Transcript Occupational disease compensation and mental disorders in

Occupational disease compensation and
mental disorders in Finland
Teija Honkonen
MD, Psychiatrist, FIOH
14.1.2004
WORK-RELATED DISEASES
WORK-RELATED DISEASES
DISEASES (AT LEAST PARTLY)
CAUSED BY WORK
OCCUPATIONAL DISEASES
The Occupational Disease Act
• It refers to a disease which is probably primarily
due to physical, chemical or biological factors
associated with work
• A disease caused by psychic or social factors is
not compensated as occupational disease in
Finland
Occupational disease compensation and
mental disorders in Finland
• A mental disorder (psycho-organic syndrome) can
be compensated through the statutory accident
insurance system either
– as an occupational disease resulting from a
chemical factor or
– as a consequence of an occupational accident
Occupational disease compensation
• Every year in Finland, individual cases of
intoxication by organic solvents are diagnosed as
occupational diseases resulting from exposure to
chemical factors
• Mental symptoms associated with such
intoxication cases are compensated as any other
occupational disease symptoms
Mental disorders and statutory accident
insurance system in Finland
• The accident refers to a sudden, unexpected event
caused by an external factor, taking place
irrespective of the insured person's intention and
causing him / her a physical or mental injury or
disease
• Therefore, mental disorders, such as stress
reactions, can be compensated as a result of an
occupational accident
Post traumatic stress disorder (PTSD)
• A person must have been exposed to a traumatic
event
• The person persistently reexperiences the event
• The person avoids reminders of the event and has
generalized numbness of feeling
• The person has symptoms of increased arousal
Post traumatic stress disorder (PTSD)
• The three types of symptoms must be present
together at least one month
• The disorder must cause clinically significant
distress or impairment in social, occupational or
other areas of functioning
Working group on the clarification of mental
disorder-related occupational disease
compensation in Finland
• In September 2001 the Ministry of Social Affairs
and Health set up a working group with the
assignment to clarify whether or not a psychic
factor related to work or work environment could
constitute the basis for occupational disease
compensation
OCCUPATIONAL DISEASE
DIAGNOSTICS: TWO-STEP EVIDENCE
EVIDENCE OF GENERAL CAUSAL RELATIONSHIP
EVIDENCE OF CAUSAL RELATIONSHIP
IN A PARTICULAR INDIVIDUAL
The prospective longitudinal studies
• According to research results there is a
recognisable association, at group level, between
work-related strain factors and mental symptoms
• However, there is no unambiguous scientific
evidence of causal relationship between a clearly
definable work-related strain factor and
individually diagnosable mental disorder
Conclusions
(Working group on the clarification of mental disorder-related
occupational disease compensation 6/2003)
• At present, there is not sufficient evidence to include
psychic factors in the occupational disease legislation in
Finland
• It is necessary to develop methods to measure mental strain
at work and to engage in further research on the
association between work-related mental strain factors and
mental disorders
• In the future, research should also focus on the impacts of
prolonged psychological strain situations
Mental disorder compensation
- potential problems
• If mental disorders were compensated in accordance with
the Occupational Disease Act as occupational diseases
caused by psychic factors, problems would arise due
– to the still lacking medical knowledge of causal
relationship
– to the undeveloped methods to measure psychological
strain objectively at individual level
– to the problems of the validity and reliability of
psychiatric diagnoses