Occupational Health

by Anna Harrington

Stress management


By the term work-related stress we mean the process that arises where work demands of various types and combinations exceed the person’s capacity and capability to cope.

This is the HSE definition of stress. However it does not reflect that stress is often an accumulation of non-work and work pressures. Stress is a negative response to a situation, after the individual has appraised the situation and their own individual strengths, weaknesses and capacity to perform.

Stress is a significant cause of serious illness and can lead to cardiovascular dysfunction or increase the incidence of viral and other infections through suppressing the immune system. It is also recognised as causing underperformance, presenteeism (at work but not performing) and sickness absence. While an employee is stressed, they are distracted, their minds are elsewhere, either worrying about the problem or day dreaming. Other effects of stress in employees are errors of judgement, poor communications and relationships, and high turnover of staff. When stress is at an extreme, it can result in the individual closing down physically and mentally. It can be preceded by a level of heightened awareness and can result in breakdown, where the individual cannot function and experiences clinical anxiety and depression.

The effects of stress on an individual will be both biological and psycho-social. Symptoms are wide and varied, which is why knowing the individual is important. A change in behaviour is the significant factor.

Stress symptoms

Common symptoms are

  • The individual becomes tearful, withdrawn, explosive, erratic and unpredictable
  • Physical pain, poor sleeping patterns and changes in dietary intake, due to the effects of stress on the metabolic system
  • An increase in infections, due to effects on the immune and inflammatory systems
  • Anxiety and hyper-vigilance, with effects on the cardiovascular system, such as raised blood pressure and pulse rate.

Individuals will have developed their own ways of controlling stress, some of which, such as substance abuse and cigarette smoking, contribute to poor health. The process of appraising the stress situation is an important decider in how the individual will react.

There are different levels of stress, which everyone will experience:

  • At the first level stress is a stimulant, which is necessary to stimulate some action or work. At this level the individual will feel energised.
  • The next level will bring elements of irritation and friction.
  • The third level will cause significant arousal and will affect performance detrimentally.
  • At the fourth level, serious harm is being done to the health of the individual and performance will have dropped off.

Employee stress in the work place

Stress is caused by the individual perceiving potential threat or harm. The person will appraise this threat to consider what is the potential harm and what resources they have available to prevent harm from occurring. There are some benefits to be considered: in other words, can personal gain be had, and does this change the negative stress into a positive situation which they are able to manage? The outcome of these considerations will be affected by the individual’s personality, the organisational culture, personal context (home and personal relationships and resources), past experience and the resilience of the individual.

However, the HSE focus areas for the management of stress are

  • Demands – what and how much is the individual expected to do? What are their feelings about the demands placed on them? Are there conflicting demands? Is it possible to do the required work in the time allotted?
  • Control – is the employee able to control their work/life balance or are there conflicts? Is the individual able to prioritise their work load and pace of work?
  • Role – is the role unambiguous? Is the individual doing a number of roles? Do the roles conflict?
  • Relationships – is the work environment one that promotes positive relationships and communications? Does the individual feel as though they are an accepted part of the team? Is there conflict and are there ‘difficult characters’?
  • Change management – how is change managed and implemented? Are employees involved in the change process? What sort of consultation mechanisms are in place? Do they feel as though they are listened to?
  • Support – does the individual trust their line manager? Does the line manager have credibility and integrity? Is the individual given enough financial and other resources to do their role effectively?

Generally, stress in the workplace is on the increase. The main work causes sited being an increased workload, organisational change/restructuring, and management style and relationships at work (Absence Management Survey, 2010, CIPD).

See also Stress Management.

Stress management policy

The Health and Safety Executive has an example of a stress management policy. The policy should

  • Explain what the business is trying to achieve through the management of stress (such as promoting mental wellbeing as well as putting in systems to control stress); this should be linked to other policies, such as health and safety, flexible working and attendance/absence
  • Inform the reader to whom the policy applies–usually to the whole workforce
  • State who holds overall responsibility, who will undertake risk assessments, who is responsible for implementing recommendations from the risk assessments, what responsibilities employees have
  • State that there will be consultation with employees, staff representatives, unions, HR, safety, line managers and others, as appropriate
  • Detail provisions for training –who will be trained and in what; managers should have training in managing stress within themselves and others and general good staff management practices; staff should have training in managing their own stress levels
  • State how employees with stress will be managed (the provision of support services, such as occupational health, cognitive behavioural therapy, employee counselling and assistance programmes)
  • Detail how control measures will be monitored (through the collection of, for example, sickness absence data, staff surveys, productivity levels, focus groups, toolbox talks)
  • State when the policy will be reviewed (in a couple of years or at trigger points from the monitoring data)
  • Possibly include resources for further information, such as the HSE stress management website.

The purpose of the policy is for the organisation to set out the way in which it will control, manage and prevent stress from adversely affecting the employees. It is purely about the management of stress and will not consider the promotion of mental wellbeing or management of mental ill health. As with all policies, implementation will require line managers to be trained in the management of stress. It will also be necessary to have an individual who is able to conduct stress risk assessments within the organisation.

Primary prevention

This first proactive stage should focus on the organisation and the way people interact within it. How do they behave towards each other, what are the unwritten norms and expectations? This is part of what makes up an organisational culture – the unwritten rules, methods and styles that guide the behaviour of individuals. The culture will be set by the organisation’s ‘controllers’, usually the senior management team, so it lies with them to be clear about demonstrating the type of behaviour and style of communications.

Job roles need to be considered, using the HSE Stress Management Framework, to appraise levels of inherent stress within them and to source solutions to reduce the stress.

Secondary prevention

This will lie more with the individual and teams. The aim is to prevent harm from occurring and to stop any distress which may be apparent. This can be through

  • Employee/team development to increase personal efficacy in relation to beliefs around being able to cope and manage such as resilience training
  • Developing the social and community aspects of the business – the social aspects means the levels of support, understanding and involvement from colleagues and line managers
  • Encouraging individuals to build their own resilience so they are aware of the resources available to them and their own capabilities
  • To have flexibility and awareness to be able to stop stress if it is occurring.

Tertiary management

This is really about assisting those who are ill and suffering and returning them back to equilibrium. The workplace has a vital role to play in this as it can affirm their abilities to the individual with the help, for example, of occupational health professionals, vocational rehab programmes, employee assistance programmes or cognitive behavioural therapy.