04
Mental Health
and Stress
HEALTH POLICIES
01. Proactive Health Policy
02. Internal Health Relationships
03. Health Surveillance and Screening
04. Mental Health and Stress
05. Getting People Back to Productive Work
06. Employee Wellness and Engagement
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Mental Health and Stress
Contents
Contents
Why stress and mental ill-health are
different problems for an organisation . . . . . 3
Take action to improve
your organisation’s strategy . . . . . . . . . . 5
Use the resources available to help
your line managers engage with this topic . . 7
Help your employees become more
resilient to stress . . . . . . . . . . . . . . . .9
Case studies from learning organisations . . 11
Further Information . . . . . . . . . . . . . . 13
Notes . . . . . . . . . . . . . . . . . . . . . 14
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About the Proactive
Health Policies booklet
series
Management of employee health and
wellbeing is an important challenge
for all organisations. Becoming
proactive in health management can
assist corporate responsibility, reduce
company costs, increase productivity
and, most importantly, improve
people’s lives.
involved engage with a similar set of
ideas. These ideas will enable a flow
of information and understanding that
can push the health agenda forward.
They highlight:
This nest of six health policy booklets
is designed to support organisations
in becoming proactive in health
management. They are a starting
point to help the different disciplines
• Good practice
• Key focus areas
• Important concepts
• Useful tools and links
Booklet 4 - Mental Health
and Stress
Mental health and stress have
been identified as key contributors
to ill-health effects on the workingage population, which represents
a substantial cost to the industry
some of which is hidden in reduced
productivity. The management of
mental wellbeing is complicated
by stigma and discrimination in the
workplace. The government has
responded with a national strategy for
mental health and work1.
This document aims to provide the
context and case for improving
mental health and managing stress
in the workplace, and outlines
management approaches that
organisations can use to provide
benefit to both employer and
employee.
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Mental Health and Stress
Why stress and mental
ill-health are different
problems for an
organisation
Confusion between stress and mental ill-health can lead to
organisational inactivity. Managing stress can prevent mental
ill-health and resultant absences.
The Health and Safety Executive (HSE)
defines stress as ‘the adverse reaction
people have to excessive pressures or
other types of demand placed on them at
work’. However, stress is not an illness
but a state that can be good as well as
bad; the pressures and demands that
cause stress can have a positive effect,
although excessive and prolonged
stress could lead to mental and physical
illness. The most common presentations
of mental ill-health are anxiety and
depression, which may be the result of
issues such as a ‘difficult life event’ such
as bereavement or problems at work.
Many organisations see mental ill-health
and stress as a Pandora’s box that should
not be opened, for fear of all the ‘stress’
cases that may be identified. However,
managers should work towards viewing
stress and mental ill-health differently,
the default positions for stress should not
be time off work, nor turning a blind eye.
Stress in life is unavoidable, but needs to
be managed and controlled, to prevent
the excessive and prolonged exposure
that will lead to mental ill-health problems.
While there is a lack of data relating
specifically to the rail industry, stress
is considered as being one of the
industry’s major work-related ill-health
issues. Across the wider transport and
communications sector, the 2010 TUC
biennial survey of safety representatives
showed stress as the most frequently
identified ill-health hazard at 59%2. Stress
was also identified in RSSB research
on the management of health needs
(2005), as the second biggest health
problem of concern to the rail industry3.
These findings are in agreement with the
2012 Chartered Institute for Personnel
and Development (CIPD) report that
put stress as the single major cause for
absenteeism4.
Since stress is acknowledged as an issue
in all organisations, the question must
be ‘how can organisations control stress
levels?’
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The medical profession itself has difficulty with a lack of distinction
between non-specific psychological symptoms and diagnosable
mental illness; it is ‘a debate over the provision of more healthcare,
set against concerns about over-medicalisation’. And so it is not
surprising that many organisations have failed to act decisively on
this issue. However, there is ‘strong evidence that work is generally
good for mental health and the benefits usually outweigh the risks’5.
Opitmum Stress
= Positive
wellbeing
Performance
Boredem
Unhappiness
Anxiety
The Pressure performance curve.
The target for organisations is a balance between too much and too little pressure
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Mental Health and Stress
Take action to improve
your organisation’s
strategy
Taking action to improve organisational conditions and
controls is a big step, but support and guidance are readily
available.
There are a number of reasons why
employers should take steps to make
adjustments for people with mental
health conditions. There are legal
requirements, which are defined in the
Health and Safety at Work Act 1974 and
the Management of Health and Safety
at Work Regulations 1999. But there
are also more positive reasons, such as
making your organisation a responsible
and engaging place of work.
There is much that an employer can do
to improve the management of mental
wellbeing in the workplace. A proactive
organisation could be defined as one
that recognises that work is ‘on the whole
very good for mental health’6 in terms of
getting employees back to work, and who
actively promotes ‘productive and healthy
working conditions’7 to prevent workrelated ill-health problems.
NICE provides recommendations to
employers on how they can promote
mental wellbeing through productive and
healthy working conditions, key points8
include:
• Provide a strategic and coordinated
approach to promoting employees’
mental wellbeing.
• Integrate the promotion of mental
wellbeing within all policy and
practices concerned with managing
people.
• Create an awareness and
understanding of mental wellbeing
and reduce the potential for
discrimination and stigma related to
mental health problems.
• Adopt a structured approach to
assessing opportunities for promoting
employees’ mental wellbeing and
managing risks .
• Provide the opportunity for flexible
working, where practical, and promote
a supporting culture.
• Strengthen the role of line managers
in promoting the mental wellbeing
of employees through supportive
leadership style and management
practices.
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NICE recommends the use of frameworks
to promote and protect employee
mental wellbeing, for example: HSEs
Management standards for work-related
stress9. This focuses on changes to
the organisation and job rather than
the individual. It identifies the six main
sources of stress as being:
• Demands in the workplace, such as
workload
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• The support they are given
• Working relationships
• A person’s role within an organisation
• Organisational change
Against each of these risk areas, the HSE
management standards highlight good
practice. Your organisation could put
together plans to make managers aware
of these standards and how to use them.
• The control an employee has in the
way they work
Photo: Network Rail
Is your organisation onto the right track to manage health?
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Mental Health and Stress
Use the resources
available to help your line
managers engage with
this topic
The NICE, NHS and CIPD guides will assist your line managers
to understand and promote the mental wellbeing of their staff.
The Equality Act (2010) outlines an
employer’s duty to make reasonable
adjustments for people with disabilities, in
order to ensure that they have the same
access to everything that involves gaining
or keeping employment as a non-disabled
person. From a business perspective,
making a few small adjustments to enable
a member of staff to continue doing their
job is far less expensive than the costs of
recruiting and training a new employee.
The NHS guide below provides a good
resource to help with these adjustments:
talking to their team members about
stressful and mental health issues such
as:
http://www.nhshealthatwork.co.uk/images/
library/files/Government%20policy/
Mental_Health_Adjustments_Guidance_
May_2012.pdf
• Talking at an early stage
The ‘Shift … Line managers’ resource’10
offers a guide to line managers about
engaging with people experiencing
mental health problems. It covers many
of the issues line managers have about
• Identifying early signs of distress
• Using ordinary management
procedures to identify problems and
needs
• Understanding patterns of absence
• Things to consider when an employee
appears or says that they are
‘stressed’
• Engaging with someone who is
reluctant to talk about their mental
health
• Managing an employee who becomes
tearful and upset
• Managing the rest of the team
• Communicating with colleagues
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Line managers can find useful
suggestions for talking about stressful
situations with their team members in this
document:
http://www.hse.gov.uk/stress/pdfs/
manage-mental-health.pdf
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‘There’s no one ‘right’ way to talk about
mental health - everybody’s different. But
what’s important is to try. Far better to talk
and occasionally say the wrong thing than
to ignore the problem and hope it will go
away.’
Carrie Thomas, mental health trainer
Further useful resources for line managers can be found on
the MIND website: http://www.mind.org.uk/media/43719/
EMPLOYERS_guide.pdf
and another about taking stock of mental health in your market place
which gives guidance to line managers: http://www.clearkit.co.uk/
public/cms/80/87/101/921/Resource_2_Take_Stock_of_MH_in_
your_workplace_final.pdf?realName=ZjpyU1.pdf
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Mental Health and Stress
Help your employees
become more resilient to
stress
Guides to build resilience within your employees as part of
your mental health strategy are waiting to be used.
The HSE stress management standards
can help an organisation to positively
affect the mental health of its employees.
In addition to the HSE resource,
organisations may also offer their
employees help to make them more
resilient to pressures at work. CIPD
recommends an employee-centred
approach11 where individuals are provided
with education and support to help them
deal with the problems they face in the
workplace.
1. Identify perceived health and
wellbeing issues and programme
vision
Business in the Community have
developed an Emotional Resilience
Toolkit12 which provides a practical guide
to promoting the resilience of individuals
and teams in the organisation. This
includes a 12-step model for developing
an initiative to build emotional resilience
as part of a health and wellbeing
programme. The steps are listed
below; and you can find full details
and a business case and best practice
recommendations, by downloading the
toolkit at, http://www.bitc.org.uk/ourresources/report/emotional-resilience.
7. Clarify initial objectives
2. Know the business environment
3. Create the project team
4. Evaluate current resources
5. Create/review the core framework
6. Undertake a needs analysis
and establish KPIs
8. Develop the year’s programme
9. Find the right business partners
10.Communicating the programme
11.Launching the programme
12.Evaluation and on-going programme
management
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Transport for London – Learning to be resilient to stress
Transport for London (TfL) started their stress reduction group in
2004. Its aim is to teach employees life skills to deal with difficult
times and build a long lasting resilience to stress. The group is
facilitated by skilled experienced counsellors and uses different
behavioural techniques to help employees understand and manage
stressful situations more effectively. Each group contains six to
twelve employees who attend a two-hour session every week for
six weeks. Follow up sessions are available for any employee who
requests additional support at a later stage.
The effects of stress were monitored before and after the group
began. After three years, the numbers of working days lost for
employees who went on the course came down from over 3,000 per
year to around 1,000. This saving of 2000 days represents a cost
saving to the business of approximately £400,000.
Source: ORR health case studies
Transport for London are already seeing the benefits of their work in this area
Employee guidance on managing stress
• Network Rail have produced stress guidance for line managers
on mental health using the MIND document called: Emotional
Health, http://www.mind.org.uk/media/43719/EMPLOYERS_
guide.pdf
• East Midland’s OH provides face-to-face toolbox talks lasting
two hours, to promote awareness of psychological and MSD in
workplace.
• TfL have produced a managing stress-employee guide.
Rail organisations are starting to act to improve performance within this area.
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Mental Health and Stress
Case studies from
learning organisations
Many organisations have decided to act to manage mental
health and stress rather than believe it is beyond them to make
a positive difference.
Case Study
BT - strategy for mental health
The mental health strategy consists of
three phases:
• Reducing stress at source through
workplace and job design
• Identifying early signs of stress and
supporting individuals to address
work pressures that cause stress
• Helping people suffering from stress
to cope and recover
The strategy has resulted in initiatives
that promote good health, prevent illhealth, identify those at risk and provide
early intervention.
Over the past four to five years, the
sickness absence rate due to mental
health problems has fallen by 30%
despite pressured market conditions
and BT now gets almost 80% of people
who have been off for more than six
months with mental illness back into
their own jobs, compared with 20%
nationally.
http://www.hse.gov.uk/involvement/
casestudies/btgroup.htm
Many of the largest UK and global organisations are engaging with the mental ill-health stress issue.
They are finding business benefits for their organisations and improving the working lives of many
employees.
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Case Study
Hertfordshire Wellbeing programme for schools
The Hertfordshire’s Grid for Learning
web page provides guidance for school
on managing stress, which includes:
• Stress management and wellbeing
guidance for schools.
• Model HR policies for stress and
wellbeing.
• Information on the Wellbeing
programme which works with
schools to create a healthy and
positive working environment.
• Stress management toolkit which
includes a stress survey form, stress
risk assessment and action plan and
guidance on how to complete a risk
assessment.
• General guidance on mental health
and HSE standards.
• Information on a third party
employee assistance programme
for schools at a small cost per
employee per annum. This covers
areas of work-life balance, managing
stress, handling conflicts and help
individuals to improve their skills and
confidence and deal with personal
areas such as buying a house,
managing money etc.
http://www.thegrid.org.uk/info/
healthandsafety/stress.shtml
The longer organisations like Hertfordshire’s Grid for Learning tackle mental health issues, the
stronger their solutions become. Leaving these issues unresolved will just hide the problems.
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Mental Health and Stress
Further Information
Promoting mental wellbeing through productive and healthy working conditions:
guidance for employers, PH 22, NICE, 2009
http://guidance.nice.org.uk/PH22/Guidance/pdf/English
Government national strategy on mental health:
https://www.gov.uk/government/publications/the-mental-health-strategy-for-england
HSE Management standards for work-related stress, HSE, 2008:
http://www.hse.gov.uk/stress/standards/index.htm and a guide for employers on making
the Mangement Standards work: How to tackle work-related stress http://www.hse.gov.
uk/pubns/indg430.pdf
Sainsbury Centre for Mental Health identifies key components of effective work-based
programme: http://www.centreformentalhealth.org.uk/index.aspx
BITC Emotional Resilience Toolkit: http://www.bitc.org.uk/resources/publications/
emotional_resilience.html
Mindful employer Line Manger’s Resource – A practical guide to supporting staff with a
mental health condition, Mindful Employer, 2011 (an update to www.shift.org.uk which
provides SHIFT Line Manager’s Resource: for practical guidance on managing and
supporting people with mental health problems in the workplace):
http://www.hse.gov.uk/stress/pdfs/manage-mental-health.pdf
The Work Foundation provides reports and event relating to resilience:
http://www.theworkfoundation.com/Research/Workforce-Effectiveness/Health-Wellbeing/
Resilience
Vocational rehabilitation: what is it, who can deliver it, and who pays?, Sainsbury Centre
for Mental Health, 2008:
http://www.centreformentalhealth.org.uk/pdfs/vocational_rehab_what_who_paper.pdf
Foresight Mental Capital and Wellbeing Project, final project report, The Government
Office for Science, 2008 Sets out its suggestions for employers on promoting good
mental wellbeing and the enhancement of mental capital:
http://www.bis.gov.uk/assets/biscore/corporate/migratedD/ec_group/116-08-FO_b
New Economic Foundation Five ways to wellbeing, A “five-a-day” programme of social
and Five Steps a Day personal activities that can improve mental well-being. The five
steps are “Connect with people; Be active; Be curious; Learn; Give”
http://www.neweconomics.org/projects/five-ways-well-being
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IOSH provides an occupational toolkit for stress with training material, preventative
action, early action and interventions, referrals and rehabilitation and further information.
NHS Choices provides information on understanding and managing stress, anxiety and
depression: http://www.nhs.uk/Pages/HomePage.aspx
Notes
Working our way to better mental health: a framework for action, Department of Work and
Pensions and Department of Health 2009
1
2
ORR overview of work related ill-health in the GB rail industry in 2010, ORR, 2011
RSSB research project T389 Management of Health Needs Report 1: The current
position across the rail sector, 2005.
3
4
CIPD Absence Management Annual Survey Report 2012
5
Is work good for your health and wellbeing? Waddell & Burton 2006).
Vocational rehabilitation: what is it, who can deliver it, and who pays?, Sainsbury Centre
for Mental Health, 2008
6
7
Promoting mental at work: guidance for employers, PH 22, NICE, 2009
8
Promoting mental wellbeing at work: guidance for employers, PH 22, NICE, 2009
HSE Management standards for work-related stress, HSE, 2008
http://www.hse.gov.uk/stress/standards/index.htm
9
Shift – the Department of Health’s programme to reduce the stigma and discrimination
directed towards people with mental health problems http://www.hse.gov.uk/stress/pdfs/
manage-mental-health.pdf
10
11
http://www.cipd.co.uk/hr-resources/factsheets/stress-mental-health-at-work.aspx
12
Emotional resilience toolkit – Healthy people = healthy profits, BITC, 2009
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