Returning to work after sick leave due to common mental disorders is a process with inherent ethical conflicts and potential dilemmas. A study conducted at the University of Gothenburg has shown that the goals of the employer and other stakeholders can diverge at times.
The background to the study, published in the journal Health Care Analysis, is the increase in sick leave due to common mental disorders, a term incorporating depression, anxiety and stress-related disorders.
Recommendations for improving return to work processes often underline the importance of cooperation and coordinated interventions between the employer, the Swedish Social Insurance Agency (Försäkringskassan) and healthcare services. The various stakeholders are assumed to share the common goal of getting the employee back to work.
However, in the theoretical analysis of the different stakeholders' ethical frameworks and goals, the researchers found not only agreement, but also a large number of potentially conflicting interests.
Potential conflicting goals
The Swedish Social Insurance Agency aims at a gradual reintegration into the workplace, considering it sufficient for the employee to perform the bare essentials of their duties. Employers, on the other hand, may lack a willingness to support and pay an employee who is less productive/underperform, at the same time as they have a rehabilitation responsibility.
In the return to work process, the healthcare system has two roles: on the one hand, as a care provider that respects the patient's self-determination and integrity, and on the other hand, as an expert in assessing work ability.
Another observation presented in the study is that an overly optimistic assessment of a person's work ability can have a negative impact on their actual work ability and health. This risk must be balanced against the benefits offered by a return to work as absence from the labor market can exacerbate mental health problems.
Moreover, according to the researchers, not everyone on sick leave is motivated to return to their job, a desire that is generally assumed to be true in the process, as the workplace may be an underlying cause of their sick leave. The study also raises the matter of each individual's responsibility to adapt their private life in a manner that restores and maintains their work ability.
Productivity and respect
One prominent member of the group behind the study is Thomas Hartvigsson, a researcher in practical philosophy at the University of Gothenburg whose areas of interest include medical ethics and patient rights:
"Essentially, defining work ability is a matter of how to organize the workforce as productively as possible while respecting other important values. Different ways of organizing health insurance entail giving different ethical values precedence at the expense of others," he says.
One of the academics responsible for the study is Elisabeth Björk Brämberg, associate professor of occupational medicine and a researcher at the University of Gothenburg and Karolinska Institutet. She emphasizes the importance of expanding our knowledge in this field:
"The majority of people on sick leave due to common mental disorders return to work within 60 days. At the same time, the interventions aimed at supporting people on sick leave in their return-to-work process are extensive, and thus there is a risk of leaving fewer resources for other types of healthcare. We need to take a step back and improve our knowledge about how to identify those who need more help at an earlier stage. The scientific evidence for current interventions is too weak," she says.