Stress is one of the slipperiest of health and safety topics. Though it's seen by managers as, at best, a difficult subject and, at worst, a complete impostor, stress in the workplace just cannot be ignored.

Both the HSE and the Court of Appeal have made it clear that it is an issue to which no responsible employer can turn a blind eye, and that, in turn, means that managers need to be equipped to deal with it. But how best to structure management training on this difficult subject?

The starting point for stress training has to be the establishment of some common ground as to what stress is and to sell to attendees the need to take it seriously and to manage it in the workplace.

The typical group is likely to include at least one attendee who really believes "if you can't stand the heat, you should get out of the kitchen" and probably several others who are put off by the difficulties of measuring and managing stress.

Talking about such things as pressure, coping and feelings takes many managers into uncomfortable territory, so the sooner we can establish a bridgehead of common ground, the better.

Fight or flight

Training should emphasise right from the start that stress is not simply pressure, but pressure that exceeds the individual's ability to cope. It should be honest about the fact that people do vary in their responses to pressure, and indeed that a person can handle different levels of pressure at different times.

As part of this, trainers will typically explore the physical effects of stress, quoting the body's "fight or flight" response. They will explain that while this may have stood people in good stead in the Stone Age when confronted with some lethal wild animal (sabre-tooth tiger is the favourite), "fight or flight" is only of limited use and can actually be damaging to health when we are regularly stuck in traffic on the motorway, angry that we are late for that key meeting.

Many trainers will also refer to the pressure/performance curve, to show how the first response to increased pressure is actually an improvement in performance, but as pressure continues to build, the improvement in performance first slows, then plateaus and finally reverses (overload and burnout).

Using a stress questionnaire such as the Holmes and Rahe stress scale can also be very helpful in showing that it is possible to quantify stress.

It is also a smart way to introduce variety, interaction and engagement into the training. It brings out the importance of life events (bereavement, marital break up, birth or illness of a child) in the mix of pressures faced by the average individual.

Trainers can then make the point that such events not only increase the pressure on the individual, but at the same time may well reduce their ability to cope - hence stress increases.

Standard practice

Any good stress management training is likely to be founded on the HSE's Stress Management Standards, which give a thorough explanation of what causes stress and how it can be controlled.

One of the key messages to get across is that it is possible to do something about stress, and a competent training course on the subject should encourage managers by showing practical examples of things that can be done in the workplace to minimise stress. Examples, based on the management standards, would typically include:

• the need for clear roles and responsibilities, giving people the authority to do their job and avoiding muddy accountabilities that leave people uncertain of where they stand
• having clarity of purpose at all levels (company, department, team, individual)
• giving people as much autonomy as possible in their working lives (though with appropriate resources and support), since having some control over what you do and how and when you do it is a major stress buster
• developing policies and (more importantly) practices that eliminate bullying and harassment from the workplace
• creating a culture of mutual respect; so, as a manager, do you convey respect in the way that you speak to and otherwise interact with your colleagues? ("do as you would be done by")
• dealing with stressors such as noise, poor workplace heating/ventilation, overcrowded working environments
• providing a confidential counselling service, which may be in the form of a telephone helpline.

These are all issues that are clearly the responsibility of directors and managers; failure to deal with them is not just bad health and safety, it's poor management.

If your organisation is going beyond general stress awareness to implement a thorough assessment and management programme, this is likely to involve stress audits in the form of questionnaires to staff and possibly focus groups and managerial risk assessments. In such cases, the training should support the programme and prepare people at different levels for participation in the process.

For managers, this might mean training in applying classic risk assessment techniques (identifying the hazards and who might be harmed, evaluating the risk level, recording findings and then monitoring the controls that are introduced as a result) to stressful work environments.

Self help

Training for managers should also put forward actions people can take for themselves to improve their resilience to pressure. These should be techniques that managers and supervisors can use, as well as the people in their teams.

This is also a good opportunity to pose the question: "You may yourself not suffer from stress, but are you a carrier? Do you pass stress onto others?"
This is getting into more personal territory (what works for one may not work for all) but could include things like:

• humour: laughter is not just the best medicine but also a great stress buster and defuser of tension
• outdoor activities: many people experience a sense of release in the countryside or any other wide open space
• exercise: there is plenty of evidence that exercise is not only good for your health but also makes you feel good by releasing endorphins into the bloodstream
• self-affirmation and development of a positive self-image
• problem-solving techniques to help people put their difficulties in perspective and focus on possible solutions rather than disaster scenarios
• prioritisation: so that people concentrate on the areas of their work that matter most and could be most productive
• use of assertiveness techniques, which are rooted in the idea that each person should show respect for others but is in turn entitled to be treated with respect.

Training that concentrates on practical issues is much more likely to be successful than that which spends too much time on all the health and psychosocial aspects.

The practical approach reassures managers that there are specific steps they can and should take to minimise stress. It is also an approach that is much more likely to be acceptable and non-controversial to those attending. There is nothing worse than gaining awareness of a problem without being given the tools to deal with it.

Visible support

The other major topic the training should cover is the practical steps a manager should take to help someone in their team who is suffering from stress. This section will typically cover:

• stress identification
• practical help
• dignity and respect
• confidentiality
• company procedures including, where needed, the involvement of occupational health and HR departments.

Research into training effectiveness suggests strongly that the sort of content that is best retained and applied is that which can be put into practice immediately after the course.

Courses should therefore focus on giving managers and supervisors a toolkit of practical actions that can be put into effect literally as soon as the training is complete.

Follow up (revisiting the messages from the course either one-to-one between the trainee and their manager or alternatively at a subsequent training session) also tends to maximise both retention and putting the key messages into practice.

Sadly, courses that do not do this are quickly forgotten and so become a waste of time and money.

More seriously, stress problems that could have been dealt with fairly easily in the early stages had the manager been properly equipped to deal with them may deteriorate into cases of permanent and irreversible ill health - which is morally wrong and bad news for all concerned.