Beating the stress test

The link between stress and ill health is a matter of chemical reactions inside the body. Group risk professionals can help workers get the right mix. Edmund Tirbutt reports

The keynote session at this May’s Group Risk Forum, Psychological Wellbeing at Work: Risks and Benefits, may have started off with a few juicy statistics – sickness absence costs £600 per person per year, 40 per cent of organisations now report an increase in stress-related absence, and the probability of employees who have been off work for six months getting back to work in another six months is reduced to 10 per cent.

But Professor Ivan Robertson, visiting professor at Leeds University Business School and a director at Robertson Cooper soon proved that he was far from being your average Joe who skirts over the surface of this type of subject matter. This was probably the first time that most in the audience had ever received an insight into the workings of cortisol – the so-called “stress hormone” that your adrenal gland pumps out into your system when you feel subjectively stressed, and an explanation of how that explains the debilitating effects of poor work environments on both physical and mental health. 

“What cortisol does is help us deal with whatever stress we have to cope with and does everything that readies you for an immediate response” he explained. “It interferes with blood flow, blood pressure and heart metabolism and it supresses the immune system as you don’t need it in the short term to deal with the threat.”

Delegates agreed this exposition helped to explain the now indisputable link between mental and physical health problems.

For example, poor psychological health results in a 40 to 60 per cent elevation in the risk of cardiovascular illness and, if things go as far as burn-out, creates a 60 to 80 per cent increase in obesity and diabetes risks.

Professor Robertson, who is also author of Well-Being: Happiness and Productivity at Work, said: “There’s not really a very clear understanding amongst the general population about how it is that psychological problems could present physical health problems but these are all well documented through research.

“10 years ago if you talked to people who were familiar with the scientific literature you could probably have got the debate going on how strong the impact was of poor psychological health on  cardiovascular health, immune system problems and glucose sugar renovation related issues. If you ask people who know the literature now about whether there’s any debate at all about that then the answer is no.”

Absenteeism was stressed as being only part of the problem, as psychological wellbeing has a stronger link to performance than physical health, depression and anxiety. As individual performance translates into organisational performance, employers ignore this at their peril.  Employee Assistance Programmes (EAPs) were highlighted by Professor Robertson as having a worthwhile job to do here but did not represent the entire solution.

“People might go to an EAP when it’s bad enough but there’s an earlier stage going on” he explained. “As well as absence there are other consequences from elevated or reduced psychological health or wellbeing. The most recent study shows a 50 per cent recovery rate from those who use EAPs but people only go to them later than preferable if you really want to catch things early and more effectively reduce costs and increase performance.

“The simplest way to identify issues early is to construct a wellbeing survey across the organisation but this is not an organisational survey and not an engagement survey. The biggest single route to improving things is then through management and leadership. The one thing that reports from various government sponsored bodies in this country have in common is that they identify the role of the line manager and the leadership of the organisation in people’s health and wellbeing at work.”

“It’s important to provide people with control about how they go about doing their work and to provide the resources and support they feel they need to effectively do their role,” continued Robertson. “In some roles it can be simple things like when they take toilet or other breaks, whereas in others it’s more complex. Pressure is good and high-demand workplaces are good but it’s only when people don’t have enough control and resources to cope with demands that you start to hit problems.

“The best jobs are high demand and high control. People feel at their best in the workplace when they have achieved something that was worth achieving. But pressure can be too high, and this is often more to do with ambiguity than intensity, and if pressure is too low then performance deteriorates. In short, leaders need to work to get people into the middle pressure/performance range where they are motivated and well and have high performance and enjoyment.”  

Resilience training was emphasised as having a useful role to play, although this could take many forms and it wasn’t yet entirely clear what the right formula was. The most effective programme in studies reviewed by Robertson Cooper was based on one 90-minute session whereas most of the others involved two-hour sessions for 10 weeks. But this finding was stressed to be interesting rather than definitive.

Professor Robertson’s key message was that people very often still see the wellbeing of the workforce as an employee benefit and overlook the fact that it is also a significant benefit to the organisation. The problem is that the results in the latter respect don’t become evident immediately.

“The research evidence and case study evidence is crystal clear but many organisations still just pay lip service to improving wellbeing, and when it comes to investing they often hold back and focus on things with short-term gain” he concluded. “The only way to counter this is to focus on return on investment and identify the strategic benefits.

“Management can often fail to appreciate factors causing poor mental health as they are naturally quite resilient and don’t have a problem dealing with pressure themselves. Therefore they expect everyone else to cope.”

In a session headed Let’s Put Group Risk at the Heart of People’s Cover, Ellipse chief executive John Ritchie inquired whether “as a sector we are possibly well below the positive psychological wellbeing line ourselves. I just wonder if we have lots of negative ways of thinking and talking?”

His beef is that the group risk field has a massive communications deficit and that for generations it hasn’t really listened to people. The language we use tends to exclude people and obscure issues and, in his view, it may even discourage people.     

He said: “Being sold to can feel quite uncomfortable and we don’t really respect our consumers. I think insurers look down their noses at their distribution, they just do. I think it’s one of our worst habits but it’s rarely talked about. These things have got to stop. We seem to need complexity but have we got the confidence to simplify the process, simplify the product and really let people feel they are sorted?”

Ritchie reasoned that if we are going to communicate through digital benefits platforms we need to remember the wise words of recently deceased advertising guru David Abbott who said that words needed to be “plain, simple and familiar.” But, more than that, we also have to actually “Do it”.

He continued: “We have these fantastic communications platforms but how often are they used for messaging about life cover and long-term sick cover and critical illness cover? Only once a year in the benefits window, and it’s ridiculous. There’s no return on investment on all that insurance spend if the benefits aren’t communicated. My contention is that the sector is lagging in digital and lagging in communication. We need to become more like retailers, like Next, with fantastic communication and execution.”

“The average customer is not illiterate and not innumerate. Do we believe the old adage that life cover is never bought but has to be sold? I’m not so sure. I think if you show people and give them some sensible tools to work out what they should do to protect their families then most of them will do the sensible thing, even if they realise that financially it puts them under a little bit of pressure.”

Some of these sentiments were wholeheartedly endorsed by Steve Bridger, head of group risk at Aviva , in How is Today’s Ageing Workforce Impacting the way Risk Benefits are Being Structured?,

as he predicted that most conversations with employers about group risk products for older workers are likely to revolve around offering choice through flexible benefit schemes.

Bridger said: “Digital consumers are much better educated than we give them credit for. It’s not complicated to understand that if I go off sick then after a period of time someone will give me some money and access to health. It’s not complicated to work out that if I die whilst in service a lump sum will be paid to help my beneficiaries and dependants have some financial security. So why do we think it’s that complicated?”

Bridger also questioned whether stress was in fact actually increasing as a problem, suggesting that it could just be that the recording of stress that has gone up.

He said: “It’s a lot easier than in the past to have a dialogue with a friend or GP to say that life is getting on top of you. When we look at some corporates we help and do diagnostics and understand the cost of absence for what we always hear is how stress incidences have shot up. But actually when you get under the surface of it it’s just reported better, although at least that means we know about it which means we can intervene and do something about it.”