"We Are All Digging Our Tunnels": Health Professionals' Strategies for Managing (Work-related Mental Ill Health in) the Swedish Welfare System

This presentation addresses the topic of professional work, through an empirical study of health professionals’ efforts to manage people suffering from work-related mental ill health. Focus is directed towards the dilemmas facing the many interrelated professions engaged in this area. Therefore, the study examines various negotiating strategies that different kinds of health professionals employ in relation to organizational frameworks, national economic incentives and the social security system.

Mental health problems are a growing global concern. In Sweden, the welfare state’s cost of mental health has been particularly high since the 1990s. Dealing with mental health issues has therefore received political attention, not least in regard to how it is related to the working environment. Due to its political embeddedness, work-related mental ill health is a useful starting point for drawing attention to the complex and intertwined relation between professional work, policies of health and illness and the organization of care within the Swedish welfare system. 

The presentation is based on qualitative methodology, consisting of fieldwork and 30 semi-structured interviews within Swedish primary health care and occupational health care. Informants are health professionals involved in the diagnosis and/or treatment of work-related mental ill health: physicians, therapists, counsellors, occupational therapists, nurses and behavioral scientists.

In performing their professional roles when managing work-related mental ill health, results point towards health professionals’ employing primarily four strategies. These strategies are often locally articulated, individual solutions. Yet, there is a common structural character to the type of dilemmas the various professional groups encounter. Furthermore, while some structural aspects are negotiable through tampering with diagnosis, or redistributing resources, others, as abiding to the Swedish Insurance Agency’s rules, are not. Finally, while health professionals often stay within the given structural frameworks, on rare occasions, they consciously go against them.