1. Occupational disease compensation and mental disorders in Finland Teija Honkonen MD, Psychiatrist, FIOH 14.1.2004

2. 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