By L. C. Praxis · May 2026
I. The Observation
In the 2026 national budget, expenditure on sick pay, work assessment allowance (AAP) and disability benefits totals 263 billion kroner. Sick pay: 66.7 billion. AAP: 55.9 billion. Disability benefits: 140.6 billion. All three items are rising (Ministry of Finance, 2026).
For comparison, the entire defence budget is 100 billion. The entire justice sector is 55 billion.
In 2025, 32.7 million working days were lost to certified sick leave. Of these, 8.5 million — more than one in four — were due to mental health conditions (NAV, 2026). Mental health-related sick leave has increased by approximately 45 per cent in five years.
At the same time, the Storting (Norwegian parliament) enacted a change to the Working Environment Act on 1 January 2026 that "clarifies" the requirements for psychosocial working conditions. And in 2023, the government presented an escalation plan for mental health running until 2033. Mental health is thus prioritised — on paper. This raises the question: What have all the previous priorities actually achieved?
II. What Do We Know?
The funnel: sick leave, AAP, disability
NAV's own figures show a chain: 70 per cent of new AAP recipients come from sick leave. 80 per cent of new disability benefit recipients come from AAP (NAV, 2025). This means that every long-term sick leave that is not resolved has a statistical probability of becoming permanent exclusion from working life.
Oslo Economics estimates that this exclusion costs Norway 190 billion kroner per year in lost economic output — in addition to the benefit expenditure (Oslo Economics, 2024).
Mental health in the workplace
STAMI (the National Institute of Occupational Health) estimates that 35 per cent of long-term absence is work-related. Of all sick leave cases during a year, approximately 15 per cent can be attributed to psychosocial conditions at work (STAMI, 2021).
A review of 31 longitudinal studies with over 200,000 participants shows that psychosocial quality at work — control over one's own tasks, social support, clear roles — is strongly and independently linked to mental health and sick leave (Dagens Medisin, 2024).
Workers who experience unsupportive management have a 50 per cent higher risk of long-term absence exceeding 40 days. Workplace bullying increases the risk of both sick leave, mental health problems and disability (STAMI, 2016).
Among 20-year-olds, 30 per cent of sick leave is due to mental health problems. Milder mental health conditions — situational imbalance, unspecified complaints — have increased by 145 per cent (NAV, 2025).
A history of broken promises
Mental health has been "prioritised" in Norwegian health policy for over 25 years. It is worth examining what that has meant in practice.
In 1998, the first escalation plan for mental health was launched. During its implementation period, the number of psychiatric inpatient beds was significantly reduced — despite politicians promising the opposite.
In 2014, Health Minister Bent Høie introduced "the golden rule": mental health and substance abuse treatment should have stronger budget growth than somatic care. The rule was repeatedly broken by the regional health authorities. No consequences followed.
In 2023, the Støre government presented a new escalation plan for mental health, with 3 billion kroner over ten years. The Norwegian Psychological Association called the funding "inadequate". The funds are allocated as block grants to municipalities — there is no guarantee they will actually be spent on mental health (Psykologforeningen, 2023).
In 2025, the mental health and substance abuse clinic at Oslo University Hospital was told to cut 110 million from its budget. The clinic's budget is expected to be reduced by nearly 25 per cent over a few years. In Northern Norway, two of four DPS (district psychiatric centre) inpatient units were slated for closure. The waiting time for adult mental health services was 55 days in 2024 — the target is 40 (Helsedirektoratet, 2025).
The journal Psykologtidsskriftet described this history as "a pigsty of failure and broken promises" (Reme, 2022).
The health enterprise model: built-in abdication of responsibility
A pattern repeats itself: politicians set targets, the health enterprises do something else, and no one is held accountable. The model is designed that way.
When hospitals were organised as enterprises in 2002, they were governed by a business logic. The Storting sets overarching goals. The Health Minister issues mandate letters. But the enterprise boards — which are not democratically elected — make the actual budget decisions. When budgets tighten, mental health loses. Every time. Psychiatry is never "profitable" in a system that measures activity in DRG points and day-surgery procedures.
The Office of the Auditor General (Riksrevisjonen) has documented "criticisable and serious deficiencies" in mental health care. The Storting has repeatedly asked for mental health to be prioritised. The health enterprises do the opposite. The number of psychiatric inpatient beds has more than halved since the model was introduced (Riksrevisjonen, 2021). In 2025, a private member's bill in the Storting called for an investigation of alternatives to the entire model (Stortinget, 2025).
Norway already spends more money per capita on mental health care than any other country, with a higher density of psychiatrists and psychologists than anywhere else. Yet waiting lists are long, staff are exhausted, and patients receive too little help (Røssberg, 2023). The problem is not a lack of resources. It is a governance system that makes it rational for each individual enterprise to deprioritise what politicians say they should prioritise.
The new Working Environment Act: clarification, not change
From 1 January 2026, the Working Environment Act "clarifies" the requirements for psychosocial working conditions. The legal text now explicitly mentions: unclear or contradictory demands, emotional burdens, imbalance between workload and time.
But as the Labour Inspection Authority (Arbeidstilsynet) itself states: these are not new requirements. They are a specification of duties that already applied (Arbeidstilsynet, 2025). Employers who have not addressed psychosocial working conditions have therefore been breaking the law for years. What is new is that enforcement is now easier — Arbeidstilsynet has signalled that it will prioritise inspections and can impose penalty fees on the spot.
The question is whether clearer legal text changes anything when the fundamental problem is a lack of follow-up and culture.
III. What Does This Mean for Policy?
The Norwegian system treats mental health as a health problem to be solved by health services. When more people become ill, we allocate more for treatment. When treatment capacity falls short, we create escalation plans. When the escalation plans are not followed up, we create new ones.
Meanwhile, research shows that a significant proportion of the mental health problems leading to sick leave originate in — or are exacerbated by — the workplace. Poor management, unclear roles, bullying, high demands without control. These are not conditions resolved by a psychologist after a 55-day wait.
In Pragmatikerne's party programme, the starting point is that efficiency means better working conditions and management — not running faster. For mental health, this means three things:
Invest in the workplace, not just in treatment. STAMI documents that a significant proportion of sick leave can be prevented through better psychosocial and organisational working conditions. Control over one's own work, supportive management and clear roles are the protective factors. A SINTEF study shows that targeted management can reduce sick leave by up to 20 per cent. Prevention is cheaper than repair.
Measure efficiency including sick leave. Today, an organisation can report high productivity while sick leave stands at 10 per cent. Pragmatikerne holds that efficiency should always be measured including sick leave. This makes it visible that employers who invest in working conditions actually deliver more.
Break the funnel. The chain sick leave, AAP, disability is documented. Every long-term absence that is not resolved early has a statistical probability of becoming permanent. This means that early intervention in the workplace — not merely faster access to treatment — is critical. The new IA agreement (Inclusive Working Life Agreement) for 2025-2028 points in this direction, but without binding mechanisms it risks becoming yet another plan that looks good on paper.
Stop hiding behind the enterprise model. The health enterprises are a governance system where politicians set targets and enterprise boards make budget decisions. The result is predictable: mental health loses to somatic care in every budget meeting, because the system rewards "profitable" procedures. Politicians can say they prioritise mental health. The enterprises can say they are following their budget frameworks. No one is accountable. Either the governance model must be changed so that political priorities are actually followed up — or we must stop pretending that mental health is prioritised.
Norway has spent 25 years promising that mental health will be prioritised in the health system. The result is longer waiting lists, cuts in inpatient beds and an escalation plan that professionals call underfunded. The system treats mental health as a health problem to be solved by health services, while research shows that a large part of the problem originates in the workplace. And the governance model ensures that even the funds that are allocated are not necessarily spent on their intended purpose.
263 billion kroner a year. That is the price we pay for a system that repairs instead of prevents, and promises instead of delivers.
References
Arbeids- og inkluderingsdepartementet. (2025). Prop. 1 S (2025–2026). → Full reference
Arbeidstilsynet. (2025). Kravene til det psykososiale arbeidsmiljøet blir tydeligere fra årsskiftet [Requirements for the psychosocial work environment become clearer]. → Full reference
Dagens Medisin. (2024). Psykososial kvalitet på jobben styrer sykefraværet [Psychosocial quality at work determines sick leave]. → Full reference
Helsedirektoratet. (2025). Psykisk helsevern for voksne — ventetid [Mental health care for adults — waiting time]. → Full reference
Holte, A. (2022). En svinesti av svikt og brutte løfter [A trail of failures and broken promises]. Psykologisk.no. → Full reference
NAV. (2025). Utviklingstrekk i folketrygden: Helserelaterte ytelser [Trends in national insurance: Health-related benefits]. → Full reference
NAV. (2025). Stadig flere blir sykmeldt med en psykisk diagnose [More and more people signed off with a mental health diagnosis]. Arbeid og velferd. → Full reference
NAV. (2026). Nedgang i sykefraværet i 2025 [Decline in sick leave in 2025]. → Full reference
Norsk Psykologforening. (2023). Gode mål, men mangler konkrete tiltak og finansiering [Good goals, but lacking concrete measures and funding]. → Full reference
Oslo Economics. (2022). Samfunnsøkonomisk vurdering av marginalisering og utenforskap [Socioeconomic assessment of marginalisation and exclusion]. → Full reference
Riksrevisjonen. (2021). Undersøkelse av psykiske helsetjenester [Investigation of mental health services]. → Full reference
Røssberg, J. I. (2025). Hvorfor får vi så lite ut av pengene i norsk psykiatri? [Why do we get so little for the money in Norwegian psychiatry?]. Aftenposten. → Full reference
Statens arbeidsmiljøinstitutt. (2016). Arbeidsplassen og sykefravær [The workplace and sick leave]. → Full reference
Statens arbeidsmiljøinstitutt. (2021). Arbeidsrelaterte helseproblemer og sykefravær [Work-related health problems and sick leave]. → Full reference
Toppe, K. & Mossleth, S. (2025). Representantforslag om helseforetaksmodellen [Private member's bill on the health enterprise model]. Stortinget. → Full reference
About the author: L. C. Praxis writes about politics, economics and everyday life for Pragmatikerne.
See also: Who Bears the Risk? — On mortgages, interest rate risk and debt problems.
If you need help: Mental Helse's helpline (Norway): 116 123 (24/7). Kirkens SOS (Norway): 22 40 00 40.