In summaryStress is becoming a more pertinent issue for organisations and may are coming round to implementing ways to control the problem. We look at ways of helping employees get through stressful times as well as condense Health & Safety Executive guidelines that could have an effect on corporate liability. Case study- Sheffield City Council.

Article in fullThere is an old Chinese proverb that reads: "That the birds of worry and care fly above your head, this you cannot change. But that they build nests in your hair, this you can prevent." While it is unlikely that the ancient Chinese had a great deal of experience with stress - at least in its present form - the proverb is quite apt at describing the issue.

These days, stress is almost impossible to escape from. Employees may try to run from its effects, but can rarely hide. According to the Confederation of British Industry/Axa's Room for improvement: absence and labour turnover survey 2004, stress is now the second highest cause of absence among non-manual workers. Employee Benefits/HSA's Healthcare Research 2004, meanwhile, showed that stress has risen as a cause of sickness absence for the third year running. This is supported by research commissioned by the Health & Safety Executive, which indicates that half a million people experience work-related stress at a level they believe is making them ill.

Yet, despite almost exhaustive debate about the topic, numerous myths still abound. An exact definition of stress has proved particularly elusive. Gareth Emmonds, HR consultant at consultancy firm Black Mountain, explains: "The biggest myth is that stress is an illness. It can cause clinical illness, but it is not [an illness] itself. As a society, we don't know enough about stress and its causes to really know what it is."

Equally tricky is identifying when staff are suffering. One way is to encourage line managers to establish close relationships with employees. Any unusual behaviour such as drastic mood swings, increased absence or physical symptoms such as migraines can then be identified early on. Emmonds adds: "The key thing is being able to identify stress and where it rears its ugly head. Be honest enough to tackle it with [staff]."

Doctor Jenny Leeser, clinical director of occupational health at healthcare provider Bupa, however, believes that employers should tackle the problem at its source and aim to prevent rather than treat stress cases. "There are other ways of doing it besides looking for people who are actively suffering. For a start, you could look at your organisation and see what management practices are in place to see if you can improve them so you don't actually create the suffering in the first place. Where I would prefer to see companies coming from is risk assessment and prevention."

Some of the main causes of work-related stress, for example, stem from poor management practices such as passing on unmanageable workloads to staff, unsympathetic management and periods of organisational change. A survey by law firm Peninsula in September this year revealed that the stress of heavy workloads, for example, limited the number and duration of breaks that 89% of respondents were able to take during a working day. In 2001, just 61% said that stress affected them in this way.

Employers may also be surprised to learn that being under-stimulated at work can be just as stressful for employees. "[One] myth is that stress is intrinsically bad for you. In moderation it is good," says Mark Simpson, managing director of Axa PPP Occupational Health Services.

And this is before employees' personal problems enter into the equation. Unfortunately, employees don't leave their stresses behind when they leave the house, which can also affect concentration and productivity levels. Simpson explains that this symptom is less obvious for employers to detect but can be one of the most costly. "By the time someone goes off sick with stress, they've usually been underperforming for some time. The problem is that absence is more obvious than lost productivity."

When it comes to tackling the problem, there are a number of steps that employers can take. If staff are becoming stressed thanks to a single source, the problem can usually be rectified fairly easily once this has been identified. "If you've got an organisation full of young mothers then you might relieve some of their stress by looking at your childcare offering," explains Bupa's Leeser.

She adds that stress can be tackled on three levels. "There's a sort of hierarchy. The first is looking at it at a corporate level and putting in a good management structure and support schemes. The second is teaching people coping skills and the third is the first aid [stage]."

Healthcare benefits have a large role to play at each of these levels. The first step is looking at preventative options that tackle stress at its source before it has a chance to develop further. In the Sutherland v Hatten case nearly three years ago, the Court of Appeal ruled that an organisation that provided staff with a confidential counselling service was unlikely to be found in breach of its duty of care. Since then employee assistance programmes (EAPs) have fast become the benefit of choice for tackling stress.

EAPs can be particularly useful for employees that have non-work related problems, such as legal or financial issues. While they are a good source of advice, however, EAPs are unlikely to tackle the fundamental causes of stress in the longer term. "It's a bit like saying if you poison your employees, you won't be found guilty if you buy them private medical insurance," says Axa PPP's Simpson.

And, following this April's Barber v Somerset County Council ruling, simply putting an EAP in place is no longer enough. Employers must now also be proactive about getting staff to use it when necessary if they are to avoid breaching their duty vented. So employees that require treatment could benefit from private medical insurance (PMI). "If a clinical psychologist does an initial assessment and decides [staff] do have more profound psychological problems, we can fast-track them to see a consultant psychologist," explains Simpson.

But he adds that many staff may choose not to utilise the benefit amid concerns about their employer's perceptions of staff that seek psychiatric treatment. "Some employees, despite having full PMI cover, prefer to self-fund psychiatric treatment because of the stigma attached."

The idea that only weak individuals suffer from stress is another myth. This view is gradually beginning to change, but it may still be some time before stress is fully understood. "The point is that everybody can feel the effects of excess pressure, so just because it isn't you today doesn't mean it won't ever be. I think people are now more accepting of it, but are a little bit apprehensive about what to do," explains Bupa's Leeser.

In less severe cases, alternative therapies such as massage and reflexology may help employees to relax. Physical symptoms including tense, knotted muscles can also help to detect stress at a much earlier stage.

While stress is treatable, Britain's move towards a compensation culture has added a new challenge for bosses. "How do you put in benefits for people who have become victims of the whole issue?" asks Axa PPP's Simpson.

The wording of pension arrangements is particularly important. Employers need to ensure that it covers the possibility of ill-health retirement and an employee's work capability in case staff are unable to return to their original role.

The HSE's draft stress management guidelines may help employers to determine which approach will best suit their organisation. Its impact, however, will very much depend on an organisation's culture. Simpson believes that the reporting system will not give employers an accurate picture of how their organisation is affected by stress. "People will always claim that they work too hard and are paid too little," he says.

But Stephen Clark, corporate human resources manager (occupational health and safety) at Sheffield City Council, says that the standards have helped to identify potential stress hot spots. "It's an excellent product in terms of something you can use that matches up with the real world and gives you an idea of where you can help."

Even with a good stress management policy in place, there will always be some individuals that slip through the net. But even in its earliest stages any treatment is bound to make a difference. In the words of another Chinese proverb: "The journey of a thousand miles starts with a single step."

Health & Safety Executive guidelines

The Health & Executive's (HSE) stress management standards are due to be published this autumn. The final draft was drawn up following a pilot run by employers during 2003 and a public consultation which ended in August.

The management standards will cover six main causes of workplace stress: demand, control, support, relationships, role and organisational change. In order to meet the HSE's expectations, a set percentage of employees must indicate that they are satisfied with criteria set out under each of the Standard's headings. Rather than setting out an approved code of practice, it is intended to serve as a guidance for employers.

Wolfgang Seidl, EAP director at Accor Services, believes the guidelines will make it difficult for employers to ignore the issue without breaching their duty of care. "The HSE guidelines will force organisations to make some changes. Employers are obliged to check the stress levels of their staff."

• Find the draft standards at www.hse. gov.uk/stress/revdraftstandards.pdf

Case studySheffield City Council is one of the organisations that piloted the Health & Safety Executive's (HSE) draft stress management standards.

The Council, which employs 19,000 staff, uses a phased approach in the return to work of employees suffering from stress. Stephen Clark, corporate human resources manager (occupational health and safety), explains that the first step is to remove the stigma often attached to stress. "One of the things that we've tried to do is make stress something that people can talk about."

Once stress has been diagnosed, the Council's occupational health department liaises with employees to arrange counselling and a flexible return to work programme, which involves gradually building up their duties and the amount of time they spend at work. "If someone has been off work for a long time, it can be quite scary walking back through the door," says Clark.

He adds that the HSE's guidelines have helped to identify areas where stress is a particular problem.

Tackling the issue is an ongoing priority for the Council, which has spent the past year working to amalgamate its stress management policies. "We have got about as diverse a workforce as you can imagine. Stress is one of our big two conditions when staff are off work due to ill health. It's not a programme with a clear definite end to it. It's one of those things that you have to keep on top of."

What have employers introduced to combat workplace stress?Counselling/employee assistance programmes 83%Flexible working 66%Policies on bullying/harassment 60%Massages 18%Job swapping/matching 11%Source: Employee Benefits/HSA Healthcare Research 2004