4. Government guidance

In February 2011, the government launched a new mental health strategy for England. No health without mental health outlines how a new emphasis on early intervention and prevention will help tackle the underlying causes of mental ill-health. It sets out how the government will work with the NHS, local government and the third sector to help people recover and challenge stigma.

Central to these plans is an additional investment of around £400 million to improve access to modern, evidence-based psychological therapies over the next four years. The aim is to extend the current programme available to offer personalised support to 3.2 million people across the country, making available a choice of psychological therapies such as Cognitive Behavioural Therapy (CBT), counselling for depression, and interpersonal psychotherapy and ensuring access for anyone who needs it.

However, there is widespread scepticism about how these aims are going to be achieved in the face of the swingeing cuts to health services that are taking place and the huge rise in demand for mental health services in particular.

No health without mental health is available to download at www.dh.gov.uk/en/Healthcare/Mentalhealth/MentalHealthStrategy/index.htm

The National Institute for Health and Clinical Excellence (NICE) has produced Promoting mental wellbeing through productive and healthy working conditions: guidance for employers available to download at: www.nice.org.uk/PH22

HSE guidance

Since 2004, the HSE has developed its Stress Management Standards and produced a range of publications aimed at getting employers to deal with stress in their workplaces. The HSE proposes that employers:

• develop a stress policy;

• carry out a risk assessment on stress, using the Management Standards;

• map out an action plan on stress;

• organise a focus group; and

• meet with workers returning to work after sickness absence from stress.

The HSE leaflet, Securing management commitment, gives three reasons why employers should commit to tackling stress:

1) The legal case: the law requires employers to tackle stress;

2) The business case: tackling stress brings business benefits; and

3) The moral/ethical case: tackling stress prevents ill health.

Chapter 2 explained the legal case duties on employers to manage stress. The HSE argues that the business case arises because work-related stress can have adverse effects for organisations in terms of:

• employee commitment to work;

• staff performance and productivity;

• staff turnover and intention to leave;

• attendance levels;

• staff recruitment and retention;

• customer satisfaction; and

• organisational image.

On the ethical case, the HSE argues that there is “now convincing evidence that prolonged periods of stress, including work-related stress, have an adverse effect on health.” It mentions physical effects such as heart disease, back pain, headaches, gastrointestinal disturbances and psychological effects such as anxiety and depression (see Chapter 1).

The HSE argues that employers should negotiate a stress policy with workers. Its model policy sets out the roles and responsibilities for tackling stress and emphasises the role safety reps can play. The policy is available on HSE’s website.

Stress Management Standards

The centrepiece of the HSE’s efforts to tackle stress in recent years has been its Management Standards. Although it says a good number of employers in the public and private sector are using the Management Standards, it does not have a comprehensive list of those involved.

The Management Standards have also been endorsed by unions. For example the TUC has stated:

“The TUC welcomes these standards. In the absence of legislation, they are the most effective tool that employers can use to help end the epidemic of stress-related illness. We hope that employers will work with safety representatives and stewards to use them within every workplace.”

The HSE believes that the Management Standards help simplify risk assessment for work-related stress. It states that they help identify the main risk factors for work-related stress, help employers focus on the underlying causes and their prevention and provide a yardstick by which organisations can gauge their performance in tackling the key causes of stress.

However, the TUC's 2010 safety reps’ survey found that stress remains the top workplace health concern, despite the existence for several years now of the HSE’s Management Standards. The report says: “Clearly many employers are failing to tackle the issue, and big public sector organisations such as central and local government, the NHS and education are major culprits. This is unlikely to be helped by the current environment of unfettered cost-cutting. However the private sector is also blighted by stress — in fact it is the most widespread hazard in 12 out of 14 industrial sectors.”

There is some evidence that the Management Standards may not be as effective as hoped in reducing workplace stress and that the continuing poor economic climate is exacerbating the problem. However, although the TUC is continuing to campaign for an ACOP, at present the Management Standards remain the means by which reps can raise the issue of workplace stress and take steps to tackle it.

Before using the Management Standards

The HSE states that the following steps need to be taken before using the Standards:

• secure senior management commitment;

• secure commitment from employees and their representatives;

• set up a steering group;

• develop a project plan;

• secure adequate resources — in particular, staff time;

• develop a communications/employee engagement strategy;

• if appropriate, develop an organisational stress policy; and

• record what you have done.

It proposes five steps to successfully implement the process:

Step 1: Identify the risk factors

The Management Standards highlight the six main risk factors for work-related stress: demands, control, support, relationships, role and change:

Demands include issues such as workload, work patterns, and the work environment. The Standard is that: “Employees indicate that they are able to cope with the demands of their jobs.”

Control means how much say the person has in the way they do their work. The Standard is that: “Employees indicate that they are able to have a say about the way they do their work.”

Support includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues. The Standard is that: “Employees indicate that they receive adequate information and support from their colleagues and superiors.”

Relationships includes promoting positive working to avoid conflict and dealing with unacceptable behaviour. The Standard is that: “Employees indicate that they are not subjected to unacceptable behaviours, e.g. bullying at work.”

Role is whether people understand their role within the organisation and whether the organisation ensures that the person does not have conflicting roles. The Standard is that: “Employees indicate that they understand their role and responsibilities.”

Change includes how organisational change (large or small) is managed and communicated in the organisation. The Standard is that: “Employees indicate that the organisation engages them frequently when undergoing an organisational change.”

There is an additional standard for the six risk factors, which is: “Systems are in place locally to respond to any individual concerns”.

The HSE also produces “states to be achieved” to accompany each of the standards. These “describe the organisational behaviour that must be present to achieve the respective standard” and “highlight good management practice in each of these areas”.

Step 2: Who can be harmed and how

The HSE argues that information can be gathered from a range of sources:

• Existing sources — on sickness absence, productivity, staff turnover, performance appraisals, team meetings, informal talks, walk-throughs and talk-throughs;

• Surveys — such as the HSE’s own Indicator Tool or other surveys;

• Other methods — toolbox talks and focus groups.

Step 3: Evaluate the risks

This step aims to discuss the conclusions from the data and to develop solutions. The HSE states that, “It is critical that your employees and their representatives participate in this process” and that employers should “work in partnership with employees and their representatives to develop actions to take”.

Step 4: Record your findings

This means the steering group should produce an overall action plan for the organisation. The HSE says the plan should be created and agreed “with senior management, employees and their representatives”.

Step 5: Monitor and review

This step requires employers to check the action plan and whether it has been implemented. The HSE suggests further meetings and surveys to test the effectiveness of the action and has produced a checklist to evaluate whether the risk assessment was “suitable and sufficient”.

Making the Management Standards work

The International Stress Management Association (ISMA) has produced a guide, Making the Stress Management Standards work, which is endorsed by the HSE and the TUC. It draws some lessons from experience and says that programmes were most successful if decisions and policies were first tested on pilot groups and if support was in place before introducing the stress management approach. They worked well if initial benchmarking is carried out and when different methods of assessment were used.

Programmes are not very successful if:

• a survey is carried out without first educating managers about stress and the reason for tackling it; and

• if a survey is carried out without prior communication with staff.

Programmes were less successful if:

• there was no senior management commitment;

• the project group making the decisions did not understand stress and the issues involved;

• the results of surveys were not communicated effectively to staff; and

• solutions to problems were determined by senior management with no input from staff.

They were also not successful if attention was only paid to educating the individual.

Problems with the Management Standards

The HSE quotes academic research that the Stress Management Standards are effective in tackling the issue. University of London researchers produced a report, A business case for the Management Standards for Stress (RR431), that backed HSE’s approach.

However, more recent evidence has disputed these claims. A report for the HSE by Packham and Webster, Psychosocial working conditions in Britain, published in 2009 contained some depressing findings.

Five years after the Management Standards were introduced the researchers found that they had not delivered the hoped for improvements. Some “faint” signs of improvement appeared in 2007, but these did not continue the following year and in 2009: “There is no longer a downward trend in the number of employees reporting that their job is very or extremely stressful and little change in the number of employees aware of stress initiatives in their workplace or reporting discussions about stress with their line managers.”

The researchers concluded that: “Psychosocial working conditions for British employees have not generally significantly changed between 2004 and 2009. The predicted improvement in working conditions as a result of HSE’s roll-out of the Management Standards for work-related stress has not materialised as yet, and the number of workers reporting that their job is highly stressful is no longer steadily decreasing. 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.”

If the HSE’s excuse is that it is “too early” to judge the standards, for trade union reps it may be too late. The Standards were developed as voluntary guidance instead of an Approved Code of Practice, which unions wanted, and which the HSE entertained a decade ago. Although the Standards are laudable goals, there are no sanctions if employers fail to make the necessary improvements or simply ignore the process. Workers will rightly become cynical if they are a fig leaf for action. Although the Standards offer opportunities for trade unions to engage their employer on the issue, what matters is getting workers to experience a step-change reduction in stress in their workplace.

Acas guidance on mental health

Acas stresses that mental health problems can affect anyone regardless of their age, gender, ethnicity or social group. The most common forms of mental ill health are anxiety, depression, phobic anxiety disorders and obsessive compulsive disorders.

Mental illness is classed as a disability (at the point of diagnosis) under the Equality Act 2010. The Act makes it unlawful for an employer to treat a disabled person less favourably for a reason relating to their disability, without a justifiable reason. Some forms of mental illness — such as dementia, depression, bipolar disorder, obsessive compulsive disorder and schizophrenia — are classed as a disability and need to be covered in an employer’s equality policies.

Acas guidance states that employers can do three key things to help manage mental health at work:

• provide training — to raise their awareness of stress and mental health issues;

• develop good interpersonal skills — to help nurture trusting relationships with staff anxious about disclosing their mental health problems; and provide

• an organisational infrastructure that supports and guides workers by providing clear policies and procedures for managing mental health.

Acas on stress and depression

Acas has produced guidance on stress and depression in the workplace and has laid out a 10-point plan on stress for employers. Managers should:

• be aware of changes in day-to-day behaviour, such as not coping at work, under pressure, seeming distracted, loss of motivation or absenteeism;

• not make assumptions, since inconsistent behaviour may well be a “blip”, rather than the signs of a more serious problem;

• get to the root of the problem by approaching the individual privately, and informally asking if they are feeling alright;

• take responsibility if the cause of the problem is work-related, such as work overload or poor working practices, and remedy it;

• consult the safety representative;

• talk to the employee about changes which may be possible, such as flexible working, if the issue is a domestic one;

• if the employee has not already found support, point them in the right direction of help from their GP or a counsellor;

• create a culture which eradicates the stigma mental health can carry by introducing key policies and making support options available, like employment assistance programmes or access to occupational health;

• ensure stress and Occupational Health Service policies are implemented in practice by means of the training of management and staff; and

• ask the company to provide advice regarding exercise, a balanced diet and a healthy work pattern, since evidence suggests these can be useful in treating mild depression.