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

The study followed ten of eleven young adults, aged 21 to 30, who had completed the original intervention on a family farm in southern Sweden. All participants had a diagnosis of autism spectrum disorder under the ICD-10 classification and had been socially withdrawn for a median of two years before the study began, with withdrawal periods ranging from one to eight years. Critically, none of them had any employment, education, or other organized occupation in the year prior to the intervention, and all were receiving social insurance benefits. These were individuals for whom conventional welfare approaches had, by and large, failed to break a cycle of isolation.

The intervention itself was grounded in occupational science and combined established principles from animal-assisted and nature-based therapy. Participants attended the farm two half-days per week for 12 weeks, working in small groups under the guidance of two female supervisors, one a physiotherapist with extensive experience of dogs and horses, the other a social worker trained in equine-assisted interventions. Each session began with coffee or tea, moved into organized activities with animals or in nature, such as grooming and groundwork with horses, feeding and caring for livestock, gardening and food preparation, and ended with a shared meal and a group conversation in which future activities were planned together.

An earlier study by the same team had already shown that the program was feasible and that attendance was remarkably high, with participants describing the farm as a comfort zone where they could safely practice being, doing, belonging and becoming, the dimensions of meaning in daily life articulated by occupational scientists Ann Wilcock and Kirk Hammell. The new follow-up asked the crucial question that most intervention studies avoid: what happens a full year later, when the supervisors, the structured routine and the weekly rhythm of farm life are no longer there to hold participants in place?

The answer was cautiously encouraging. Using summative content analysis of semi-structured telephone and written interviews, the researchers coded each participant’s occupational trajectory as improvement, partial improvement, no change or deterioration. Seven of the ten participants showed improvement of some kind. One participant was on the verge of permanent employment after a period of internship and had stopped smoking along the way. Another held an organized occupational activity outside the home two days a week. Five more reported partial improvements, including completed vocational training or internships, obtaining a truck driving licence, or taking up horseback riding as a leisure activity, even though their occupational activity at follow-up resembled pre-intervention levels. Three participants reported no change at all.

Beyond the headline numbers, the interviews revealed something important about how these young adults experienced the welfare system itself. Participants described a diffuse and fragmented landscape of supportive initiatives, but also long waiting times for decisions by the various authorities, ambiguity over which agency was responsible for them, and recurring meetings and uncertainties about care, rehabilitation and benefits that they found deeply stressful. All of their energy, several reported, was consumed by worry about administrative processes. This finding matters because it suggests that even well-designed interventions may struggle to produce lasting change when the surrounding welfare architecture is disorganized and slow.

The socioeconomic dimension of the study gives its findings unusual weight. The total direct cost of the intervention was 525,000 Swedish kronor, including taxes and social security contributions, which works out to roughly 44,000 kronor per participant for the twelve planned places. This is a modest figure when set against Swedish estimates of the lifetime cost of long-term exclusion from the labour market, calculated at around nine million kronor per young person, of which about seven million reflects lost production. And those figures exclude the substantial consequential costs that often accompany prolonged exclusion, including deteriorating health, substance abuse and criminality, which can inflate lifetime costs considerably further.

The arithmetic, the authors argue, is compelling even when success rates are modest. If only one in ten participants, as seen in this study, moves into employment or organized occupation, the intervention may still pay for itself from a societal perspective, since a single sustained exit from long-term exclusion could offset the costs of many treatment places. The findings align with a growing body of health economic evidence for nature-based and social prescribing programs, including a social return on investment analysis that found economic returns of five times the investment for a nature-based outdoor intervention, and a Swedish study showing reduced healthcare consumption among patients receiving nature-based rehabilitation. Being with animals, particularly horses, appears to add further dimensions, offering non-verbal social interaction, physical closeness and opportunities for developing life mastery that are difficult to replicate in clinical settings.

The study’s limitations are real and acknowledged by the authors. The sample was small, there was no control group, and the data relied entirely on self-report. The cost accounting reflected a research context and cannot simply be transplanted to ordinary operations. Several participants were also largely satisfied with their situation, preferring economic stability and predictability over extensive social contact, which challenges any assumption that employment is the only meaningful outcome. Nonetheless, the high retention of participants, with only one person declining the follow-up interview, is striking given that these were individuals with long histories of social isolation who typically disengage from services.

What emerges from this research is a picture of a low-threshold, community-embedded intervention that the existing welfare system can realistically implement, and that vulnerable young adults are willing to stick with. The authors point to care farming programs in the Netherlands and Norway as models of how the green rural sector can be integrated with healthcare and social work, creating interventions that benefit participants while generating new work and environmental sustainability in rural areas. Controlled trials, though methodologically challenging for such individualized programs, are needed to verify effects and cost benefits. But the message for occupational therapists and policymakers is clear: when conventional treatments fail young adults with autism, a farm, some animals and a structured routine may achieve what a waiting room cannot, and society may even come out ahead financially.

Subject of Research: Animal-assisted and nature-based farm intervention for young adults with autism and social withdrawal, assessed one year later with a socioeconomic perspective

Article Title: Animal-assisted and nature-based intervention on a farm for young adults with autism and social withdrawal – A one-year follow-up with a socioeconomic approach

Article References: Holmberg, S., & Gunnarsson, A. B. (2025). Animal-assisted and nature-based intervention on a farm for young adults with autism and social withdrawal – A one-year follow-up with a socioeconomic approach. Scandinavian Journal of Occupational Therapy, 32(1), Article 2588046. https://doi.org/10.1080/11038128.2025.2588046

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2588046

Keywords: autism spectrum disorder, animal-assisted intervention, nature-based intervention, care farming, social withdrawal, occupational therapy, young adults, health economics, social prescribing, equine-assisted therapy, Sweden, welfare services