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Stress at the Workplace and Its Impacts on Productivity: A Systematic Review from Industrial Engineering, Management, and Medical Perspective

2022, Industrial Engineering & Management Systems

In every fast-paced surrounding, stress is present in every life aspect, including at the workplace. It is a deeply personal experience, with various stressors affecting every individual differently. This study assessed the past and present workplace stress-related information and analyzed its impact on productivity. It primarily concentrates on the field's philosophical principles, while providing a collection of directions for future study as well. This study was formed in the statement of PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). The impact of stress at the workplace on the employee's productivity was observed in the cohort and cross-sectional studies from the perspective of industrial engineering, management, and medicine. Four eligible studies were qualitatively assessed from 2,642 identified literature through four databases (Cochrane, Science Direct, Scielo, and PubMed) using keywords stress, impact, productivity, industrial engineering, management, and medicine. The study was convinced that stress at the workplace contributes to worsening relationships at home, worsening relationships between superiors and subordinates as well as contracting diseases. It has a potential negative impact on productivity. Furthermore, the work environment plays a significant contribution in inducing workplace stress because of human physiologic response. Noxious stress is detrimental to the human body, especially if maintained in the long run. Therefore, stress management is imperative before it is too late.

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This review of the literature gives information about work stress, factors in the working environment that cause stressful situations and negative health consequences of the workplace stress. Stressors are pointed out in details that lead to stress at the workplace. Approaches to the stress are explained and most famous models of the stress are assessed critically in this review. This article highlights the work stress and its adverse effects on the physical and mental health of an employee. Finally, recommendations for future research are given and areas are highlighted where there is need of more empirical research.

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Stress is much in the news at present but it isn't a new problem. Pressure is part and parcel of all work and helps to keep us motivated. But excessive pressure can lead to stress which undermines performance, is costly to employers and can make people ill. Research reveals that many working days are lost to stress, depression and anxiety. Work-related stress costs a huge burden to the society. Stress takes many forms as well as leading to anxiety and depression it can have a significant impact on an employee's physical health. Research links stress to heart disease, back pain, headaches, gastrointestinal disturbances and alcohol and drug dependency. Individuals are more willing to admit that they are suffering from stress if they can expect to be dealt with sympathetically. In some cases good counseling may be all that is needed. This paper aims at studying the stressors that affects an individual at work, to examine the effects of stress and suitable measures which employe...

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In today's age of automation, advanced technology & high competition, man has great dreams of a luxurious living & enjoys at the thought of experiencing it. It is a well-accepted fact that every human being is an individual with his own unique characteristics & ways of responding & behaving. These various ways of responding & behaving can be either positive or negative & these can make one's life a happy or a miserable one. These facts are true for every individual in every sphere of life. In today's fast moving world every individual strives hard to achieve their dreams & the best of luxurious living but faces stress in the process of doing so. The present study will bring to light the stress level, sources of stress & stress management strategies.

Littera Scripta

Andrea Bencsik

Erick Onsongo

Over the past few decades the stress had become a growing dilemma in organization and cause unfavorable effects on job performance. Stress is a universal element that affects employees worldwide. There are many barriers that affecting the employees in the workplace. Work stress often affects the employees in the workplace, where each employee will feel it at least once in their workplace. Work stress is a real life problem that not only affects the organization, but the employees mainly become victims of stress. stress become a familiar element in organization and nowadays the workplace become more complicated, which bring more negative impacts to the employees compared to positive impacts. Stress among workers is greater than before which also effect on the whole performance of the employees. Stress which occurred in workplace declared as harmful to physical and emotional responses that happen within a human being when the requirement of the job do not match the employees‟ capacity...

Norliyana Zakaria

The systematic review in this study is looking at the causes of stress in the workplace. The authors will identify the most leading causes of work-related stress, as well as their impacts on employees’ physical well-being, mental health and work performance. In addition, the stress factors arising from work environment or atmosphere, workplace relationships, organizational culture, career growth, role conflict, and work-life balance are highlighted. Finally, the authors discuss on several stress coping approaches, namely getting social support, attending stress coping or stress management programmes, upgrading work environment, and reforming organizational culture.

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• v.40(6); 2016 Dec

Perceptions of work stress causes and effective interventions in employees working in public, private and non-governmental organisations: a qualitative study

Kamaldeep bhui.

1 Barts and The London School of Medicine and Dentistry

Sokratis Dinos

2 BPP University, London

Magdalena Galant-Miecznikowska

Bertine de jongh, stephen stansfeld.

Aims and method

To identify causes of stress at work as well as individual, organisational and personal interventions used by employees to manage stress in public, private and non-governmental organizations (NGOs). Qualitative interviews were conducted with 51 employees from a range of organisations.

Participants reported adverse working conditions and management practices as common causes of work stress. Stress-inducing management practices included unrealistic demands, lack of support, unfair treatment, low decision latitude, lack of appreciation, effort–reward imbalance, conflicting roles, lack of transparency and poor communication. Organisational interventions were perceived as effective if they improved management styles, and included physical exercise, taking breaks and ensuring adequate time for planning work tasks. Personal interventions used outside of work were important to prevent and remedy stress.

Clinical implications

Interventions should improve management practices as well as promoting personal interventions outside of the work setting.

The conceptualisation of work stress is of crucial importance when developing interventions for the workplace. Work-related stress is defined as ‘a harmful reaction that people have to undue pressures and demands placed on them at work’. 1 As many as 440 000 people in the UK complain of work-related stress, depression or anxiety that makes them ill; nearly 9.9 million work days were lost as a consequence in 2014/2015. 1 The most recent Health and Safety Executive (HSE) report (2015) gives a prevalence of 1380 and an incidence of 740 per 100 000 workers, and also concludes that work stress is more common in public service institutions. 1 The estimated economic costs to the British economy as a result of stress at work are considerable, with £14.3 billion lost in 2013/2014, 2 and the higher costs in public service amount to £1.2 billion per year. 3

Work stress can lead to physical illness, as well as psychological distress and mental illness. 4 , 5 , 6 The recent increase in work stress has been linked with the global and national recession, 7 - 9 job insecurity and work intensity, all leading to greater workloads and more interpersonal conflicts, 3 and can have an impact on children's mental health through disrupted parenting. 10 Essentially, stress in the workplace may be the result of exposure to a range of work stressors and appears to arise when people attempt to manage their responsibilities, tasks or other forms of pressure related to their jobs, and encounter difficulty, strain, anxiety or worry in this attempt. 11 Work stressors can take different forms depending on the characteristics of the workplace, and may be unique to an organisation or an industry. 12 Theoretical models of stress consider it to be either related to adverse life events and stressful environments or the individual's physiological and psychological responses to stressors, or a ‘transactional’ interaction between the individual and environment. 13 , 14 – 17 Although theoretical models conceptualise stress as a result of an imbalance between perceptions of external demands and internal resources, the consensus between theoretical academic models and lay representations of definitions of stress is far from clear. Definitions of stress in the research literature as well as those reported by lay people vary considerably. For example, Kinman & Jones 18 found that there was a lack of consensus on conceptualisations of stress, and a number of different personal, social, environmental and work-related factors were used to define and interpret the meaning of stress. 11 Brooker & Eakin 19 suggest that concepts such as power or control in relation to gender and class are related to stress, yet models of stress do not explicitly take them into account. For example, Page et al 20 found that participants perceived stress as a feminine trait associated with weakness, thus few people admit to it.

Cahil, 16 Cooper et al 13 and Marine et al 21 describe categories of stress management interventions that target individuals or organisations; these can be further segmented as preventive interventions at primary, secondary or tertiary levels. 22 Primary interventions aim to prevent the causal factors of stress, secondary interventions aim to reduce the severity or duration of symptoms, and tertiary or reactive interventions aim to provide rehabilitation and maximise functioning among those with chronic health conditions. 23 Individual interventions may include stress awareness training and cognitive–behavioural therapy (CBT) for psychological and emotional stress. Organisational interventions affect groups of people at work and may include workplace adjustments or conflict management approaches in a specific organisation. Some interventions target both the individual and the organisation, for example policies to secure a better work–life balance and peer-support groups. Bhui et al 's systematic review 24 found that interventions that target individuals show larger effects compared with organisational interventions on individual outcomes such as levels of depression and anxiety. However, individual interventions did not improve organisational outcomes such as absenteeism, which is the most important indicator of loss of organisational productivity. The evidence gaps identified in this review included studies that compared different types of organisation (e.g. public, private and non-governmental organisation (NGO)), and studies that examine whether they employ and benefit from similar interventions, given that different sectors deploy very different business processes, levels and consistency of resources and profit focus, and public service or charitable objectives. Furthermore, studies tended to be based in work settings, rather than considering all interventions applied outside of work that people found helpful. 25

These evidence gaps continue to exist despite the growing body of research into work stress. Our systematic synthesis of the research evidence on managing work stress showed a wide variety of organisational settings, research methods and outcome measures, such that too many questions were being asked but few answered definitively. 24 We concluded that more empirical research was required, but that surveys were premature until there was a better understanding of:

• What work stress issues do employees and managers face on a day-to-day basis?
• What are organisations and employees already doing about work stress in the workplace and outside of work?
• What are the interventions that employees perceive to be the most effective when managing work-related stress?
• Should the approaches taken by public and private organisations and NGOs be distinct given the very different levels and consistency of resources, focus on profit, and public service or charitable objectives?

The present study used qualitative interviews to address these questions and to identify individual, organisational and personal interventions and their perceived effectiveness in managing work-related stress. Contrasts between different types of organisation were also investigated.

Participants

The sample used in this study was purposive (e.g. type and size of organisation, vocational role) and explored participants' experiences of work stress in the course of their working day. A total of 12 organisations took part in the study, of which 6 were public organisations, 4 were private organisations and 2 were NGOs. Three organisations were based outside London, whereas the remaining 9 were based in London. Organisations were from a variety of sectors, including education, health services, insurance, graphic design and betting agencies. The purposive sampling methods aimed to ensure as broad as possible a representation of organisations, levels of the organisation and types of work within the organisation.

For the organisations that met the inclusion criteria, the senior manager was contacted by telephone and informed about the nature of the study, and agreement was reached for participation in the study. The researchers selected a number of employees in different positions along the hierarchy so there is representation from different roles: 28 of the participants were in managerial roles, and the remaining were in non-management positions. We interviewed approximately 5 participants per organisation. A total sample of 51 employees (17 men and 34 women) took part in the study; 26 participants were aged 30 years or under, 17 were between 31 and 50 years and 8 were over 51 years old.

Procedure and topic guide

The topic guide was piloted on six employees who had experienced work stress. The content of these pilot interviews was used to refine the topic guide and to gain feedback from participants on clarity and appropriateness of the questions. Organisations were approached and invited to participate by e-mails containing information on the nature of the study and the data collection processes. Participation was voluntary; the interviews were conducted face to face and, whenever possible, at the interviewee's place of work. The interviews were semi-structured and lasted up to 45 minutes. The topic guide focused on factors that may cause stress and/or absence, personal experiences of and/or recommendations on managing stress at work and experiences of effective individual and organisational interventions to manage work-related stress (see the appendix for topic guide).

The interviews were transcribed verbatim, excluding any potentially identifying information. The data collected were subject to thematic analysis in order to identify and describe recurring themes. 26 Themes and subthemes were organised using the framework approach that is commonly used in policy-relevant qualitative research. 27 Charts were generated from the themes, the range and nature of the experiences were mapped, and patterns between and within themes were revealed. Typologies were iteratively generated to accommodate the data if existing themes were inadequate or were better grouped within a higher theme. Content analysis was also performed by counting the frequency of themes in order to identify their relative prominence in the data, and also to reveal types of interventions and contexts, and views about effectiveness. These frequencies are presented only to support the strength of the findings in these data rather than to estimate prevalence more generally. With this purpose in mind, the analysis proceeded until saturation was reached, and only themes on which saturation was reached are presented.

Data were organised by three higher themes that captured the aims of the study:

• perceived causes of stress at work
• individual and organisational stress management interventions and their perceived effectiveness
• personal interventions to manage stress at work.

Causes of stress at work

The narrative data on participants' understanding of factors that may cause stress at work suggested working conditions, management practices, nature of job, life events and financial factors ( Table 1 ). The majority of participants ( n = 42/51) referred to working conditions as a main source of stress. Working conditions were mainly related to factors such as workload, the physical environment (e.g. noisy offices, lack of windows, small rooms, and offices in which the temperature was either too low or too high for comfort), long working hours, heavy workloads and understaffing.

NGO, non-governmental organisation.

‘We are short [staffed] so two people cannot go on holiday at the same time, so it's such an inconvenience and … we are trying to cover the days, nights and it's like wrrrr … really stressful place to be … ’ (female, 24, NGO).

Working conditions were the main cause of stress regardless of the sector people worked in; people working in the NGO or the public sector more often referred to the physical environment and workloads as relevant factors. Private sector employees more often referred to long working hours and a lack of structure to the working day.

A similar number of participants ( n = 40) suggested that the nature of the job itself contributed to stress, with participants from private organisations and NGOs more often reporting this as a cause of stress. Participants attributed stress more specifically to a job with high unpredictability in what may be required from day to day, or a job that demands unsociable hours.

‘Shift work … I find that quite stressful because it affects my personal life because I have to work during the weekends and that's when most of my family and friends are off … ’ (female, 26, NGO).

Management practice was proposed as a cause of stress by more than half of the interviewees ( n = 32), but was least often implicated in the public sector organisations. Participants in high managerial positions (e.g. head of unit) tended to refer to management practice as a cause of stress less often than employees in non-managerial positions. However, for all other participants (e.g. middle management positions and employees) no differences were observed. Management practice as a cause of stress related to personal style of leadership, implicating lack of warmth and support with a feeling that staff were unimportant and not respected as people; insufficient praise or confidence-building were also important omissions that caused stress. Limited opportunities for decision-making (often referred to as low decision latitude) and lack of transparency as well as unrealistic demands, poor communication and effort–reward imbalance were all implicated.

‘That's what makes you angry, because there's nobody taking my case. As soon as this phone goes to my boss and they complain about me, nobody asks me what happened. And even if I'm right, they still apologise. Why? I've done nothing wrong. It's them. They've done the wrong thing’ (male, 45, public). ‘ … the message the organisation gives to you is that you don't really matter’ (female, 40, NGO).

Life events were identified as another contributor to the level of stress experienced by employees regardless of the type of organisation they worked for ( n = 21). Life events referred to problems with family or relationships, death and sickness, as well as trying to maintain a balance between work demands and responsibilities in the social and personal or family lives of respondents.

A small number of respondents ( n = 6) reported financial factors as a cause of work stress; financial strain causing work stress was related to working for organisations that lacked a benefits package, or in which the salary did not reflect the amount of effort invested in work. Job insecurity as a cause of work stress reflected fears about losing income and facing further financial strain.

Individual and organisational stress management interventions

Participants were asked about any interventions at their workplace for managing stress. Overall, participants referred less frequently to individual interventions; such interventions were also either secondary or tertiary. In particular, they were either psychological interventions such as face-to-face telephone or internet counselling, or educational interventions or training courses that taught practical skills such as organisational management and assertiveness ( Table 2 ).

NGO, non-governmental organisation; TOIL, time off in lieu.

Some patterns emerged in the use of individual interventions by type of organisation: NGOs were least likely to deliver individual interventions to employees, perhaps owing to cost. In terms of effectiveness, those participants who received one-to-one counselling interventions thought these were effective, mainly because they could be accessed promptly when needed.

‘So [I] went to my [general practitioner] GP and they set it up through my local authority for face-to-face counselling, so I was seeing the occupational therapist, [had] face-to-face counselling and that happened on my day off. So [I] could do some work at home, because I was very tired I didn't have the stress of having to get into work, so just took a bit off. So [it was] kind of a package of things that just assisted me for a while’ (female, 49, public).

Organisational interventions were more often mentioned by workers in public sector employment and in contrast to individual interventions, they were mainly primary or secondary ( Table 2 ). Most of these organisational interventions were related to management practices ( n = 35/51). In particular, participants mentioned efforts to develop a management style that was supportive and improved communication, as well as frequent team meetings and supervision and two-way feedback.

‘[The manager is] one of those people that make you feel appreciated, even if it's a little thing she will praise you for it. A lot goes for being praised, that in itself can take away stress. If someone turns around and says what you are doing is a fantastic job you feel good’ (female, 52, public).

A supportive organisational and team culture, a collective spirit including dialogue in groups and space for discussion, and educational and training courses to improve management skills were frequently reported as effective interventions to manage stress at work ( n = 27/51).

‘ … it's good that we all sit down together and discuss anything that may be causing a problem or tension, or anything we feel needs to be adjusted’ (female, 27, public).

Flexibility in working hours, well-planned shifts and environmental or structural interventions such as a staff room for relaxation were mentioned by almost a third of the participants as effective ways of managing work stress. Participants working in private sector organisations rarely report the existence of any interventions related to work structure (e.g. flexibility in work times), whereas in the public sector there was evidence of trying to introduce more flexibility.

‘ … time off in lieu […] seems to work quite well 'cos it's about that work–life balance’ (female, 54, public).

Almost half of participants ( n = 22) said training and career development opportunities in the workplace were effective for managing work-related stress, as they made them feel adequately informed and valued. Appropriate training and adequate equipment and resources allowed employees to perform their roles effectively. A small number of interviewees ( n = 3) suggested training in stress management was a useful intervention.

‘[My manager] is very good at sending people on training courses. I've just been on one which is positive interactions, which was telling you the right way of dealing with situations’ (female, 52, public).

Finally, a small number of participants ( n = 9/51) reported that there were a number of health promotion interventions (e.g. courses, exercise) at their workplace to help them prevent work stress. Participants thought that being subsidised for gym membership or being encouraged by their organisation to exercise during their working day were very effective interventions. None of the participants working for NGOs mentioned health promotion.

‘ … we're quite actively encouraged to do lots of exercise in this trust, we get lots of emails about walking to work, or running … I think linking exercise and well-being and being healthy at work […] I think that's always good, it would be good to have that in every institution’ (female, 28, public).

Personal interventions to manage work stress

Participants were asked general questions about their personal strategies to manage work stress. We were interested in personal interventions not provided by their employers but ones that were used and considered effective.

Table 3 shows the types of personal interventions used at work. Some interventions helped employees process stressful thoughts and think through difficult situations, akin to what CBT therapists might suggest as cognitive restructuring and tackling cognitive distortions – for example, focusing on positive rather than stressful situations, and using self-reflection to gain a better perspective.

Effective personal interventions to manage stress at work (total number of respondents: 51)

‘Yeah, yeah or if something happens I try and think, erm, so there's another technique I learnt in the last place I worked at was five questions so I ask, the why questions five times, why this? why is it causing stress? … because of this, why is that? Why is that? And I usually get to the root cause and that usually chills me out a bit if I deal with the root cause rather than the thing causing me the stress’ (male, 30, public).

Support from colleagues and friends was the most frequently reported personal intervention for managing stress at work.

‘I actually had to say to a colleague, “I can't see the wood for the trees here, can you help me?” and the colleague was absolutely brilliant and helped me so we got through it. I got some excellent help from a colleague yeah and that was someone I worked with in the team who does the same job as me. My manager was very supportive and helpful as well’ (male, 41, private).

Keeping oneself organised and maintaining a structured schedule at work were thought to be very effective personal interventions. These included planning, reducing overtime, prioritising tasks and keeping a better balance between work and personal life.

‘One of the signals for me is if my desk starts getting a bit messy, it means I'm chasing between too many projects and that's often the time when I personally just take stock, think, right, what do I need to do, look at a priority list, clear the decks again and sort of take a bit of a step back and review. So that's how I manage it and I find that to be helpful for me’ (male, 47, public).

Almost half of the participants ( n = 24) pointed out the importance of a healthy lifestyle when trying to manage stress at work. In particular, exercise was the most frequently reported personal intervention. Participants also acknowledge the importance of healthy eating as a means of maintaining a healthy weight and better health in general, both of which helped people to better manage stress at work.

‘Exercise is the most important thing for me for stress. So yeah, if I'm stressed, as long as I can, I'll often leave work at a decent time and go for a run and come back to work or go take my computer home and go for a swim and then do some more work. As long as I can make sure I can get some exercise in then I'm fine. It kinda works quite good 'cause I can generally take a longer lunch break and go to the gym at lunch and then, you know, work later or whatever it is. That's probably the most important flexibility for me at work is being able to have that’ (female, 32, private).

Finally, having out-of-work interests and leisure activities was reported by more than half of the participants ( n = 31). For example, participants mentioned relaxation during lunch breaks and going on holidays as an effective personal intervention.

‘We do get inspired by going to talks and design galleries and illustration events and all that sort of thing, they're hobbies as much as they are a career but, at the same time, I think that, in a way, [this] helps to alleviate the stress levels at work because what you're doing at work is part of your hobby as well’ (male, 30, private).

A mixture of personal, organisational and individual interventions were reported in our study, but these are not often captured together, with emphasis often being given to workplace changes or separate public health approaches to lifestyle and physical activity. 28 – 30 The majority of individual and organisational interventions reported were secondary and tertiary preventive interventions, with less emphasis on primary prevention.

High-demand and low-control situations and effort–reward imbalance related to working conditions, management style and the type of job were causing distress at work. 12 , 31 , 32 It is also important to address management practices as one of the most significant and consistent work-related stressors. Management practice as a stressor was also more prominent in private and NGO sectors than in the public sector and in middle and low management positions than in higher management ones. Participants identified poor communication with management, unfair treatment and, above all, the feeling of not being appreciated as the biggest sources of stress for them. Furthermore, many participants highlighted working conditions, such as physical environment, unsociable working hours and under-staffing, as causes of their work stress, the harmful effects of which have been identified in previous research. 18 , 33 Financial factors, mainly a lack of financial recognition by the organisation, were also reported as a cause of stress. According to Stranks, 11 when workers experience insufficient rewards in the form of salary or amount of praise received, or are missing recognition, the feeling of devaluation might appear and can contribute to an experience of work stress.

Interventions used by employees to manage stress at work: perceived effectiveness

Participants in the present study tended to report mainly the presence of primary and secondary organisational interventions (as opposed to individual interventions) at their workplace. With regard to individual approaches, these were mainly psychological interventions. Although there is much research that has documented the effectiveness of psychological interventions, these are usually provided at the secondary or tertiary level rather than for primary prevention. 34 – 36

Organisational interventions were discussed by the participants more frequently and were also more often perceived as effective in managing stress at work than individual interventions. One of the main reasons that organisational interventions were identified as an effective way of managing stress was because they were primary interventions with the aim to modify or eliminate environmental stressors. Participants in the present study identified the organisational interventions to manage stress at work as: job redesign, change of organisational culture, encouragement of participative management, introduction of work–life balance policies, flexible working and reconstruction of the organisation as well as improvement of organisational communications. 11 The literature on organisational interventions does not identify management practices as an intervention. The main reason may stem from the fact that management is seen as part of organisational structures rather than as potentially subject to modification to manage stress. Our findings highlighted management practices as an important workplace intervention, especially management characteristics such as open communication, supportiveness, approachability and being appreciative; these ranked the highest in terms of perceived effectiveness. Improving management practices as an intervention and introducing flexibility in working structures were much more apparent in the public sector as opposed to the private sector and the NGOs. Content analysis suggested that there may be a relationship between reported causes of stress and individual and organisational interventions. For example, stress was less often reported in the public sector because there were more management interventions than in other sectors, and these were perceived to be effective by the participants.

Most personal interventions identified by participants were related to health behaviours such as exercise, meditation and healthy eating, as well as leisure activities and social support from family and colleagues. Although personal interventions outside the workplace were not considered by the organisations, it is important to emphasise the power of such interventions and that they should be included in future intervention packages. For example, physical activity programmes have been among the few organisational interventions that show convincing effects on absenteeism in accord with our previous reviews, but physical activity could be encouraged more generally. 24 , 30 By adapting organisational interventions to capitalise on and encourage personal individual interventions outside the workplace, stress management in the workplace may be less necessary or more effective where it is needed.

Strengths and limitations

The results suggest that employees in private organisations and NGOs report more perceived causes of stress and have fewer interventions in place to help employees manage stress compared with public sector organisations, notably National Health Service (NHS) employers. We have listed potential organisational, individual and personal interventions that were used and found to be helpful. These might be tested as correlates of better workforce health and well-being and less work stress.

A limitation of the study was related to the sample characteristics. Although there were variations, especially with regard to type, size and location of the organisations involved, the sample consisted of only 12 organisations in total. A larger number of organisations would have provided us with more variety of occupations and organisation size and location, which would have given a more complete picture concerning the causes of stress and interventions between sectors. Our study is exploratory, and although these are perceived causes, the findings should not be understood in terms of epidemiological causal relationships, but rather as important ways in which workers think about and manage work stress, providing clues as to how interventions might be developed, tested and located in these work settings.

Qualitative studies offer new insights and provide the in-depth and experience-near perspectives of participants, rather than an overtheorised and superficial analysis. The findings will contribute to future in-depth work including more varied samples, as well as survey research to test for interventions that correlate with organisational measures of health and well-being. Future work should also consider how to improve management practices, as these seemed to have the most important influence on reducing work stress. More research is needed to further explore the differences between private, public and NGO sectors and different job types such as education and healthcare to examine whether they respond to the same or different intervention techniques. Finally, research needs to take into account compositional effects including the demographic characteristics of samples, and the cost effectiveness of interventions.

Topic guide

General questions to start the interview

• How do you find your job with regard to demands, pressure, working hours, etc.?
• Are there any elements in your job that you find stressful?
• What are the common organisational factors that can cause stress at work?
• What are the common individual factors that can cause stress at work?

Managing stress at work (both managing yourself and other people)

• If you manage other people, how do you manage stress?
• How do you manage other people's stress at work?
• How do you deal with this?
• What were/are the challenges?
• Can you give any examples?

Managing return to work (managing both yourself and other people)

• How do you manage your return to work after sickness?
• How do/did you manage their return to work after sickness?
• If no experience, how would you manage their return to work?

Policies: managing stress at work and return to work

• How has this policy been put together?
• How effective is it in practice?
• What are the strong and weak points of this policy, if any? Or
• How (in what ways) would you change this policy?
• 12. What would you say are the best (individual and organisational) policies for managing employee stress?
• 13. What would you say are the best (individual and organisational) policies for managing employee return to work after sickness absence?

Declaration of interest None.

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Article Contents

1. introduction, 2. the psychology of stress, 3. the law relating to stress, 4. broader structural questions, 5. conclusion.

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Stress at Work: Individuals or Structures?

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A C L Davies, Stress at Work: Individuals or Structures?, Industrial Law Journal , Volume 51, Issue 2, June 2022, Pages 403–434, https://doi.org/10.1093/indlaw/dwab006

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Stress is a significant practical problem in modern workplaces. According to the Health and Safety Executive (HSE), more than half of all working days lost to ill health each year are attributed to stress, depression or anxiety. This article offers an overview of the occupational psychology literature on workplace stress, focussing on the job demands–resources or JD-R model, developed by Demerouti et al., and highlighting two important points: first, that stress at work is not just about excessive job ‘demands’ but also about inadequate ‘resources’ to cope with those demands; second, that stress-related ill-health is not just a matter of vulnerability on the part of the individual worker, but is also about the way in which the workplace is organised. The article then draws on these insights to offer a critique of the way in which health and safety law and tort law approach workplace stress, arguing that both bodies of law are overly focussed on treating stress as a matter of individual vulnerability. It concludes by drawing out some broader implications of the occupational psychology literature for areas of employment law less obviously related to workplace stress, and for casual or platform working.

Stress is a significant practical problem in modern workplaces. Although stress is not itself a diagnosable medical condition, it can cause both mental and physical health problems. According to the Health and Safety Executive (HSE), more than half of all working days lost to ill health each year are attributed to stress, depression or anxiety. 1 Stress is gendered, with women between the ages of 25 and 44 being significantly more likely to report work-related stress than men of the same age. 2 And it has a particularly high impact on the public sector, being more prevalent in public administration, health care and education than in other parts of the economy. 3 Polls of workers suggest that the most common causes of stress are high workloads, the way people are managed, and inability to achieve a satisfactory work–life balance. 4 It seems likely that the last of these helps to explain the greater prevalence of stress among women, given the double burden of juggling work with significant caring responsibilities many women in the relevant age group will experience. 5

It is too early to say what the impact of the Coronavirus pandemic will be on workplace stress, but it seems likely that it will significantly exacerbate the problem in many cases. Sadly, it is already apparent that there will be large-scale redundancies as a result of the pandemic, something which is generally regarded by psychologists as a highly stressful life event in itself. 6 For those who have been fortunate enough to stay in work, greater flexibility to work from home has been a benefit for some, but new sources of workplace stress have also presented themselves, including the risk of catching the virus, fears about future redundancies, and the added challenges of juggling work with home-schooling and childcare, again with emerging evidence of gendered impact. Further work will be needed to investigate these effects.

Despite the day-to-day reality of stress at work both pre- and post-pandemic, the legal literature on the subject is relatively limited, albeit with some notable exceptions. 7 Of course, there has been some interest in the cases dealing with what the courts term ‘psychiatric injury’ at work, a type of injury which often stems from employees being placed in stressful situations. 8 And more recently, there has been some important scholarship on mental health at work, which may include mental ill-health caused by stress at work, from the perspective of disability discrimination law in particular. 9 Nevertheless, a broader analysis of the law’s approach to workplace stress is long overdue.

In the first part of this article, I will offer an overview of the psychology literature on workplace stress, in order to develop a clearer understanding of the psychological processes involved when a worker develops a health problem because of stress at work. This is an important exercise because, too often, it is tempting to rely on personal experience and anecdote as our starting-point for thinking about stress. Two key points emerge from this literature. First, although we tend to think about stress-related ill-health as stemming from ‘stressors’, such as long working hours or high workloads, psychologists focus on a combination of factors, some of which place demands on the worker and some of which help the worker to cope with those demands. Problems arise when demands and resources are not properly balanced. Second, the worker’s own ‘vulnerability’ or ‘resilience’ is only one factor among many: from a psychological perspective, workplace stress is also viewed as a matter of workplace structure and organisation.

In the second part of the article, I consider two areas of law typically thought of as being concerned with workplace stress: health and safety law and tort law. The HSE’s approach to workplace stress is well-informed by the psychology literature and in many respects asks the right set of questions. 10 However, it is not clear that asking a manager to complete a ‘stress risk assessment’, for example, will in practice generate the kinds of profound structural change that might be needed to combat stress. Tort law’s approach to workplace stress tends to focus rather too heavily on the individual worker, particularly through the foreseeability test. 11 The employer is only liable where it could have foreseen that the worker would develop a health problem, and this in turn usually depends on the worker having taken time off work on a previous occasion because of stress-related ill-health. This treats stress as a matter of individual vulnerability and largely ignores the role of broader structural factors such as how the workplace is managed.

In the third part of the article, I develop the idea of thinking about workplace stress as structural matter in two related directions, to identify questions for future research. One is to examine the role of areas of law not obviously related to stress in providing working people with a ‘resource’ to combat stress. This offers another way of thinking about the justifications for employment law. The other is to examine the situation of casual or platform workers. These workers have tended to be overlooked in the psychology literature, which usually focuses on employees in ‘traditional’ jobs and workplaces, and their legal entitlements under both health and safety law and tort law are somewhat uncertain. But their working arrangements lack many of the structures associated with tackling stress, offering another reason to be concerned about the rise and rise of these forms of working in the modern economy.

In this section, I offer a review of some of the psychology literature on occupational stress and some of the empirical evidence about its prevalence in UK workplaces. My aim is to ground the discussion of the law in a sound understanding of the science.

An important caveat at the outset is that this literature deals principally with stress generated within the workplace. Many workers experience stress at work because of non-work factors, such as family problems, which in turn make it more difficult for them to cope at work. 12 Of course, the workplace may be more or less accommodating of these issues—through policies around working time or emergency leave, for example—and it may be difficult to untangle the precise combination of causes of an individual’s difficulties. 13 But issues surrounding non-work stress will not be my main focus.

A. Definition

The dictionary definition of stress is a state of mental or emotional strain brought on by external pressures. 14 Psychologists point out that stress is not inherently negative: for example, feeling a bit nervous before a big event, such as a sporting or dramatic performance, may aid alertness and focus because the stress triggers the production of adrenaline as part of the body’s ‘fight or flight’ response. 15 This type of positive stress is sometimes referred to as ‘eustress’. 16

But the type of stress (or ‘distress’ 17 ) with which I am concerned is the negative type: where the external pressures overtop the individual’s capacity to cope. 18 This may be either acute—in response to a specific, devastating event—or chronic—involving sustained pressure over the longer term. Within psychology, there are various ‘scales’ of acute ‘stressors’ which assign values to different types of event (bereavement, divorce or moving house, for example) in order to calculate the extent to which a person is at risk of an adverse reaction to the particular combination of stressors they face at any given time. 19 Not surprisingly, losing one’s job is high on these scales, though problems within the workplace also feature. However, as we shall see, many of the cases on stress at work have been concerned less with particular catastrophic events and more with stress in its chronic form, for example, where the stressor is an unmanageable workload persisting over many months or years.

Importantly, being stressed is not, strictly speaking, itself a diagnosable psychological condition, but it can lead to the development of psychological conditions such as anxiety or depression. 20 Stress is also widely believed to be a factor in physical ill-health, ranging from increased susceptibility to coughs and colds, to the development of heart disease. 21 This is thought to be because the body’s physiological responses to stress, such as raised blood pressure and heightened immune responses, can become harmful if they cannot be regulated and brought back to normal after a short period of time.

B. Models of Occupational Stress

Occupational psychologists have developed a number of different models to help explain workplace stress. The demand-control model (DCM) associated with Karasek predicts that workers will experience stress where they have high demands placed upon them, particularly a heavy workload with deadlines, coupled with a lack of control over how they organise their working day. 22 The effort-reward imbalance (ER-I) model predicts that workers will experience stress where the effort they put in at work is not acknowledged through appropriate rewards, which might include pay or promotion prospects. 23 A difficulty with both these models is that while there is empirical evidence to support their claims, they are overly simple, focussing on one or two dimensions of what tends to be a highly complex problem in practice. 24 Probably a more popular model in the literature today is the job demands—resources or JD-R model, developed by Demerouti et al. 25 This takes account of a much wider variety of factors which may generate or help to guard against stress, and offers a more subtle account of the psychological processes at work. I have chosen to focus on this model largely because I find its nuanced explanation more persuasive, but also because space precludes a full overview of all the available approaches.

Under the JD-R model, job ‘demands’ include, most obviously, workload, but can also refer to other factors like unpleasant working environments or hostility from customers. 26 Excessive job demands can cause negative consequences for the worker such as exhaustion or ‘burnout’. Job ‘resources’ refers to a variety of factors that motivate or support workers in doing their jobs, including pay, job security, autonomy, voice and supportive colleagues or managers. 27 Job resources generate positive outcomes, typically labelled ‘work engagement’. The idea is that the resources available to the individual will help them to feel motivated or ‘engaged’ in their job. As Bakker and Demerouti explain, ‘[J]ob demands and resources are the triggers of two fairly independent processes, namely a health impairment process and a motivational process’. 28 However, the two processes are not entirely unconnected, because job resources—as well as generating motivation in themselves—can also serve as a ‘buffer’ against the negative consequences of job demands, such as burnout. 29 It seems likely that the efficacy of any particular resource in addressing job demands will depend on the nature of those demands. For example, if a worker has to confront highly emotional situations every day, supportive colleagues and managers are likely to be more relevant in addressing this particular job demand than a pay rise, for example, whereas overtime pay might provide some encouragement in the event of a short-term surge in demand. 30

Having outlined the JD-R model, it may be helpful to say a bit more about job demands and resources in themselves. It is important to note at the outset that demands and resources are not watertight analytical categories: something that is identified as a demand in one workplace may be experienced as a resource in another, or perceived differently by different groups of workers. 31 I offer some examples of this below.

Demands are the easiest to explain, and tend to be used to cover four main types of demand: workload, work/life balance, physical environment and emotional engagement. 32 Demands are not inherently a bad thing—after all, a key objective of the employment relationship is the exchange of work for pay, and from that perspective the ‘demands’ are what the employer is seeking to get out of the relationship. Some of the literature distinguishes ‘demands’ or ‘threats’ (negative) and ‘challenges’ (positive) in order to clarify this point. 33 Problems only arise when the demands are excessive, or insufficiently buffered by resources, or both. It is also worth noting that the nature of the demands experienced by workers is likely to vary from job to job, and one of the strengths of the JD-R model, according to its proponents, is its ability to be used in a variety of different work settings. 34 For example, the relevance of emotional engagement is likely to be higher in, for example, teaching or nursing, than it is in manufacturing, where workload and features of the physical environment (heat, noise, poor air quality and so on) may be more of an issue.

Resources are more complex. A useful framework is the individual, group, leadership, organisational or ‘IGLO’ classification set out by Nielsen et al. 35 This identifies the four main levels at which resources might be present. At the level of the individual worker, the worker’s personal resilience is important. This includes resources such as ‘self-efficacy’ (used in psychology to denote a person’s belief in their own capacity to succeed in a particular situation), self-esteem and optimism. 36 Obviously, the key point here is that workers’ personal traits affect their response to job demands, which explains why it is common to find that not all workers in a group faced with the same, overwhelming job demands will develop burnout over time. This is not in any sense to ‘blame’ workers for their situations, but rather to acknowledge the variety of human responses, in the same way that not everyone will develop a physical injury in response to heavy lifting or sitting at a desk all day. In recent years, another ‘individual’ factor, which has attracted attention in the literature, is ‘job crafting’. 37 This is the ability of the individual to make some adaptations to their day-to-day work to suit their interests and preferences. For example, a worker who enjoys teaching others might informally take on the role of training new members of staff, even though this role is not formally assigned by the employer. Allowing workers some scope to do this can have positive effects on their well-being.

Turning now to the ‘group’ level, the focus here is on the positive impact that a worker’s relationship with their team can have on their well-being. 38 A key factor here is the social support that team members are able to provide for each other. At the ‘leadership’ level, attention has focussed on the nature of the relationship between a manager and their team, and on the effect of different management styles. 39 For example, managers might motivate their teams in different ways—by promising rewards, such as pay rises, or through softer measures such as providing encouragement—and these can be studied for their impact on well-being.

At the organisational level, a particularly popular focus of the literature over many years has been ‘autonomy’. 40 This is the idea that giving workers some scope to determine parameters such as when and in what order they complete their work tasks increases their satisfaction and motivation at work. There are numerous studies establishing a relationship between autonomy and well-being, and of course for many people, though by no means everyone, repetitive, monotonous work is less likely to be satisfying. Some more recent studies have, however, begun to question this relationship given the potential for highly autonomous workers to experience constant and conflicting demands, for example, when they are expected to monitor work emails at all times, but this phenomenon does not necessarily undermine the general point about the value of autonomy. 41 Other job characteristics of relevance to worker well-being include: job tasks requiring a variety of different skills, being able to complete a whole task rather than just a component part, and the task itself having value or meaning, such as a positive impact on other people. 42 A body of literature further suggests that various human resources (HR) practices can have a positive impact. 43 These include providing clear feedback on performance, rewarding good performance, and offering training. Job security has also been a popular topic for analysis and the evidence suggests a positive relationship between job security and worker well-being. 44

There have been numerous empirical studies designed to test the JD-R model’s predictions. 45 Most of these use surveys of workers in particular sectors to identify the demands placed upon them and the resources available to them, and the causal link between the demands and resources on the one hand, and the outcomes for workers. 46 A smaller group of studies uses observation to verify workers’ explanations of their experiences. 47 There has also been a more recent push towards longitudinal studies, in which the same workers are surveyed on several occasions over time, acknowledging the fact that the development of—or prevention of—workplace stress is a long-term phenomenon. 48 The various processes envisaged by the JD-R model, such as the buffering role of resources, are well-supported by the empirical evidence, though of course there are ongoing attempts to refine the model. A particular problem, as pointed out by Schaufeli and Taris, is that the model’s breadth is both a strength and a weakness: it can be adapted to a variety of different contexts, but studies ‘testing the model’ in practice usually test different subsets of factors and may therefore be examining quite different things. 49

C. Relevance for Law

This review of the occupational psychology literature offers a number of useful insights into workplace stress. Two messages are particularly important. First, from this perspective, workplace stress is not solely an issue about the individual worker’s susceptibility to particular stressors. Although an individual’s resources are relevant, the way in which the workplace is organised and managed is also an important consideration. 50 Studies cannot easily establish the relative significance of these different factors, but they do demonstrate the basic point that stress is as much a structural as a personal phenomenon. Second, although excessive workplace demands, particularly high workloads, are a key factor leading workers to experience stress, the presence or absence of job resources is also highly relevant. A heavy workload is more likely to result in negative outcomes for the worker if it is coupled with, for example, low pay, tedious work and unsupportive management.

Before applying these insights to the legal materials, it is important to note the risks of taking ideas from one discipline and applying them in another. One potential problem is that the purposes of the two disciplines may be radically different. Occupational psychologists seek to understand and model workplace stress primarily in order to design interventions to tackle it. 51 These might be structural interventions aimed at employing entities, or therapeutic interventions aimed at workers. From this perspective, understanding the causes of stress and its negative consequences, such as exhaustion and burnout, is essential in understanding how to remove, reduce or address these causes. This understanding can be quite wide-ranging in nature. Presumably, employers can then decide—on a cost-benefit basis, for example—which interventions they consider to be worth pursuing. In this regard, there may be a bias towards organisational rather than individual interventions, which can be implemented by occupational health and HR professionals across an organisation at relatively low cost. As we shall see, although the law does have some preventative aims, its purposes are more complex.

Another factor to bear in mind is that what we might term the ‘preoccupations’ of the two disciplines may be quite different. The psychology literature tends to focus on larger, more traditional workplaces, again, perhaps because of the audience of occupational health and HR professionals who are more likely to be working in big firms. There is relatively little analysis of the JD-R model in contexts which seem very immediately and obviously problematic to lawyers, such as employment via internet platforms, or workplaces with a high proportion of casual workers. 52 One might reasonably hypothesise that workers in these workplaces may be more prone to ‘distress’ because of factors such as monotonous or repetitive work, a lack of control over the working day when working ‘on demand’, and difficulties accessing support from managers and colleagues when working sporadically or remotely. But, with the exception of a few studies of temporary workers, it appears that relatively little research has been carried out in these contexts. I return to the significance of this in section 3, below.

In this section, I will examine the law’s treatment of stress. This presents an immediate problem in view of the literature just considered. How can we sensibly define the law relating to stress? On one view, we could include almost any area of law that is intended to promote what we might term, following the ILO, ‘decent work’. 53 For example, legislation designed to promote collective bargaining or consultation should improve workers’ sense that they have a voice at work, which is one of the ‘job resources’ of value in buffering against stress. But this approach would not make for a practical article. The alternative is to focus on those areas of law which deal explicitly with preventing or remedying stress, the principal examples being health and safety law and tort law. 54 This will be my strategy here, though I will return to the broader point about decent work in section 3.

Before getting into the detail, it is worth pausing to consider what these various bodies of law are designed to do, since there is some diversity even within the narrower focus. Health and safety law has an explicitly preventative focus. It places duties upon employers and others to assess the risks to health within their business and to take reasonable steps to prevent workers and others from suffering illness or injury as a result. HSE is responsible for enforcing the law, which can include investigating incidents and prosecuting employers in the most serious cases. In recent years, HSE has had a particular focus on workplace stress, no doubt because of the evidence indicating that a high proportion of working days lost to ill-health are nowadays lost to stress-related problems. Tort law allows employees to seek compensation from their employer where they have suffered physical or ‘psychiatric’ injury at work due to the employer’s negligence. 55 This may be relevant where the employee has suffered mental or physical ill-health as a result of workplace stress. Although the primary focus of this body of law is providing the injured employee with a remedy for losses suffered, it is often suggested that it might also indirectly perform a deterrent function. Employers who are aware of the prospect of litigation in this area might take steps to protect themselves against liability, some of which may benefit employees.

The closest alignment between the occupational psychology literature and the law is therefore in the field of health and safety, where there is a clear focus on identifying potential causes of stress and taking steps to address them. The connection in relation to tort law is less obvious, but still present. Deciding whether the employer has been negligent involves deciding whether the employer has breached its duty of care towards the employee, which in turn requires a judgment about the preventative steps the employer should have taken. However, it will be argued here that both bodies of law take a strongly individualistic approach to workplace stress, treating it primarily as a matter of individual vulnerability rather than as a reflection of the way the workplace is organised and managed.

A. Health and Safety

In this section, I outline the law relating to health and safety as it applies to workplace stress, and the guidance on the topic developed by HSE. I argue that the guidance, while well-designed in general terms, is more likely in practice to result in minor changes to an individual’s job than in broader structural change in the workplace. There are also concerns about the enforcement of health and safety law and its proper application to the full variety of working relationships, not just to employees.

Under section 2(1) Health and Safety at Work etc Act 1974, ‘It shall be the duty of every employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees’. 56 A failure to discharge this duty is a criminal offence under section 33. There are further duties to put in place a policy on health and safety 57 and to engage in consultation with trade union or other representatives. 58 Under the Management of Health and Safety at Work Regulations 1999, r. 3, the employer is placed under a duty to conduct a risk assessment. 59 This is central to ensuring that the employer gives consideration to the specific risks arising in the workplace and takes steps to prevent them. The ‘principles of prevention’ are derived from EU law 60 and are given effect by r. 4 and Schedule 1, and include the following matters of potential relevance to workplace stress:

(d) adapting the work to the individual, especially as regards the design of workplaces, the choice of work equipment and the choice of working and production methods, with a view, in particular, to alleviating monotonous work and work at a predetermined work-rate and to reducing their effect on health… (g) developing a coherent overall prevention policy which covers technology, organisation of work, working conditions, social relationships and the influence of factors relating to the working environment; (h) giving collective protective measures priority over individual protective measures…

While the employer’s duty is, of course, to comply with the law, HSE plays an important role in providing detailed guidance on how the law should be applied and interpreted in particular contexts, and in setting priorities for enforcement. Thus, HSE’s approach to workplace stress is likely to be highly influential when employers are seeking to understand what the law requires of them in practice.

HSE first issued guidance on protecting employees’ physical and mental health from the effects of workplace stress in 1995, 61 and now has a sophisticated set of ‘management standards’ to tackle stress at work. 62 The management standards are set out on HSE’s website as follows:

Demands—this includes issues such as workload, work patterns and the work environment Control—how much say the person has in the way they do their work Support—this includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues Relationships—this includes promoting positive working to avoid conflict and dealing with unacceptable behaviour Role—whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles Change—how organisational change (large or small) is managed and communicated in the organisation 63

It is immediately apparent that these standards have been developed in the light of the psychology literature. 64 Demands are expressly included, and also feature within some of the other headings, for example, in the focus on role conflict and dealing with unacceptable behaviour (which might include violence or emotional demands from customers, for example). And resources are also present, covering all levels of the organisation, from the worker’s immediate colleagues to senior management.

HSE has published a ‘workbook’ to support employers to fulfil their statutory duty to conduct a risk assessment and take preventative steps in relation to stress. 65 This advises various common-sense steps, such as setting up a working group, surveying the workforce, and drafting and publicising a policy. It focuses in particular on organisation-wide activities, though it also highlights the importance of conducting individual risk assessments where it is apparent that a particular employee is at risk. This is supplemented an Indicator Tool, which can be used to survey the workforce, 66 and by further guidance documents such as an ‘example stress policy’, 67 a leaflet entitled ‘are you doing enough’, 68 and the Talking Toolkit to support conversations about stress. 69 My concern is that—despite HSE’s best efforts to ensure a structural focus—the end result is more likely to be a series of small-scale changes to individuals’ jobs.

One example is the treatment of ‘control’. As we have seen, having greater autonomy over the organisation of the working day and the work itself may act as a buffer against stress. The Workbook identifies the following as ‘what should be happening’:

Where possible, employees have control over their pace of work, eg have a say over when breaks can be taken. Employees are encouraged to use their skills and initiative to do their work. Where possible, employees are encouraged to develop new skills to help them undertake new and challenging pieces of work. The organisation encourages employees to develop their skills. Employees are consulted over their work patterns. 70

It offers further practical suggestions for achieving these objectives and some ‘dos and don’ts’ for employers. 71 However, the Workbook shies away from proposing any profound structural changes. For example, it identifies ‘project meetings, one-to-ones, performance reviews’ as suitable forums in which to give staff the chance to have a say in how their work is organised. 72 These are, of course, good ideas, but they are likely to involve either individual employees or small groups. There is no suggestion of, for example, holding a workplace-wide review of working time and flexible working policies (in the light of legal requirements and best practice) to identify whether more people could work flexibly or from home across the organisation as a whole. In turn, this puts pressure on individual employees to make a case for change for themselves.

Similarly, under the heading of ‘demands’, the Workbook identifies ‘what should be happening’ as follows:

The organisation provides employees with adequate and achievable demands in relation to the agreed hours of work. People’s skills and abilities are matched to the job demands. Jobs are designed to be within the capabilities of employees. Employees’ concerns about their work environment are addressed. 73

Again, these are important objectives, but the suggested ways of achieving them focus largely on holding meetings with individuals to discuss work plans, workload and how to prioritise. 74 There is no discussion of, for example, whether the employer has enough staff to meet demands, which is a particular issue in the public sector after years of austerity, or how demands themselves might be managed. The risk is that the focus shifts too readily to the individual’s ability to cope with their workload, whatever that workload might be.

While it is always to be hoped that good employers will make an effort to comply with health and safety standards regardless of how they are enforced, the prospect of investigation and enforcement has a role to play in raising the profile of such standards and encouraging less enthusiastic employers to take them seriously. But HSE has limited resources and a wide range of responsibilities, and although it has occasionally used its formal enforcement powers in relation to stress, 75 I have been unable to find any recent examples. 76 In 2019, HSE updated its guidance on investigations to state:

HSE will consider investigating concerns about work-related stress where: There is evidence that a number of staff are currently experiencing work-related stress or stress-related ill health, (i.e. that it is not an individual case), but… HSE would expect concerns about work-related stress to have been raised already with the employer, and for the employer to have been given sufficient time to respond accordingly. 77

It is worth noting that stress-related illnesses are not reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR), so the main route for prompting investigation by HSE would be a complaint, presumably from the affected workers or their trade union. 78 It is unclear whether any investigations have been undertaken as a result of the change in guidance.

Moreover, formal enforcement powers are something of a blunt instrument and are unlikely to be used to deal with less serious cases. This can be illustrated by reference to the improvement notice issued to the West Dorset General Hospitals NHS Trust in 2003. According to information released by HSE, the Trust had no risk assessment in place and no stress management policy, despite evidence of stress-related absences and high workloads, and had signalled that it had no intention of making stress a priority for another twelve months. 79 Under the well-known Ayres and Braithwaite ‘enforcement pyramid’, this was a classic case for formal enforcement because there did not appear to be any evidence of willingness to comply on the part of the employer. 80 While it is, of course, sensible to reserve limited enforcement resources for the most serious cases, this means that employers who make some effort to comply are unlikely to be troubled by the enforcement process, and there is little regulatory pressure on them to improve.

An alternative option is to allow working people themselves to enforce health and safety law through the civil courts. Since 2013, this possibility has been limited by section 69 Enterprise and Regulatory Reform Act 2013, which amended section 47 Health and Safety at Work etc. Act 1974 so that an action for breach of statutory duty is only available where the relevant health and safety regulations expressly so provide. However, claims may still be brought in negligence—discussed further below—and the courts often draw on health and safety law to determine whether the employer is in breach at common law. This is particularly true in relation to the employer’s approach to risk assessments. 81

Another limitation of health and safety law is uncertainty about its personal scope, and the extent to which employers owe duties to working people who are not employees. This issue was addressed recently in the IWGB case. 82 It was held that the EU Framework Directive, Article 3, 83 required Member States to implement health and safety protections for ‘workers’ as defined in EU free movement and equal pay law. 84 This meant that the UK’s use of the term ‘employee’ in the 1974 Act and other implementing measures was insufficient. 85 The judge thus held that the government had failed properly to implement Articles 8(4) and (5) of the Framework Directive (the right to leave the workplace in a situation of imminent danger) 86 and Article 3 of the Personal Protective Equipment (PPE) Directive (the employer’s duty to provide PPE) 87 with respect to workers, because these are rights currently available to employees only. However, the picture was more complex in relation to the general health and safety duties intended to be imposed on employers under Articles 5(1) and 6(1) of the Framework Directive. While these are implemented for employees only under section 2 of the 1974 Act, the judge was satisfied that these provisions of the Directive had nevertheless been properly implemented because section 3 made equivalent provision for ‘persons not in [the employer’s] employment who may be affected’ by the conduct of the employer’s business, which included workers (and others).

From the perspective of stress, this ruling puts beyond doubt the point that the employer should consider the needs of workers as well as employees when developing a policy on stress, conducting risk assessments and taking preventative steps. Although HSE has long taken the view that health and safety law is broad in scope, 88 there is now an urgent need for it to revisit and update its workplace stress guidance to ensure that it is relevant to different types of working arrangement. The current guidance tends to assume that it is being applied in a workplace with very traditional employer/employee relationships. For example, there is a strong emphasis on training, both to provide opportunities for staff to develop their careers, and to help them deal with difficult situations, 89 but it seems unlikely in practice that much training would be on offer for workers with short-term casual contracts. More profoundly, there is a major structural question about the extent to which precarious working arrangements of various kinds are inherently likely to put working people at a greater risk of stress-related ill-health, regardless of their specific design. I return to this point below.

To sum up, the HSE’s management standards have clearly been drafted based on psychological research, but the more detailed guidance provided by HSE is unambitious. There is a tendency for bold statements about demands, control and other factors to collapse into minor changes to a particular individual’s working experience. There are also questions about the extent to which the management standards are relevant to working people who are not in traditional ‘employee’ relationships and whether they are effectively enforced. At least three areas can be identified for reform. First, HSE’s guidance should be redrafted to emphasise the importance of considering structural changes within the employing entity to reduce the risk of stress before making adjustments to individuals’ jobs. Second, greater priority should be given to workplace stress in HSE’s enforcement activity. Although HSE clearly cannot tackle every case of stress, occasional use of its formal powers in serious cases would raise the profile of stress as a significant workplace issue. Third, new guidance is urgently needed to help employers consider suitable preventative steps to tackle the stress experienced by people in non-standard working relationships.

B. Tort Liability

Another body of law with an obvious role to play in dealing with stress at work is the law of tort. At common law, the employer is under a duty to take reasonable care to protect its employees 90 from injury at work. 91 This duty arises both in the law of negligence, because of the nature of the employment relationship, 92 and as an implied term of the contract of employment. 93 As we have seen, stress itself is not a diagnosable condition, so there is no liability in respect of stress per se, but claims may be brought where the employee has developed a physical or mental illness as a result of workplace stress. 94 Most of the reported cases relating to stress in fact concern mental illness, which is referred to by the courts as ‘psychiatric injury’. 95 I will argue in this section that the law’s approach is highly individualistic, focussing largely on the particular employee’s response to the circumstances and how their ‘vulnerabilities’ might have been managed, rather than on the broader structural factors at play. This perpetuates an unhelpful narrative about workplace stress, which is not consistent with the psychology literature.

One manifestation of this is in the courts’ approach to ‘foreseeability’. 96 Foreseeability is regarded as relevant to establishing whether the employer has breached its duty of care (alongside the seriousness of the injury to the employee and the cost of taking precautions to prevent it) and, to some extent, to establishing causation (whether the employee’s illness was a result of their work situation). The key question is what the employer could or should have predicted based on its knowledge of the situation. The courts begin from the premise that no job is inherently likely to cause ‘psychiatric injury’:

The notion that some occupations are in themselves dangerous to mental health is not borne out by the literature to which we have already referred: it is not the job but the interaction between the individual and the job which causes the harm. 97

This contrasts with the position in relation to physical injury, where it is recognised that some jobs—in the police or the fire service, for example—do carry greater risk, though workers in those services are taken to have accepted the risks inherent in their job not attributable to their employer’s negligence. 98 It is, of course, true that not every employee will develop ‘psychiatric injury’ as a result of a stressful work situation: in most of the cases before the courts, it is apparent that other employees in the same workplace facing the same conditions have not become ill as a result. But this is the starting-point for the courts’ focus on the individual.

Very occasionally, it is possible to establish liability on the basis of a ‘single stressful event’: where the workplace problem that caused the injury was so extreme that it was foreseeable that any employee of ‘ordinary robustness’ might suffer ‘psychiatric injury’ as a result. This was argued in the Yapp case, in which a diplomat was suddenly withdrawn from his posting without being given an opportunity to challenge allegations which subsequently turned out to be unfounded. 99 It was held that while the argument was available in principle, it was not made out in Yapp itself, because the employer’s action was not so extreme as to make the ‘psychiatric injury’ foreseeable in the absence of any known prior vulnerability on the part of the claimant. 100 However, a version of the argument succeeded in Melville , in which the claimant was a prison officer who was occasionally called upon to deal with suicides at the prison where he worked. 101 The Home Office had a procedure for supporting staff who had been in this situation but it had not been implemented properly in relation to the claimant. 102 The Court of Appeal upheld the judge’s finding that the Home Office was liable. The Home Office had in fact foreseen that prison officers might suffer psychiatric injury when dealing with suicides and it did not matter that this was in relation to all staff rather than the particular claimant. It was in the nature of a traumatic event that the claimant would show no signs of vulnerability before the event occurred.

However, where the claim relates to more general stressors, such as workload, it is necessary to show that the employer was aware of what the courts refer to as a particular vulnerability on the part of the claimant in order to establish that the ‘psychiatric injury’ was foreseeable. In most successful claims, this is done by demonstrating that the employer had been put on notice by a previous episode of stress-related ill-health. For example, in Walker , the first case in which an employer was found liable for ‘psychiatric injury’, it was crucial that the employee, a social work manager, had suffered two breakdowns as a result of his heavy workload. 103 After the first breakdown, he returned to work and was provided with additional support, but this was soon withdrawn, with the result that he suffered further ill-health and was ultimately unable to work again. It was held that the employer was not liable for the first breakdown, on the basis that it could not have been foreseen, but was liable for the second. Some of the more recent cases have relaxed this approach to some extent, finding that injury was foreseeable where the employee had clearly and repeatedly notified the employer of concerns about stress and workload, without suffering a breakdown or taking time off. 104 Nevertheless, the requirement remains that the employer should be aware of vulnerability on the part of the particular employee.

Crucially, although the employee’s work situation is relevant in establishing foreseeability, it does not appear that it could ever be sufficient. In the well-known Hatton guidelines, a number of factors relating to the work situation feature in guideline 5, as follows:

Is the workload much more than is normal for the particular job? Is the work particularly intellectually or emotionally demanding for this employee? Are demands being made of this employee unreasonable when compared with the demands made of others in the same or comparable jobs? Or are there signs that others doing this job are suffering harmful levels of stress? Is there an abnormal level of sickness or absenteeism in the same job or the same department? 105

However, the remainder of the guideline summarises factors demonstrating the vulnerability of the individual employee and it is clear from the judgment as a whole that these are regarded as much more important in establishing foreseeability. Indeed, a clear contrast between stress cases (apart from those involving a ‘single stressful event’) and other types of case is that foreseeability must be established in relation to the particular claimant rather than just a class of persons to which the claimant belongs.

The (unintentional) effect of the courts’ approach is to construct a narrative that employees who develop ‘psychiatric injury’ as a result of stress do so because they are particularly vulnerable, and to downplay the role of workplace factors such as workloads, long working hours or lack of sympathy from management. The deterrent effect of tort law is, of course, controversial and contested. But to the extent that it does exist, this approach largely absolves employers of the need to think about how the design of a particular job may be causing or contributing to the stress experienced by the employee.

Another element of establishing breach of the employer’s duty of care is a consideration of what precautions the employer could have taken, but failed to take, in order to protect the employee. As we saw above in the discussions of both Walker and Melville , employers are particularly likely to be held liable in cases where it is apparent that they decided what precautions were required but then failed to implement their own decision. 106 In less clear-cut cases, the judge must identify with some precision the precautions the employer should have taken, considering its size and administrative resources (with clear echoes of unfair dismissal law) and their likelihood of success. 107 The Court of Appeal in Hatton provided a non-exhaustive list of steps, including ‘giving the employee a sabbatical; transferring him to other work; redistributing the work; giving him some extra help for a while; arranging treatment or counselling; providing buddying or mentoring schemes to encourage confidence; and much more’. 108 Again, the focus is largely on steps to remedy the perceived vulnerability of the individual, rather than on reshaping the work or the workplace.

Perhaps the high-point of this emphasis on the individual is the idea that the employer’s provision of an occupational health service is likely to be a sufficient precaution in most cases. Again, this is clear from Hatton :

an employer who tries to balance all these interests by offering confidential help to employees who fear that they may be suffering harmful levels of stress is unlikely to be found in breach of duty: except where he has been placing totally unreasonable demands upon an individual in circumstances where the risk of harm was clear. 109

This is problematic from the perspective of the literature considered in the first part of this article. While there is nothing wrong with providing an occupational health service, it again tends to ‘individualise’ the problem of workplace stress. It is treated as a matter to be addressed by providing the employee with advice, rather than by restructuring the work or the workplace to make the employee’s situation less stressful. In some workplaces, such as that in Melville , the nature of the work cannot be changed, and the provision of support becomes essential. But in other cases, restructuring should be the employer’s first port of call. 110 The Court of Appeal in Hatton added the important qualification about intolerable pressures, indicating that occupational health provision is not the answer in every situation. This was borne out in Daw , where the court held that the only effective precaution the employer could have taken was to reduce the claimant’s workload. 111 The provision of an occupational health service and the claimant’s decision not to use it were held to be irrelevant in that case. Nevertheless, there is a worry that cases like Daw are the exception rather than the rule, so that the message about stress and individual vulnerability is reinforced.

To sum up, tort law constructs a narrative that ‘psychiatric injury’ caused by stress at work is largely a matter of vulnerability on the part of the claimant employee. This is illustrated by the way in which foreseeability is interpreted and applied, and by the emphasis on counselling as a sufficient precaution in most cases. This inhibits tort law’s capacity to fulfil its secondary goal of prompting employers to take preventative measures, such as redesigning jobs and workplaces to make them less stressful for their employees. To align the law more closely with what we know about stress from the JD-R model, the courts ought to place more emphasis on the predictive value of the work situation when considering foreseeability for the purposes of determining whether the employer is in breach (and, ideally, accept that foreseeability of stress-related psychiatric injury need only be established in relation to a class of persons to which the claimant belongs), and acknowledge that the employer’s obligation to take preventative steps should include reorganising the work, where possible, as well as providing support to individuals.

So far, the discussion has focussed on how a psychologically-informed understanding of stress might help us to critique and develop those bodies of law dealing explicitly with workplace stress, such as health and safety law or tort law. But the insight that the way in which workplaces and working lives are structured and organised is a key factor in either generating or combating stress at work has much broader implications too. These will be the focus of this section. I will develop two points. First, to tackle workplace stress in a comprehensive manner, many other bodies of law also need to be considered, including some that we would not normally think of as having any relationship to workplace stress at all. Second, the organisational and structural causes of stress seem likely to have significant implications for workplaces that are not arranged along ‘traditional’ lines, such as workplaces with significant use of casual work or platforms in the gig economy. Both of these points do, of course, raise huge issues, so I will need to confine myself to offering an overview and suggesting some questions for further research.

A. Other Areas of Law

There are many different ways of illustrating the argument that a legal regime promoting ‘decent work’ has a significant role to play in combating workplace stress, but for reasons of space, I will offer just two examples: working time and trade union representation in the workplace. The examples are contrasting in the sense that the relationship with tackling stress is much more obvious in the case of working time than it is in the case of trade union representation. Thinking about these bodies of law from the perspective of stress sheds new light on how they might be justified and interpreted.

The relationship between stress and hours of work may be obvious, but the mechanisms involved are complex. In many workplaces, long hours working is a ‘coping strategy’ for dealing with the fact that the amount of work to be done (the ‘demands’ of the job) far exceeds what can be accomplished in ‘normal’ working hours. 112 This may not be a problem if it is only occasional and foreseeable—a surge in demand in a retail business just before Christmas, for example—but long-term or unpredictable long-hours working can be a significant stressor. Long-term long-hours working impedes workers’ ability to spend time resting and recuperating, and can generate a sense of deep dissatisfaction through the inability ever to feel on top of job demands.

The Working Time Regulations (WTR) 1998 113 do, of course, have a health and safety objective at their heart, since they implement a Directive based on the EU’s health and safety competence. 114 In addition to the various enforcement mechanisms in the Regulations themselves, they have come to play a role in tort claims relating to workplace stress. Where the employer knows that the employee is working significantly in excess of the 48-hour limit, this can be relevant to the question whether the employee’s stress-related illness was reasonably foreseeable, particularly if the employee has refused to sign an opt-out and has complained about excessive hours. 115 However, thinking about the WTR from the perspective of stress adds a new dimension to the old argument about the legitimacy of the opt-out. The opt-out has long been controversial, in particular because of the likelihood that many workers will have no choice but to sign an opt-out as a condition of getting or keeping a job, so that the genuineness of any ‘consent’ they might have given can be called into question. 116 But from a stress perspective, the worry is that the opt-out might legitimise long-hours working as a means of coping with excessive workloads, rather than forcing the employer to tackle the cause of the problem, either by reassigning or reorganising work or by helping workers to manage their workloads more effectively. In particular, because the opt-out once signed remains valid for the duration of the employment, there is no obvious means of forcing the employer to review the situation to assess the impact of long-hours working on the worker over time.

A less obvious example of a body of law with relevance to workplace stress is that relating to trade union recognition and collective bargaining. On a simple level, collectively bargained terms and conditions are likely to ensure that workers are better paid for their efforts, which under some older models is considered to be a good protection against workplace stress. On a more sophisticated view though, a trade union presence in the workplace can help to give workers a voice on a variety of fronts: for example, in managing demands, such as excessive workloads, or securing resources, such as better training or support services. Empirical evidence suggests that unionised workplaces offer a wider variety of mechanisms for workers to articulate their concerns. 117 Perhaps most importantly, trade union representatives can play a significant role in coping with change in the workplace, which can be a significant source of stress for workers, particularly if they do not know what is happening and do not feel that their interests are being represented. For example, where unions are strong, employers might be more willing to respond to a need to improve productivity by training and empowering workers rather than by developing ever more aggressive performance monitoring strategies. 118

Of course, this is not to suggest that dealing with workplace stress should be regarded as a principal justification for policies to promote trade union membership or to support collective representation at work. But it does highlight a hidden cost of the failure to make these policies a central plank of labour policy in the UK over the past few decades. As workplaces have become more individualistic, there are fewer institutions in place to serve as ‘buffers’ against the kinds of job demands that can lead to stress-related illness. Both workers and, ultimately, employers have suffered as a result.

B. Casual or Platform Work

A thread running throughout this article has been a concern about the situation of working people who are not employees in ‘traditional’ jobs. This group tends to be under-represented in occupational health research, and faces uncertainties about legal entitlements. One of the key indicators of stress levels in the economy—working days lost through sickness absence due to stress—does not cover casual workers for whom the concept of a ‘sick day’ does not exist. What I want to highlight here is the extent to which temporary, casual or ‘gig’ work is likely to involve a combination of high demands and low resources, not just as a matter of a particular context at a particular time, but as a matter of the inherent structure of the job.

Of course, it is important to be careful about sweeping generalisations covering large numbers of differently-situated working people. However, we could reasonably hypothesise that some of the key problems associated with distress at work are likely to be more present in on-demand working of various kinds than they are in traditional jobs. 119 For present purposes, four examples will suffice. First, as we have seen, job insecurity has been shown to be a predictor of distress, and this is inherent in temporary or casual working. Second, constant work availability is associated with negative outcomes for permanent employees—for example, being expected to respond to work calls outside normal working hours—which might suggest that being called upon to work unpredictably and at short notice will also be a stressor for casual workers in particular. Third, having control over work tasks is a key resource which can buffer against stress, but this is wholly absent in some parts of the ‘gig’ economy where, once the worker has logged on to an app, their every move is governed by the app’s dictates. Fourth, having supportive colleagues is another buffering resource, but this is less likely to be present among dispersed workers who may not be able to meet each other very easily to develop a sense of community, and may be more obviously in competition with each other for the available work.

In practice, some of these hypotheses are not entirely borne out by the literature. One key example is around job insecurity. Here, the evidence tends to suggest that permanent employees react more strongly to job insecurity than do temporary workers. 120 However, the reason for this is significant. Permanent employees expect a high level of job security, so rumours that jobs may be at risk (for example) have a particularly harmful effect because they breach those expectations, taking away one of the valuable things about having a permanent job. Temporary workers experience this form of distress much less readily because they have lower expectations of security in the first place. Another key variant is the relationship between the individual’s job and other activities. For example, there is evidence to support the view that workers with ‘gig’ economy jobs are happier where the job is not their sole source of income or sole activity. 121 So a student doing a delivery job at weekends to make some extra money is likely to experience this very differently to someone doing the delivery job as their main job to support their family. The ‘gamification’ of some gig economy jobs—where completing a task quickly is rewarded in some way, as if it were a computer game—plays into this distinction, by making unskilled and potentially tedious work ‘fun’ for people who do not depend on it.

However, the literature exploring stress among gig economy workers is very much in its early stages of development, and there is relatively little material on more long-standing but similar phenomena such as temporary or casual working, so there is a lot more research to be done. From a legal perspective, it would be helpful to see greater dialogue between lawyers and psychologists on the most appropriate way to frame research questions about different forms of working.

My aim in this article has been to draw attention to a difference of emphasis between the psychology literature on stress and the legal approach. While the law tends to treat stress as a matter of individual vulnerability, to be addressed through tweaks to a person’s job or the provision of counselling, the psychology literature opens up the idea that a much broader range of factors can have an effect—positive or negative—on stress at work and its negative health effects. These are principally concerned with the way in which work is organised and managed—factors such as employee voice, support from colleagues or job security, for example—with the individual’s own susceptibility occupying a much less prominent place in the analysis. I draw three conclusions from this work.

First, the law should be more open to the idea that stress can have structural causes and that strategies to prevent or reduce the prevalence of stress should focus on structural change as well as support for individuals. This might be relevant in several different ways. For example, in risk assessments, greater emphasis might be placed on reviewing and altering workplace practices that contribute to stress—such as job insecurity or the lack of a mechanism for employee voice—as well as on factors relating to the individual’s job. In tort litigation, the courts could be more open to the idea that poor workplace practices may, in some cases, make harm foreseeable even where the affected individual had not shown previous signs of stress-related ill-health.

Second, we should be more aware of the role of worker well-being as a potential secondary justification for various elements of labour law. I do not wish to suggest that well-being can displace other more familiar justifications, such as inequality of bargaining power, dignity or human rights, but rather that it adds another important dimension to a multi-faceted approach to justifying labour law. Many elements of labour law—controls on working hours, rights relating to trade union recognition, protection against unfair dismissal and so on—can be seen as having a positive effect on employee well-being by buffering against stress. An attraction of well-being as a justification is that it is effective from multiple perspectives: it is an aspect of the dignity of working people, it benefits employers because happy and healthy workers are likely to be more productive, and it benefits the state because there should be less call on sickness benefits or healthcare services if workers are well-cared-for at work. Of course, it is incomplete—any one intervention is not likely to be transformative in its own right—but it should be given greater consideration than at present. This is potentially particularly important in relation to the gig economy, where harm to workers’ health and well-being is a significant argument against being allowed systematically to dispense with the normal protective structures of employment law.

Third, there is an urgent need for further research on the psychological effects of work in the ‘gig economy’ and of casual work more generally. I drew attention earlier to the limited range of psychology literature on this topic and the general tendency to focus on standard long-term employment relationships when examining employees’ responses to demands and resources at work. There are good reasons to believe that casual work may have negative effects on workers’ well-being, both because of its inherent uncertainty and irregularity and because of the knock-on consequences of that uncertainty, such as difficulties in organising workers or providing them with support from colleagues. But—as the example of temporary work and job insecurity shows—the picture is not entirely straightforward and it would be preferable to have more evidence from which reliable conclusions could be drawn.

I would like to thank Hugh Series and the Editor and referees for comments on an earlier draft, and participants in the Industrial Law Society’s online conference in September 2020 and the University of Haifa’s faculty seminar in January 2021 for their input. Responsibility for errors and omissions remains my own.

Health and Safety Executive, Work-Related Stress, Anxiety or Depression Statistics in Great Britain, 2019 (October 2019), drawing on data from the Labour Force Survey and the Health and Occupation Research Network for general practitioners. In 2018–19, stress, depression or anxiety accounted for 44% of work-related ill health and 54% of working days lost.

ACAS, Stress and Anxiety at Work: Personal or Cultural? (May 2019).

See, for example, A. Väänänen et al., ‘The Double Burden of and Negative Spillover Between Paid and Domestic Work: Associations with Health Among Men and Women’ (2005) 40 Women and Health 1–18.

See T.H. Holmes and R.H. Rahe, ‘The Social Readjustment Rating Scale’ (1967) 11 Journal of Psychosomatic Research 213, 216.

Two leading scholars in the area are Brenda Barrett and Graeme Lockwood. See, for example, B. Barrett, ‘Should Employers Be Held More Responsible for Stress at the Work Place?’ (2011) 11 Contemporary Issues in Law 37; ‘Psychiatric Stress – An Unacceptable Cost to Employers’ (2008) 1 Journal of Business Law 64; Graeme Lockwood et al., ‘An Assessment of Employer Liability for Workplace Stress’ (2017) 59 International Journal of Law and Management 202.

See, for example, P. Handford, ‘Psychiatric Injury in Breach of a Relationship’ (2007) 27 Legal Studies 26, setting the employment cases in their broader context.

See, for example, M. Bell, ‘Mental Health at Work and the Duty to Make Reasonable Adjustments’ (2015) 44 ILJ 194; G. Lockwood et al., ‘Mental Health Disability Discrimination: Law Policy and Practice’ (2014) 14 International Journal of Discrimination and the Law 168.

See Barrett (2008), above n.7, 66–7.

Walker v Northumberland CC [1995] ICR 702.

See, for example, M. Hudson, The Management of Mental Health at Work (London: ACAS, November 2016), 2.1.

Relevant legislation includes Working Time Regulations 1998 (SI 1998/1833); Employment Rights Act 1996, s 57A.

https://www.lexico.com/definition/stress (last visited 24 March 2021).

Known as the Yerkes-Dodson law: RM Yerkes and JD Dodson, ‘The Relation of Strength of Stimulus to Rapidity of Habit-Formation’ (1908) 18 Journal of Comparative Neurology and Psychology 459.

A term coined by H. Selye, Stress without Distress (Philadelphia: JB Lippincott Co, 1974).

RS Lazarus and S Folkman, Stress, Appraisal and Coping (New York: Springer 1984), 21.

See, generally, American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: DSM-5 , 5th edn (Washington: American Psychiatric Publishing 2013). The lines are blurred somewhat by the World Health Organisation’s International Statistical Classification of Diseases and Related Health Problems , 10th Revision (Geneva: WHO, 2019), which includes as code F43 a category of diagnosable disorders labelled ‘reaction to severe stress and adjustment disorders’, though these tend to be triggered by acute stressors.

See, for example, AE Nixon et al., ‘Can Work Make You Sick? A Meta-Analysis of the Relationships between Job Stressors and Physical Symptoms’ (2011) 25 Work and Stress 1; N. Schneiderman et al., ‘Stress and Health: Psychological, Behavioral, and Biological Determinants’, (2005) 1 Annual Review of Clinical Psychology 607.

See, for example, RA Karasek, ‘Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Design’ (1979) 24 Administrative Science Quarterly 285; R Karasek and T Theorell, Healthy Work: Stress, Productivity, and the Reconstruction of Working Life (New York: Basic Books 1990).

For example, J Siegrist, ‘Adverse Health Effects of High Effort-Low Reward Conditions’ (1996) 1 Journal of Occupational Health Psychology 27.

AB Bakker and E Demerouti, ‘The Job Demands‐Resources Model: State of the Art’ (2007) 22 Journal of Managerial Psychology 309, 311–2.

E Demerouti et al., ‘The Job Demands-Resources Model of Burnout’ (2001) 86 Journal of Applied Psychology 499; AB Bakker et al., ‘Job Resources Buffer the Impact of Job Demands on Burnout’ (2005) 10 Journal of Occupational Health Psychology 170; Bakker and Demerouti (2007), above n.24; AB Bakker and E Demerouti, ‘Job Demands-Resources Theory: Taking Stock and Looking Forward’ (2017) 22 Journal of Occupational Health Psychology 273.

Demerouti et al. (2001), above n.25, 501.

Ibid. 501–2.

AB Bakker and E Demerouti, ‘Job Demands-Resources Theory’ in PY Chen and C Cooper (eds), Wellbeing: A Complete Reference Guide (Chichester: John Wiley & Sons, 2014), 45.

Bakker and Demerouti (2007), above n.24, 314–5.

WB Schaufeli and TW Taris, ‘A Critical Review of the Job Demands-Resources Model: Implications for Improving Work and Health’ in GF Bauer and O Hämmig (eds), Bridging Occupational, Organizational and Public Health: A Transdisciplinary Approach (Dordrecht: Springer 2014).

For example, Schaufeli and Taris, above n.31; A van den Broeck et al., ‘Not all Demands are Equal: Differentiating Job Hindrances and Job Challenges in the Job Demands-Resources Model’ (2010) 19 European Journal of Work and Organizational Psychology 735.

Above n.28, 45.

K Nielsen et al., ‘Workplace Resources to Improve Both Employee Well-Being and Performance: A Systematic Review and Meta-Analysis’ (2017) 31 Work and Stress 101, 102.

See D Xanthopoulou et al., ‘The Role of Personal Resources in the Job Demands-Resources Model’ (2007) 14 International Journal of Stress Management 121, 123–4; D Xanthopoulou et al., ‘Work Engagement and Financial Returns: A Diary Study on the Role of Job and Personal Resources’ (2009) 82 Journal of Organizational and Occupational Psychology 183.

For example, A Wrzesniewski and JE Dutton, ‘Crafting a Job: Revisioning Employees as Active Crafters of their Work’ (2001) 26 Academy of Management Review 179.

For example, P Torrente et al., ‘Teams Make it Work: How Team Work Engagement Mediates between Social Resources and Performance in Teams’ (2012) 24 Psicotema 106.

For an overview, see J Skakon et al., ‘The Impact of Leaders on Employee Stress and Affective Well-Being: A Systematic Review of Three Decades of Empirical Research’ (2010) 24 Work and Stress 107.

For example, Karasek, above n.22; B Schreurs et al., ‘Job Insecurity and Employee Health: the Buffering Potential of Job Control and Job Self-Efficacy’ (2010) 24 Work and Stress 56.

See S Schieman and MC Young, ‘Are Communications about Work Outside Regular Working Hours Associated with Work-to-Family Conflict, Psychological Distress and Sleep Problems?’ (2013) 27 Work and Stress 244; A Väänänen and M Toivanen, ‘The Challenge of Tied Autonomy for Traditional Work Stress Models’ (2018) 32 Work and Stress 1.

A well-known paper on this topic is JR Hackman and GR Oldham, ‘Motivation through the Design of Work: Test of a Theory’ (1976) 16 Organizational Behavior and Human Performance 250.

For an overview of studies in this area, see K van De Voorde et al., ‘Employee Well-Being and the HRM–Organizational Performance Relationship: A Review of Quantitative Studies’ (2012) 14 International Journal of Management Reviews 391.

For example, Schreurs, above n.40.

For useful meta-analyses, see ER Crawford et al., ‘Linking Job Demands and Resources to Employee Engagement and Burnout: a Theoretical Extension and Meta-Analytic Test’ (2010) 95 Journal of Applied Psychology 834; JRB Halbesleben, ‘A Meta-Analysis of Work Engagement: Relationships with Burnout, Demands, Resources and Consequences’ in AB Bakker and MP Leiter (eds), Work Engagement: a Handbook of Essential Theory and Research (New York: Psychology Press 2010).

For example, AB Bakker et al., ‘Dual Processes at Work in a Call Centre: an Application of the Job Demands-Resources Model’ (2003) 12 European Journal of Work and Organizational Psychology 393; AB Bakker et al., ‘A Multigroup Analysis of the Job Demands-Resources Model in Four Home Care Organizations’ (2003) 10 International Journal of Stress Management 16.

For example, Demerouti et al. (2001), above n.25.

For an overview, see T Lesener et al., ‘The Job Demands-Resources Model: A Meta-Analytic Review of Longitudinal Studies’ (2019) 33 Work and Stress 76.

Schaufeli and Taris, above n.31.

See G Tinline and C Cooper, ‘Work-Related Stress: The Solution Is Management Not Mindfulness’ (2019) 48 Organizational Dynamics 93. It is perhaps telling that early versions of the JD-R model did not include individual resources at all and that this is a later addition to the model: see Bakker and Demerouti, above n.28; Schaufeli and Taris, above n.31.

For example, Bakker and Demerouti, above n.28, 53–8; T Cox et al., Organisational Interventions for Work Stress: A Risk Management Approach (London: HSE Books, 2000); C Mackay et al., ‘“Management Standards” and Work-Related Stress in the UK: Policy Background and Science’ (2004) 18 Work and Stress 91; Nielsen, above n.35, 115.

See C Bernhard-Oettel et al., ‘Comparing Three Alternative Types of Employment with Permanent Full-Time Work: How Do Employment Contract and Perceived Job Conditions Relate to Health Complaints?’ (2005) 19 Work and Stress 301; M Clarke et al., ‘“This Just Isn’t Sustainable”: Precarious Employment, Stress and Workers’ Health’ (2007) 30 International Journal of Law and Psychiatry 311; L Hünefeld et al., ‘Job Satisfaction and Mental Health of Temporary Agency Workers in Europe: A Systematic Review and Research Agenda’ (2020) 34 Work and Stress 82.

https://www.ilo.org/global/topics/decent-work/lang--en/index.htm (last visited 24 March 2021).

Disability discrimination law may also be relevant where a worker develops a disability as a result of stress at work, or where stress exacerbates an existing disability (above n.9), but for reasons of space, I will not consider this in detail here.

Many people regard the term ‘psychiatric injury’ as unhelpful but I use it here because it is used by the courts. It is used to distinguish feelings such as grief or shock from more serious problems for which compensation may be sought.

I discuss the significance of the definition of ‘employee’ further below.

Section 2(3).

Section 2(4)–(7).

SI 1999/3242.

Council Directive 89/391/EC on the introduction of measures to encourage improvements in the health and safety of workers at work (‘the Framework Directive’), Article 1.

Health and Safety Executive, Stress at Work: A Guide for Employers (London: HSE Books, 1995).

https://www.hse.gov.uk/stress/standards/ (last visited 24 March 2021). There is also a European social partner framework on stress (European Trade Union Confederation et al., Framework Agreement on Work-Related Stress (24 March 2021)), and a UK equivalent (Confederation of British Industry et al., Work Related Stress – A Guide (2005).

For evaluation, see K Nielsen et al., ‘Conducting Organizational-Level Occupational Health Interventions: What Works?’ (2010) 24 Work and Stress 234. For examples of research supported, commissioned or published by HSE, see T Cox, Stress Research and Stress Management: Putting Theory to Work (London: HSE Books, 1993); Cox et al. (2000), above n.51; Mackay et al. (2004), above n.51; R Cousins et al., “Management Standards” and Work-Related Stress in the UK: Practical Development’ (2004) 18 Work and Stress 113; JA Edwards et al., ‘Psychometric Analysis of the UK Health and Safety Executive’s Management Standards Work-Related Stress Indicator Tool’ (2008) 22 Work and Stress 96.

HSE, Tackling Work-Related Stress Using the Management Standards Approach: A Step-By-Step Workbook (March 2019).

HSE, Management Standards Indicator Tool (nd), available at https://www.hse.gov.uk/stress/resources.htm (last visited 24 March 2021) under the ‘tools, templates and checklists’ tab.

Available at https://www.hse.gov.uk/stress/resources.htm (last visited 24 March 2021) under the ‘tools, templates and checklists’ tab.

HSE, Talking Toolkit: Preventing Work-Related Stress (nd), available at: https://www.hse.gov.uk/stress/index.htm (last visited 24 March 2021).

Above n.65, 49.

An improvement notice relating to workplace stress was issued to West Dorset General Hospitals NHS Trust in 2003 and to United Lincolnshire Hospitals NHS Trust in 2009: see N. Paton, ‘HSE issues improvement notice to NHS trust’, Personnel Today, 17 March 2009.

There are searchable registers of notices and prosecutions at: https://www.hse.gov.uk/enforce/convictions.htm (last visited 24 March 2021).

See https://www.hse.gov.uk/stress/reporting-concern.htm (last visited 24 March 2021), and B Liversedge, ‘HSE announces it will inspect stress “if criteria are met”, Safety Management (24 March 2021), available at: https://www.britsafe.org/publications/safety-management-magazine/safety-management-magazine/ (last visited 24 March 2021).

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, SI 2013/1471.

See https://www.hse.gov.uk/foi/releases/westdorsetgen.pdf (last visited 17 August 2020).

I Ayres and J Braithwaite, Responsive Regulation: Transcending the Deregulation Debate (Oxford: OUP, 1992).

Kennedy v Cordia (Services) LLP [2016] UKSC 6, [2016] ICR 325, [110].

R (Independent Workers’ Union of Great Britain) v Secretary of State for Work and Pensions [2020] EWHC 3050 (Admin).

Above n.60.

Above n.82, [82]–[83].

Health and Safety at Work etc Act 1974, s 53(1).

Above n.60, and see Employment Rights Act 1996, ss 44 and 100. The government is, at the time of writing (March 2021), proposing to amend s 44. See the draft Employment Rights Act 1996 (Protection from Detriment in Health and Safety Cases) (Amendment) Order 2021.

Directive 89/656/EC on the use of personal protective equipment.

See https://www.hse.gov.uk/enforce/enforcementguide/investigation/status-intro.htm (last visited 24 March 2021) and Lane v Shire Roofing [1995] IRLR 493.

Above n.65, Appendix 6.

There is virtually no case law considering other types of employment relationship, though Freedland makes a strong case for extending the duty, at least in modified form, to workers and others: M Freedland, The Personal Employment Contract (Oxford: OUP, 2005), 152.

An oft-cited summary is that provided by Swanwick J in Stokes v Guest, Keen and Nettlefold (Bolts and Nuts) Ltd. [1968] 1 WLR 1776, 1783.

See S Deakin and Z Adams, Markesinis and Deakin’s Tort Law , 8th edn (Oxford: OUP 2019), 123.

See Yapp v Foreign and Commonwealth Office [2014] EWCA Civ 1512, [2015] IRLR 112 for guidance on managing the differences between claims in contract and tort in this context.

An empirical study by Lockwood et al., above n.7, showed that very few claims in fact succeed.

This terminology is arguably unhelpful, but I use it for consistency with the case law. For a powerful critique of the requirement, see R Mulheron, ‘Rewriting the Requirement for a “Recognized Psychiatric Injury” in Negligence Claims’ (2012) 32 OJLS 77. For an analysis of the law in work and non-work cases, see D Nolan, ‘Psychiatric Injury at the Crossroads’ [2004] JPIL 1.

Hatton v Sutherland [2002] EWCA Civ 76, [2002] ICR 613, [23] (Hale LJ).

Hatton , above n.96, [24], referring to Law Commission and HSE materials cited at [3]–[10].

Ibid. [12].

Yapp , above n.93.

Ibid. [119]–[133], and see also Piepenbrock v London School of Economics and Political Science [2018] EWHC 2572 (QB), [2018] ELR 596.

One of the cases heard with Hartman v South Essex Mental Health and Community Care NHS Trust [2005] EWCA Civ 6, [2005] ICR 782, [126]–[138].

Although this might seem to create a perverse incentive not to ‘foresee’ injuries, the employer would have had a strong argument that it had not breached its duty of care had it implemented its own policy properly: ibid. [136].

Above n.11.

For example, Daw v Intel Corp (UK) Ltd [2007] EWCA Civ 70, [2007] ICR 1318; Dickins v O2 Plc [2008] EWCA Civ 1144, [2009] IRLR 58.

Hatton , above n.96, [43]. Breaches of health and safety law are relevant in negligence cases but do not obviate the need to establish all the usual elements of the claim, a point neatly illustrated by Bailey v Devon Partnership NHS Trust (QB, 11 July 2014, unreported).

Above nn 11 and 101, respectively.

Hatton , above n.96, [43], points 9 and 13.

Ibid. [33].

Ibid. [34].

Above n.101.

Above n.104.

For an early case tackling the issue from a contractual perspective, see Johnstone v Bloomsbury HA [1992] QB 333 (CA).

Above n.13.

Article 118a of the Treaty Establishing the European Community, now Article 153 TFEU, provided the basis for successive Working Time Directives, the latest being Directive 2003/88/EC.

Hone v Six Continents Retail Ltd [2005] EWCA Civ 922, [2006] IRLR 49; but cf Sayers v Cambridgeshire CC [2006] EWHC 2029 (QB), [2007] IRLR 29.

For empirical evidence and discussion, see C Barnard et al., ‘Opting Out of the 48-Hour Week: Employer Necessity or Individual Choice? An Empirical Study of the Operation of Article 18(1)(b) of the Working Time Directive in the UK’ (2003) 32 ILJ 223, 245–8.

See, for example, J Benson, ‘Employee Voice in Union and Non-union Australian Workplaces’ (2000) 38 British Journal of Industrial Relations 453. However, it is important to acknowledge that stress is a significant problem in the UK public sector, which is highly unionised, suggesting that union voice may not always be a sufficient buffer against, for example, high levels of demand caused by budget cuts.

See V Doellgast, ‘Collective Voice under Decentralized Bargaining: A Comparative Study of Work Reorganization in US and German Call Centres (2010) 48 British Journal of Industrial Relations 375.

See the literature cited at n.52 above.

N de Cuyper and H de Witte, ‘Job Insecurity in Temporary Versus Permanent Workers: Associations with Attitudes, Well-Being, and Behaviour’ (2007) 21 Work and Stress 65.

Clarke et al., above n.52.

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