Denmark

The Danish Agency for Labour Market and Recruitment (STAR) is responsible for implementing and following up on employment policies in Denmark. The overall aim is to help as many people as possible into the labour market or education. In line with active labour market policies, Danish employment policies have since 1994 demanded that unemployed people actively qualify and apply for jobs and education in return for social benefits (Kongsgaard, 2022). As in other OECD countries, there has been a shift in how unemployment is understood: rather than being a problem related to economic trends and structures, unemployment is seen as something that the individuals need to actively address (Jørgensen, 2008). Psychological, physical, social, and other problems must not stand in the way of getting a job. Therefore, it is not enough to match vacant positions and relevant citizens, but one also has to create services that respond to the citizens’ problems (Bjerge et al., 2020; Kongsgaard, 2022). All reforms of the employment system since have had as their primary aim the broadening of the scope of the workforce. As a result, the focus on activation applies to most groups of unemployed people (Andersen & Larsen, 2018; Bjerge et al., 2020; Kongsgaard, 2022). 

There is little mention in the Danish employment policies of people with substance use specifically. These people are typically categorised as socially marginalised (socialt udsatte in Danish) and are entitled to services under the Act on Social Services. They may have an underlying mental illness and/or substance use, or they are homeless or support themselves by prostitution. Some policies define social marginalisation by the complexity, multitude, and variety of different problems (for more details, see Bjerge et al., 2020). Other policies present the problem and the response to the problem elusively as help and support to stabilise the persons’ life situation to such a degree that they become able to participate in work-oriented services (Kongsgaard, 2022). Further, the marginalised persons’ situations are often represented as a temporary stage in their lives, which they can change or be helped out of so that they can either work or take early retirement.

In 2009, job centres were established in the 98 Danish municipalities with the core responsibility for unemployment services. Job consultants counsel and advise unemployed people in order to find their clients a job that matches their qualifications. There are no specific educational requirements to becoming a job consultant. Approximately 40% of them are social workers; the rest come from a mix of educational and training backgrounds ranging from hairdressing and carpentry to academia and accountancy (Fagbladet 3f, 2016).

Job centres are there to help the unemployed enter the labour market and to help young people in particular enter the educational system. The centres are obliged to maintain a constant focus on job opportunities and help companies and organisations recruit the kind of labour they need. The Danish job centres also focus keenly on the work-first approach, that is, on creating the most direct and fastest route to employment through education and training and with the help of increased skills. Ever since the establishment of the job centres, these centres have been subjected to more and more centralised regulations and demands. The system is extremely stringent, so much so that the employment system works as a silo in relation to, for example, social services and even internally (Caswell & Larsen, 2017; Kongsgaard, 2022). 

Unemployed people are categorised as ready for work (arbejdsmarkedsparate in Danish), ready for education (uddannelsesparate), or ready for activity (aktivitetsparate). As summed up by Kongsgaard (2022), ‘everyone is ready for something’ in this line of thinking (Kongsgaard, 2022, p. 34). The last category, being ready for activity, is most interesting in relation to this report, as ‘ready for activity’ is most often used in relation to people with multiple problems alongside unemployment, including substance use and/or mental health problems.

Also, interventions targeting unemployed marginalised people sometimes come under the administrative realm of the Authority of Social Services and Housing. Substance use treatment services mainly operate under this agency (apart from health-related regulations regarding the distribution and handling of, for example, substitution medications) as well as other services related to social marginalisation, such as homelessness or disabilities. The municipalities are responsible for the psychosocial and medical treatment of substance use, and treatment services are frequently organised in sectors alongside psychiatry, social affairs, disabilities, and so on. Recently, though, some municipalities have developed a stronger awareness on employment in all sectors of the municipality (Aarhus Kommune, n.d.).

JobFirst was tested in 2016–2017 by job centres in 15 municipalities where the members of the target group were categorised as ready for activity and regarded as marginalised citizens (Styrelsen for Arbejdsmarked og Rekruttering, 2018). The idea was that these people should enter the labour market as fast as possible in the right job match, and the motivation for working should come through the right tasks. The evaluation showed that the target group experienced better mental health, that they to a higher degree believed in their own abilities, and that 19% managed to obtain ordinary working hours (12% in the control group) with an average of 4.6 working hours a week (2.75 working hours in the control group) (Styrelsen for Arbejdsmarked og Rekruttering, 2018). JobFirst did not have a specific focus on co-operation between different sectors, yet it was centred around the hopes and wishes, and aims and resources of the people and close collaboration between the job centre and the individual. 

A special cross-disciplinary resource clarification process can be initiated if problems other than unemployment, such as substance use, are suspected and if it is likely that people risk being unemployed for an extended period or on early retirement if no special measures are taken. The response in such a situation is cross-disciplinary cooperation between different administrations and service sectors (Styrelsen for Arbejdsmarked og Rekruttering, 2023a, 2023b). In a process which lasts from one to three years, the focus lies on developing the working skills and competencies of the individual through concrete, active initiatives. The municipal rehabilitation team evaluates the needs of the individual, who may have a range of complex problems (Styrelsen for Arbejdsmarked og Rekruttering, 2023b). The Danish Agency for Labour Market and Recruitment (STAR) themselves point out that the registration of alcohol and drug treatment is incomplete in the resource clarification process, which implies that some individuals in these services use substances.

In 2018–2022, the municipalities had the possibility to refer socially marginalised people to work where they could earn up to DKK 20,000 (about 2,600 euros) a year without having to pay taxes or any deduction of social benefits (Socialstyrelsen, 2022). This initiative was intended to give marginalised people new opportunities and encourage workplaces to help them. The evaluation showed that 89 out of 98 municipalities used the free pass. More than one third of all visitations led to employment, and the average tax-free income was DKK 15,500 (about 2,000 euros). The free pass was increasingly used during the try-out period, leading to encouraging results among the socially vulnerable who had been assigned to the try-out in 2019 and who had used the free pass: while 75% were employed less than six months after the assignment, 35% were employed in the same workplace for more than six months (Socialstyrelsen, 2022). The visitation process for the social free pass was administered by a municipal social worker. Some municipalities assigned the try-out to employment services, others to social services. Both options were reported as helping the socially vulnerable, who were recruited, among others, at shelters and drop-in centres. Twelve percent of the individuals in the try-out had been enrolled in drug treatment the same year that they received their social free pass. The starting point of the programme – that the individuals should find a workplace on their own – was perceived as problematic for some participants (Socialstyrelsen, 2022).

Three municipalities are set to launch try-out services in 2023 to provide customised cooperation between substance treatment and job centres specifically for young people aged 15–25. This service is to enhance the participants’ inclusion in the labour market and reduce problems related to substance use at the same time (Metodecentret, n.d.). The try-out is based on a pilot study in one municipality, which established genuine and successful collaboration between professionals from the treatment centre and the job centre. JobRus takes its point of departure in the participants’ wishes, hopes, and resources. Their everyday lives, wellbeing, and treatment outcomes are systematically registered by tools tested in the MOVE treatment programme (short for motiverende, opfølgende, virksom, effektiv in Danish; motivational, active follow-up, effective, and efficient), including registration of TEM factors (trivsels- og effektmåling in Danish; evaluation of wellbeing and effectiveness).

Individual placement and support (IPS, see Fact box 1) is available in several Danish municipalities. Data from the initial try-outs in four municipalities in 2012–2017 showed that in comparison to regular services, the level of entering work or education had increased by 13% in IPS programmes (Christensen & Eplov, 2018). The try-outs focus on a holistic approach and cooperation between sectors, and also rely on a manual and evidence-based procedure. In this programme administered by job centres, the IPS consultants have specific training and responsibilities. They work in close collaboration with the 15–25-year-olds and with the psychiatric system. Some individuals with substance use were included in the try-outs, while other municipalities have later customised an IPS programme specifically for substance users. 

The municipality of Copenhagen is a particularly well-known example: individuals with substance use and/or mental illness can enter the IPS programme either through a drug treatment centre or a psychiatric centre (Københavns Kommune, n.d.). The programme only accepts participants on non-insurance-based social benefits. Alongside the IPS programme, the participants will also be enrolled in either drug or psychiatric treatment. According to numbers on the municipal website, up to 62% of the participants have obtained jobs. However, it is not specified which particular groups this applies to. While the evaluation suggests a positive effect, it is difficult to gauge in detail from the available numbers how strong the effect is.

Some private providers of employment services identify addiction as one of the possible themes included in the process of helping unemployed individuals. Municipalities can purchase private services to help individuals who not only have employment problems but also have other issues to deal with. An example is the socio-economic enterprise the Green House (væksthuset in Danish) (Væksthuset, n.d.), where key employment services professionals have taken courses in addiction counselling and provide feedback and coaching to their colleagues. This is to ensure that all employees have basic knowledge about substance use and treatment. In this sense, discussions of problematic substance use and ways to handle it are integrated in the individual employment service. Also, Green House staff may suggest that the participants enroll in substance use treatment as part of the process. There is no publicly available evaluation of these services yet, but the organisation itself estimates that 20–30% of all participants in their programmes have a problematic substance use. Annually, some 2,000 citizens are enrolled in these employment programmes. 

As a whole, the review shows that there is a lack of employment services and policies in Denmark specifically targeting individuals with substance use problems. However, it also shows that several services and policies are aimed at marginalised individuals with complex problems, which may also include substance use. While the evidence is still limited, there are indicators that IPS and the social free pass can have a positive effect. It will also be interesting to follow JobRus in the coming years, as the project includes an accessible, externally conducted evaluation. However, it is not possible to point to any specific services that have proven particularly successful so far in helping substance users into the labour market. There are nevertheless some important findings to consider from services that target marginalised individuals more broadly. Firstly, holistic services operating across different sectors and expertise are important. Secondly, it is equally important to focus on individuals as active actors in shaping the aims and processes of the services. At the same time, it is crucial that professionals believe in the individuals. These insights echo other studies of employment and social services directed towards people who for various reasons may be excluded from the labour market and who do not profit from ordinary employment services (Bjerge et al., 2019; Danneris & Caswell, 2019; Kongsgaard, 2022; Larsen & Caswell, 2022; Væksthuset & Aarhus University, 2017).