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This is an excerpt from the TUC book "Hazards at Work: Organising for safe and healthy workplaces", the best-selling guide to health and safety at work. To buy a copy order here (if you are a safety representative on a TUC training course please speak to your tutor about getting a discounted copy)

BASIC FACTS ABOUT STRESS

What is stress?

According to the HSE, stress is “the adverse reaction people have to excessive pressure or other types of demand placed on them”. The HSE explains: “Pressure is part and parcel of all work and helps to keep us motivated. But excessive pressure can lead to stress which undermines performance, is costly to employers and can make people ill”. See the HSE work-related stress web page

The European Agency for Safety and Health at Work explains that “stress can be said to be experienced when the demands from the work environment exceed the employee’s ability to cope with (or control) them”. See their Factsheet 31

The TUC endorses these definitions and safety representatives can use the HSE version as a working definition.

Incidence of work-related stress

According to the HSE website

• In 2007/08 an estimated 442,000 individuals in Britain who had worked in the past year believed that they were experiencing work-related stress at a level that was making them ill, according to the Labour Force Survey (LFS).
• The 2007 Psychosocial Working Conditions (PWC) survey indicated that around 13.6 per cent of all working individuals thought their job was very or extremely stressful.
• The annual incidence of work-related mental health problems in Britain in 2007, as estimated by the HSE, was approximately 5,750 new cases per year. However, this almost certainly underestimates the true incidence of these conditions in the workforce.
• According to the LFS an estimated 237,000 people, who had worked in the past 12 months, first became aware of work-related stress, depression or anxiety in 2007/08, giving an annual incidence rate of 780 cases per 100,000 workers.
• Estimates from the LFS indicate that self-reported work-related stress, depression or anxiety accounted for an estimated 13.5 million lost working days in Britain in 2007/08.
• LFS survey data suggests the incidence rate of self-reported work-related stress, depression or anxiety has been broadly level over the years 2001/02 to 2007/08, with the exception of 2005/06 where the incidence rate was lower than all other years.
• Teachers and lecturers, nurses, other people working in the public sector, and some professional and managerial groups have high prevalence rates of self-reported work-related stress according to the LFS. Other research suggests there are high incident rates of work-related mental illness for these occupational groups, and also for medical practitioners and those in public sector securit ybased occupations such as police officers, prison officers, and UK armed forces personnel.

In the TUC’s 2008 safety representative survey:

• Stress is cited in more than half of all workplace; 53 per cent of safety representatives reported stress in workplaces with under 50 employees, the figure rising to 66 per cent in workplaces with over 1,000 employees.
• Stress is more prevalent in the public sector, where two-thirds (66 per cent) of safety representatives identified it as a major concern compared with 47 per cent of representatives in the private sector.
• In 10 out of the 14 economic sectors, stress was the top concern for safety representatives.

Effects of stress

Stress is a natural reaction to excessive demand or pressure. When we feel pressured, hormonal and chemical defence mechanisms are triggered in the body. This is often called the ‘fight or flight’ reaction. It evolved so that we are better prepared to deal with dangerous or life-threatening situations. Mobilised for action we begin to perspire, blood vessels to the skin constrict, muscle blood vessels swell, the stress hormones adrenalin and cortisol are released. If we cannot ‘release’ that tension, the hormonal/chemical mechanisms can have serious long term effects.

Physiological changes appear such as: dry mouth and throat; butterflies in the stomach; moist palms; flushed face; pounding heart and muscle cramps

If pressure is prolonged, too frequent or out of control, physical ill health problems may develop, such as: appetite loss; comfort eating; weight gain or loss; indigestion or heartburn; constipation or diarrhoea; sleeplessness; sweat bouts; headaches; backpain; nausea; breathlessness; fainting spells; impotence/frigidity and eczema.

Stress can also cause emotional and mental health problems. Society’s attitudes to mental ill health are very different from those to physical ill health and add to the pressures on stressed individuals. When this is the case, people may try to hide their emotional and mental symptoms, not asking for help until their problems are seriously out of control.

Psychological conditions triggered by prolonged stress include: fatigue; anxiety; depression; hostility and aggression; psychosomatic complaints and neuroses.

The symptoms can be: irritability; indecision; suppressed anger; loss of concentration; inability to
complete one task before starting another; feelings of paranoia; feelings of inadequacy; tearfulness at minor problems; lack of interest in people and things outside work and constant tiredness and a feeling that sleep does no good.

Short-term symptoms can develop into much more serious long-term ill-health conditions. Stress can play a role in:

• heart and circulation – hypertension (high blood pressure); coronary thrombosis (heart attack); heart disease; strokes
• digestion – peptic ulcers; colitis (inflammation of the bowels); vomiting; diarrhoea
• immune system – lowered resistance to infections; chronic asthma; chronic dermatitis; possible increased risk of cancer
• mental health – depression; chronic anxiety; mental breakdown; suicide; social isolation

Stress is also linked with health-damaging habits, such as smoking, over-consumption of alcohol and escapist eating, all of which are associated with other diseases.

Causes of stress

Sometimes the causes of work-related stress and its effects are immediately obvious, but often it can be more difficult to identify them. Trade unions start from the position that employers can create stressful conditions in the workplace which adversely affect workers. Some employers are defensive and claim that stress at work is explained by workers bringing external stress factors into the workplace, and that these are either the cause of, or make a significant contribution to, the stress they experience. They argue that workplace stress is not the employer’s responsibility alone. While external factors can clearly be a contributory factor, in this chapter we are only concerned with factors experienced at work that can lead to the development of stress-related symptoms and subsequent illness – regardless of external factors.

Another complicating factor is that individuals often react differently to similar stimuli, so something that has a serious effect on one worker can more easily be copedwith or dismissed by another. Some employers argue that, because we all react differently, it isn’t possible to deal effectively with stress caused by work, or to conduct meaningful assessments to identify causes and problems. Some academics even believe that there are particular characteristic traits that mean some people are naturally ‘bullies’, while others are natural ‘victims’. These kinds of explanation can lead many employers, and even some union representatives, to treat stress as an individual or case-work problem, rather than a collective issue that affects the whole workforce. This should not be the case: safety representatives need to be able to identify exactly what it is in the way work is organised or managed that creates stressful conditions and damages members.

Because of the prevalence of stress-related illness and absence the HSE undertook a consultation in 1999 to find out what options for dealing with stress were preferred by workers and employers. That consultation resulted in a majority view from both unions and employers for some effective regulation of stress, with at least an Approved Code of Practice. The HSE responded by deciding to develop management standards for work-related stress that would help employers conduct effective risk assessments, and setup appropriate structures to deal with the issues identified. These management standards cover six key areas of work design that, if not properly managed, are associated with poor health and wellbeing, lower productivity and increased sickness absence. In other words, they cover the primary sources of stress at work. They represent a set of conditions that, if present, reflect a high level of health, wellbeing and organisational performance. The standards came into effect in 2004. More information can be found at www.hse.gov.uk/stress/standards/index.htm.

Stress reactions can be caused by a single factor – as in the case of bullying, for example – but they are often the result of a combination of factors. This means it is important for safety representatives to understand each of the six factors and be able to identify them in the workplace, as this can influence the degree of stress an individual experiences. Specific factors identified under the six main headings will contribute to the development of stress-related symptoms in many workers. The six areas are:

• Demands – this includes issues such as workload, work patterns and the work environment
• Control – how much say the person has in the way they do their work
• Support – this includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues
• Relationships – this includes promoting positive working to avoid conflict and dealing with unacceptable behaviour
• Role – whether people understand their role within the organisation and whether the organisation ensures they do not have conflicting roles
• Change – how organisational change (large or small) is managed and communicated in the organisation.

Checklist

Download the Stress Checklist (PDF)

LEGAL AND OTHER STANDARDS FOR PREVENTION AND CONTROL

There is no specific law dealing with stress. However, there are a number of laws that apply. See the following chapters of this book:

• SRSC Regulations 1977 – Chapter 3, with reference to safety representatives’ rights and consultation
• Health and Safety at Work etc. Act 1974 – Chapter 12, dealing with the general duties of employers and employees under Sections 2–9. Generally, the employer has a duty to ensure the health, safety and welfare of employees, and this includes mental as well as physical health
• Disability Discrimination Act – Chapter 24
• Working Time Regulations – Chapter 44
• Civil law, which places a duty of care upon employers to their employees – Chapter 52
• Management of Health and Safety at Work Regulations 1999 – Chapter 13 and below

The risk assessment duty in the Management of Health and Safety at Work Regulations is the starting point for the regulation of work-related stress. The duty in these Regulations is outlined in the box below, and the HSE Stress Management Standards toolkit is the recommended way to conduct such risk assessments.

HSE management standards for work-related stress

The Management Standards define the characteristics, or culture, of an organisation where the risks from work-related stress are being effectively managed and controlled.

The standards link directly to the risk assessment process as required under the Management of Health and Safety at Work Regulations, and the HSE has developed a toolkit to help employers take effective action to address the problems. The standards recognise that stress is a collective or cultural problem, and that the resolution lies in identifying the causes and applying control measures to remove those factors causing the problem, which in turn enables the employer to meet the duties on them in respect of workers’ health.

The six aspects of work that the HSE standards identify are listed in the box below.

Organisations representing workers and employers in the EU (The European Social Partners) produced a report in December 2008 on the success of the framework agreement on work-related stress in raising awareness of the problem, and the progress made towards procedures to recognise, prevent and manage work-related stress. The report says that the agreement, signed in October 2004, has been instrumental in promoting awareness, particularly in some of the newer EU nations, and increasing the momentum towards action.

In the UK the HSE’s report on Psychosocial Working Conditions in Britain in 2008 (www.hse.gov.uk/statistics/pdf/pwc2008.pdf) concludes that the results of the surveys between 2004 and 2008 have not changed significantly. A discernable improvement in the 2007 survey was not carried forward into 2008. It states: “The predicted improvement in working conditions as a result of the roll-out of the HSE’s management standards on work-related stress has not materialised as yet, and the number of workers reporting that their job is highly stressful is no longer decreasing.” It goes on to say that: “The lack of impact to date of the Management Standards could reflect the long latency between organisations first implementing the process and benefits being realised. Equally, with so many other economic and social factors affecting worker perceptions of their working conditions, any effect may be masked.”

The TUC and trade unions continue to be concerned that the HSE has taken almost no enforcement action over work-related stress, relying instead on persuading and encouraging employers to better manage it. Apart from one improvement notice issued towards the end of 2003 against an NHS trust in the south-west of England, the most high-profile HSE action over stress has been an extended project that began in September 2006, in five sectors where related absence was high: education, local and central public services, health services and financial services.

This project focused on advising and encouraging employers. It provided a comprehensive programme of one-day, free-of-charge workshops aimed at senior managers. The workshops provided training on the management of work-related stress, focusing on the risk assessment process using the management standards and toolkit. Participants were expected to go back to their workplaces and set the process in motion; meanwhile HSE inspectors would visit and help employers review what they had done, help to overcome problems and generally give advice on making the process successful. A follow-up programme of ‘master classes’ on specific topics was arranged for later in 2007. No report of this project is available, but anecdotal evidence suggests that the results are less than could have been expected. In the tertiary education sector, for example, trade union safety representatives in colleges and universities have reported little change.

Using the HSE Stress Toolkit

The HSE toolkit helps employers undertake the risk assessment process. The toolkit can be downloaded from www.hse.gov.uk/stress/standards/downloads.htm It emphasises the need for senior management commitment to identify, ameliorate and control risks, and argues for effective partnerships with employees, their representative organisations, and safety representatives.

The main part of the kit is a questionnaire for employees, linked to an analysis tool (a computer spreadsheet) into which the results of the questionnaire can be input. This then calculates the responses, and indicates the scale of any problems the survey has identified. The results are presented in ‘traffic-light’ format, so that green indicates a satisfactory state, amber a marginal or potential problem, and red ‘actual problems’ that need to be tackled immediately.

The HSE recommends that the employer establishes a steering group to monitor and oversee the process. The group should also consider the results and recommend appropriate responses to control the problems, and to play an active part in tackling the problems. The steering group should include adequate trade union representation.

It also recommends that the employer establish focus groups to facilitate employee participation in the process. This will demonstrate the employer’s commitment to a participative process in managing the risk and give staff an opportunity to express their views and feed in information and reactions to the process to enable it to be refined and developed.

The role of union safety representatives is emphasised at all stages in the process: during the assessments; in steering and focus groups; and in determining effective controls.

The HSE toolkit gives comprehensive advice on developing a stress policy, which strongly emphasises the role of safety representatives in developing stress management initiatives.

Stress Management competency indicator tool

Following on from research commissioned by the HSE, this additional tool was introduced into the toolkit early in 2009.

Line managers play a vital role in the identification and management of stress within an organisation. They are likely to witness problems caused by stress first hand, and will be in the best position to notice changes in staff behaviour that may indicate a stressrelated problem. They are also the first point of contact when an individual feels stressed.

It is essential that line managers are equipped with the correct skills and behaviour to be able to manage these situations. The HSE worked with the Chartered Institute of Personnel and Development (CIPD) and Investors in People to design this tool to allow managers to self-assess whether they currently have the behaviour identified as effective for preventing and reducing stress at work. Its aim is to help managers reflect on their behaviour and management style. Safety representatives could also use the questionnaire to assess line manager competence as part of an inspection or monitoring process. www.hse.gov.uk/stress/mcit.pdf

The HSE Stress microsite was updated in March 2009. It contains the toolkit, access to free leaflets, case studies and other information and resources. www.hse.gov.uk/stress/index.htm

WHAT CAN SAFETY REPRESENTATIVES DO?

Safety representatives need to intervene at the primary level. They should act to address the causes of stress and so prevent workers developing stres srelated symptoms and illness which in turn may lead to absence, and in the worst cases, nervous breakdown, mental illness and even suicide. See www.hazards.org/suicide/cryingshame.htm

To do so the safety representative should ensure that:

• the employer has an effective stress control policy in place
• the implementation of the policy and its effectiveness is monitored
• the employer is using the management standards and toolkit correctly
• suitable and sufficient risk assessments are conducted, taking stress into account as a hazard
• real control measures are in place to eliminate factors that cause stress
• safety representatives are fully involved in dealing with stress-related issues
• any partnership in the stress management project is a true partnership, and
• the safety committee monitors and checks that any problems are under control.

Monitor the workplace

Safety representatives need to keep in regular contact with their members and check that stress problems are under control. Ensure that there are suitable procedures for members to report problems, and that any problems can be tackled by representatives without exposing the members concerned to risk of victimisation.

Safety representatives can survey their members using the TUC Stress MOT to identify which stressors are the biggest problem (see www.tuc.org.uk/stressmot). This will help to identify the areas of the workplace and the stressors which most need risk assessments.

Safety representatives can also use mapping techniques to identify problems. (See the Hazards workers’ guide to body mapping, risk mapping and interactive hazards detective www.hazards.org/tools/).

Safety representatives should report their concerns and those of their members to management in writing. Use Chapter 7 above for ideas on how you can make sure that management gets things done.

Stress policy

Safety representatives can negotiate a work-related stress prevention policy with their employer, preferably as part of the overall health and safety policy. An effective policy on work-related stress should:

• recognise that stress is a health and safety issue
• recognise that stress is about the organisation of work
• be jointly developed and agreed with unions
• have commitment from the very top
• guarantee a blame-free approach
• apply to everyone

The objectives of a work-related stress policy should be to:

• prevent stress by identifying the causes of workplace stress and eliminating them
• recognise and deal with stress-related problems through consultation, participation and co operative working
• ensure that managers, supervisors and employees are trained to deal with and prevent work-related stress
• rehabilitate employees suffering stress through the provision of independent confidential counselling

The policy should contain agreed arrangements for joint monitoring and review to assess its effectiveness. An example of a stress policy can be found on the HSE website [pdf]

Coping with stress

Trade unions should ensure that members suffering from stress are represented and cared for. Individual grievances must be dealt with effectively and special arrangements negotiated to protect their needs.

Some employers have:

• introduced Employee Assistance Programmes or counselling services. These can be useful but only as a part of an effective work-related stress prevention policy
• tried to reduce the effects of stress by lifestyle campaigns, promoting healthy eating and fitness.

These campaigns can help workers relieve the immediate strains caused by stress, but they can never remove the source of stress

FURTHER INFORMATION (in alphabetical order)

European Agency for Safety and Health at Work

• Factsheet 31: Practical Advice for Workers on Tackling Work-Related Stress [pdf]

European Trade Union Institute for Research, Education and Health and Safety (see Section 6.4 for contact details)

• Stress at Work – special edition of TUTB newsletter September 2002 Issue No.19–20

Hazards magazine factsheets (see Section 6.2 for contact details)

• No 92: A Job to Die For
• No 83: Drop Dead – Overwork
• No 78: Get a Life! Work–life Balance
• No 77: Drugs and Alcohol Policies
• No 70: Bullying at Work
• No 69: Not What We Bargained For: Changing Workplaces
• No 65: Sickness Absence Policies
• No 59: DDA and Work-related Ill Health
• No 49: Overwork: Fatigue, Long Hours and Pressure

£1.50 each for union subscribers. £6 for nonsubscribers

Hazards magazine website

Excellent news and resources on the Hazards Worked to Death web resource page and Get a Life web resource page. Also ‘Crying shame: Stress-related suicides’ from Hazards

HSE priced and free publications on work-related stress

• For all the latest documents containing general standards and guidance on stress, go to the HSE web page
• Alternatively, obtain a free copy of the latest HSE Books catalogue, CAT 34, by telephoning 01787 881165

HSE work-related stress website

The HSE has a specific web page which draws together HSE information on work-related stress in one place
Recently developed management standards for stress

HSE Stress toolkit

HSE model stress policy

International Labour Organisation (see Section 6.4 for contact details)

Resources on stress

Labour Research Department (see Section 6.2 for contact details)

• Tackling Bullying and Harassment £4.95
• Stress at Work £4.70

London Hazards Centre (see Section 6.2 for contact details)

Stress at Work
Stress, Ill Health and Hazardous Employment Practices

TUC (see Section 6.1 for contact details)

• The TUC stress web page
• The TUC Stress MOT
• TUC Guide to the Stress Management Standards
• Tackling Stress at Work: a TUC Guide for Safety Reps £2.50 www.tuc.org.uk/publications/index.cfm
• Keeping well at work. A TUC guide (2nd edition) TUC Publications £9.99 www.tuc.org.uk/publications/index.cfm
• Essential information for safety representatives. Keep up to date on health and safety by reading Risks, the TUC’s weekly e-bulletin for safety representatives

Trade union information

• Many unions provide guidance on stress. The website addresses of all trade unions are on the TUC website a
  Hazards magazine has listed the health and safety pages of most trade unions
  Contact your union or visit your union’s website to find out if it produces any guidance on stress. For example, the NUT has produced a document on tackling stress [pdf]. UCU stress toolkit

The UK National Work-Stress Network

• News, networking and resources