Occupational Therapists in Finland Arrive Too Late to Help the Unemployed

Unemployment is usually framed as an economic problem, a matter of statistics, labour markets and policy levers. But a new study from Finland argues that it is also an occupational one, and that the health professionals best equipped to address it are being called in far too late. The research, published in the Scandinavian Journal of Occupational Therapy, offers the first systematic look at how occupational therapists in Finland work with unemployed people, and it paints a picture of a profession with real expertise but limited access, often meeting clients only after every other option has been exhausted.

The scale of the problem is considerable. The Organization for Economic Co-operation and Development estimates that roughly forty million people across its 38 member countries are unemployed. Finland, a nation of 5.6 million, reported 311,100 unemployed individuals in August 2025, of whom 129,200 had been out of work for twelve months or longer, the threshold the International Labour Organization uses to define long-term unemployment. That gives Finland the second-highest unemployment rate in the European Union, and the number of unemployed people grew by more than 30,000 during the very period in which the study was conducted.

Despite this, occupational therapy research has largely ignored the situation. A 2018 search of a dedicated occupational therapy database found only ten articles with unemployment as their primary focus, and a repeat search for the present study added just five more. The authors, T. Turtiainen, L. Rosenberg and I. Jansson, note that most existing work concerns people returning to jobs they already have, or supporting those with disabilities into employment. People who have no job to return to have remained, in their words, somewhat neglected.

To fill the gap, the team adopted a phenomenographic approach, a qualitative method designed to map the different ways professionals understand and experience their own practice. Nine occupational therapists from three different regions of Finland and a range of organisational settings took part. Data were gathered through one focus group, two dyadic interviews and two individual interviews, with each participant or group meeting twice during April and May 2024 in sessions lasting 60 to 90 minutes. Analysis followed the established seven-step phenomenographic procedure of familiarisation, condensation, comparison, grouping, articulating, labelling and contrasting, with translation into English occurring only at the articulation stage to preserve original meaning. Participants were given the chance to comment on preliminary results, and all who responded approved them.

The analysis produced six categories of description, organised into two sets of three. The first trio captures how therapists currently work with unemployed people: Assessing, Coaching and Collaborating. The second captures how they believe the work should develop: Adapting to new ways of working, Increasing awareness of occupational therapy, and Advocating for better opportunities to participate in working life. Assessment emerged as the dominant activity. All participants assessed work ability and occupational functioning, and most described it as their main task, typically across one to seven meetings using interviews, standardised tests, self-assessments, observation and questionnaires.

Yet the assessment process itself revealed a structural paradox. Because unemployed clients have no workplace, therapists had nowhere to observe work-related performance directly, so evaluations were usually carried out in clinical settings, sometimes supplemented by visits to rehabilitative work placements. More strikingly, the therapists reported that assessments were frequently commissioned not to move clients toward rehabilitation or employment, but to determine eligibility for benefits, disability pensions or assistive devices, often because a physician’s medical statement was too thin to satisfy the authorities. One participant described seeing rejected statements and immediately understanding why: they simply lacked adequate descriptions of work ability, meaning the entire assessment had to be redone.

Coaching, by contrast, was a goal-oriented practice aimed at enhancing work ability at a pace suited to each individual, whether by practising job interviews, building social skills, establishing daily rhythms or finding training placements. Some therapists used the Individual Placement and Support model and worked directly with employers, intervening early whenever a job was at risk. But coaching also exposed how alien the world of work had become for many clients. Some had never worked or had been away from employment for years, and therapists described clients who were strikingly unaware of their own rights, responsibilities and opportunities within the unemployment and social insurance systems. As one participant put it, the role of worker is one of the roles of adulthood, yet healthcare services often speak only of inability, never of what work could mean.

Collaboration was described as essential but chronically underdeveloped. Therapists contributed expertise on work ability and human occupation to multiprofessional and multisectoral networks spanning health, social and employment services, yet many reported being invited only occasionally, or forgotten altogether when meetings were arranged. Participants described services as fragmented, with professionals rarely talking to one another and clients often unaware of who was even part of their own support network. One participant called collaboration the most important part of occupational therapy practice with unemployed people, while another summed up the consensus bluntly: no one knows these things alone. With only about seven occupational therapists per 10,000 inhabitants in Finland, the profession’s low visibility outside healthcare compounds the problem.

The deeper tension the study uncovers is a conflict of roles. Therapists want to be advocates, pushing for earlier interventions, employment services that employ occupational therapists directly, and more humane labour markets that see people’s capacities rather than their diagnoses. But because their assessments feed decisions about benefits and rehabilitation eligibility, they also function as gatekeepers, categorising clients as worthy or unworthy of support. Drawing on the capability approach, the authors argue that this individual-level focus risks adapting people to a flawed system rather than challenging the system itself, echoing warnings in the literature that occupational therapy can become an agent of maintenance for existing social inequities. The participants themselves were not satisfied with the status quo: they called for assessments to move out of clinics and into real work environments, for unemployment and work ability to feature in professional education, and for the profession to shift from last resort to preventive measure. The authors conclude that occupational therapists could serve as a bridge between health, social and employment services, but caution that their insights rest on practitioner perspectives alone. Including the voices of unemployed people themselves, they write, is the crucial next step.

Subject of Research: Occupational therapy practices with unemployed people in Finland

Article Title: Occupational therapy practices among unemployed people in Finland

Article References: Turtiainen, T., Rosenberg, L., & Jansson, I. (2025). Occupational therapy practices among unemployed people in Finland. Scandinavian Journal of Occupational Therapy, 32(1), Article 2585856. https://doi.org/10.1080/11038128.2025.2585856

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2585856

Keywords: occupational therapy, unemployment, Finland, work ability, phenomenography, long-term unemployment, rehabilitation, capability approach, multisectoral collaboration, labour market, welfare services, occupational science