Shrinking the stigma

Workplaces have become part of a national conversation on mental health and stress, but the tension between individual interventions and structural change remains.

In recent years, celebrity voices, charity campaigns and social media have all joined in destigmatising mental health issues. But employers still struggle to join up strategies on psychosocial risk.

The tension between the focus on individualised interventions and a long-term structural approach is now playing out against the backdrop of the COVID-19 pandemic and a recession. The ‘new normal’ is putting more work into homes, and more personal issues into work, while raising awareness of individuals’ increased emotional loads. As organisations look to deliver ‘COVID-secure’ workplaces, the pandemic is encouraging holistic thinking about the psychosocial factors affecting their workforces and productivity.

Drawing a line

For many, the pandemic represents a line-in-the-sand opportunity to address psychosocial risk. ‘It’s a good time to be in the field – people are more aware than they would have been prior to COVID,’ says Juliet Hassard, associate professor of occupational health psychology at the University of Nottingham.

At the UK Health and Safety Executive (HSE), senior psychologist Peter Kelly agrees. ‘Let’s use it to re-engage health and wellbeing, let’s be adventurous and step out. COVID will be here for the next couple of years, so it’s time to create workplaces that really promote health.’

But can employers access the research, tools and management standards to help them proactively manage psychosocial risk, stress and the resulting mental ill health? How should they incorporate it into business plans and reporting structures? A ‘marketplace’ of systems, audits and consultants has also sprung up, but there’s little in the way of agreed best practice. Will the forthcoming publication of ISO 45003 align strategies and point employers in the same direction?  

Boiling over?

In the last decade, indicators of work-related stress have steadily tracked upwards (see Psychosocial surge, below). In the UK, the Management of Health and Safety at Work Regulations 1999 require any employer with five or more staff to conduct a risk assessment that includes work-related stress, then act on it.

However, many organisations feel that their duty of care is satisfied by a policy document and tertiary interventions, such as contracting an employee assistance programme (EAP), wellbeing vouchers or mental health first aid training. That falls short of what many practitioners – and indeed the HSE – would like to see.

At mental health charity Mind, head of workplace wellbeing Emma Mamo sets out the best case scenario. ‘Any strategy needs mechanisms to get a picture of what’s going on, then interventions at an organisation, team and individual level. Mental health strategies are best dealt with top down, bottom up and side to side. Organisations often know that, but they don’t necessarily know where to start, or they try things in pockets and need to work out how it all hangs together in a framework that can develop over time.’

Likewise, Neil Shah, chief insights officer at International Wellbeing Insights (the research and consultancy arm of non-for-profit consultancy the Stress Management Society), says that employers often offer ‘pieces of the jigsaw’ instead of the ‘bigger picture’. ‘You need a strategic approach that uses tertiary support, but also addresses the structural challenges that create stress in the first place. Most organisations we engage with are looking to mitigate the stress they’ve caused to their employees. But that “health and safety” approach of managing and mitigating risk is fundamental.’

Peter at the HSE wants EAP providers to move on from dealing with the individual casualties of toxic work environments to taking a preventative approach. ‘I’ve issued an open message to the Employee Assistance Professionals Association, to not just focus solely on providing interventions to the individual, but to do proactive and preventative work as well. They should ask themselves, what can they offer a client organisation to manage and promote mental health better, not just mental ill health?’

Among secondary interventions, there is growing interest in ‘job design’, or giving employees a greater input in defining job roles. Rachel Lewis, an occupational psychologist at consultancy and research group Affinity Health at Work, is reassuring. ‘We’ve found – and the research shows – that changes in job design can be relatively small: it doesn’t mean giving people control over everything. For example, teams have designed the shift rota for a call centre, but the employer also has a voice in the process.’

Neil recommends bringing everyone into the fold of responsibility for stress strategies. ‘It is often divided between human resources and the health and safety team. But to have long-term success, a strategy needs a multifunctional approach – so that also includes learning and development, and senior leadership, and employee representatives.’

A fresh start

Across all sectors, the pandemic has created the time and space to explore new ideas. At Mind, Emma says: ‘In many organisations, you would always hear: “That’s the way we’ve always done it.” But now, there’s appetite for a reset.’

In addition, the HSE guidance on working safely during COVID stipulates that mandatory risk assessments should include psychosocial risk. Peter says: ‘If it’s an effective COVID risk assessment, it needs to include the psychosocial element. Organisations need to involve people in planning, there has to be a clear narrative about what the organisation is going to do, and staff need to feel reassured their health and safety is being looked after. The work environment, and social attitudes there, will be influential in the uptake of physical procedures and processes.’

Rachel says this is an essential measure. ‘Lots of people will be returning to work with mental health issues because of anxiety or loss, or job insecurity and their financial situation. So we need to put in place tertiary services, such as online counselling, occupational health services, EAPs, counsellors in the workplace, setting up Schwartz rounds in the workplace.’

No silver bullets

Work-related stress has generated a packed marketplace of service offerings, often based on audits using diagnostic tools, staff surveys and reports.

However, Juliet feels some consultants sell generalised solutions for unique problems. ‘Stress management has been characterised as a bit of a “silver bullet” industry, but an off-the-shelf approach has limited levels of success. Every organisation has different challenges, so you need a tailored approach. It’s akin to the weight loss industry: it’s about systemic change, long-term behavioural change, and often what works for one person doesn’t work for another.’

Peter also expresses doubts. ‘There’s a multiplicity of people offering a multiplicity of things – but a large majority are based at an individual level, without an organisational assessment of what you need. Consultants need to be proactive about actively addressing these issues.’

Moses syndrome

In a crowded landscape, the HSE’s own stress management standards are often viewed as the stone tablets of psychosocial risk management: published by the regulator, backed by the unions, and with a track record dating back to 2004. They define characteristics of an organisation where stress is managed effectively, under six headings: demands, control, support, relationships, role and change. The HSE has published new COVID-specific risk assessment guidance, emphasising the need to include stress and mental health impacts.  

However, the standards aren’t seen as a universal panacea. Rachel says: ‘The HSE stress management standards are a good, simple way for organisations to start to assess what the risks are. But it’s quite hard for organisations to see what to do at the local level – they operate at a high level.’ And while her concerns extend to stress management tools as a whole, Emma and Rachel question whether today’s diagnostic tools fully address today’s issues. ‘There are different groups and communities, who will have a different experience on a number of issues that impact on mental health – for instance, people who identify as LGBT+ can have a higher incidence of mental health issues,’ says Emma. ‘Race and microaggressions and institutional racism will also have a massive impact. So at this point, a focus on intersectionality is important.’  

It’s about systemic change, long-term behavioural change, and often what works for one person doesn’t work for another

Rachel, who is also a lecturer at Birkbeck, University of London, points to the links between stress at work and inequality. ‘In the current environment, including Black Lives Matter, understanding the impact that COVID has had on equality in organisations, and how it may have further disadvantaged some groups, is increasingly relevant. I think there will be a greater appetite to focus on social justice at work. Certainly, clients are asking us to audit issues around social justice, fairness and inclusivity.’

In response, Peter points to the stress management standards’ credentials drawn from key models of work-related stress. It includes a 35-question staff survey – probing issues such as harassment, long hours and control of working life – that he says are as relevant in 2020 as in 2004.

Guidance on its way

One initiative that holds out the promise of an objective, internationally-agreed approach to psychosocial risk management is the forthcoming publication of ISO 45003. The document extends the scope of ISO 45001 to stress and psychosocial risk. The text has reportedly undergone a dramatic rewrite since the first draft in 
late 2018, which took a classic ‘hierarchy of control’ approach.

Peter acted as an expert adviser to the ISO Project Committee. ‘Taking a hierarchy of control model leads you into an obstacle – you can’t eliminate the risk. So the new text is based on having primary, secondary and tertiary interventions, as all the evidence says that is the way to go. ISO 45003 won’t be the saviour of the world, but it would be helpful if people looked at it. The message that needs to get out is that [managing psychosocial risk] is not just the “nice” thing to do, it’s the right thing to do.’