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The risks of keeping going

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If you have ever felt unable to meet a deadline, your workload keeps piling up and you have spent the weekend going through hundreds of unanswered emails, it’s probably safe to say that you are stressed. Are you having sleeping problems and nervous twitches, are you constantly tired? You are not the only one. There are half a million people in the United Kingdom that, according to Mind, experience work-related stress at a level they believe is making them ill.

The 13th National Absence Management Survey conducted by the Chartered Institute of Personnel and Development (CIPD) in partnership with SimplyHealth is one of the existing methods to measure work-related stress. This year’s results show an increase in stress-related absence in the workplace over the past 12 months. The report indicates that 66% of the 667 organisations included in the survey cited stress as the top cause of long-term absence for non-manual workers.

These results are not exactly surprising. According to the Health and Safety Executive (HSE), stress, defined as the adverse reaction people have to excessive pressure or other types of demands placed on them at work, has consistently been one of the most reported types of work-related illness. Work-related stress caused workers in Great Britain to lose 10.4 million working days in 2011/12, according to the Labour Force Survey conducted by the Office of National Statistics.

Most experts agree that not every pressure or difficult situation at work must be considered as stress or leading to stress, but when those pressures become excessive or prolonged, the possibilities of suffering stress significantly increase. The CIPD’s survey reveals that workload, management style, relationships at work and a considerable organisational restructuring are ranked as the main causes of stress. Although an excessive workload was already mentioned among the most frequent sources of stress last year, “this time appears to be even more of an issue, increasing across all sectors except the non-profit”, the CIPD’s report says.

Once again, non-work factors like relationships and family are also listed as the top causes of stress, while poorly designed jobs, lack of training and long hours are considered less important.

However, the difficulty of diagnosing stress is at the core of the problem and might hide a higher prevalence. Jamie Patterson, cognitive-behavioural and stress specialist at Abermed, one of the UK’s largest occupational health providers, says: “Unlike depression and anxiety conditions, there are currently no formal diagnostic criteria for stress as a medical condition in its own right. Therefore, when people research stress they may also be including those who have depression or a clinically defined anxiety condition – but lumping them together as the umbrella term of stress. Stress is a physiological state, influenced by psycho-social factors and can be the gateway to a range of clinically defined conditions.”

Success equals stress

Some people would argue that having a fast and successful career, especially in some well-remunerated but highly competitive industries, implies accepting the risk of stress, sacrificing resting time and personal relationships and devoting yourself entirely to work. Some employers would expect full-time availability, particularly from new recruits or employees aiming for promotion.

“No job should expect the continued 24/7 availability of an employee,” Jamie says. “If an employee feels they have to make such promises, then one can infer a lot about the culture of an organisation and perhaps the employee should assess his or her options. Advances in technology, while undoubtedly beneficial to working life, have not helped the availability conundrum and need to be managed accordingly.”

He adds: “It is natural that people want to impress if they are in a new position but there are many ways to do this without making a rod for your own back by promising your full-time availability. People may climb the career ladder through hard work and working long hours at times. However, perhaps those that last the course and remain effective (i.e. don’t burn out) work smarter than this, for instance, delegating, using resources available to them, knowing when to ‘put in a shift’ and when to take a break. Research has indicated that people may manage high work demands more effectively if they also have control over how they manage these demands.” 

According to the Aviva’s Health of the Workplace Report, published last year, 27% of employees said they’re tired all the time and 23% considered themselves really stressed. One in five people said that they worry about work in the evenings and weekends and the same number mentioned that they can see that their colleagues are showing the signs of stress. The top five employees’ concerns about stress were feeling stressed, having stressed colleagues, the lack of understanding about stress in the workplace, the lack of provisions for dealing with it and the likelihood of becoming stressed themselves.

The link with absenteeism

According to the CIPD’s report, organisations that identify stress as one of the top causes of absenteeism are 20% more likely to address the issue than those in which this is less of an issue.

Once a stress-generating situation has been identified in an organisation the path to manage it becomes easier, although not necessarily clearer. The CIPD’s survey found that 58% of their respondents consider that their organisations are taking steps to reduce stress, but a third think that their organisations “are not doing anything”. The findings, similar to the previous year’s, also show that over the past 12 months 27% of the organisations included in the research have taken measures on stress management for the entire workforce, while 18%  have only done it for the senior management positions.

The report confirms that staff surveys, risk assessment, stress audits and introducing flexible working hours to improve the employee’s work-life balance, are the most common methods to manage stress. It also notices that the public sector is more proactive in finding ways to deal with the incidence of stress and uses a broader range of methods.

The public sector has identified stress as the principal cause of long-term absenteeism (79% of surveyed organisations), more than the private, non-profit and manufaturing and production sectors. Over the past year, 21% of all public sector employers reported an increase in absences due to stress-related situations. They also reported poorly managed organisational change and restructuring as a top cause of stress. “This is likely to reflect the ongoing, widespread changes and budget cuts in this sector,” says the report.

Jonathan Houdmont, lecturer in occupational health psychology at the University of Nottingham, says: “One would hope that the majority of organisations in the UK are familiar with HSE’s Management Standards for work-related stress, but it doesn’t seem to be the case. Many organisations I speak to have never heard of the standards or the risk assessment tool available free of charge on HSE’s website.”

Beyond absenteeism, beyond the borders

Last July, a group of experts from the International Labour Organization (ILO) warned of a general rise in mental illness due to widespread stress in the workplace in Europe and elsewhere, with extreme cases even leading to suicide. The ILO’s statement mentioned the decision of a French judge to charge the ex CEO of France Telecom for psychological harassment after a wave of employees’ suicides at the company. Between 2008 and 2009, while France Telecom was going through a process of restructuring because of the global financial crisis, 35 workers took their lives and several of them left notes blaming unbearable work pressure.

The relationship between suicide and economic recession was also exposed in a study published last August in the British Medical Journal. A study conducted by researchers from the universities of Liverpool and Cambridge, and the London School of Hygiene and Tropical Medicine, linked the UK recession and an increase in the number of suicides, something that has also been reported in Greece and Spain. This research, a time-trend analysis comparing the current number of suicides with those that would be expected if pre-recession trends had continued, showed that between 2008 and 2010, there were 846 more suicides among men than would have been expected and 155 more among women. Historically, short term yearly fluctuations in unemployment have been associated with annual changes in suicide rates among men but not among women.

The relationship between work stress and heart disease has been recently established for the first time. An investigation published last September in The Lancet made a conclusive link between the two. The pan-European study concluded that people in stressful jobs are 23% more likely to experience an event linked to heart disease than less stressed individuals. The researchers came to the conclusion after analysing data on almost 200,000 people from seven European countries, including the UK. “Our findings indicate that job strain is associated with a small but consistent increased risk of experiencing a first coronary heart disease event, such as a heart attack,” said study leader Professor Mika Kivimaki, from University College London.

A further study, published in the scientific journal Occupational Medicine in December, found that stressed older men are four times more likely to have heart disease. It suggests there is a clear difference between younger and older workers.

The employer’s duty

It is an employer’s responsibility to manage stress at work. The Management of Health and Safety at Work Regulations 1999 dictate that every employer shall make a suitable and sufficient assessment of the risks to the health and safety of their employees, make the appropriate arrangements for effective planning, organisation, control and monitoring and review such arrangements. Also, under the Health and Safety at Work Act 1974, the employer shall provide and maintain a working environment that is, so far as is reasonably practicable, safe and without risks to health.

Jamie, who has been working on stress management for the last 13 years, considers that although the law requires employers to identify potential health risks and take steps to manage them, some workplaces may be better at actually ‘walking the talk’ than others. “Organisations may be good at getting someone in to do a stress talk, but what happens then? What ongoing wellbeing activities, policy revisions, new initiatives occur? Has a stress audit been carried out, have any ‘hot spots’ been identified and managed as far as is reasonably possible? Those in the senior positions need to be on board with such initiatives and lead the way. Some employers may be reluctant to focus on stress too much for fear of ‘opening a can of worms’, however, in all likelihood, not tacking stress poses the real harm.”

In an interview with Safety Management in August 2012, Emma Donalson-Feilder, an occupational psychologist for Affinity Health at Work, mentioned that during bad economic times, when business are being squeezed, they tend to focus on their survival and lose sight of the importance of their employees’ wellbeing. She insisted managers should play a key role in creating a more stress-free environment, but questioned whether they had adequate training to do that. “When somebody is good at their job, they are happy to be promoted, but when they start managing people things are very different. Managers are not always supported to make that transition and develop people management skills,” she said.

Although stress has usually been associated with non-manual workers, the CIPD’s survey indicates that stress is also the leading cause of long-term absenteeism among manual employees, although rates are still slightly higher among non-manual workers. “The fact that the issue is reported to affect both worker categories indicates there  are risk factors in each occupational setting. The demand-control factor is something that can affect any worker type,” Jamie says.

As more employers recognise the impact of stress in their workers, there is an increasing number of resources available to help them manage these and other health risks: training courses, e-learning packages, the free Health for Work Adviceline and various employee assistance programmes. Both HSE and the CIPD recommend implementing a stress policy and taking a psychosocial risk management assessment to deal with it. A model stress policy and case studies on business best practices are available on HSE’s website.

For the last 14 years, the 7 November has been commemorated as National Stress Awareness Day, with the aim of increasing the understanding of a condition that affects thousands of people and businesses across the United Kingdom. Organisations that have not yet made stress management a priority can take that day as an opportunity to examine their existing policies and tackle the problem before it becomes even more damaging to both themselves and their employees.

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