Absence special: stress – in the grip of it

The CBI/AXA annual absence survey, released last week, found that non work-related stress, anxiety and depression was the most common cause of long-term absence. Government guidelines on how to manage it and a growing pile of evidence on tackling stress have not solved the problem.

A report by the Royal College of Psychiatrists in March adds that sickness absences due to mental health problems such as stress are likely to be longer than those caused by physical health problems, accounting for 47% of long-term absence.

The government has acted to tackle stress by announcing a new army of ‘talk therapists’ to help stress victims back to work. Meanwhile, ministers are poring over the recommendations in Dame Carol Black’s report, published in March, on improving the health of the working age population.

Black’s report, Working for a Healthier Tomorrow, as well as emphasising the role of occupational health practitioners, employers and line managers in tackling stress, recognises that GPs and the NHS in general are badly equipped to deal with the issue. She proposes new multidisciplinary ‘fit for work’ teams which would work with GPs, with a key part of their remit to identify stress early and rehabilitate employees.

Getting back to work

While the government is still deliberating about Black’s recommendations, it has already made clear it supports increased access to psychological therapies, such as cognitive behavioural therapy (CBT), as a way to get people with mental health problems back to work.

In February, health secretary Alan Johnson announced that 3,600 extra therapists are to be trained as part of an investment of £170m in the NHS.

However, these initiatives will not solve the problem of stress-related absence on their own. The report by the Royal College of Psychiatrists, commissioned by Black to support her recommendations, supports increased access to CBT but warns that the evidence for its benefits is slim.

“Few studies have measured the extent to which such interventions improve occupational outcomes, including presenteeism (where staff feel they must be in work despite being ill) and absenteeism,” it states.

Holistic approach

The report also advises that the factors affecting how an individual with mental health problems returns to work are so complex, with many of them unrelated to the workplace, that rehabilitation alone is unlikely to reduce sickness absence.

The key is to tackle stress in a holistic way, says professor Amanda Griffiths of the Institute of Work, Health and Organisations at the University of Nottingham.

“One common mistake is to look at stress solely as an individual problem,” she points out. “It is not. It is a reflection of systems that are not working well.

“Many aspects of an organisation’s function will have a role to play – selection, in­duction, training, target-setting, appraisal systems and performance review, and the provision of and marketing of support systems, such as occupational health and unions, management training and policies on issues like harassment, bullying and stress. These are concerned with prevention and good management. Good management is stress management,” adds Griffiths.

However, the rise of stress-related absence suggests many organisations are not applying good practice.

The official guide is the Health and Safety Executive’s Stress Management Standards, launched in 2004. The standards advise employers on how to develop a company culture, communications and management practices that help prevent stress, and give advice on risk assessments and a partnership approach with employees and unions.

The standards are supported by guidance for HR and line managers as well as management competence developed by the HSE with the Chartered Institute of Personnel and Development. Among these competences are managing workload, planning, empowering staff, managing conflict and, of course, training and development.

There is no shortage of evidence on what employers find effective in managing stress. A survey of employers in Personnel Today’s sister title Employment Reviewin October 2007, for example, identified the four most effective ways to tackle stress:

  • Work-life balance initiatives
  • Train managers in stress awareness
  • Conduct regular staff appraisals where stress is discussed
  • Ensure that health and safety risk assessments take account of stress-related factors.

Understanding stress

The HSE defines the role of HR as “understanding what stress is and what constitutes a healthy workplace” and knowing “what skills, abilities and behaviours are needed to manage employees in a way that minimises work-related stress”. Much stress-related absence is caused by the behaviour of line managers towards their subordinates and their refusal or inability to identify when employees are suffering from stress.

One current HR trend is to build stress management into job design. According to Employment Review’s survey, HR practitioners rate work-life balance initiatives as the most effective stress-management intervention: one in four put this top of the list.

If the business case is not enough, then the risk of an employment law claim will help HR make the business case for interventions to tackle stress.

Employers have a statutory duty of care, and under health and safety legislation they have an obligation to undertake risk assessments to reduce the incidence of work-related stress. One way they can do this is to introduce an employee assistance programme (EAP) where staff can access third-party counselling or simply talk to a sympathetic ear.

David Whincup, head of the London employment department at law firm Hammonds, says that the Black recommendations will not affect the law, if adopted by the government. “The review doesn’t change the law or affect the legal liability of employers. As before, there is a point beyond which employers cannot push staff, but where this point lies will vary depending on the individual employee.”

Payout bonanzas

One incentive to manage stress is the fact that stress cases can lead to big payouts. In Walker v Northumberland (1996), North­umberland County Council paid £175,000 in compensation to a former employee, John Walker, for severe mental stress as result of over-work.

The case of Sutherland v Hatton highlighted the fact that for an employer to be liable, the personal injury must be “reasonably foreseeable”. So employees need to alert employers about any stress-induced problems they experience.

However, employers should beware relying on an EAP alone. In the case of Intel Corporation UK Ltd v Tracy Ann Daw, Daw suffered a psychiatric breakdown caused by overwork. The court found the employer should have taken immediate action, and dismissed the argument that offering Daw a counselling service was sufficient for it to discharge its duty towards her.

Whether it’s fear over legal actions or a real desire to improve your employer brand, the best way to tackle stress is simply to be a good employer.

In practice: GlaxoSmithKline

Global pharmaceutical company GlaxoSmithKline (GSK) has operations in 116 countries and employs more than 100,000 people across the world. A staff survey revealed that employees perceived their work demands as “excessive” and that only 22% of the workforce were “engaged, energised and resilient”. Almost 40% of senior staff felt engaged, but “compromised in terms of energy and resilience”.

With this in mind, GSK developed a set of management tools to promote the personal resilience of staff so they are better able to cope with change and work-related stress. Key features include: a corporate culture that supports employee health the re-engineering of business processes to minimise pressure, a health risk appraisal for all staff and an early intervention case management approach to attendance management.

For the last two years, all managers have focused on ensuring that health is a fundamental part of the leadership framework. Resilience has been built at all levels, both for teams and individuals.

The key is to keep it simple, says Dr Adrian Chojnacki, vice-president, employee health management, GSK. “You should focus on daily practices – behaviours that will create a more supportive work environment. There are quick wins – easy fixes that will relieve pressure quickly, and one or two more challenging issues that are within your team’s control,” he asserts.

More than 22,000 employees have been through this process since 2003, and since the programme began, work-related mental ill health cases have decreased by 60%, and all mental ill health absence has fallen by 20%.

In practice: Nationwide Building Society

Financial services company Nationwide has some 680 branches and employs about 19,000 staff. In 2006 the society merged with Portman Building Society, creating a mutual body with assets of more than £160bn.

Since then, a shift to a more customer-focused way of working has been introduced. This has put additional pressure on staff, and the company wanted to help them deal with resulting stress. The aim was to help staff ask for help when stressed rather than letting the situation deteriorate, potentially to the point of illness.

Nationwide’s 80 top managers and HR staff went through a “Managing Troubled Employees” workshop run by The Validium Group. This training course acted as a reminder of existing support services could offer, including the company employee assistant programme (EAP). The intention was to encourage more managers to refer staff to the EAP when they were stressed.

The feedback from managers was positive, and EAPs are now more widely used across the company. “Everyone has found the insight into how to tackle stress in themselves and others very useful,” comments Harvie Hughes, occupational health and safety consultant at Nationwide.

“Managers were taught to recognise the early signs, including irritability, reduced eye contact and inconsistent work output. Case studies were used to devise new ways of supporting individuals and groups,” adds Hughes.

The positive effect on staff attendance is reflected by the financial performance of the company: at the end of 2007, Nationwide’s half-yearly figures showed that the lender’s underlying profit before tax was £394m, up from £306m in September 2006.

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