ABSTRACT
A policy shift “from welfare to workfare” occurred in the US in the 1960s, and a comparative study revealed that such a shift had occurred in many of the countries studied. Because many recipients of certain social security benefits had mental health issues, the countries studied focused on mental health measures with a legal basis.
The UK, Denmark, and the Netherlands used public authority to implement primary prevention based on a psychosocial instrument. Denmark rated the status of efforts by employers and published its ratings online. The Netherlands has promoted primary prevention through occupational physicians and the Occupational Health and Safety Service based on labor and management talks. All of the European countries studied have implemented regulations against harassment. The French regulations are substantial. Germany lacks full-fledged policies to manage psychosocial risks through public authority, but it has substantial legal protections in the workplace, such as regulations on working hours and termination.
In terms of tertiary prevention, Germany has mandated that employers provide support so that individuals who are absent from work due to sickness can gradually return to work. Under the management of the Employee Insurance Agency, the Netherlands encourages employees to return to work and it encourages employers to allow those employees to resume working. Legislation is designed to penalize either party in terms of job or income security if it fails to fulfil its obligations. If an employee is unable to continue working for the same employer, the employee performs alternative work for another employer or the employee works for a reintegration agency [re-integratiebedrijf] on a limited basis while being treated. Denmark has implemented measures to deliberately assist individuals who have taken a leave of absence to promptly return to work after a mental health issue. Local governments act as a hub for relevant parties such as the employer, the employee, and hospitals. The UK provides multifaceted and sustained job assistance through Jobcentre Plus, which assesses the work capability of individuals with disabilities and then coordinates with relevant parties.
Countries in Northern Europe such as the Netherlands and Denmark provide generous job and income security to individuals who have taken a leave of absence due to a mental health issue. In addition to statutorily guaranteed job security, Germany mandates that wages continue to be paid for a brief period and it provides a sickness allowance for up to 78 weeks over a three-year period. In addition to statutorily guaranteed job security, the UK has a social security system covering unemployment and disability. However, most of the European countries studied do not, in principle, treat a mental disorder as a work-related illness or injury.
Principally intended to protect the human rights of the disabled and to promote an active workforce, laws to prohibit discrimination against the disabled that originated in the US have spread to many European countries. These laws do not appear to have created jobs, but they have helped to encourage a culture of diversity and inclusion.
Out of the countries studied, the UK was the only one in which courts tended to have widely found employers civilly liable for employee mental health issues. However, such cases are increasing in France as well.
None of this legislation appears to have clearly helped to address mental health issues at the national level. Nonetheless, data on improvements in collective working environments and the effectiveness of individual psychotherapy interventions and community-based approaches are being collected, even if just to analyze trends. These data may offer clues to address those issues in the future.
