Usefulness of an ability-based health model in work ability assessments provided by psychiatrists and psychology specialists writing social security certificates

Abstract

Purpose: To investigate whether adding descriptions of the health factors “ability,” “environment” and “intentions/goals” to the officially sanctioned biomedical disability model (BDM) would improve assessments of work ability for social security purposes. Method: The study was based on a theoretical design consisting of textual analysis and interpretation. Two further work ability models were defined: the mixed health model (MHM), which describes health factors without assessing a person’s abilities in context, and the ability-based health model (AHM), which assesses abilities in a concrete context of environment and intention. Eighty-six social security certificates, written by psychiatrists and psychology specialists in a Norwegian hospital-based mental health clinic, were analysed in relation to the three work ability/disability models. Results: In certificates based on the BDM, a general pattern was found of “gradual work training”. The MHM added health factors, but without linking them together in a concrete way. With the AHM, work ability was assessed in terms of a concrete unified evaluation of the claimant’s abilities, environments and intentions/goals. Conclusion: Applying the AHM in work ability assessments, in comparison with the BDM and the MHM, is useful because this foregrounds claimants’ abilities in a context of concrete goals and work-related opportunities, as a unity.

Implications for Rehabilitation

• A concept of health should include ability, environment and intentions/goals as components.

• When all three of these components are described in concrete terms in a work ability assessment, an integrated picture of the individual’s abilities in the context of his/her particular intentions/goals and work opportunities comes to the fore.

• This kind of assessment makes it possible to meet the individual’s needs for individual follow-up in a work environment.

• Action theory
• disability
• holistic health
• ICF
• social security medicine
• work ability assessment

Acknowledgements

We would like to thank the consenting claimants and experts, Wenche Bratland for secretarial assistance, and Søren Brage, Bjørgulf Claussen, John Gunnar Mæland and Bård Natvig for helpful comments. We also thank Kersti Wagstaff for linguistic guidance and copy editing.

Declaration of interest

Vestfold Hospital Trust, Norway, financed this research project. The authors report no conflicts of interest.