Early detection of common mental disorders: challenges for social workers handling sickness benefit claims

Abstract

Long term sick leave due to common mental disorders such as depression, stress and anxiety disorders is an increasing problem in Denmark and other welfare societies. Moreover common mental disorders make up an increasing percentage of claims for disability pension. Early detection of common mental disorder is of huge importance in order to decrease economic costs and increase mental health status of the population. A screening tool identifying mental health problems was introduced to social workers who were to test it on citizens claiming sickness benefits. However some social workers were critical towards using it. In their experience, the screening tool was unethical as it contained questions that could potentially endanger the citizen’s mental health and, social workers, they were not educated to deal with such situations. This paper explores the working reality of social workers in order to better understand how they interpret the encounters between themselves and citizens with mental health problems. By use of symbolic anthropology we unfold their frame of interpretation, containing the topics: a) A change in the perception that sickness and work exclude one another, guided by governmental sickness policy, b) The core working tasks: work ability assessment and determining whether the citizen is sick or not, c) Being responsible for one’s mental health status and d) Whether common mental health disorders are real diseases or not. Together, these topics form an interpretational framework that could be useful to integrate when designing similar screening programs in the future.