The new quarterly figures from Nav indicate that Norway is consolidating its position as the world leader in sickness absence, particularly among young people with mental illness. It is urgent to find better solutions, but then we need a more nuanced absenteeism debate. So far, the discussion of dropout among young adults has referred to difficult life events, bad feelings, health problems and mental disorders as if they were the same thing. It isn’t. The message to young people sounds like a good old-fashioned “pull yourself together”, and is neither knowledge-based nor accurate. Feelings and diagnoses For a young person with incipient depression, a message to toughen up can be downright harmful. The message hits exactly the same wound that the depressive self-criticism is already gnawing at, and makes everything worse: “I suck, nobody likes me, I’m not going to succeed.” There is nothing easy about so-called “lighter” mental disorders. When we as clinicians make diagnoses, we must follow strict criteria according to the World Health Organization’s international diagnosis manual. This requires thorough and structured clinical assessments of the patient’s overall situation. What symptoms are described, how does the patient function in their relationships and activities and how has this changed recently? How is the contact with the patient in the conversation here and now? Depression involves low mood, loss of energy and a reduced level of activity. The ability to enjoy, feel interest and motivation is impaired. It is difficult to concentrate, sleep is disturbed and appetite is reduced. Self-esteem and confidence are affected and notions of guilt and worthlessness are often present. The condition changes little from day to day and can be followed by so-called “somatic symptoms” such as motor slowness or restlessness, loss of sexual desire or weight loss. Even in the case of a so-called mild depressive episode, two or three of these symptoms must have been present for at least two weeks to “achieve” the diagnosis. Depression is something completely different from “feeling depressed” or being reluctant to do a difficult work task. It also has nothing to do with weakness or laziness, and is not due to a lack of understanding of the value of working or contributing to society. Apples and pears One reason for the confusion about mental stress, ailments and disorders is NAV’s absenteeism statistics, which are based on registrations from attending physicians. In this system, “Psychological reasons” for calling in sick include a number of different conditions. Diagnosed mental disorders such as anxiety and depression are among these, but so are so-called “mental imbalance situational”, “depressed feelings” and “psychological symptoms and ailments” to name a few. When all these conditions are presented together in dramatic media reports, we get an absence debate that mixes apples and pears. Nobody knows what phenomena we are really talking about. It is, of course, legitimate to discuss various reasons why more young people apparently report mental illness and are called in sick due to emotional stress. Today’s diagnosis-driven system (and language) is not perfect either. The problem is the oversimplified analyzes where young people’s openness about mental health is made a main challenge, and where some more than suggest that we have psychologized an entire generation into puzzles. Such a line of debate fails many young people with mental disorders and very real needs for help. Important questions about how we can better help them return to school and work are neglected. Good news We now know a good deal about the latter. Several studies have documented that structured psychological treatment that directly addresses opportunities and challenges in a work situation can provide faster recovery and reduced sickness absence for people with common mental disorders such as anxiety and depression. At the same time, intensive and interdisciplinary treatment models, such as Individual Job Support (IPS), have produced almost startlingly good results for people with more complex mental disorders and social difficulties. Patients who we previously assumed would live in permanent disability and ostracism are now being helped into ordinary work. Here, a small revolution has taken place in the mental health services. Where we previously thought sequentially (first treatment, then work), there is now a large professional consensus that treatment and work rehabilitation should take place at the same time. The key discovery is that a good working environment for most people has health-enhancing effects as a source of coping, meaning and belonging. Unfortunately, the good integrated services are too poorly developed and only available to parts of the population and in some parts of the country. Expensive to leave it alone Systematic summaries of knowledge have shown that multidisciplinary treatment that actively helps people with mental disorders return to work is profitable. When we know that mental disorders cost society more than 330 billion annually, there is good reason to call for a more nuanced absenteeism debate. Moral pointing fingers should give way to up-to-date knowledge about mental health and work. The term “mild” mental disorders should also be scrapped. Send us your opinion Want to write? Feel free to contact us at news Ytring with your post. The guidelines can be found here. Published 11.12.2024, at 22.24
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