1. Stress is not a medical problem
That's right - stress is a normal physiological reaction to external stimulus. If you remove or reduce this stimulus, stress will improve. If you don't - the stress will get worse and over time likely result in a range of health problems.
It really is as simple as that - however due to complex social, economical and political situations within a workplace setting, it's not recognised as well, and more importantly, employers feel there's a limit to what they can do about it; reactively or pro-actively.
As an Occupational Health Physician, I can advise away, however I'm not the one that has the ability to change the situation - only the employer and employee has the real power to do so.
This is why advising on stress in general is largely unsatisfactory.
2. It saddens me when work related stress has been so poorly managed, that it becomes an intractable medical problem
Alluding to the first point - I've seen this all too frequently. Resulting in long term sickness absences, grievances, reduced productivity, unemployment, and in some cases suicide.
Most of the time, this is a largely a preventable situation which has persisted much longer than required. The health conditions can become chronic (long term) which makes it relatively difficult to treat.
3. By the time of referral, there usually is no easy fix - which makes it harder to manage
Stress at work rarely happens overnight.
It usually results from several workplace stressors (external or internal) that have been present over a substantial period of time.
Of course, you can have the odd day where there's a sudden increase in demand or workload which quickly resolves, but we don't usually see these in OH. They're usually long term stressors, perhaps some that an individual is vulnerable to, or some that affects multiple staff members. Whether it's been happening for weeks or years - the longer it's poorly managed, the more difficult it is to address.
It's rare that an OH clinician is able to solve these problems by penning a report with some suggestions. It needs independent multi-professional input over time to suggest and implement solutions, followed by a clear prevention focused strategy for the organisation as a whole. This can save companies a huge amount of money over time - but few companies invest in this. Why?
4. Work related stress is commonly linked to systemic / organisational issues, making it difficult to address on an individual basis
When you see several individuals from the same company or organisation who are stressed; it's clear this is most likely linked to organisational issues. Without naming specific organisations, we know that many are reputed for poor culture, budget cuts, redundancies, and poor staffing. Some organisations have this problem on a transient basis due to specific company changes or organisational shifts, therefore I've seen many cases where an increased level of stress in the workforce can easily be pre-empted.
As part of a company's transition management, it doesn't seem apparent that the workforce's stress or mental health is considered as part of the strategy. This is a key area that many businesses could manage more effectively - saving themselves a substantial amount on costs amongst other things.
5. I frequently have to impart the same basic advice for management of work related stress which can easily be found on the HSE website - I wish employers could communicate what steps they've taken so far with reference to this before they refer.
Work related stress is a management problem, hence as a minimum the organisation needs to be able to demonstrate that they've taken some basic steps to address the issues presented. Legally this is an employer's responsibility under the Health and Safety at Work Act 1974 and failure to do so can result in substantial fines.
In my opinion, OH departments and OH providers should take on more responsibility in ensuring management have taken certain minimum steps prior to referring - recognising that an important part of our work is educational and promoting preventative strategies to both employers and employees with a view to become self sufficient when managing work-related stress.