English summary: HIGH LEVEL OF UNTREATED MENTAL DISTURBANCES AMONG THE LONG-TERM UNEMPLOYED
Background: The study examines the results of capability-based work capacity assessments amongst the long-term unemployed clientele of three labour force service centres: Oulu, Kainuu and Raahe subregion. The purpose of the study was to establish the types of disorders impairing the work and employment capacity of clients facing employment challenges and to identify the types of treatment and rehabilitation needed.
Methods: The clients, whose employment or (professional) education had not proceeded, were assigned to work capacity assessments conducted by a rehabilitation physician. The results of the work capacity assessments of these clients are presented as a descriptive case study in the form of a synopsis. The work capacity assessment included an extensive report on the client's health, school, work history and social life, a clinical, capability-oriented medical examination, and an examination by a psychologist, neuropsychologist or psychiatrist where necessary. In the overall assessment, the views of the labour force service centre team, who were familiar with the client, were also utilised.
Results: There were altogether 1512 clients within the three labour force service centres in 2008. Of these, 225 clients, that is 15%, were assigned to the rehabilitation physician. The long-term unemployed examined were diagnosed with a large number of disorders impairing their work capacity that were, for the most part, untreated or incompletely treated from the viewpoint of the treatment guidelines. A total of 65% of the examined were diagnosed with a mental disturbance impairing their working capacity. There were 1.27 recommendations made per client, that is to say, a client could receive more than one recommendation for further plans. Of the 225 clients examined, 82% were given recommendations for treatment or rehabilitation (185 recommendations) while 77 recommendations were made for a permanent disability pension (34% of all clients examined). Only 4 clients (2% of those examined) were found capable of working.
Conclusions: The impaired work capacity of the long-term unemployed has gone largely unrecognised by public health services, social services and labour administration. The unemployed whose disorders cause symptoms that in themselves create alienation and inhibition appear to miss out on health care services. The disorders concerned include affective diseases, neurosis of anxiety or fear, schizophrenia, substance abuse and mental disability, for example. These long-term unemployed cannot be helped through education and employment support activities until their disorders are adequately treated and their capability of working reaches a sufficient level. As long as treatment does not reach these people, the result will be an increase in alienation and a permanent loss of work capacity.
