De-stressing the workforce

assistance programmes and counselling are increasingly popular mental health
interventions. But how do they actually work in practice?  By Tim Cuthell

assistance programmes (EAPs) have become increasingly familiar in the UK since
they first evolved from the welfare counselling services of the 1970s. EAPs
play a central role in stress management by offering a range of services to
employees and, usually, their relatives.

their counterparts in the US, UK EAPs are almost entirely used on a
self-referral basis, with the employee or their family member contacting the
service directly for help.

reactive use of counselling and advisory services is generally accepted as a
positive intervention that will help users to understand their problems and
formulate strategies and actions to resolve them. By doing so, the support
provided by EAPs can help to reduce stress, whether it is in the workplace, at
home, or in both.

self-referral often happens only once a problem has grown into a crisis, and
relies on the individual recognising that they have a problem. This severely
restricts the role that an EAP can play because many people who would benefit
from help do not, or will not, recognise that they have a problem and are,
therefore, unlikely to contact their EAP – in fact, only between 5 and 15 per
cent of employees do so in the UK.

OH services operate differently. The majority of referrals are initiated by
management, and self-referrals, if available, play a lesser role. This means OH
advisers are more active in the process of identifying symptoms and encouraging
employees to seek help and treatment. But, even then, this only occurs once the
OH adviser knows the employee.

a result, many employees with a variety of problems, be they physical,
emotional, behavioural or psychological, will not get help until their problem
is ‘big enough to warrant help’. Even then, not all employees will accept or
ask for help – after all, the fear of losing your job is one of the greatest
concerns in modern life. It is no surprise then that people do not, as a rule,
rush to tell their employer, or someone paid by their company, that they have a
problem that could make them less efficient and effective at work.

what is the answer? We need to go looking for these people and, once we find
them, we need to be able to take some kind of ethical action to encourage them
to get help.

stress proactively

is a symptom, not a diagnosis. The Health and Safety Executive (HSE) defines
work-related stress as ‘the adverse reaction people have to excessive pressures
or other types of demand placed on them’.

do you identify stress? This is an important question for OH practitioners. The
reality is that one is very unlikely to see stress other than in the most
extreme cases, such as violent outburts – for example, road rage, nervous
reactions (shaking, crying, sweating or running away), or symptoms of
post-traumatic stress disorder (PTSD).

most cases, the adverse reaction described by the HSE is a less noticeable,
often secret, reaction to stress. The problem is usually related to a loss of
feeling in control, and the consequent discomfort and anxiety will manifest
itself in a variety of different behaviours.

can you identify then? Performance at work is the most likely clue. These
factors are easily identified once a stress problem has escalated to crisis

recognise them sooner requires skill and experience, along with the ability to
empathise and recognise tension, anxiety and the feelings of oneself and of
others (this capability is also known as emotional intelligence).

how employees usually act, interact, behave and perform at work enables us to
notice a difference when something begins to change.

are many possible reasons for these changes, such as an increase in pressure, a
decrease or change in social support, bereavement, promotion, increased or
different responsibilities, problems at home, boredom and illness.

these changes early is the key. Having done so, you then need to know what can be
done and who would be the best person to do it.

and perhaps the greatest challenge, is to be able to engage in a conversation
with the affected employee in such a way as to encourage them to get help. An
inappropriate or clumsy intervention will only result in denial that there is a
problem, with the employee going to increasing lengths to cover up their
problems as they get worse.

and support

managers play a vital role in stress management. Often they are in daily
contact with employees and, even when they are managing remote workers, they
will be the person with whom the employee has most contact.

are, therefore, ideally placed to recognise signs and symptoms of stress
earlier than anyone else in an organisation. If line managers can develop
skills in understanding and the early recognition of stress, everyone will

few managers have been trained in these skills. This is a role where OH
professionals can take a leading role. OH nursing advisers are well placed to
provide training for HR and line managers, as well as being available to
provide advice and guidance on a day-to-day basis. This guidance will include
helping them to identify situations in which it would be appropriate to refer
an employee for assessment and support.

is best done using a team approach, discussing the situation and agreeing the
form that any referral will take. This will ensure the organisation knows what
is going on in cases where it has been established that an employee is experiencing

nursing adviser should be able to provide an initial assessment of the
situation. In the case of workplace stress, this will involve answering the
following questions:

What pressures is the individual experiencing?

What influence will their personality have on their response to these

What coping skills do they have and how well developed are they?

some cases, the nursing adviser will be able to provide appropriate support by
giving information and advice. This could include:





Facing problems

Identifying and using available support

Information about employers’ policies

Medical conditions


Time management.

nursing adviser can also play a role in ‘signposting’ – identifying where more
specialist advice and information is required. Examples of such areas include
alcohol and drug problems, childcare and eldercare issues, financial problems
and legal problems.

this case, the task is to identify the underlying problem behind the symptoms.
For example, a financial problem may be precipitated by the breakdown of a
relationship that, in turn, was caused by an alcohol problem. Poor timekeeping
may be caused by problems at home – such as difficulty with childcare

other cases, this will require an assessment by a psychologist or appropriately
trained counsellor.

role played by the OH adviser is to be the professional located within the
employing organisation who decides that a particular individual needs
specialist help. The nursing adviser may then make a referral or may recommend
this course of action to the HR or line manager.

of the reasons why EAPs have become increasingly popular in the UK in recent
years is because they are able to offer a range of support for individuals
experiencing problems (usually through a single point of contact), they are
free to the user and they are confidential.


will usually offer self-referrals and will also offer the facility for
management referrals.

UK Employee Assistance Professionals Association (UK EAPA) Standards of
Practice and Professional Guidelines for Employee Assistance Programmes 2000
lists the core delivery elements of an EAP, including ‘consultation for
individual managers and the facility to make employee referrals’.

practice, referrals to EAPs happen like this:

The employee recognises they have a problem and that the EAP is able
to offer support and guidance. They know how to contact the service and are
comfortable enough to make a telephone call to ask for help. And they do so.

The employee may not have recognised or accepted that they have a
problem, but someone else has brought it to their attention. The situation is
under control but serious enough to warrant an intervention by a line manager,
personnel/ HR, or the OH professional.

intervention will do two things – first, enable the employee to recognise they
have a problem that is unlikely to disappear without specialist help and,
second, motivate the person to ask for help. And they do so.

The employee will not recognise or accept that they have a problem.
Informal approaches have been attempted but failed. The situation is not under
control. There may be a risk to the safety of the employee or others – for
example, an employee who drives a company vehicle and is unable to do so
safely. Performance at work is impaired to the extent that disciplinary action
and, possibly, dismissal is inevitable unless something changes.

line manager, personnel or HR manager or OH professional formally interviews
the employee and explains:

What the problem is – performance

What evidence the employer has to support this claim – attendance, behaviour,
timekeeping, mistakes, failures etc

What changes the employer needs to see to improve the situation and within what

discussion then needs to take place between the employee and the referring
manager to confirm they have a common understanding of the problem and the
urgency involved.

employee agrees they need help to address the situation. The employer explains
they need tangible evidence that the employee is seeking help.

is an agreement that the employee would benefit from contacting the EAP, is
prepared to do so and will provide written consent for feedback to be given to
the employer.

referring manager calls the EAP and gives details of the formal referral. They
agree that the EAP will advise whether or not the employee has made contact
with the service within a specified time – usually one week.

referring manager confirms this call has been made and that the employee is
expected to contact the EAP within one week. And they do so (or if not, the
employer may begin disciplinary proceedings or consider dismissal).

on referrals

will usually provide a support service for referring managers. This is designed
to help identify where a referral may be appropriate, and to talk through the
process and possible outcomes. Encouraging employees to get help can be
difficult and an interview – formal or informal – will make both parties
anxious and needs to be managed professionally, ethically and appropriately.
The support service will help coach the referrer through this process.


be effective, the EAP must be confidential. UK EAPA provides standards on
confidentiality to which registered EAPs must comply.


plays a vital role in stress management. This role includes three components:
assessment, treatment and referral.

Assessment may be conducted by line managers, HR managers or the OH department.
Where it is not the OH department, they can train and support non-medical
colleagues to intervene

Treatment may be provided by OH directly, but OH advisers must recognise
boundaries and their limitations

OH advisers are often the most appropriate gatekeepers for onward referrals for
specialist treatment.

Cuthell is corporate support services manager for AXA PPP Healthcare – The professional advisory
association for EAPs – UK Employee Assistance Professionals Association (UK
EAPA) – publishes standards of practice and professional guidelines for EAPs


Cynical outlook

Deterioration in appearance

Increasingly working to the book


Long hours

Loss of confidence

Missed deadlines


Reduction in quality of work

Social withdrawal

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