in 5 major municipalities in the Netherlands Municipality is in the lead. Diagnosis and discussion in multidisciplinary team (social services; UWV; mental health sector). Integral service package: psychological treatment (without waiting times) social interventions (debt relief, housing services, activation) Problem solving approach. Quick job placement (comparable with IPS). Coaching client AND employer during and after placement. Source: OECD (2014), Mental Health and Work: the Netherlands, OECD Publishing, Paris. 14

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16 Success factors for effective integration of services After publication of OECD Report Sick on the Job, the Ministry of Social Affairs and employment took stock: Local government should be in the lead and contract other parties. Personal network and relationships are critical. Professionals should have time for consultation of other professionals in the field. Privacy issues should be solved. Source: Inspectie Sociale Zaken en Werkgelegenheid (2012)Samen de focus op werk. Een landelijk beeld van de samenwerking tussen professionals werk en inkomen en de gezondheidszorg, augustus

17 Service providers and Employee Insurance Agency signed a convenant Goal is to keep people at work or get them to work: working relationship between regional UWV agencies and mental health care providers in order to help clients as much as possible with job retention or to promote an optimal reintegration process. Key areas for collaboration include: sharing knowledge about function of work as part of effective treatment; increasing in-depth knowledge about (severe) psychiatric illnesses for UWV professionals; tailoring efficient treatments that facilitate job retention and effective reintegration. Source: GGZ Nederland en UWV (2012). 17

18 In December 2014, an evaluation research was published Out of 77 regions of the Employee Insurance Agency At first glance 10 were interesting enough for consideration Of which only 2 functioned according to expectations And could be a model for nationwide implementation What is the difference between successful and unsuccessful regions? Source: Holwerda, A et al (2014) Samenwerkingsverbanden tussen GGZ en UWV gericht op re-integration van mensen met een matige tot ernstige psychische stoornis. Groningen, december

19 Recommendations (Quick Wins) for organisations Organise an annual conference on mental health at work for organisations and professionals. Organise regional meetings for continuous education, knowledge exchange and case studies. Create multidisciplinary guidelines from a shared perspective (in NL: psychologists, general practitioners and occupational physicians do have one guideline for mental health and work) Make one shared plan for each client, covering treatment as well as work. Make sure there is one contact person for professionals from other involved organisations. Source: Holwerda, A et al (2014) Samenwerkingsverbanden tussen GGZ en UWV gericht op re-integration van mensen met een matige tot ernstige psychische stoornis. Groningen, december

20 Organisation culture is important, do not underestimate differences. Health and social care Person centered Made to measure Guidelines Professional autonomy Work and income Process oriented Mass production Regulations Bureaucratic hierarchy 20

21 Acknowledge the specific qualities of other professionals AND organisations Make clear what you expect from other and what others may expect from you About payments, procedures and privacy Share with each other the limitations (laws, codes of conduct, regulations) Take the time at the start of the collaboration to discuss this with your professional partners Source: Holwerda, A et al (2014) Samenwerkingsverbanden tussen GGZ en UWV gericht op re-integration van mensen met een matige tot ernstige psychische stoornis. Groningen, december

22 Fullfil necessary requirements on a system level for a sustainable solution. The organisation that benefits most, should contribute most One organisation should take the lead Create incentives for cooperation P4P for mental health professionals and for employment case workers Monitor outcomes routinely 22

23 Take home message If you want to achieve significant change in order to really support people with moderate and severe mental illness, you have to start to change yourselves, break a couple of existing rules and create better fitting ones. 23

24 GGZ Nederland is the sector organisation of specialist mental health and addiction care providers in the Netherlands. The aim of GGZ Nederland and its members is to ensure the availability of high quality, accessible, affordable and sustainable mental health care. In 2013, its 113 members employed 89,500 staff who provided specialist mental health care to 815,800 clients. This is a market share of 80.6% in the health insurance market and more than 90% in child and youth care, sheltered housing, addiction care and forensic care. Seated in Amersfoort, its 66 employees represent the interests of its members in an on-going and constructive dialogue with client organisations, health insurers, national and local governments, professional associations and trade unions. Website: cnas@ggznederland.nl Source: GGZ Nederland (2013), GGZ in de Zorgverzekeringswet 24