Going from working in a high-demand profession to a hospital stay for severe depression can happen to even the most driven, confident employees. Katrien Deboodt of De Haan on the Flemish coast is a well-educated businesswoman. When she became pregnant with her son in 2007, this change, along with stress from her work, caused Deboodt to have an “emotional and psychological crash,” including thoughts of suicide.

“Before, I was a perfectionist, and I was not always happy with my results,” says Deboodt. “I was expecting too much of myself, and I eventually wasn’t satisfied with anything I was doing … I wanted the best for other people, but I forgot myself.”

Thanks to intensive therapy and support from her husband, Deboodt was eventually ready to work again, but she struggled with the anxiety of starting over. Her doctor recommended she contact GTB, a Flemish organisation financed by VDAB that helps those who’ve been faced with mental health problems or certain disabilities to enter the job market. Each process is tailored to meet the individual’s needs.

While mental health issues cost Belgium 3.4% of GDP, reduced productivity and lost employment are much larger expenditures than health-care fees. “We find mental health problems are very widespread,” says Veerle Miranda, an economist in the Social Policy Division of the OECD. “One person in five has a mental health problem, and that is the case in all our member countries. Being unemployed often worsens your mental health, so if VDAB can intervene as soon as possible, the problem won’t be so severe.”

Only within the last decade have mental health problems been given heightened attention in Belgium and other OECD countries. In Flanders, when employment policies were transferred from VAPH, the Flemish agency for people with a disability, to VDAB in 2006, there was an increased awareness of mental disorders. This move identified those who had issues unrelated to their professional skills that kept them from employment. The sluitend maatpak, or custom-made approach, is a VDAB policy created about seven years ago that says everyone who is a job seeker should receive guidance that meets his or her individual needs.

“Before this approach, a lot of people with mental health problems were hidden in the figures somewhere, but no one really cared or knew they were there,” says Luc Henau, general manager at GTB, which is subsidised by the VDAB and the ESF, the agency that implements the European Social Fund in Flanders.

This revealed a “relatively large subgroup” with severe medical, mental, psychological or psychiatric problems (known as the MMPP group). Many in this group desired work, but they weren’t ready for regular employment and first needed other assistance.

Many agencies, one direction

In 2009, a pilot project was launched to assist those in the MMPP group for up to 18 months. It was successful and is still in place today. Job seekers receive help from a GTB job coach, a psychologist and an empowerment coach who helps lead them in progressive steps to employment.

Labour and health sectors are combining their resources to make the GTB programme work. “A few years ago, we didn’t talk much, but now we pick up the phone and share information,” says Bie Bijnens, director of training and coaching for WEB, a Turnhout-based organisation that is involved in the programme.

Before this cooperation, the psychologist and the labour sector may have given the client conflicting messages on when it’s appropriate to begin employment. “We are working very hard so that the client is steered in one direction,” says Henau.

Removing the stigma

Not placing labels on job seekers with mental health issues may help relieve the stigma often associated with these problems. One way Flanders is tackling this concern is when job seekers, no matter their abilities, first visit a VDAB office. If someone is suspected of needing special assistance after speaking with a VDAB representative, this person isn’t told they have a disability and must visit another organisation, as was the case before 2008. Instead, they are sent to talk to someone from GTB or another service within the same building.

Another way to remove stigma is hiding the particular issue in a code system based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. “If a specialist notes that someone has F142, you will immediately know the rights of this person regarding labour, like the right to a workshop,” explains Henau.

In the future, a different system could be used that would be even less of a stigma than the DSM code – the International Classification of Functioning, Disability and Health (ICF), which is gaining popularity in Europe. “In DSM, you have to show your weaknesses to receive guidance, but the ICF focuses more on a person’s strengths,” says Henau. “In fact, everyone has strengths and weaknesses.”

Henau says they are currently working on an experiment with the ICF system and hope to have this model approved by the Flemish government.

Changing employer attitudes

The ICF system may also benefit the unemployed when contacting potential employers. The OECD review found “significant reluctance” by Flemish employers to hire someone with mental health problems.

“Not every employer is throwing open its doors,” admits Henau, but he thinks communication is key to improving the situation. “There is a difference between saying to an employer: ‘Do you want to take someone with autism?’ and ‘You are looking for someone who doesn’t make mistakes on a job that requires strong concentration. We have the right person for you’.”

Multiple sources from GTB note that those struggling to get back into the workforce are often more motivated and loyal to an employer because they now fully appreciate having a job, which also is a good selling point.

One job seeker fitting this profile is Ahmed Abidar, who sought help from GTB and WEB after struggling with mental health problems. He recently completed a practical placement programme, which allows clients to slowly build up their working capacity, starting with a couple of days a week, in the hope of reaching full-time employment.

“He worked very well, and when he needed to take a break, we had to tell him to take a break, to stop working!” says An Bruylandt, a WEB empowerment coach.

“Before, I found it difficult to leave home and meet people, but now it’s easier, and I’m ready to start work again,” says Abidar.

The programme encourages practical placements with a family member or someone in the neighbourhood, as it’s “less threatening” and will help build their self-confidence again, says Bijnens. In some cases, if a person isn’t ready to move into a regular work environment, they may begin with volunteer work or a sheltered workshop, which is offered by WEB and other similar organisations.

The VDAB may also provide subsidies to employers for the loss of production by someone re-entering the job market, with less funding over time as the employee develops.

A new beginning

In the meantime, Katrien Deboodt is back at work. Starting with volunteer positions, she steadily got used to regular activity again until she was ready for employment. Since 2010, she has worked in a job that allows her to properly balance her personal and professional life, and she has been able to have another child without the mental health repercussions.

“Now I have more self-confidence,” she says. “I believe in myself. Maybe this period was a turning point in my life that had to happen in order to be able to start down a new path.”

While the VDAB programme has primarily focused on the unemployed, the OECD recommends the system also further target those who are employed but at risk of losing their jobs because of mental health problems. Henau says they are currently developing a “work and welfare” vision to focus on long-term careers.

The OECD also advises employment services to better target the mild or moderately mentally ill and young people who may have mental health problems before entering the job market.

Now that a programme is up and running, it’s time to look at a legal framework, with more consistent rules, says Henau. It’s “crucial”, he says, to develop a proposal with the Flemish government to make sure the legal framework is complete by 2014, before the elections.

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