Occupational disease compensation and mental disorders in Finland

1
Occupational disease compensation and mental
disorders in Finland

• Teija Honkonen
• MD, Psychiatrist, FIOH 14.1.2004

2
WORK-RELATED DISEASES
WORK-RELATED DISEASES
DISEASES (AT LEAST PARTLY) CAUSED BY WORK
OCCUPATIONAL DISEASES
3
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

4
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

5
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

6
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

7
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

8
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

9
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

10
OCCUPATIONAL DISEASE DIAGNOSTICS TWO-STEP
EVIDENCE
EVIDENCE OF GENERAL CAUSAL RELATIONSHIP
EVIDENCE OF CAUSAL RELATIONSHIP IN A PARTICULAR
INDIVIDUAL
11
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

12
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

13
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