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GOTHENBURG, Sweden – Returning to work after sick leave for mental health reasons is fraught with ethical dilemmas and conflicting interests among stakeholders, according to a new study from the University of Gothenburg. The research, published in the journal Health Care Analysis, highlights the potential for disagreement between employers, healthcare providers, and social insurance agencies regarding the return-to-work process for individuals with common mental disorders like depression, anxiety, and stress-related conditions.
The study comes amidst a rise in sick leave due to these disorders. While current recommendations emphasize cooperation and coordinated efforts between stakeholders, the research reveals underlying tensions and diverging goals.
Researchers found that the Swedish Social Insurance Agency (Försäkringskassan) often prioritizes a gradual reintegration, accepting even minimal performance initially. Employers, however, may be reluctant to pay for underperformance while still bearing rehabilitation responsibilities. Healthcare providers face a dual role, balancing patient autonomy with expert assessments of work ability.
“Essentially, defining work ability is a matter of how to organize the workforce as productively as possible while respecting other important values,” says Thomas Hartvigsson, a researcher in practical philosophy at the University of Gothenburg and a key member of the research team. “Different ways of organizing health insurance entail giving different ethical values precedence at the expense of others.”
The study also points out the potential for overly optimistic assessments of work ability to negatively impact an individual’s actual health and ability to function. This risk must be weighed against the potential benefits of returning to work, as prolonged absence can exacerbate mental health issues. Furthermore, the researchers acknowledge that not all individuals on sick leave are motivated to return to their previous jobs, particularly if the workplace contributed to their condition. The study also raises questions about individual responsibility in managing personal life to maintain work capacity.
Elisabeth Björk Brämberg, associate professor of occupational medicine and a researcher at the University of Gothenburg and Karolinska Institutet, notes that while most people return to work within 60 days, the extensive resources devoted to return-to-work interventions may divert resources from other healthcare needs. “We need to take a step back and improve our knowledge about how to identify those who need more help at an earlier stage,” she says. “The scientific evidence for current interventions is too weak.”
The study underscores the need for a more nuanced understanding of the ethical complexities and stakeholder conflicts involved in returning to work after mental health leave, calling for improved strategies to support individuals throughout the process.
The full study can be found in Health Care Analysis: DOI: 10.1007/s10728-024-00491-1
