Greenland

The act on treatment of addiction (Inatsisartutlov om behandling af afhængighed, 2019) regulates the service for citizens with substance use problems. The law lays out a free-of-charge national treatment offer within an organisational frame of a one-stop shop. It also points to cross-sector cooperation to ensure that the citizen remain free of addiction after treatment, and that the wellbeing of children in families affected by addiction is paid special attention both on the strategic and the practical levels. Before the treatment or as soon as possible after it has begun, the home municipality must start to prepare an after-care plan for interventions needed on work, housing, job training, and general follow-up after treatment. The local treatment centre (Allorfik), the municipality, and the local health service are required to agree on the objectives of cross-sector and multidisciplinary cooperation and the distribution of responsibilities. The cooperation may also involve the correctional services, the police, and other authorities or private actors relevant for the individual citizen with addiction (Inatsisartutlov om behandling af afhængighed, 2019). The treatment centres map the users’ overall situation with the help of a slightly modified version of the Addiction Severity Index (McLellan et al., 1980).

Greenland has three main types of transfer income: job-search benefit, early retirement pension, and public benefits. As of 1 July, 2023, the labour market benefit was replaced by the job-search benefit (jobsøgningsydelse in Danish). The new law and the revised law on public benefits are important to the Government’s aim to enhance self-support and enable jobseekers to take responsibility for their own situation. The new elements in job-search benefit legislation make this benefit conditional. A job offer cannot be turned down, jobseekers have to apply actively for work, and they cannot refuse to move for a job after being unemployed for 12 or 24 months. The job-search benefit can be granted permanently and corresponds to 90% of the minimum salary for workers who are members of SIK (Sulinermik Inuussutissarsiuteqartut Kattuffiat), the largest labour union in Greenland. The rate goes down to 80% after 26 weeks, and to 65% after 1–2 years. It is not yet specified if the job-search grant is available during substance use treatment (Inatsisartutlov om jobsøgningsydelse, 2022).  

Public benefits are provided in acute situations, or they can be permanent if all other options have been exhausted. Permanent benefits are meant to correspond to 65% of the minimum salary for uneducated workers on a SIK agreement. This should cover reasonable expenses (rimelige udgifter) for housing and other necessities, and includes a small amount for daily living expenses (rådighedsbeløb). It is tax free and measured out with some discretion, which means that similar families might receive significantly different public benefits, and in some families the perceived economic incentives for obtaining employment are low (Pedersen, 2022b). These potential negative incentives are addressed in the revised law, which will become effective in 2024 (Inatsisartutlov om offentlig hjælp, 2022).  

Residents under the age of 66 and with reduced work ability can apply for early retirement pension (Inatsisartutlov om førtidspension, 2015; Inatsisartutlov om ændring af Inatsisartutlov om førtidspension, 2020). The law aims to bring more citizens on early retirement pension back into the labour market on the basis of an evaluation of their work ability. In a three-tier system, being able to work 51–75% qualifies for the lowest pension, having 26–50% of the work capacity left qualifies for a middling pension, while being able to work only 25% or less qualifies for the maximum pension. The work ability of those under 60 is re-evaluated every five years. 

The Finance Bill for 2021 identified explicitly the reasoning behind the legal reforms on job-search benefit and public benefits as higher employment, improved incentives for employment, clear rights and obligations, and less discretion in measuring out public assistance. This would also release administrative resources (Government of Greenland, 2020). The policy direction in the plan behind Allorfik is in line with this. In the foreword, the Minister of Health stated that the plan should be seen in the light of the Government’s work with an early retirement pension reform, an employment reform, and especially the efforts to get the unemployed included in the labour market. The plan had a major role in ensuring that families who need help also get it. It also has a function in reducing unemployment and enabling Greenland to become self-sufficient with a well-educated labour force (Naalakkersuisut, 2015). 

The rules and regulations lay out the ways in which all citizens can be a part of the labour market (given that they are able enough or can gain the ability to participate), but apart from the general employment service in Majoriaq centres, no services are provided nationally which would include individuals with present and former problems with substance use. The Majoriaq centres have three principal tasks: job placement, education and employment guidance, and enhancement of qualifications for employment and education. Small local projects may exist, but were not located.

The employment system aims to facilitate good matches between jobseekers and employers on a labour market that has challenging structures in terms of geography, available job types, and skills distribution. The overarching interventional approach regarding help to access the labour market is up-qualification or education first, and the Majoriaq centres are seen as a key to this. The Ministry of Social Affairs and Labour has the overall responsibility for both social services (including public benefits) and the labour market. 

The national treatment system in Greenland is free of charge. Treatment is primarily available for alcohol, cannabis, and gambling dependence in the same treatment institutions for all three addictions. This has proved relevant given the size of the population. Alcohol use is the most common reason behind treatment, but 30% of those with a problem of alcohol use also have a problem with cannabis use, and 80% of those with cannabis use and 60% of those with gambling addiction also have a problem with alcohol (Andersen et al., 2022).

Allorfik, a unit under the Ministry of Health, has since 2016 managed the treatment nationally (Niclasen et al., 2020). The general Allorfik unit serves as a knowledge centre on addiction, with treatment centres for persons aged 15 and above in the five largest towns, which is where 62% of the population live. For the 24% of the population living in other towns, a private provider offers treatment locally twice a year, and once a year in the two smallest towns (Qaanaaq and Ittoqqortoormiit). The 14% of the population living in villages are either offered in-patient treatment in Nuuk or internet-based treatment (Andersen et al., 2022). All treatments for substance use problems and gambling are registered in the National Database on Substance Treatment. In 2021, 741 treatment cycles were registered among 696 individuals. In other words, 1.55% of the population aged above 15 years were in substance use problems treatment at least once (Andersen et al., 2022). This is 4–5 times more than in Alcohol Use Treatment (AUD) in Denmark (Sundhedsdatastyrelsen, 2020).

Many individuals treated for substance use live outside the cities, where there is economic growth and a lack of employees. In the Majoriaq centres, the participants are divided into three match groups according to the level of effort that their cases need. Those in Match group 1 are ready for a job. Match group 2 includes individuals with limited education and some labour market experience, but no health issues. Those in Match group 3 have health or other challenges. For example, children in this group may be without care, which can prevent a connection to the labour market. The needs of those in Match group 3 are covered by the municipal social services system (Danmarks Evalueringsinstitut, 2019; Holt & Thuesen, 2022). The evaluation of the Majoriaq centres found that it was hard to help even those participants to employment in the smaller towns (Danmarks Evalueringsinstitut, 2019; Holt & Thuesen, 2022). In general, it was hard to find employment incentives for citizens in Match group 2, because other support such as housing support and lower daycare charges end as soon as the citizen enters full-time employment. Holt and colleagues (Danmarks Evalueringsinstitut, 2019) interviewed only a few jobseekers, but they found that almost all interviewees in Match group 2 had trauma and personal issues that stood in the way of employment. Among citizens in up-qualification, too, a majority was similarly described to have experiences and personal issues with a possible negative impact on their performance and outcomes. At the same time both the employees and the employers in the Majoriaq centres agreed that the employees lacked professional skills to help citizens with psychological and social problems, as most of them were educated as office assistants (Danmarks Evalueringsinstitut, 2019).

There were also cooperation difficulties between Majoriaq and the local social services (Danmarks Evalueringsinstitut, 2019; Holt & Thuesen, 2022) and not least between the substance use treatment and the local social services (Dyrberg et al., 2023). Decentralised cooperation is clearly difficult. To help the local social services, the Allorfik centres agreed in 2019 to draw up mandatory aftercare plans for citizens that do not have children, who have a job, a home, and a stable economy. In 2022, Allorfik and the municipalities made 35% and 29% (varying from 22% to 48% between the municipalities) of the aftercare plans respectively. In 36% of the cases, aftercare plans were not made (Dyrberg et al., 2023).  

The most important regulation of labour market interventions in Greenland is the legislation on the one-shop-stop approach to job provision, job training, and education in the Majoriaq centres (Inatsisartutlov om job-, vejlednings- og opkvalificeringscentre, 2015). The municipalities run a Majoriaq centre in each of the 17 towns in Greenland. These centres are also responsible for the service to the nearby villages. Each Majoriaq has three sections: a labour market section, an education counselling section, and a skills upgrading section (Danmarks Evalueringsinstitut, 2019; Holt & Thuesen, 2022). 

Majoriaq centres are tasked with drawing up an action plan for their clients to bring them into employment or education. The up-qualification and the labour market sections are still divided in many Majoriaq centres (Danmarks Evalueringsinstitut, 2019). Educational upskilling courses help the clients to take a school-leaving exam, while practical upskilling is provided to the young or younger citizens who need to strengthen their personal and social skills before they are ready to start work or an educational upskilling course (Danmarks Evalueringsinstitut, 2019; Holt & Thuesen, 2022; Departementet for Uddannelse, Kultur, Idræt og Kirke, n.d.). Practical upskilling is either a practical course (værkstedskursus) for 10 month or involves other measures, which may also include job training. Most up-qualification courses, 54%, were offered to citizens in Match groups 1, and 13% of the participants in up-qualification were aged 30 and above. Most participants, 61%, were engaged in educational upskilling, 13% had their practical skills upgraded, and 15% were involved in other types of non-educational up-qualification (Danmarks Evalueringsinstitut, 2019).

Practical up-qualification may differ between the Majoriaqs (and is not available in all of them), but most centres have courses where the participants prepare goods for the centre or the local community, prepare meals or cook for the centre, make outdoor clothing, or produce wooden objects (without competing with the private sector). One centre grows vegetables for the local community (Danmarks Evalueringsinstitut, 2019). While the Majoriaq employees and participants have rated the courses positively, only 54% of the participants completed their practical up-qualification course (Danmarks Evalueringsinstitut, 2019). 

When a person is ready to go into the educational system, he/she can in Majoriaq apply to any education offered to Greenlandic citizens. All education in Greenland is free of charge, and a salary or student allowance will be available. 

Individuals with a former substance use problem can – as the population as a whole – contact the local Majoriaq centre themselves or they might be referred to the centre by their social worker. Clients with substance use or in treatment are not provided special service.

Job training (revalidering) comes with a regular salary or financial support corresponding to 70% of the minimum salary for an uneducated worker under agreement with the workers’ union SIK. 

Interventions for labour market integration are governed by legislation and emphasise a unified approach in all 17 Majoriaq centres, which play a pivotal role in the provision of employment services, including employment guidance, skills enhancement, and education. Crucially, up-qualification and practical upskilling courses prepare citizens for employment or further education. Based on their employment needs, the citizens are categorised into Match groups, with services tailored accordingly. However, challenges arise in helping citizens with psychological and social issues, as there is a lack of professional expertise among Majoriaq employees. Furthermore, there are cooperation difficulties between the Majoriaq centres, local social services, and substance use treatment services, hindering effective service delivery. Lack of collaboration is still a major problem.