Co-authored by Dr Libby Artingstall, Co-Founder and Director of Team Mental Health

"Whether you work with 10 people, 10,000 people or just yourself, paying attention to mental health in the workplace has never been more important"1

With the Health and Safety Executive (HSE) recently reaffirming its commitment to tackling work-related stress, in this article we consider what is meant by this, the impact of work-related stress on mental and physical health, and what steps businesses can take to measure and reduce stress in the workplace. We also examine the potentially significant implications of ignoring this issue and whether a tough approach from the HSE will ensure that stress is brought to the forefront of discussions in the workplace. 

Everyone's business

The World Health Organisation defines mental health as a state of wellbeing reflecting an ability to cope with day to day difficulties, realise and achieve potential, and contribute to communities.2 Like physical health, mental health is something that everyone has. Mental ill health reflects a deterioration in mental health which can impact negatively on our ability to interact with and understand others, to function, and to care for ourselves or others.

Whilst work related stress itself is not considered a mental illness, it is a significant risk factor for developing one.3 When it is prolonged, work-related stress can lead to mental health conditions such as anxiety and depression, as well as physical conditions. 

With over 15 million days lost at work every year because of work-related stress4, what is clear is that it is everyone's business. 

  • 1.4 million workers suffering from work-related stress5
  • Stress, depression or anxiety is the most commonly reported cause of work-related ill health in Great Britain6
  • One in four people in the UK will experience mental ill health at some point7
  • Mental health problems are the largest single source of disability in the UK8
  • Suicide is the leading cause of death in young people under 35 and men under 509
  • Work-related stress accounts for 44% of all cases and 57% of all working days lost due to ill health in the UK10
  • The overall economic cost of work related stress in the UK is estimated to be £5 billion11

What is work-related stress? 

It's important to recognise the difference between pressure and stress. Pressure in work can be a positive thing. It can motivate, drive ambition and enhance performance; but only to a point. Stress reflects the place after this point. When pressure becomes overwhelming and difficult to manage, performance declines, as can mental and physical health.12 The HSE defines stress as "the adverse reaction people have to excessive pressures or other types of demand placed on them"13.

Research shows that people exposed to prolonged periods of work-related stress are more likely to develop mental illnesses such as an anxiety disorder or depression14. Alongside this, there is also evidence to suggest that there can be a negative impact when it comes to our physical health. Chronic low levels of stress and repeated activation of the stress response and the physiological reaction that ensues can result in increased blood pressure and contribute to the build-up of fat tissue and weight gain thus increasing the risk of heart attack, stroke, renal problems and diabetes15.

As such, through reducing risk, recognising the signs and managing stress effectively we can limit the likelihood of associated mental or physical illness. 

HSE priorities

The HSE's Business Plan for 2019/20 sets out priorities for the HSE, building on the previous year's plan and drawing on the sector plans and Helping Great Britain Work Well strategy. 2019/20 marks the third year of the HSE's focus on tackling three major causes of work-related ill health: musculoskeletal disorders, occupational lung disease and work-related stress. The plan highlights specific priorities, within an overall framework that reinforces the ongoing commitment to major issues including mental health and work-related stress.

In their Priority Plan for work-related stress, the HSE state that they will develop a suite of leading indicators that will measure stress risk management performance in businesses/sectors. Over the course of the next year, the HSE will focus on "supporting the provision of appropriate tools to support the management of stress"16, including:

  • Publishing bespoke work-related stress material for public sector organisations, including "Talking Toolkits" informed by the HSE's public stress pilots and work on violence in the NHS and Prison Service.
  • Publishing updated advice for SMEs on assessing work-related stress risks using the Management Standards.

Risk management

Regulation 3 of the Management of Health and Safety at Work Regulations 1999 requires employers to carry out a "suitable and sufficient assessment of the risks to the health and safety of its employees to which they are exposed whilst they are at work and  to put into place appropriate measures to control them". Employers with five or more employees need to record the significant findings of the risk assessment. 

Whether an employer is a small business or a large corporation, the law requires all employers to assess the risk of work-related stress and put steps in place to tackle those risks, either by removing the risk or reducing it as far as reasonably practicable. Although employers have a legal duty to protect employees from stress at work, diagnosing and treating stress is not their responsibility. 

The HSE's position is that work-related stress should be treated as any other workplace hazard. The HSE wants to see a significant increase in the number of employers taking a proactive stance to managing work-related stress through the Management Standards approach (the HSE's approach for preventing stress at work), which helps identify and manage the six causes of stress at work, namely: demands; control; change; relationships; support; and role17.

Reducing risk

Set out below are the six causes as identified by the HSE in the Management Standards, with corresponding risk and protective factors18. Risk factors predispose an experience whereas protective factors reduce the likelihood or limit the impact of an experience. Through minimising risk factors and optimising protective factors we can seek to prevent or reduce the risk of work-related stress19.

Recognising and managing stress The signs of stress will vary from person to person and it is important to be aware of how we may feel, think or act during times of stress. Some signs of stress can include20:

  • Feeling overwhelmed
  • Difficulty focusing
  • Racing thoughts
  • Feeling irritable or argumentative
  • Angry outbursts
  • Loss of motivation
  • Poor self-esteem
  • Reduced performance
  • Indifference
  • Poor time keeping
  • Taking more time off work
  • Using unhealthy ways to cope more frequently

Once stress is identified, early intervention is possible with stress management strategies to limit its negative impact. Again, effective stress management will vary from person to person, so it is important to take some time to explore what works for the individual.

  • Be active and spend time outside in green space
  • Make time to connect with and spend time with others
  • Set yourself new challenges or rediscover an old interest or hobby
  • Be kind to yourself and others
  • Find time to regularly relax
  • Express gratitude
  • Be present and appreciate of what's around you 
  • Seek support from a health care professional
  • /ul>

    While the individual benefits of reducing and managing stress are clear, it's important to consider the organisational benefits of taking proactive, preventative action. Key positive outcomes can include a happier, healthier and more productive workforce; reduced absenteeism and presenteeism; improved staff retention; protection from reputational damage and reduced risk of litigation; and improved desirability as a workplace21.

    Time for change

    The HSE's continuing tough stance against those who breach their legal health and safety duties should encourage employers to sit up and take note. In 2017/18, out of 6,000 investigations, there were 8,940 enforcement notices and 517 prosecution cases, with a 95% conviction rate.

    Furthermore, £72.6 million was secured in fines for health and safety offences prosecuted by the HSE and, in Scotland, the COPFS22.

    But how will this translate to work-related stress? With the HSE historically tackling physical (rather than mental) ill-health, how do they propose to measure compliance and effectively enforce breaches?

    Unlike for occupational lung disease and musculoskeletal disorders, the HSE have not specifically pledged to prioritise interventions, inspection activity and enforcement on high-risk sectors/activities. They have simply stated that they "will provide an effective regulatory framework by researching the continued effectiveness of the Management Standards approach". 

    The HSE state that if an employer follows the Management Standards approach above, they will be adopting an approach that is considered suitable and sufficient. It will be interesting to see whether the HSE during routine inspections request copies of risk assessments relating to work-related stress and whether failure to have one in place will result an improvement notice being issued. 

    Certainly if the regulatory regime is to have teeth, it needs to be supported by an effective programme of pursuing those who fail to follow those standards, whether that is through targeted inspection, enforcement notices and/or prosecution. Our initial view is that improvement notices will be used in the first instance: it remains to be seen if the HSE show an appetite in the future to prosecute businesses who fail to comply with their duties.

    The mental health of individuals at work is beginning to be treated as an issue that deserves recognition and respect. Only time will tell if the HSE's commitment to making work-related stress everyone's business will be sufficient to drive change. 


    1. Mental Health at Work-




    5. HSE Business Plan 2019/20

    6. HSE Business Plan 2019/20


    8. Work Health Expert Committee Report 2018

    9. World Health Organisation, 2008; MQ, 2017; Office for National Statistics, 2017

    10. HSE Business Plan 2019/20

    11. HSE Priority Plan- Work-Related Stress





    16. HSE Business Plan 2019/20


    18. Acas, 2017; Health & Safety Executive, 2018


    20. Hobbs, 2017; Health & Safety Executive, 2018b; NHS, 2017; Sheffield, 2015

    21. Mills et al, 2007; Knapp, McDaid & Parsonage, 2011; Health and Safety Executive 2008; Sainsbury Centre for Mental Health 2007; NICE, 2009; Stevenson & Farmer, 2017; Walters, 2019

    22. HSE Business Plan 2019/20

    The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.