The Finnish Institute of Occupational Health’s research project "Brief psychological treatments and psychotherapies as part of future occupational healthcare" investigated the implementation and effectiveness of psychotherapy in occupational health care. During the project it was observed that the number of therapy appointments varies from six to ten or even twenty times, and the criteria for referral to treatment and followup of effectiveness vary between different occupational health care providers.
“It is unclear whether the duration of psychotherapy is determined more by the number of appointments allowed by the occupational health care agreement or by the actual need for treatment,” says Sanna Selinheimo, Senior Researcher at the Finnish Institute of Occupational Health.
“It should be possible to demonstrate the benefits of therapy to patients, employers and decision-makers in order to develop the appropriate forms of mental health support in occupational health care,” Selinheimo emphasises.
Effects on work ability are not unambiguous
An analysis of the register data on occupational health care clients, which is exceptionally extensive even by international standards, revealed that the majority of those referred to psychotherapy did not have long absences due to mental health reasons.
People with previous mental health problems had an increased risk of incapacity for work even before referral to therapy. The increased risk of incapacity for work had continued for at least one year before the referral to therapy.
"Therapy can be particularly helpful for people with a lot of sickness absences. In order to reduce human suffering, it would be important to provide access to care as soon as signs of incapacity for work appear. It is important to assess the type of treatment that best meets the individual needs of patients who do not experience incapacity for work. This would promote efficient allocation of resources," Selinheimo says.
The results of the study also demonstrated that the rates of incapacity for work of the control group decreased similarly to those who had undergone therapy.
"The appearance of signs of incapacity for work triggers various support functions in occupational health care and workplaces, which this register dataset fails to describe. In other words, psychotherapy is not the only support option when depression or anxiety affects work ability," Selinheimo says.
Recommendations
So what should be done to improve a situation that is often difficult? Occupational health care should assess the criteria for referring to different services. Occupational health services and employers should further develop the assessment of effectiveness in order to assess whether the various benefits are realised as well as possible.
There is a need to improve the integration of talk therapy with other work ability support measures carried out by occupational health care and the workplace. It would also be beneficial to develop the followup of talk therapy and referral to further treatment according to the needs of the patient. The key is to develop the assessment of need for care with a focus on mental health.
“Stratifying treatment by referring patients to different treatments on the basis of their risk factors, severity of symptoms and prognosis, would support appropriate allocation of resources,” Selinheimo reflects.
Learn more about the studies
- The project was implemented by the Finnish Institute of Occupational Health and funded by Kela.
- The register study is based on occupational health care customer data from Terveystalo, combined with several national registers.
- The project also included a questionnaire survey carried out for occupational health services on the implementation of various talk therapies.
- More detailed information about the research project.
- Published in the international, peer-reviewed publication series BMC Health Services Research the study examined changes in work disability pathways in Finnish register data among people receiving brief psychotherapy and their peers.
- The original study based on survey data published in the medical journal Duodecim:
Lyhytpsykoterapia ja muu keskusteluhoito toteutuu vaihtelevasti työterveyshuolloissa.
Further information
- Sanna Selinheimo, Chief Researcher, Finnish Institute of Occupational Health, tel. +358 43 825 0397, sanna.selinheimo [at] ttl.fi (sanna[dot]selinheimo[at]ttl[dot]fi)
