Any organization which seeks to establish and maintain the best state of mental, physical and social wellbeing of its employees needs to have policies and procedures which comprehensively address health and safety. These policies will include a mental health policy with procedures to manage stress based on the needs of the organization and its employees. These will be regularly reviewed and evaluated.

There are a number of options to consider in looking at the prevention of stress, which can be termed as primary, secondary and tertiary levels of prevention and address different stages in the stress process (Cooper and Cartwright 1994). Primary prevention is concerned with taking action to reduce or eliminate stressors (i.e., sources of stress), and positively promoting a supportive and healthy work environment. Secondary prevention is concerned with the prompt detection and management of depression and anxiety by increasing self-awareness and improving stress management skills. Tertiary prevention is concerned with the rehabilitation and recovery process of those individuals who have suffered or are suffering from serious ill health as a result of stress.

To develop an effective and comprehensive organizational policy on stress, employers need to integrate these three approaches (Cooper, Liukkonen and Cartwright 1996).

Primary Prevention

First, the most effective way of tackling stress is to eliminate it at its source. This may involve changes in personnel policies, improving communication systems, redesigning jobs, or allowing more decision making and autonomy at lower levels. Obviously, as the type of action required by an organization will vary according to the kinds of stressor operating, any intervention needs to be guided by some prior diagnosis or stress audit to identify what these stressors are and whom they are affecting.

Stress audits typically take the form of a self-report questionnaire administered to employees on an organization- wide, site or departmental basis. In addition to identifying the sources of stress at work and those individuals most vulnerable to stress, the questionnaire usually measures levels of employee job satisfaction, coping behaviour, and physical and psychological health comparative to similar occupational groups and industries. Stress audits are an extremely effective way of directing organizational resources into areas where they are most needed. Audits also provide a means of regularly monitoring stress levels and employee health over time, and provide a base line whereby subsequent interventions can be evaluated.

Diagnostic instruments, such as the Occupational Stress Indicator (Cooper, Sloan and Williams 1988) are increasingly being used by organizations for this purpose. They are usually administered through occupational health and/or personnel/human resource departments in consultation with a psychologist. In smaller companies, there may be the opportunity to hold employee discussion groups or develop checklists which can be administered on a more informal basis. The agenda for such discussions/ checklists should address the following issues:

• job content and work scheduling
• physical working conditions
• employment terms and expectations of different employee groups within the organization
• relationships at work
• communication systems and reporting arrangements.

Another alternative is to ask employees to keep a stress diary for a few weeks in which they record any stressful events they encounter during the course of the day. Pooling this information on a group/departmental basis can be useful in identifying universal and persistent sources of stress.

Creating healthy and supportive networks/environments

Another key factor in primary prevention is the development of the kind of supportive organizational climate in which stress is recognized as a feature of modern industrial life and not interpreted as a sign of weakness or incompetence. Mental ill health is indiscriminate—it can affect anyone irrespective of their age, social status or job function. Therefore, employees should not feel awkward about admitting to any difficulties they encounter.

Organizations need to take explicit steps to remove the stigma often attached to those with emotional problems and maximize the support available to staff (Cooper and Williams 1994). Some of the formal ways in which this can be done include:

• informing employees of existing sources of support and advice within the organization, like occupational health
• specifically incorporating self-development issues within appraisal systems
• extending and improving the “people” skills of managers and supervisors so they that convey a supportive attitude and can more comfortably handle employee problems.

Most importantly, there has to be demonstrable commitment to the issue of stress and mental health at work from both senior management and unions. This may require a move to more open communication and the dismantling of cultural norms within the organization which inherently promote stress among employees (e.g., cultural norms which encourage employees to work excessively long hours and feel guilty about leaving “on time”). Organizations with a supportive organizational climate will also be proactive in anticipating additional or new stressors which may be introduced as a result of proposed changes. For example, restructuring, new technology and take steps to address this, perhaps by training initiatives or greater employee involvement. Regular communication and increased employee involvement and participation play a key role in reducing stress in the context of organizational change.

Secondary Prevention

Initiatives which fall into this category are generally focused on training and education, and involve awareness activities and skill- training programmes.

Stress education and stress management courses serve a useful function in helping individuals to recognize the symptoms of stress in themselves and others and to extend and develop their coping skills and abilities and stress resilience.

The form and content of this kind of training can vary immensely but often includes simple relaxation techniques, lifestyle advice and planning, basic training in time management, assertiveness and problem-solving skills. The aim of these programmes is to help employees to review the psychological effects of stress and to develop a personal stress-control plan (Cooper 1996).

This kind of programme can be beneficial to all levels of staff and is particularly useful in training managers to recognize stress in their subordinates and be aware of their own managerial style and its impact on those they manage. This can be of great benefit if carried out following a stress audit.

Health screening/health enhancement programmes

Organizations, with the cooperation of occupational health personnel, can also introduce initiatives which directly promote positive health behaviours in the workplace. Again, health promotion activities can take a variety of forms. They may include:

• the introduction of regular medical check-ups and health screening
• the design of “healthy” canteen menus
• the provision of on-site fitness facilities and exercise classes
• corporate membership or concessionary rates at local health and fitness clubs
• the introduction of cardiovascular fitness programmes
• advice on alcohol and dietary control (particularly cutting down on cholesterol, salt and sugar)
• smoking-cessation programmes
• advice on lifestyle management, more generally.

For organizations without the facilities of an occupational health department, there are external agencies that can provide a range of health-promotion programmes. Evidence from established health-promotion programmes in the United States have produced some impressive results (Karasek and Theorell 1990). For example, the New York Telephone Company’s Wellness Programme, designed to improve cardiovascular fitness, saved the organization $2.7 million in absence and treatment costs in one year alone.

Stress management/lifestyle programmes can be particularly useful in helping individuals to cope with environmental stressors which may have been identified by the organization, but which cannot be changed, e.g., job insecurity.

Tertiary Prevention

An important part of health promotion in the workplace is the detection of mental health problems as soon as they arise and the prompt referral of these problems for specialist treatment. The majority of those who develop mental illness make a complete recovery and are able to return to work. It is usually far more costly to retire a person early on medical grounds and re-recruit and train a successor than it is to spend time easing a person back to work. There are two aspects of tertiary prevention which organizations can consider:

Counselling

Organizations can provide access to confidential professional counselling services for employees who are experiencing problems in the workplace or personal setting (Swanson and Murphy 1991). Such services can be provided either by in-house counsellors or outside agencies in the form of an Employee Assistance Programme (EAP).

EAPs provide counselling, information and/or referral to appropriate counselling treatment and support services. Such services are confidential and usually provide a 24-hour contact line. Charges are normally made on a per capita basis calculated on the total number of employees and the number of counselling hours provided by the programme.

Counselling is a highly skilled business and requires extensive training. It is important to ensure that counsellors have received recognized counselling skills training and have access to a suitable environment which allows them to conduct this activity in an ethical and confidential manner.

Again, the provision of counselling services is likely to be particularly effective in dealing with stress as a result of stressors operating within the organization which cannot be changed (e.g., job loss) or stress caused by non-work related problems (e.g., bereavement, marital breakdown), but which nevertheless tend to spill over into work life. It is also useful in directing employees to the most appropriate sources of help for their problems.

Facilitating the return to work

For those employees who are absent from work as a result of stress, it has to be recognized that the return to work itself is likely to be a “stressful” experience. It is important that organizations are sympathetic and understanding in these circumstances. A “return to work” interview should be conducted to establish whether the individual concerned is ready and happy to return to all aspects of their job. Negotiations should involve careful liaison between the employee, line manager and doctor. Once the individual has made a partial or complete return to his or her duties, a series of follow-up interviews are likely to be useful to monitor their progress and rehabilitation. Again, the occupational health department can play an important role in the rehabilitation process.

The options outlined above should not be regarded as mutually exclusive but rather as being potentially complimentary. Stress- management training, health-promotion activities and counselling services are useful in extending the physical and psychological resources of the individual to help them to modify their appraisal of a stressful situation and cope better with experienced distress (Berridge, Cooper and Highley 1997). However, there are many potential and persistent sources of stress the individual is likely to perceive him- or herself as lacking the resource or positional power to change (e.g., the structure, management style or culture of the organization). Such stressors require organizational level intervention if their long-term dysfunctional impact on employee health is to be overcome satisfactorily. They can only be identified by a stress audit.

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Selye (1974) suggested that having to live with other people is one of the most stressful aspects of life. Good relations between members of a work group are considered a central factor in individual and organizational health (Cooper and Payne 1988) particularly in terms of the boss–subordinate relationship. Poor relationships at work are defined as having “low trust, low levels of supportiveness and low interest in problem solving within the organization” (Cooper and Payne 1988). Mistrust is positively correlated with high role ambiguity, which leads to inadequate interpersonal communications between individuals and psychological strain in the form of low job satisfaction, decreased well-being and a feeling of being threatened by one’s superior and colleagues (Kahn et al. 1964; French and Caplan 1973).

Supportive social relationships at work are less likely to create the interpersonal pressures associated with rivalry, office politics and unconstructive competition (Cooper and Payne 1991). McLean (1979) suggests that social support in the form of group cohesion, interpersonal trust and liking for a superior is associated with decreased levels of perceived job stress and better health. Inconsiderate behaviour on the part of a supervisor appears to contribute significantly to feelings of job pressure (McLean 1979). Close supervision and rigid performance monitoring also have stressful consequences—in this connection a great deal of research has been carried out which indicates that a managerial style characterized by lack of effective consultation and communication, unjustified restrictions on employee behaviour, and lack of control over one’s job is associated with negative psychological moods and behavioural responses (for example, escapist drinking and heavy smoking) (Caplan et al. 1975), increased cardiovascular risk (Karasek 1979) and other stress-related manifestations. On the other hand, offering broader opportunities to employees to participate in decision making at work can result in improved performance, lower staff turnover and improved levels of mental and physical well-being. A participatory style of management should also extend to worker involvement in the improvement of safety in the workplace; this could help to overcome apathy among blue-collar workers, which is acknowledged as a significant factor in the cause of accidents (Robens 1972; Sutherland and Cooper 1986).

Early work in the relationship between managerial style and stress was carried out by Lewin (for example, in Lewin, Lippitt and White 1939), in which he documented the stressful and unproductive effects of authoritarian management styles. More recently, Karasek’s (1979) work highlights the importance of managers’ providing workers with greater control at work or a more participative management style. In a six-year prospective study he demonstrated that job control (i.e., the freedom to use one’s intellectual discretion) and work schedule freedom were significant predictors of risk of coronary heart disease. Restriction of opportunity for participation and autonomy results in increased depression, exhaustion, illness rates and pill consumption. Feelings of being unable to make changes concerning a job and lack of consultation are commonly reported stressors among blue-collar workers in the steel industry (Kelly and Cooper 1981), oil and gas workers on rigs and platforms in the North Sea (Sutherland and Cooper 1986) and many other blue-collar workers (Cooper and Smith 1985). On the other hand, as Gowler and Legge (1975) indicate, a participatory management style can create its own potentially stressful situations, for example, a mismatch of formal and actual power, resentment of the erosion of formal power, conflicting pressures both to be participative and to meet high production standards, and subordinates’ refusal to participate.

Although there has been a substantial research focus on the differences between authoritarian versus participatory management styles on employee performance and health, there have also been other, idiosyncratic approaches to managerial style (Jennings, Cox and Cooper 1994). For example, Levinson (1978) has focused on the impact of the “abrasive” manager. Abrasive managers are usually achievement-oriented, hard-driving and intelligent (similar to the type A personality), but function less well at the emotional level. As Quick and Quick (1984) point out, the need for perfection, the preoccupation with self and the condescending, critical style of the abrasive manager induce feelings of inadequacy among their subordinates. As Levinson suggests, the abrasive personality as a peer is both difficult and stressful to deal with, but as a superior, the consequences are potentially very damaging to interpersonal relationships and highly stressful for subordinates in the organization.

In addition, there are theories and research which suggest that the effect on employee health and safety of managerial style and personality can only be understood in the context of the nature of the task and the power of the manager or leader. For example, Fiedler’s (1967) contingency theory suggests that there are eight main group situations based upon combinations of dichotomies: (a) the warmth of the relations between the leader and follower; (b) the level structure imposed by the task; and (c) the power of the leader. The eight combinations could be arranged in a continuum with, at one end (octant one) a leader who has good relations with members, facing a highly structured task and possessing strong power; and, at the other end (octant eight), a leader who has poor relations with members, facing a loosely structured task and having low power. In terms of stress, it could be argued that the octants formed a continuum from low stress to high stress. Fiedler also examined two types of leader: the leader who would value negatively most of the characteristics of the member he liked least (the lower LPC leader) and the leader who would see many positive qualities even in the members whom he disliked (the high LPC leader). Fiedler made specific predictions about the performance of the leader. He suggested that the low LPC leader (who had difficulty in seeing merits in subordinates he disliked) would be most effective in octants one and eight, where there would be very low and very high levels of stress, respectively. On the other hand, a high LPC leader (who is able to see merits even in those he disliked) would be more effective in the middle octants, where moderate stress levels could be expected. In general, subsequent research (for example, Strube and Garcia 1981) has supported Fiedler’s ideas.

Additional leadership theories suggest that task-oriented managers or leaders create stress. Seltzer, Numerof and Bass (1989) found that intellectually stimulating leaders increased perceived stress and “burnout” among their subordinates. Misumi (1985) found that production-oriented leaders generated physiological symptoms of stress. Bass (1992) finds that in laboratory experiments, production-oriented leadership causes higher levels of anxiety and hostility. On the other hand, transformational and charismatic leadership theories (Burns 1978) focus upon the effect which those leaders have upon their subordinates who are generally more self-assured and perceive more meaning in their work. It has been found that these types of leader or manager reduce the stress levels of their subordinates.

On balance, therefore, managers who tend to demonstrate “considerate” behaviour, to have a participative management style, to be less production- or task-oriented and to provide subordinates with control over their jobs are likely to reduce the incidence of ill health and accidents at work.

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