Tackling mental ill-health of the working-age population is becoming a key issue for labour market and social policies in many OECD countries. It is an issue that has been neglected for too long despite creating very high and increasing costs to people and society at large. OECD governments increasingly recognise that policy has a major role to play in improving the employment opportunities for people with mental ill-health, including very young people; helping those employed but struggling in their jobs; and avoiding long-term sickness and disability caused by a mental disorder.

Throughout the OECD, mental ill-health is increasingly recognised as a problem for social and labour market policy; a problem that is creating significant costs for people, employers and the economy at large by lowering employment, raising unemployment and generating productivity losses. The institutional set-up in Belgium has great potential in addressing the challenges of mental ill-health and work, mainly for three reasons. First, the advanced labour legislation has a strong focus on the prevention of mental ill-health at work; second, people with a mental disorder typically receive unemployment benefits rather than disability benefits upon job loss, hence remaining closely attached to the labour market which facilitates their reintegration; and third, the integrated sickness and disability benefit system provides ideal conditions for sickness monitoring, early intervention and effective return-to-work mechanisms. However, the current system is poorly implemented, passive and reactive and is not used to prevent labour market withdrawal of people with mental illness. The recent rapprochement by the public employment services (especially in Flanders) towards the mental health sector and other benefit systems to (re-)integrate people with mental disorders is a promising evolution to improve the labour outcomes and social well-being of people with mental ill-health. A more active mindset of employers, occupational health services, and sickness insurance companies (called mutualities) will be required, as well as systematic co-financing mechanisms between the different sectors to develop models of service cooperation and integration. The ongoing mental health reform provides the ideal opportunity for integrating health and employment services.

People with mental disorders underperform in the labour market. In Belgium, their employment rates are 15 percentage points lower and their unemployment rates 10 percentage points higher than those of people without mental disorders. Many of those who are employed struggle in their jobs (four in five workers with a mental disorder report reduced performance at work) and disability claims based on mental ill-health are frequent and rising. About one third of the 260 000 disability insurance beneficiaries and a significant proportion of the 160 000 disability allowance beneficiaries have a mental disorder as primary cause for their benefit claim. In sum, the total costs for the society, employers, individuals and their families are large, amounting to an estimated 3.4% of GDP in Belgium.

Building on the findings in the recently published OECD report Sick on the Job?, this chapter highlights the key challenges in the area of mental health and work and provides an overview of the current labour market performance of people with a mental disorder in Belgium compared to other OECD countries in terms of their employment and unemployment state, as well as their financial situation. The chapter also describes the role of the different government layers and the Belgian benefit system. It ends with a discussion of the advantages and challenges of the prominent role of the unemployment benefit system for people with a mental disorder in Belgium.

This chapter assesses the capacity of the Belgian education system to support vulnerable children and youth with a mental disorder during their school career and transition into the labour market. It discusses strategies to prevent mental health problems in schools and the effectiveness of the school system in dealing with students with mental disorders. It also reviews policies directed at early school leavers who are at a greater risk of developing a mental disorder and, finally, examines the effectiveness of employment programmes to boost labour demand for vulnerable youth.

This chapter looks at the role of employers who are ideally placed to help people in the workforce to deal with mental health problems and retain their jobs. It first describes the link between working conditions and mental illhealth, reduced productivity and sick leave; then discusses prevention strategies to address the challenges in the psychosocial work environment; and, finally, looks at employer responsibilities and the involvement of occupational health services in this process.

This chapter looks at the role and functioning of the Belgian sickness and disability insurance system. It pays particular attention to responsibilities and incentives of the key stakeholders, i.e. employers, occupational health services, general practitioners and mutualities, to tackle sickness absence early on and reintegrate sick workers as soon as possible. It also discusses reintegration measures the mutualities have at their disposal.

This chapter looks at the role and functioning of the Belgian disability allowance system, the scheme for people who have never worked or not long enough to fulfil the disability insurance contribution requirements. It discusses why the outflow to work is negligible and why disability allowances are a trap for young adults.

This chapter looks at the role of public employment services (PES) in dealing with mental disorders among their clients. It starts by describing how the PES recently became aware of the issue and the active labour market programmes that are gradually being developed to support job seekers with mental health problems. The chapter discusses the mechanisms the Flemish PES developed to identify and address the needs of people with mental health problems as well as the programmes targeted at long-term unemployment beneficiaries with multiple problems, including mental disorders. The chapter ends with a short discussion of the recent outreach by the Flemish PES to beneficiaries of the social assistance and disability benefit systems.

This chapter discusses the effectiveness of the mental health care system in Belgium in providing adequate treatment to persons with mental disorders, subsequently looking at the challenges for and resource capacity in primary health care and the accessibility of specialist mental health care services. It also discusses the ongoing major reform in the mental health care sector and the potential role for the employment sector to improve the coordination between, and the integration of, the mental health care system and the employment system.