In 2002, the HSE published its first stress guidance: Tackling Work-related Stress - A Managers' Guide to Improving and Maintaining Employee Health and Wellbeing. This explained an organisation's legal duty of care and the major causes of work-related stress, and provided a simple risk assessment framework for tackling the problem.

Five years and a lot of hard work later, last November the HSE released new guidance: Managing the Causes of Work-related Stress - A Step-by-Step Approach Using the Management Standards (available from www.hsebooks.com at £10.95 or by subscription to www.hsedirect.co.uk).

But how much has workplace stress management improved in the interim?
"Somewhat", seems to be the answer. As a result of the guidance, many more organisations are now tackling the problem and several excellent best-practice case studies have emerged.

But there's still a long way to go. Over the last five years, the number of working days lost per year due to work-related stress (WRS), anxiety and depression has remained pretty constant, fluctuating around the 13 million mark, and many organisations are still failing to address the problem effectively. There are a few basic reasons why this is the case.

Survey centrism

A common misunderstanding is that an employee survey to assess stress levels counts as a stress risk assessment. Well-meaning managers therefore rush to carry out a survey with no thought to preparation or what will happen afterwards.

Although the HSE does advocate stress surveys, they are only a means to an end: to generate information on which to act. Sometimes you can do without, particularly in smaller organisations. Other information sources  such as staff satisfaction scores, focus groups and absence figures are also very useful for judging problem stress levels.

If you do plan a survey, managers must be informed. If they don't understand the rationale for a survey, they are unlikely to give it priority and encourage staff to complete it. Only staff who are happy or unhappy will then respond, and sample size is likely to be low and unrepresentative.

Even if the sample size is OK, a lack of manager education can cause other problems. One health and safety manager I recently advised showed me a survey that had been carried out six months before she arrived. She explained it had been "sitting on everybody's shelves for six months and nobody had done anything with it." When I asked if the managers had been told what to do, the answer was, of course, "no". This is not atypical. If managers don't know what they have to do, they are unlikely to take action.

In a similar situation, a council engaged me a couple of years ago to report on their survey. They gave me the survey results and explained that they were nearly a year old! By this time they had been through so many changes I advised them it was not worth using the survey. If you carry out a survey, it's important that results are communicated quickly and acted on.

Organisations sometimes want to wait until a calmer time to do the survey. One client recently told me they wanted to wait another six months until another change had happened, so "the results would be better."

In reality, there will always be some problem. My response was that, contrary to popular belief, a risk assessment (and a survey to fuel it) is not a pass or fail exercise but a proactive way of addressing problems. Surveying stress levels during a change may actually help identify and fix issues that could otherwise cost the organisation dearly.

The five-step stress risk assessment process in the HSE's new guidance

1. Identify the hazards - identify the stress risk factors, understand the Management Standards.
2. Decide who may be harmed and how - gather data.
3. Evaluate the risk - explore problems and develop solutions.
4. Record your findings - develop and implement action plans.
5. Monitor and review - monitor and review action plans and assess effectiveness.

Unfortunately, many managers do worry that the results of the stress survey will be pass or fail, so are reluctant to do one. This again illustrates the need for education. Managers need to be told to expect some poor results and see them as an opportunity for improvement rather than as a black mark.

They also need to be shown how to manage staff expectations and explain that it is not an interdepartmental competition. Sections can be encouraged to share best practice rather than score points as to which do best. Some areas will always do better than others because of the nature of their work.

I recently carried out a review of a university and noticed that stress absence in the school of health was high. Talking to the dean, it became obvious that this was partly due to the fact that employees understood the concept and were therefore more willing to admit to it and report it than employees in other departments.

Quick fixes

Even if a survey is carried out effectively, things can still go wrong. Managers may receive the results and, behaving with the best intentions, sit down and try to come up with solutions themselves. They don't realise they need to consult their staff. Some will also try for quick fixes.

Of course, many organisations don't do a survey at all. Instead, managers are given a risk assessment form to complete with their teams, often with no prior training. These forms are usually very long and laborious and comprise the HSE's stress risk factors (see Pressure relief) in various guises.

As managers are usually already busy, are generally not interested in stress and don't see the point, this becomes a tick-box exercise. They rarely consult their staff about what would help. As such, these forms are a total waste of time.

What health and safety managers need to be aware of is that HSE inspectors have now been asked to assess organisations for how much involvement both senior managers and staff have in the risk assessment process and they need to make sure managers know this too.

The worst example of the tick-box approach I've seen so far was a form that listed all 35 questions from the HSE assessment tool. Managers were asked to decide how well their team was doing against each question. They then had to come up with actions for each question.

Most managers simply rephrased the question as an action. If the question was "do employees have a say over the way they do their work?" the action recorded would be "ensure employees have a say over the way they do their work." This is far too general a response and not worth recording.

Actions must be SMART (specific, measurable, agreed, realistic and time-bound). While the forms are not usually quite so comprehensive, this type of approach is a common interpretation of the risk assessment process.

Though most organisations carry out stress risk assessments for compliance purposes, some organisations try to deal with stress for ethical reasons and are not even aware of a stress risk assessment process.

In these situations, managers often try to help staff by introducing quick fixes such as massage, while others want to train their staff in stress management. The rationale: if staff are trained to manage stress then the problems will be solved. While this may help, if the problems are due to work factors, it's not the answer.

A call centre I am working with initially came into the stress training category. The centre had recently changed its monitoring system so that people who didn't reach their targets would be put on an improvement plan. This system had been imposed by senior management and hadn't been explained properly to line managers or employees. It was causing a great deal of stress and I was asked to train the employees to reduce this. After a day talking to employees it became obvious that training staff in personal stress management would not solve the problem. After this was explained, they decided to run the whole thing properly as a stress-management project.

A couple of times I have been asked to work with teams that have already carried out stress training which has done more harm than good. The problem here is that there are now many cowboys offering stress training and because managers don't know what they don't know, they are unable to be discerning. They often go for the cheapest which is actually unfit for their purpose. To overcome this problem, the HSE has now issued guidance on choosing a consultant, available here. 

Silo mentality

Though tackling stress at work is very much a line manager's domain and research has shown that the most successful initiatives are those that involve cooperation between occupational health (OH), health and safety and HR staff, the fact that the HSE has taken up the stress baton appears to have given line managers and HR managers an excuse to abdicate responsibility. I believe this may be another reason why stress is not being tackled as effectively as it could be.

As part of an organisational review I interviewed a number of OH and HR managers. While OH staff were very tuned into stress, the HR managers were much less so. The senior HR manager happily confided that stress was no longer his problem as he had recently "delegated that to H&S".

In many organisations health and safety managers don't have the weight to get their issues heard in the boardroom. This can mean they don't get sufficient support from the top and/or the budget they have is insufficient.

Senior managers and line managers also often pay less attention to health and safety professionals than they should. Put stress under health and safety and it can go to the bottom of the pile of priorities. The result is often lip service from the top and box-ticking by managers.

If I am working with the health and safety function and HR staff show no interest, I try to get them to agree at least to attend an awareness session. If possible, I try to extend this to all senior managers. If you can get the necessary information across, the result is usually more buy-in.

In an organisation I am currently working in, stress is being tackled by a very capable and competent health and safety manager. But it has taken 18 months and some very difficult conversations to get to the point we are at now.

Initially, the health and safety manager suggested the sort of process advocated by the HSE, but nobody was interested in this. To meet legal duties he therefore introduced risk assessment forms, similar to those described earlier, for all managers to complete.

Fortunately he was more clued in than many and, before asking them to complete the forms, he trained the managers to understand stress risk assessment. On agreeing to work with them, I first explained the tick-box problem and modified the form to be more manager-friendly. I also explained that it would be helpful if managers first understood stress and the rationale for action.

While the health and safety manager agreed with this, my suggestions had to be approved by HR, so a meeting was scheduled for me to explain my rationale. At the meeting, it was obvious that the HR manager understood very little about stress and had not previously paid much attention.

However, once he listened he became much more interested and even suggested himself that a survey be carried out - something he had previously overlooked. He also agreed to training for all senior managers which generated a great deal of discussion and debate.

The whole thing gradually grew and evolved and we now have in place a process where all managers are first trained to understand stress and how to do a risk assessment via an e-learning programme which is being put on their intranet.

The organisation will then run the HSE stress survey and give managers the results. As part of the training, managers are told how to discuss results with staff and find solutions. They will then be asked to submit an action plan. HR and health and safety staff will be supporting managers and each department has a stress champion to oversee the process. HR and health and safety managers and stress champions will all have received one-day face-to-face training.

The wrong tack

Not all health and safety managers are as familiar with stress as the one in the example above and many don't really understand the concept. When carrying out a stress risk assessment they often try to apply the same principles to stress as they would to such things as slips and trips.

This is not possible and, instead of encouraging communication between staff, it results in production of the large forms and the tick-boxes I described earlier.

There is also a great deal of confusion about whether managers should be assessing their teams or individuals in their teams. Although individual differences should not be ignored, the HSE recommends a collective risk assessment process approach, which involves identifying problems common to teams. Unfortunately, I have lost count of the number of times health and safety managers have designed a form for managers to risk assess each individual in their teams.

About three years ago, I worked with a health and safety manager who was extremely committed; he had even produced an equation to calculate likelihood and severity of stress risk for each individual. Apart from the fact that  measurements  such as this  are unsuitable for the subjective concept of stress, it is also not practical. For a manager with more than a handful of staff, this task would be like painting the Forth Road Bridge.

Health and safety managers also sometimes confuse risk assessment and action plans. The idea of a collective stress risk assessment is to get managers to identify problems in their teams and then work with staff to find solutions.

At Step 4 in the risk assessment process (see box) they are required to complete a simple action plan. In practice, the action plan becomes a lengthy risk assessment form which again becomes a tick-box exercise. Since autumn 2007 I have tried to get health and safety managers in three organisations to scrap their lengthy forms but they've been very reluctant to do so.

Similarly, many health and safety managers appear reluctant to use everyday English and insist on using professional jargon. A common request is for managers to "identify hazards or assess what control measures are already in place." What does this mean? For a busy manager, this just makes it all the more remote an exercise.

To be fair, the initial HSE guidance did adhere closely to the five steps and use health and safety "speak". But in the new guidance, while the five steps are still there, the HSE has included some interpretation (see box above).

In producing the new guidance, the HSE has also adopted a much bigger picture. While the executive has always recognised the line manager's role in stress assessment and management, in the new guidance it's emphasised much more and there is a great deal of help for managers in reducing stress for their staff. There is also a stress management competency framework.

The HSE is now also trying to link its stress initiatives with other government initiatives such as absence management and heath and wellbeing. At the moment, stress, absence and performance are often tackled separately, but it really makes good sense for all three to be addressed together.

When working with organisations I usually try to get them to see this bigger picture and where possible integrate all three. This tends to be more successful where HR is involved. There have been some occasions where health and safety managers have adopted a more integrated approach, but often these good intentions have not translated into success in practice. The reason: they haven't tested feasibility first.

Two organisations I worked with recently had devised a joint stress and absence policy. In both cases, the managers were expected to inform OH as soon as an employee was off work with stress problems. In both cases, there was only one OH manager for the whole organisation and so this system was unlikely to work.

In one, this process had been written into the policy but, as managers weren't aware of this, very few did as they should and the drain on resources was not as great as it could have been. But managers who did do as expected were becoming frustrated as the OH nurse could not deal with the referrals she was receiving and the result was a long waiting list. 

Health and safety managers are very keen to do the right thing. Though compliance is often their driving force, most health and safety managers really want stress to be taken seriously to improve the health and happiness of employees. I would like to hope that, five years on, the new guidance will give them the assistance they need to do this more effectively and in another five years WRS will be much less of a problem than it is today.

A feature on stress risk assessment for students of the NEBOSH National Diploma is available here.

Dr Rosemary Anderson is a chartered health psychologist and consultant specialising in stress and absence management, health and wellbeing. She was on the working party that developed the HSE stress management standards, www.andersonpeakperformance.co.uk