Stress action plans and Occupational Health referrals

The Health and Safety Executive defines stress as 'the adverse reaction people have to excessive pressure or other types of demand placed on them'.

A level of pressure will be present in all jobs in one form or another.   Pressure and challenge, even when high, can be motivating and stimulating.  Where pressure that can be responded to effectively, it is likely to lead to job satisfaction.  However, pressure at a level and at a time where an individual cannot cope (or even too little pressure or challenge) can lead to stress.

There may be occasions when it is necessary to reactively investigate of the causes of an individual’s stress.  For example:

• When investigating the causes of sickness absence due to stress, or when planning a phased return to work after sickness absence due to stress (particularly long-term sickness absence).
• During a line manager’s incident investigation, following an individual reporting they are experiencing work-related stress or clearly exhibiting signs of stress.

Occasionally in cases of work related stress, employees may refuse to cooperate with their manager, or the organisation’s other arrangements for investigating the causes of stress.  In these circumstances every effort should be made to encourage the employee to enter into dialogue with their manager, or another representative of the organisation (e.g. HR Representative).

If it is not possible for the manager to be involved in the process described above (e.g. individual refuses to talk to their manager or wishes for a mediator in the process) the manager should contact HR to identify an alternative party to undertake discussions with the employee.  E.g. HR, Occupational Health, another manager, Trades Union Representative, etc.)

This approach described in this document is not intended to address the medical aspects of stress (e.g. clinical depression) as these should be addressed through an Occupational Health referral. 

However, it is intended to help identify and address the personal and organisational issues that have led to the individual’s perceptions of stress.

The overall aim of the process is for the individual employee and their manager to investigate the causes of (and solutions to) stress together.   It is not a blaming opportunity but rather a chance to reflect upon the situation and the circumstances around it, and to identify how to reach a satisfactory outcome (e.g. employee is able to return to work).   Approaching it in the manner described below means the employee plays a major part in identifying the issues involved in their feelings of stress and how they may be addressed.

Instructions on the Stress Action Plan process are given below.  A ‘Stress Action Plan’ form is also attached to this guidance, which can be used to record the issues identified, actions, etc.

Stage 1

The first stage of the process is for the employee to complete the Part 1 of the Stress Action Plan Form.  The employee should not complete it with their line manager, instead they should either complete it on his or her own or with the support of another person (e.g. HR, Trades Union Representative, etc.).  The support of another person may be useful to ensure the individual is being specific enough with the information they are providing.

•  Employee’s perceptions of stressors

The employee should write down their perceptions/feelings about the situation (e.g. no one listens to me, can’t cope with workload, no one interested, no support from manager, etc.).  Simple statements such as ‘I feel stressed’ will not enable the ‘Stress Action Plan’ approach to be successful.

•  Evidence of perceptions

The employee should provide examples of how they have arrived at their perceptions (e.g. instances that have led them to feel that they have no support from their manager).

•  The future

The employee should then write down the most significant issues in their work situation that they would want to see addressed (using examples from the evidence column) and how they would like these issues to be resolved, e.g. so they can return to the workplace and their job. 

•  Non-work factors

The individual should also document any non-work issues that are causing/contributing to their stress and how the organisation may be able to help the individual with those issues.

The aim of the gathering all the above information is to clearly identify:

• The employee’s perception of the issues.
• The evidence that supports their perception of the problem.
• Possible solutions to the problems, which can be used as the basis for agreeing a way forward.

Stage 2

•  Agreeing specific actions

Stage 2 should involve a meeting between the individual employee and their manager, and if necessary a HR Representative.  The purpose of this meeting should be to allow open and constructive communication between the two parties and enable a two-way sharing of views in an open and positive way.

The manager should give objective consideration to the employee’s ideas on how they wish to see any work-related issues resolved and clarify them with the employee where necessary. 

Both the employee and manager must recognise that the manager needs to balance these wishes with; the needs of the business, the potential effect on co-workers and the reasonable expectation that the employee should be able to cope with the normal pressures of the job.  In making their decisions the manager should ensure they take account of any issues arising from the Equalities Act (see below).

Although the individual’s requests cannot be guaranteed, in most cases many of their requests can be achieved or a reasonable compromise or outcome reached.

•  Documenting actions and review

The manager should document the actions agreed and the reasons for any inaction.  The manager and employee should then agree review dates (at the most one month after the creation of the Stress Action Plan) to discuss and review progress against the actions agreed.

‘Stress’ is not an illness or disability in itself.  However, severe or prolonged stress-related illness may lead to psychiatric and/or psychological conditions (such as clinical depression) that may meet the definition of disability as set down in the Equality Act.

If a person has a medical condition recognised by the Equality Act, Loughborough University is legally obliged to make reasonable adjustments to work arrangements.  ‘Reasonable adjustments’ might include actions such as temporary or permanent changes in responsibilities/tasks, flexible working arrangements, allowing time-off for medical appointments related to their disability, etc.  However, even if a person does not fall under the Equality Act, managers should still be willing to make reasonable adjustments if it means an employee can remain at or return to work. 

In addition to any work and non-work related factors, there may be medical issues involved.  In these circumstances a referral to Occupational Health (OH) will normally be necessary.

The guidance given below assumes the person is absent from work at the time of the referral. 

When to make a referral

The current attendance management policy suggests referral to OH when sickness becomes long-term (over 4 weeks). However, recent research advises that referrals take place more quickly in cases of stress, anxiety, depression or other mental health problems; or where there is re-occurrence of a previous condition.

It is advised that in these circumstances the referral process should start at two weeks, or at the latest no more than four weeks, from the commencement of sickness absence.

Questions to include in referrals

• Is the employee fit or likely to become fit to undertake all aspects of their current role?
• When is the employee expected to return?
• If the individual is not fully fit, would adjusted duties or temporary redeployment assist their return to work?
• Is there any action the employer could take to reduce the frequency/length of absence?
• Is the performance significantly affected by ill health and how long is this likely to continue?
• Is the ill health work related?
• What is your prognosis for recovery?
• Is the employee receiving appropriate treatment?
• Is the employee likely to be capable of regular and efficient service in the future?
• Is the employee fit to attend meetings?
• In your opinion, does the employee have a physical/mental impairment, which has a substantial and long-term effect on their ability  to carry out their normal day-to-day activities outlined in the job description?

Information to supply in support of a referral

Information to supply in support of a referral may include:

• Detail any other questions NOT specified above that you would like answering;
• Supplementary information if required;
• Summary of the job requirements or a copy of the current job description;
• Indicate the types of activity undertaken by the employee (tick the appropriate boxes);
• Copy of the Stress Action Plan, if available.

Other referral questions

If the employee is refusing any contact with the organisation (manager, HR, etc.) it may be also be necessary to ask other questions in the referral such as:

• What does the employee perceive to be the causes of their stress (both work and non-work factors)?
• Are there any significant work issues that the employee would wish to see addressed to enable them to return to their job?
• If so how they would like these issues to be addressed?

It is worth noting that there is a responsibility on the part of the employee to maintain regular contact with the University and a failure to do so is effectively a refusal to undertake a reasonable management instruction. This is effectively a breach of contract. Such an eventuality will need to be managed carefully in the circumstances that have given rise to the absence in the first place. However, this situation can arise and as these questions are about management issues and not medical ones, it is preferable that this element is dealt with internally wherever possible, by using the Stress Action Plan approach detailed above.

Referral questions during disciplinary investigations or capability discussions

If stress related absence has occurred at a time when a disciplinary investigation or capability process is underway, specific questions to ask in a referral would include:

• Is the person medically fit to attend a disciplinary hearing or capability discussion?
• If the person is medically unfit to attend a disciplinary hearing or capability discussion at this time, when are they likely to be fit to do so?
• How may their illness affect their ability to participate in a disciplinary or capability process?
• What steps could be taken to accommodate the employee's illness in respect of the disciplinary hearing or capability process?

Employment decisions

If employment decisions are being considered, other questions (e.g. what is the likelihood of the illness reoccurring, the length of absences and periods of good health between them) will be necessary. Other supporting information should also be provided (e.g. evidence that their condition is having an adverse effect on their ability to perform their duties efficiently).

If the situation requires a referral to Occupational health and the employee persists in not cooperating with either the organisation or Occupational Health, the employee should be advised of the potential impact of their actions.  E.g. if they refuse to attend an OH referral, the organisation may have to make any decisions about their employment with the information that it does have available.