Clampdown on sick leave for 'burn out'

Being granted sick leave for symptoms of 'burnout' could soon become much harder in Sweden due to new national guidelines to come into effect in October.

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The strict new guidelines, brought forward by the National Board of Health and Welfare (Socialstyrelsen) and the Swedish Social Insurance Administration (Försäkringskassan), will be used by doctors decide which people are unable to work.

Jan Larsson, who chairs the committee that drew up the new rules, admitted to Dagens Nyheter that they would be controversial. He said the clampdown would particularly affect conditions such as burnout and long-lasting pain.

Burnout is one of the major causes of absence in Swedish workplaces. People diagnosed currently stay off work for an average of 199 days. Under the new plans, they will often not be given any leave at all.

Burnout is officially referred to by Swedish doctors as 'utmattningssyndrom', which directly translates as 'fatigue syndrome', but which should not be confused with ME, or chronic fatigue syndrome.

According to official guidelines from the National Board of Health and Welfare, the symptoms of burnout include difficulty concentrating, difficulty in handling demands and deadlines, irritability, sleep difficulties, physical weakness or exhaustion, sometimes combined with aches, tummy troubles or chest pains.

Instead of taking people with these symptoms out of work entirely, they should instead be advised to "stop working so much," Larsson said.

Reduced sick leave periods and revised guidelines on expected work capacity are to be applied to around 90 diagnoses.

"We can't say that we have a good scientific basis for the new guidelines," said Larsson.

"Nonetheless, if we tried to skirt round the difficult diagnoses it would feel pointless to bring out guidelines."

The new guidelines are intended to cut sick leave that does not have a properly thought-through purpose. They were commissioned by the previous government and have the support of the current administration.

Under the new plan, people with burnout will usually not be granted any sick leave at all, although those whose symptoms include severe sleep problems will be granted several weeks leave. The guidelines also stipulate that an action plan should be put in place for these people.

Depression is another diagnosis to face a clampdown. People with depression currently miss an average of 341 days work. In the future, people with mild depression will not be granted sick leave at all, people with moderate depression will be granted three months, and people with serious depression will be told to stay at home for six months.

The guidelines have been developed together with groups of medical experts. According to Larsson, the experts have set out what they think is reasonable in different situations, taking account of the seriousness of the illness and the kind of job the person concerned has. This has led to the conclusion that a person with burnout should not usually be given sick leave.

"Sick leave is rarely a good means of treatment. Regarding so-called burnout, doctors are generally agreed that sick leave is not a good method of treatment."

Larsson said that people who "experience mild difficulties which are really to do with their personal situation," should not be given sick leave for burnout.

"These are difficulties that people perhaps have to learn to deal with, but which are not really an illness," he said.