1. The scale of the problem

Work-related stress has long been a major hazard for a wide range of workers and this has increased during the economic downturn. Research by trade unions, the Health and Safety Executive (HSE) and professional organisations has consistently shown that a large proportion of the workforce suffers from high levels of stress and that this often leads to mental health problems.

Unions have long fought for stress to be recognised by employers and the government as a major workplace problem. The TUC’s 2010 biennial survey of safety reps, carried out by the Labour Research Department, found that stress was the biggest hazard facing reps, with three in five (62%) identifying it as a major workplace hazard.

All eight TUC surveys since 1996 have found stress to be the major workplace concern for union safety reps.

The TUC’s 2010 safety reps’ survey findings on stress include:

• 62% safety representatives identified stress as a top five concern compared with 60% selecting overwork or stress in 2008;

• 27% picked stress out as the most important hazard in their workplace — the topic most likely to be given this level of importance in the survey;

• stress is more prevalent in the public sector than the private sector, with 68% of safety representatives in that sector saying it is a concern compared with 54%;

• it is one of the five most common hazards in 13 of the 14 industrial sectors, and is the top hazard in 12 of them; and

• it is more common in London (cited by 70%) than any other region/country.

Commenting on the findings the TUC said it was clear that: “Many employers are failing to tackle the issue, and big public sector organisations such the central and local government, the NHS and education are major culprits.”

The TUC recommends that unions should continue campaigning on stress with employers and the HSE, including for specific legal regulations. It also argues that there should be more use of enforcement measures by inspectors and that the Stress Management Standards should be incorporated in an Approved Code of Practice (ACOP).

Stress and mental health

Work-related stress is defined by the HSE as: “The adverse reaction people have to excessive pressures or other types of demand placed on them.”

The HSE states that stress is not an illness but if it becomes excessive and/or prolonged, mental and physical illness may develop.

The European Agency for Safety and Health at Work defines work-related stress in terms of the “interactions” between employees and exposure to hazards in their work environment. Stress is experienced when “the demands from the work environment exceed the employee’s ability to cope with (or control) them”. The European Agency says the advantage of this definition is that it focuses attention on the organisational causes and the control measures required.

Mental health is harder to define, not least because of the stigma often attached to it. The Royal College of Psychiatrists (RCP) states that mental health issues can range from fairly mild problems, such as sleep deprivation and fatigue, to common disorders such as anxiety and depression and, in limited cases, to severe mental illnesses such as schizophrenia and bipolar disorder. The conciliation service Acas uses the term “mental distress” to make the issue more human and accessible.

The extent of the problem

The HSE carries out a number of surveys of occupational ill-health, from occupational disease surveillance schemes to questionnaires. These surveys consistently show that stress is the second most widespread occupational health problem in the UK, after back pain. The HSE’s preferred source for estimating the scale of work-related stress in the Great Britain working population is the Self-reported work-related illness (SWI) questionnaire module in the national Labour Force Survey (LFS).

The extent of work-related stress

Since 2004, the HSE has obtained annual data on stress from the Psychosocial Working Conditions Survey (PWC) reports. The last survey, conducted in 2009, revealed that over one in six (17%) of British workers believed their jobs were extremely or very stressful. This was similar to the 2008 result, which represented the highest figure since the survey was commissioned.

The Self-reported Work-related Illness surveys (SWI for short) also paint a depressing picture. The most recent survey (2008-2009) indicated that 415,000 workers who had worked in the last 12 months were suffering from work-related stress, depression or anxiety caused or made worse by their current or past work. Tellingly, over half of these cases (230,000) were new, involving workers who first became aware of their work-related stress, depression or anxiety in the previous 12 months.

The HSE estimates that stress rates have doubled since 1990 with the rapid increase which took place during the 1990s, levelling out since 2000. The continuing economic crisis seems likely to generate a further upward trend and this is supported by evidence of increased mental health hospital admissions from 2008 to 2010.

Gender, ethnicity, age and workplace size

According to the most recent HSE figures available, women workers are more at risk of stress than men. The rate for women is slightly higher and the number of new cases affecting women is significantly higher. Women workers aged 45-54 years have the highest rates of stress, with male workers in the same age range carrying the highest rates. For both men and women, the oldest (55+ years) age group carry the lowest rates of stress.

An HSE report published in 2005 found “a significant association between work stress and ethnicity”. The report, Ethnicity, work characteristics, stress and health (RR308), revealed that 28% of non-white workers reported high levels of stress compared to 19% for white workers.

Stress by occupation and sector

Stress can affect anyone in any job. However, HSE surveys have found higher than average rates of stress among a number of occupations. These include teachers, protective service occupations such as prison officers and security staff, housing and welfare officers, nurses, civil servants and local government workers.

The TUC’s safety reps’ survey 2010 provided important information on the sectors most affected by stress. Stress was considered a hazard by 82% of safety reps in central government, 84% of reps in education, 72% in the health service, 70% in local government, 67% in energy and water, 61% in leisure services and 59% in transport and communications.

A shocking 100% of representatives in the banking, insurance and finance sector now say stress is a hazard in their workplace, compared with 57% saying this of overwork or stress in 2008.

In the voluntary sector, stress rockets to top-placed hazard, with almost nine out of 10 (86%) safety representatives in this industry citing this as a main hazard at their workplace. Bullying/harassment is also a massive problem, almost two thirds (67%) saying it is a top five hazard. Add in half of representatives citing overwork (50%) and 43% listing violence and threats and it is clear this is not a happy industry.

The TUC survey also revealed that stress appeared to increase as the size of the workplace increased. Nearly three quarters (71%) of reps in workplaces with over 1,000 workers said stress was their biggest hazard, compared to 52% in organisations with under 50 employees.

The National Union of Teachers (NUT) claims stress is now the main reason for driving teachers out of the profession. At its conference in April 2011, the union said an increase in government targets and high-stakes Ofsted inspections was fuelling a rise in serious mental health problems among school staff. Most teachers said behaviour policies in schools were inconsistently enforced, allowing many pupils to get away with bad behaviour.

This follows the publication of figures in 2010 that showed almost 309,000 school teachers — more than half of the workforce — were signed off sick for an average of two weeks in 2009.

Surveys that have looked at particular sectors include:

• Research by the UCU lecturers’ union in 2008 showed nearly four-fifths of lecturers surveyed (79.8%) agreed or strongly agreed with the statement: “I find my job stressful.” More than half (55%) reported high or very high general levels of stress.

• Research by the ATL education union in 2008 found that just over half (51%) of teachers in the state sector felt stressed, just ahead of teachers in the private sector (50%). Half of all teachers surveyed said they have considered changing jobs due to stress.

• A survey by the NASUWT teachers union in 2008 found that work-related stress affected two-thirds of teachers. One in five women teachers said they had needed to take time off work because of stress.

• A Scottish government survey in 2008 revealed that the average number of working days lost due to stress-related illness and depression was 0.6 per worker a year. However, Freedom of Information figures showed that for teachers in state schools, the figure was over three times this rate, while some Scottish councils reported levels of stress-related absence more than six times higher.

• The National NHS staff survey 2010, published by the Care Quality Commission, found that nearly one third (29%) of NHS staff were suffering from stress. Previous surveys have also put the figure at around one-third of staff. Two thirds of all NHS staff (66%) reported that they had attended work in the previous three months when they felt unwell. Of those who had attended work while unwell, the majority (91%) stated that they had put themselves under pressure to attend work, 30% felt pressure from their manager and 21% from other colleagues to attend. A larger proportion of staff in ambulance, mental health and primary care trusts reported work-related stress when compared with staff in acute trusts.

• The most recent Local Government Sickness Absence Levels and Causes Survey (2008 -2009) found that stress was the most important single cause of absence, accounting for nearly a fifth (18.5%) of all days off sick;

• After MG Rover, the last major British car manufacturer, closed in 2005, an Amicus (now Unite union) study found evidence of stress from financial anxiety as well as severe depression among those still looking for work.

The causes of mental ill-health at work

The UK National Work-Stress Network explains that the recognised causes of work-related stress are numerous and fall into several categories:

Work practices

• people unable to exert any control or influence over the demands placed upon them;

• lack of a clear job description or chain of command;

• a high degree of uncertainty about job security or career prospects;

• temporary work and fixed-term contracts;

• lack of any understanding leadership;

• cuts in government and local government funding leading to increased workloads;

• long-hours cultures;

• no recognition or reward for good job performance;

• no opportunity to voice complaints;

• heavy responsibilities with no authority or decision-making discretion;

• no opportunity to use personal talents or abilities;

• inadequate time to complete tasks to personal or company standards; and

• chances for small error or momentary lapse of attention to have serious or even disastrous consequences.

Pressure

• pressures piling on top of one another;

• pressures are unremitting or prolonged;

• there is confusion caused by conflicting demands;

• harassment or bullying;

• prolonged conflict between individuals; and

• exposure to prejudice regarding age, gender, sexuality, race, ethnicity or religion.

Management techniques

New management techniques including:

• human resource management;

• lean production; and

• business process re-engineering and total quality management.

Environment and technology

• unpleasant or hazardous working conditions;

• technology controlling workers, for example power; and

• “dialing” systems used in telephone banking where there are no gaps between calls and staff have no control.

The Whitehall II study, Work, stress and health (2004) provided important insights into the causes of stress. The study found that it was a combination of high demand and low control that caused stress-related illness. Workers in jobs characterised by low control had higher rates of sickness absence, mental illness, heart disease and pain in the lower back.

The HSE framework

The HSE has identified six causes of stress, which it calls “risk factors”:

• the demands of the job;

• control over work;

• the support from managers and colleagues;

• relationships at work;

• role in the organisation; and

• change and how it is managed.

These factors are the basis of the HSE’s approach to tackling stress, launched in 2004 — the Stress Management Standards(see Chapter 3).

The costs of stress and mental ill health

The human costs

The health effects of stress are very well documented. Work-related stress is a major factor in the development of heart disease and diabetes, according to researchers involved in the Whitehall II study.

Stress-related problems include mood disturbance, psychological distress, sleep disturbance, upset stomach, headache, and problems in relationships with family and friends. The effects of job stress on chronic diseases are more difficult to ascertain because chronic diseases develop over relatively long periods of time and are influenced by many factors other than stress. Nonetheless, there is some evidence that stress plays a role in the development of several types of chronic health problems — including cardiovascular disease, musculoskeletal disorders and psychological disorders.

Working in a high-pressure job doubles the risk of depression and anxiety for young people, according to research by Maria Melchior and other academics at King’s College London. A study of nearly 1,000 workers found that 45% of new cases of depression and anxiety were a result of stressful work. Researchers claim that, for the first time, they have established a firm link between stressful working conditions and poor mental health among young workers with no previous history of such disorders. (Psychological medicine, 37, 8, 2007).

Work-related stress could be killing more workers than workplace accidents, according to Crying shame, a report by the union-backed Hazards magazine (2008). In the UK, about 5,000 people of working age take their own lives every year. Assuming that 5% of these suicides are work-related (as they are in Japan), the death toll would 250 — more than the occupational fatalities reported by HSE each year. There have been at least four teacher suicides related to the OFSTED inspection process.

The organisational costs

The HSE’s Self-reported work-related illness (SWI) survey estimated that 11.4 million lost working days were due to work-related stress in 2008-2009. This represents around 27.5 working days lost per year for each affected case and makes stress, depression or anxiety one of the largest contributors to the overall estimated annual days lost from work-related ill health.

The Chartered Institute of Personnel and Development (CIPD) Absence management survey 2010 found that just under a third of organisations reported an increase in work-related stress compared with the previous year. Over a third (38%) of employers noted an increase in reported mental health problems, such as anxiety and depression, among employees in the last 12 months, a big increase on the previous survey when one fifth reported an increase.

The survey also notes that an increase in mental health problems was linked to a greater number of people coming to work ill in the last 12 months. It states: “Ensuring the well-being of staff is of paramount importance in times of uncertainty and there is a limit to how long employees can work under pressure before their health suffers”.

New research commissioned by SAMH (Scottish Association for Mental Health) as part of a major campaign revealed in April 2011 that the social and economic cost of mental health problems in Scotland has reached £10.7 billion per year: an increase of nearly a quarter on figures from 2004-05.

Analysis by the National Institute for Health and Clinical Excellence (NICE) says suggests that the annual cost of mental ill-health to a business with 1,000 employees is £835,355, but up to £250,000 a year could be saved by reducing absenteeism and increasing performance.

The Centre for Mental Health report, Mental health at work (2007) estimates that the total cost of mental health problems at work is nearly £26 billion each year. The majority of this cost (nearly 60%) is due to the adverse impact mental health has on the way employees do their jobs. Another third is accounted for by absenteeism and over £2 billion by staff turnover. It has also produced Removing barriers: the facts about mental health and employment (2009) available to download at: www.centreformentalhealth.org.uk/pdfs/briefing40_Removing_barriers_employment_mental_health.pdf.

Department for Work and Pensions figures in 2010 showed that over one million people received incapacity benefits for “mental and behavioural disorders” such as depression and stress (1.1 million, compared to 944,000 in 2009).