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 RehabilitationA 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.