©  Copyright 2002 Rogers Media. The following article first appeared in the February 2002 edition of BENEFITS CANADA magazine.

Ask any employee how he or she is feeling these days, and a likely response is 'stressed.' In the U.K., employers have had to take this complaint seriously and that has meant looking beyond health benefits programs for solutions and examining the sources of stress.

According to Cary Cooper, a professor of organizational psychology and health at the University of Manchester Institute of Science and Technology in England, over the past five years U.K. employers have seen a 90% increase in the number of employees suing for stress-related issues. Damages awarded have averaged approximately $800,000.

"Workplace stress is a compensatory workplace illness," says Cooper, who published Stress and Employer Liability last year. "But the employer has to know about it because the employer has a duty to care and manage psychosocial problems: work load, hours of work, how they're managed--all of these are now legitimate claims in the court."

Canadian employers are witnessing a related trend, says John Sproat, an employment law lawyer and partner at the Toronto firm Miller Thomson. Sproat says he's seen an upswing in wrongful or constructive dismissal cases where employees claim stress made it difficult for them to do their jobs. In other words, Sproat explains, employees are arguing that stress "made it untenable for me to continue my employment because whatever is causing the stress justifies me in saying 'you're effectively terminating me because you're subjecting me to stress in the workplace.' "

Overall, workplace stress remains a pervasive problem and Canadians say they are experiencing more of it. A recent study by the Canadian Policy Research Networks in Ottawa, Work-Life Balance in the New Millennium, says 55% of 6,500 Canadian employees surveyed report high levels of perceived stress--that's up from 47% in 1991.

The study cites the struggle to balance work and life as the main source of stress. The result is that employers pay over $3.5 billion per year in absenteeism costs. Some experts say it's closer to $16 billion a year when the cost of stress-related illnesses, such as depression, lost productivity, wage replacement and drugs are included. When it comes to insurance claims, John Tompkins, consultant in the health management practice at Toronto-based Hewitt Associates, estimates between 30% and 50% of long-term disability claims in Canada are stress-related.

TREATING WORKPLACE STRESS
Part of the difficulty in alleviating workplace stress is that some amount will always exist, says Tompkins. But employers can, and do, help employees cope through benefits plans. Still, he guesses the majority of health benefits programs "treat the symptoms rather than reduce or abate the causes (of stress)."

Bill Wilkerson, co-founder and chief executive officer of the Toronto-based Global Business and Economic Roundtable on Addiction and Mental Health, says benefits, including employee assistance programs (EAPs), stress management counselling and lifestyle tips, tend to reduce stress. But "if the workplace is at odds with the employee and produces conditions which induce unhealthy stress, then health benefits are not going to have much or any effect."

Apart from work-life balance, researchers in Europe and Canada note other sources of stress. Pascal Paoli, research manager at the European Foundation for the Improvement of Living and Working Conditions in Dublin, says the trend to shorter work days in Europe (and among some Canadian organizations), mostly to create jobs, has actually increased the pace of work and its intensity.

Job insecurity is another issue. Cooper says it increased when organizations in Canada and Europe began using more contract work a decade ago. That's when Cooper discovered what he called 'presenteeism.' The term refers to employees who work long hours just "to try and protect their jobs." He adds that those long hours eventually create stress-related illnesses.

When treating stress-related illnesses, Cooper says most employers miss the mark. EAPs, health initiatives and fitness programs are commendable because they provide an outlet for employees who are not coping well and for those whose stress is affecting their personal lives. But they're individual-oriented approaches, he explains, which focus on treating symptoms, such as anxiety.

"It's nice to provide support systems to people," says Cooper, "but that doesn't solve the problem of an autocratic management style, long working hours or a glass ceiling for women. You have to get at the root of it."

Employers in North America and Europe have tended to use benefits plans to deal with workplace stress because it's a simpler course of action, explains Paoli of the European Foundation. What they need to do is examine their organizational structure, which is where the sources of stress usually lie. "(Employers) have to look at the way work is organized, tasks are distributed (and what) autonomy is provided to people to manage their work and their pace," says Paoli.

To help employers determine the sources, Cooper and his research team developed the organizational stress screening tool known as ASSET, two years ago. It allows employers to survey employees anonymously on stress levels and sources, mental health, relationships and management. The results can be broken down by gender, department and age. Cooper says the results tell employers where there's a problem, the extent of it, and how they can intervene.

For example, if results show that management in one department are bullying employees, then the employer will know to step in and train management to see how their style is damaging employees' performance.

"If you went to a doctor and before you open your mouth, the doctor says 'here's a prescription, take these pills,' you'd think the guy was a loony," says Cooper. "Yet, many consultants come in and say, 'put in a gym, do meditation,' without knowing what the problem is."

While benefits programs do help employees cope, they aren't effective in every case--and that's why employers should be concerned. Cooper says if a bullying manager is causing an employee stress, an EAP can counsel him or her. But each day the employee returns to work for that manager, his or her stress is only likely to get worse.

"The EAP probably should counsel the employee to find another job," says Cooper. "But say the employee is dependent on that job, having a bullying boss who undermines and devalues you--it will damage you."

If the employee ends up leaving work or is terminated for taking too many sick days, Cooper says he or she could take legal action because the employer knew the circumstances and did nothing about it.

"If a company has an EAP or counselling service and says, 'we acknowledge that this person was being bullied, but why didn't he or she use the counselling service?' the court will rule, at least in the U.K., that you have a duty to care, to manage people's well-being in the workplace and that (benefits programs) are not a solution to the problem--they're only a temporary palliative (measure)."

Martin Shain agrees. He's a senior scientist at the Centre for Addiction and Mental Health in Toronto and is researching workplace stress. Shain also agrees that benefits programs help employees cope, but the sources of stress are "dependent on management styles and practices. Surveys will show you where your management 'hot spots' are," he adds.

By hot spots Shain refers to where managers mismanage demand-control and effort-reward--two models that researchers, including Shain, have used to examine workplace stress. Ideally, the two models should be in balance: there should be enough demand or tasks and some control in carrying out those tasks.

Employees also need to be rewarded according to the effort they put into completing tasks. If an imbalance in the two models persists--that is, too much demand, little control and too much effort, with insufficient reward--the health of the organization is at risk. While the data these two models yield is significant, Shain says you can go further below the issue--which is where his current work lies.

Underlying the two models is the concept of fairness--what Shain refers to as the 'black box' of stress. Employees' perception of whether they're being treated fairly or unfairly may be the "variable that links stress to health," he adds (see, "Stress effects," above).

If employees perceive they're being treated unfairly, it leads to feelings of betrayal. Feelings of betrayal affect the employment relationship and employee performance. "That sense of betrayal engenders a lack of trust. It ends up creating a sense of diminishment," says Shain.

These conditions lead to what Cooper calls phase two of the 'presenteeism' phenomenon he first identified--employees come to work, but due to feelings of diminishment they're not as productive as they could be.

If Shain can prove fairness is the 'black box' of workplace stress, employers will have to go beyond offering benefits programs to successfully reducing stress. Shain says that will mean "introducing CEOs to the knowledge that they need to realize something has to change (in the workplace). What typically has to change is them."

Shain says an effective way to get the message across is to translate fairness into market terms. "(CEOs) are not going to want to hear about emotions," says Shain. "Once you determine that fairness has market value you will get the attention of senior executives who realize that if they're going to deal with this presenteeism issue in any big way then they're going to have to get below the usual discourse on stress and health."

Delving deeper into the sources of stress means employers will have to rethink the work environment they've created. Wilkerson says it's become one in which the expense of stress-related health problems, the use of prescription drugs to manage them and the other costs of stress to business could soar to between $25 billion and $30 billion per year. So while benefits programs may appear to be the answer, they won't help employers pass the stress test. BC

The Romanow Commission has released its final report on the future of healthcare in Canada.

For Commissioner Romanow's recommendations, click here.

Click here for Senator Michael Kirby's report, "The Health of Canadians – The Federal Role: Recommendations for Reform."