Work related stress

Well-designed, organised and managed work is good for us but when insufficient attention to job design, work organisation and management has taken place, it can result in Work related stress. Work related stress develops because a person is unable to cope with the demands being placed on them. Stress, including work related stress, can be a significant cause of illness and is known to be linked with high levels of sickness absence, staff turnover and other issues such as more errors. Stress can hit anyone at any level of the business and recent research shows that work related stress is widespread and is not confined to particular sectors, jobs or industries. That is why a population-wide approach is necessary to tackle it. HSE has developed the Management Standards approach to tackling work related stress; these Standards represent a set of conditions that, if present, reflect a high level of health, well-being and organisational performance. This approach helps those who have key roles in promoting organisational and individual health and well-being to develop systems to prevent illness resulting from stress.

Definition of stress
Stress can hit anyone at any level of the business and recent research shows that work related stress is widespread and is not confined to particular sectors, jobs or industries. HSE's formal definition of work related stress is: "The adverse reaction people have to excessive pressures or other types of demand placed on them at work." Stress is not an illness it is a state. However, if stress becomes too excessive and prolonged, mental and physical illness may develop. Well-designed, organised and managed work is generally good for us but when insufficient attention to job design, work organisation and management has taken place, it can result in Work related stress. Work related stress develops because a person is unable to cope with the demands being placed on them. Stress, including work related

stress, can be a significant cause of illness and is known to be linked with high levels of sickness absence, staff turnover and other issues such as more errors. There is a difference between pressure and stress. Pressure can be positive and a motivating factor, and is often essential in a job. It can help us achieve our goals and perform better. Stress occurs when this pressure becomes excessive. Stress is a natural reaction to too much pressure.

Balancing demands and pressures with skills and knowledge

A person experiences stress when they perceive that the demands of their work are greater than their ability to cope. Coping means balancing the demands and pressures placed on you (i.e. the job requirements) with your skills and knowledge (i.e. your capabilities). For example, if you give a member of your team a tight deadline on a project they feel they have neither the skills nor ability to do well, they may begin to feel undue pressure which could result in work related stress. Stress can also result from having too few demands, as people will become bored, feel undervalued and lack recognition. If they feel they have little or no say over the work they do or how they do it, this may cause them stress. [back to top]

Factors in stress
Stress affects people in different ways and what one person finds stressful can be normal to another. With each new situation a person will decide what the challenge is and whether they have the resources to cope. If they decide they don't have the resources, they will begin to feel stressed. How they appraise the situation will depend on various factors, including:

their background and culture; their skills and experience; their personality; their personal circumstances; their individual characteristics;

their health status; their ethnicity, gender, age or disability; and other demands both in and outside work.

As a manager you have a duty to ensure that work does not make your team ill. Understanding how to spot the signs of stress in your team, and then know what to do to reduce stress, will help you achieve this. "For me it was a new boss. I found myself crying 'cos I couldn't keep up suddenly. Stress is where you can't cope, there's too much and you don't know what to focus on any more." (Employee, London)

Causes of stress

What about stress at home? HSE has identified six factors that can lead to work related stress if they are not managed properly. Demands: Employees indicate that they are able to cope with the demands of their jobs. Control: Employees indicate that they are able to have a say about the way they do their work. Support: Employees indicate that they receive adequate information and support from their colleagues and superiors. Relationships: Employees indicate that they are not subjected to unacceptable behaviours, e.g. bullying at work. Role: Employees indicate that they understand their role and responsibilities. Change:

Employees indicate that the organisation engages them frequently when undergoing an organisational change.

It is important to understand each of the six factors and how they are related to each other, as this can influence the amount of stress an individual experiences:

A person can reduce the impact of high demands if they have high control over their work. The impact of high demands and low control can be reduced by having high levels of support, either from colleagues or from you as a manager. Relationships can be one of the biggest sources of stress, especially where there are problems like bullying and harassment. Problems with role are probably the easier problems to solve. Change does not have to be at an organisational level to have an impact on individuals or teams, for example, changes in team members, line managers or the type of work or technology used by the team can be just as stressful. Understanding that these six factors can cause stress for employees can help employers and managers answer the questions:

Does my organisation or team have a problem with stress? If 'yes', what do I need to do or change to reduce that stress? If 'no' what do I need to do to prevent stress becoming a problem in the future? In the Management Standards section of this website, we have identified good practice guidance for each of these factors which should encourage a proactive approach to preventing and managing stress in the workplace.

Signs and Symptoms

Signs of stress in individuals Signs of stress in a group

Key message
Stress can cause changes in those experiencing it. In some cases there are clear signs that people are experiencing stress at work and if these can be identified early, action can be taken before the pressure becomes a problem. This may make it easier to reduce and eliminate the causes. It is important that everyone looks out for changes in a person's or a group's behaviour. However, in many cases the changes may only be noticeable to the person subject to the stress and so it is also important to look at how you are feeling and try to identify any potential issues you may have as early as possible and take positive action to address them; this may be raising the matter with a line manager, talking to an occupational health professional or your own GP. Stress can show itself in many different ways - see below. Some of the items in this list may not be signs of stress if people always behave this way. Managers may need to manage staff exhibiting some of these signs differently. You are particularly looking for changes in the way people behave that could be linked with excessive pressures.

Head and mental health

Heart, lungs and circulation

Skin

Metabolism

Muscles and joints

Digestive system and gut

Reproduction and growth

Immune system

Signs of stress in individuals

If you are suffering from some of the following symptoms it may indicate that you are feeling the effects of stress. If you find that work or aspects of your work bring on or make these symptoms worse, speak to your line manager, trade union representative or your HR department. It may be that some action taken at an early stage will ease the stress and reduce or stop the symptoms.

Emotional symptoms

Negative or depressive feeling Disappointment with yourself Increased emotional reactions - more tearful or sensitive or aggressive Loneliness, withdrawn Loss of motivation commitment and confidence Mood swings (not behavioural)

Mental

Confusion, indecision Cant concentrate Poor memory

Changes from your normal behaviour

Changes in eating habits Increased smoking, drinking or drug taking 'to cope' Mood swings effecting your behaviour Changes in sleep patterns Twitchy, nervous behaviour Changes in attendance such as arriving later or taking more time off.

Please note these are indicators of behaviour of those experiencing stress. They may also be indicative of other conditions. If you are concerned about yourself please seek advice from your GP. If you are concerned about a colleague try to convince them to see their GP. [back to top]

Signs of stress in a group

Disputes and disaffection within the group Increase in staff turnover Increase in complaints and grievances Increased sickness absence Increased reports of stress Difficulty in attracting new staff Poor performance Customer dissatisfaction or complaints

It is not up to you or your managers to diagnose stress. If you or they are very worried about a person, recommend they see their GP. It is up to you and your managers to recognise that behaviours have changed, be aware that something is wrong and take prompt action. Take care not to over react to small changes in behaviour. You and your managers need to act when these behavioural changes continue. Use these symptoms (both individual and group) as clues

Stress and mental health at work

Definitions Common mental health problems (CMHPs) How CMHPs and work related stress go together How CMHPs and work related stress are different Mental health problems Find out more

Definitions
Work related stress is the adverse reaction people have to excessive pressures or other types of demand placed on them at work. Mental health is how we think, feel and behave. Common mental health problems are those that:

are most frequent and more prevalent; and are successfully treated in primary care settings like GPs rather than by specialists such as Psychiatrists

Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen. (NHS Direct) Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time. (NHS Direct) [back to top]

Common mental health problems (CMHP)

One person in four in the UK will have a mental health problem at some point in their life. While mental health problems are common, most are mild. The family doctor and primary healthcare team can usually deal with them without referring the person for specialist help. Anxiety and depression are the most common mental health problems. Often these are a reaction to a difficult life event, for example moving house, bereavement, or problems at work. CMHPs tend to be short-term and are generally treated by medication from a GP. The GP will review this treatment and if there is no improvement, consider referring to a specialist. [back to top]

How CMHPs and work related stress go together

Work related stress and mental health often go together. The symptoms of stress and common mental health problems are similar, for example, loss of appetite, fatigue and tearfulness can be symptoms of both.

Work related stress may trigger an existing mental health problem that the person may otherwise have successfully managed without letting it affect their work. For people with existing mental health issues, work related stress may worsen their problem. If work related stress reaches a point where it has triggered an existing mental health problem, it becomes hard to separate one from the other. [back to top]

How CMHPs and work related stress are different

Common mental health problems and stress can exist independently. For example, people can have work related stress and physical changes such as high blood pressure, without experiencing anxiety and depression. They can also have anxiety and depression without experiencing stress. The key difference between the two is their cause and the way they are treated. Stress at work is a reaction to events or experiences at work. CMHPs can arise through causes outside work, e.g. bereavement, divorce, postnatal depression or a family history of the problem. However, people can have CMHPs with no obvious causes. Organisations can manage and prevent stress by improving conditions at work. Doctors usually treat common mental health problems by prescribing medication. However, you and your managers have a role in making adjustments and helping the person to manage the problem at work. [back to top]

Mental health problems

In practice, it can be hard to distinguish when stress turns into a mental health problem and when existing mental health problems become exaggerated by stress at work. Many of the symptoms are similar to those that people experience when they are under considerable pressure; the key differences are in the severity and duration of the symptoms and the impact they have on someones everyday life.

Usually a general practitioner (GP) will make the diagnosis and offer treatment e.g. medication, talking therapies or a combination of both. The majority of people with mental health problems are treated by their GP and most are capable of continuing to work productively. Evidence shows that employment can be of great benefit, both to the employer and to the employee. [back to top]

Find out more

Find out more about helping people with anxiety by going to the ANXIETY UK website . ANXIETY UK is a national registered charity formed 30 years ago by a sufferer of agoraphobia for those affected by anxiety disorders; it is still a user-led organisation, run by sufferers and ex-sufferers of anxiety disorders supported by a high-profile medical advisory panel. Find out more about helping people with common mental health problems on the SHIFT line manager resource website.

hat about stress at home?

Causes of stress outside work Do I have to do anything about stress outside work? Worklife balance initiatives Further support for problems outside work

Key message
A person can experience excessive pressure and demands outside work just as much as they can at work. Stress tends to build up over time because of a combination of factors that may not all be work related. Conflicting demands of work and home can cause excessive stress. Problems outside work can affect a person's ability to perform effectively at work. Stressors at home can affect those at work and vice versa. For example, working long hours, or away from home, taking work home and having higher responsibility can all have a negative effect on a persons home life something which is supposed to be a

'buffer' against the stressful events of work. In the same way, domestic problems such as childcare, financial or relationship problems can negatively affect a persons work. The person loses out as do their family and their employer. It becomes a vicious circle. It is difficult to control outside stressors, but you need to take a holistic approach to employee well-being. To manage work related stress effectively, you need to recognise the importance and interaction of work and home problems. " I think if the managers took time out generally to get to know you personally, your home life, if you've got any problems at home that might be affecting your work [it would help] to know that they're available." (Employee, London)

Causes of stress outside work

Many things in people's lives outside work can cause them stress, for example:

Family

Death (of a loved one) Divorce or separation from a partner Marriage Pregnancy Holidays Changes in health of a family member or close friend Trouble with in-laws Family arguments Children leaving home Childcare Remarriage of a family member Caring for other dependents, such as elderly relatives Family reunion Relationship breakdown or having a long-distance relationship

Personal or social issues

Change in financial state, or debt or money worries Changes in personal habits such as giving up smoking, going on a diet. Problems with weight Experiencing prejudice or discrimination Lack of friends or support Personal injury or illness

Daily hassles

Traffic jams Public transport Time pressures Car troubles

Other

Moving house, including taking out a mortgage Difficulties with neighbours Living with someone with an alcohol, drug problem or other addiction. (If studying) a deadline for coursework, exam results or trying to balance work and study Unemployment Poor living environment

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Do I have to do anything about stress outside work?

You don't have to, but it's good if you do. If you think about people's personal lives and outside stressors, you will be able to anticipate stressful times. Your employee is not obliged to tell you their personal problems, but there are some practical things you could do to support them:

Be sympathetic and proactive. Arrange a confidential meeting with the person, allowing them the opportunity to discuss any problems they wish and allowing you time to voice your own concerns. It may help to clarify whether the persons problems are work related or personal.

Be flexible. Consider offering the person more flexible working hours, or even offer them some paid time off to deal with their problems.

Offer outside support. If appropriate, you could suggest they visit their doctor and allow them time off to do so. You could also suggest support groups.

Outline the support and services your organisation offers. For example, your organisation may have a worklife balance initiative in place. These are benefits, policies, or programmes that help balance out job demands and a healthy life outside work. They can include:
o o o o o

childcare services; flexible working arrangements; family leave policies; employee assistance programmes; or fitness programmes.

Programmes of this kind can work effectively to

o o o o

retain staff; improve morale; reduce sickness absence and stress; and increase productivity and commitment.

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Work-life balance initiatives

The website of the Canadian Centre for Occupational Health and Safety questions about worklife balance. The Flexibility website contains resources for new ways of working, including achecklist and an index of articles written about worklife balance. answers some

Further support and services outside work

If your employee has raised a specific issue with you, you might like to suggest they approach one of these support services:
Alcohol

Drinkline. Advice, information and support to anyone concerned about their own or someone else's drinking. 0800 917 8292

Bereavement

Cruse Bereavement Line. Helpline for bereaved people and those caring for bereaved people. 0844 477 9400

Carers

Carers Line. Advice and information for all carers.

0808 808 7777

Young people

Childline. Helpline for children and young people in danger, distress or with any problem. NSPCC. For anyone concerned about a child at risk of abuse. 0800 1111 0808 800 5000

Disability

DIAL. UK network of disability information and advice services run by people with direct experience of disability. 01302 310 123

Domestic violence

Women's Aid and REFUGE offer a joint helpline providing practical advice and support for those experiencing domestic violence 0808 200 0247

Drugs

National Drugs Helpline. For drug users, their families, friends and carers. 0800 77 66 00

Emotional crisis

The Samaritans. Confidential, emotional support for anyone in a crisis. 08457 90 90 90

Family

Careline. National charity providing a confidential telephone counselling service. Parentline. Helpline for the parents and carers of children. 0845 122 8622 0808 800 2222

Money

National debtline. Help for anyone in debt or concerned they may fall into debt. 0808 808 4000

Older people

Seniorline. Information service for senior citizens, their relatives, carers and friends. Age Concern. For older people, their families and people working with them. 0800 00 99 66 0808 808 7575

Social welfare

Shelter. Helpline for anyone facing a housing emergency. Citizens Advice Bureaux. Free, confidential advice on a host of topics

0808 800 4444 www.adviceguide.org.uk (external link)