There is rising concern that stress-related long-term absence from work is
on the increase. What should an occupational health nurse do when asked to
devise a mental health risk assessment tool?
Q Last month we asked what
readers would do when faced with the following problem: Senior managers within
my organisation, (a local government department) are becoming concerned by the
amounts being awarded in settlement for stress-related claims, and the evidence
that stress-related long-term absence within the company is on the increase.
As the occupational health adviser, I have been asked to assess the issue
on behalf of the company and devise a strategy for the company to adopt. In
particular the company have asked me to devise a mental health risk assessment tool.
I am finding it difficult to write this "tool". Can anyone help me
before I, too, go down with stress!
I work within a large and diverse organisation and also found mental health
risk assessment it to be a difficult and complex task. I eventually managed to
produce a workable risk assessment tool based on a simple risk management
format which I hope you will find useful.
The whole workforce will be involved so you should clearly define your aims
and objectives.at the start
You should involve managers and trade unions whose support is invaluable in
securing co-operation from the workforce. It is preferable to work with someone
else who has an interest in, and experience of, work-related stress management.
Identify the hazard
A hazard is anything with the potential to cause stress. Cox’s explanation
(1998, Cox T) enabled me to produce my own definition of stress: "Stress
is an incapacitating emotional or physical state experienced by a person when
they are unable to cope with the demands put on them". This clarifies the
difference between "stress" and "demands". Demands may be
challenging, good for you, essential and necessary in a dynamic, constantly
changing and improving organisation.
Conversely they may be excessive (this depends on individual’s thresholds)
and lead to stress – which is never good for you. It is vitally important that
you know what you mean when you talk about stress as this will underpin all of
Identify who might be harmed and why
Using the definition, directly ask the staff what causes them stress. It is
better to hold semi-structured group meetings as the information gained in this
way is invaluable.
Put together different staff groups because the demands on each will be
different and staff will speak more freely in peer groups.
For example, have groups of administrative staff, groups of senior managers,
groups of technicians, etc. Aim to ask about 10 per cent of the workforce to
get a good representative group. Choose people at random (for example out of
the internal telephone directory) to minimise any bias.
Write down comments on a flip chart. You will use this information later to
categorise the findings and assess the risk. Ensure freedom to speak and
confidentiality at all times. Each session should last up to a maximum of one
Cooper and Cartwright’s Stress – a research model is useful, giving six
sources of organisational stress which can be used to give discussion headings
and order to the sessions.
– Intrinsic to the job – for example workload, deadlines and targets,
– Role in the organisation – involvement in decision-making, being valued
and appreciated and son on
– Relationships at work – relating to colleagues and managers, bullying/
– Career development – career structure, equal career opportunities, time
given for and quality of training, etc
– Organisational structure and climate – communication within the
organisation – between managers, between colleagues, climate, atmosphere, etc.
– Home-work interface – taking work home, ability to switch off, bringing
problems to work and so on
I also used another category – health, safety and welfare – to include
physical working environment/conditions, facilities for rest, physical
activity, occupational health provision, counselling and so on. If you are
interested to see if health has been affected or not, devise an anonymous
health questionnaire or use one as suggested in Mental Well-Being in the
Workplace (p 165) and get people to complete it at the session.
With the help of human resources, carry out a sickness absence audit,
looking at the number and cost to the organisation of absences related to
stress/depression/anxiety, etc. (don’t worry at this stage whether it is
work-related or not). You should identify trends and areas where sickness
absence for these reasons most commonly occurs.
Evaluate the risk. Estimate the likelihood that stress will occur, given the
control measures in place.
You should now know what the demands are which have the potential to cause
stress for each identified staff group – for example, too much work and not
enough time to do it, bullying and harassment, lack of training/career
Carry out an audit of existing stress management policies and procedures in
your organisation. For example:
– Is there a mental health policy?
– Are there family friendly/flexible working arrangements?
– Is there a bullying/harassment policy?
These are the control measures – the measures introduced by the organisation
which may reduce the risk of stress.
It should now be possible to estimate the residual risk given the control
measures in place.
Record your findings
The table (above) gives:
– An indication of how you may record/ present your findings
– Proof that the statutory duty for risk assessment has been carried out
– A basis for revision of the assessment
Managers should now be able to identify their priorities for action, that
is. those hazards that are "very likely" to cause stress should be
dealt with first. You may consider recommending the introduction of a model of
primary, secondary and tertiary control measures.
Primary – would include policies and procedures at an organisational level
which help to minimise the risk of stress, for example, human resource
policies, recruitment, person-job fit procedures, career development
Secondary – would include implementing training for managers and supervisors
about the causes of work-related stress, how to manage it and carry out risk
Tertiary – would include the provision of reactive occupational health
facilities, early contact and intervention for those who report being stressed
or are absent because of a stress-related illness, counselling and so on.
Review and revision
The assessment should be reviewed as the nature of work changes (identified
by monitoring), or if the assessment needs to be changed in any way. Regular
monitoring should be made of sickness absence figures and interventions made
Elaine Halligan, BSc(Hons) RN, OHND, NEBOSH, Cert Ed
Occupational Health Nurse/Adviser Bournemouth and Poole College Bournemouth
A Don’t re-invent the wheel. I am
using the pressure management indicator from Resource Systems. It’s a
scientifically validated tool with high credentials – expensive though.
A The process for identifying job stress is the same as any other risk
– Identify the hazards
– Determine the risk
– Introduce control measures
– Review the effectiveness of the control measures.
The first step to identifying job stress is to consider the job. Are there
any potential hazards applicable to this role? For example:
– Shift work
– Working away from home
– High/low workload
– Inflexible working hours or schedules
– Lack of control over the working environment.
These are just a very small selection of well-known hazards associated with
job stress. Good sources of information on identifying hazards include the HSE,
Department of Health, trade unions and community health promotion units.
Once the hazards have been identified, the next step is to determine the
level of risk by considering whether a hazard has a negative impact on an
individual. This level of risk depends on the individual and his or her own personal
vulnerabilities and they must be taken into account when completing an
assessment. Personal issues may include home or health problems, lack of
assertiveness skills, severance concerns, interpersonal conflicts and
If you have identified any hazards that do have a negative impact on an
individual it is then necessary to introduce control measures. It is not
possible to have all the answers; try to address issues one at a time rather
than attempt to solve all the issues immediately.
Some organisations may need to look at introducing global control measures
in order to change the culture. Other control measures may be personal to an
individual. Once again the above sources of information have documented ways of
reducing and controlling job stress. Reviewing the effectiveness of control
measures can be done by carrying out the risk assessment on an annual basis.
It is vital that a risk assessment tool is not seen as a medical examination
of an individual’s mental health, rather it is an assessment of the potential
difficulties, tensions or imbalances that may be experienced in a particular
Marianne Micklewhite RGN OHND
Occupational Health Adviser, British Energy
A We would be delighted to
offer you and your local authority the help required, through the deployment of
the Pressure Profile (formerly PMI) which has been developed in conjunction
with Dr Stephen Williams and used to great effect by Leeds City Council.
This was the subject of Stressed Out, a recent Channel 4 documentary. The
pressure profile is currently being deployed by a number of government bodies
and household name companies – all of whom are keen to get on top of stress.
In essence we can profile an entire workforce, giving individual employees
an individual report on how pressure is affecting their morale and health,
details of where the pressure is coming from, how resilient the individual is,
as well as advice on improving their ability to cope.
Aggregate data is collated to produce a macro report for the organisation
showing which groups of staff are at risk. The tool is so powerful it can
pinpoint departments where staff are actively considering leaving their
Through our network of associates we can also help your organisation to help
those identified with clinical symptoms.
Operations Director, Business Health
This dilemma is a complex issue and needs addressing in smaller discrete
sections. Things to consider are: what is the driver behind the course of
action? In this case it is to reduce the cost of stress claims/litigation. How
is this best done?
The long-term aim is to match the company aims to the employees’
expectations,but often this does not make economic sense.and business
reorganisation often only shifts the problem to someone else. A quick fix
method is personal coping strategy training. If the employees are trained the
levels at which they feel stress are elevated so they are perceived to cope
Training in techniques to reduce the stress arousal/response often helps, ie
meditation, relaxation, cognative restructuring and so on but again these
techniques only change your perception of the problem and not remove the
What are you trying to measure? How much stress a person can take before
developing a problem, how the organisation in general is coping with stress
issues, what signs of stress are about?
I feel the only way to address the stress issue is to include it as part of
the total employee risk/benefit /cost analysis package,.put a price on it,.then
go about minimising the risk in the best way possible.
This may well mean a mental health tool kit, but I feel this may only be a
small part of the solution.
Occupational Health Nurse Manager AON Occupational Health
Q Our March dilemma page
featured a question about what an occupational health nurse should do when
asked to deal with drug and alcohol testing as part of a pre-employment health
assessment in the absence of a company policy.
A You are right to question
the absence of a policy. I was in a similar position as a peripatetic
occupational health adviser.
My client’s employees were required to travel all over the world and undergo
drugs and alcohol screening prior to entering the sites of some of their
customers. Not only did they not have a substance misuse and alcohol policy,
but their employees were being screened with no back up or support.
I am in the process of assisting them in implementing a policy that involves
screening before departure, appropriate systems of referral and treatment for
individuals and training for managers.
How about gathering all the relevant information and putting forward a draft
policy that lists the positive aspects of a substance misuse and alcohol
A forward-thinking personnel team will recognise that it has appointed a
valuable occupational health adviser who is engaged in proactive practice.
Occupational Health Adviser, Future Health Partnership
A You are absolutely correct
to be concerned that your company has asked you to perform drug and alcohol
testing without having a policy in place. Testing is only a means of monitoring
and enforcing a substance abuse policy, it is not an end in itself.
All transport operators should have effective substance abuse policies in
place and these should be backed up by a clearly planned and fair testing
scheme. The chain of custody is essential and should provide the following:
– Formal, approved guidelines (SAMSHA).
– Full training in carrying out the procedure.
– A tamper-evident kit to be used with the chain of custody.
– A "watertight" procedure that links paperwork to sample to
– An evidential (that is,. legally defensible) result.
– The full support of an accredited laboratory (toxicologists, expert
witnesses, technical support).
It is essential that employees are aware of their responsibilities. It is
unreasonable to expect employees to comply with rules or guidelines which are,
in effect, secret.
The crucial question for your manager, meanwhile, must surely be, "What
shall we do with a positive result?" Because if the employee is uninformed
of the rules/guidelines, and their consequent responsibilities, then they
cannot be disciplined for thwarting the rules.