1. Karl Kuhn Former Chief Scientist and Senior policy Adviser in the Federal Institute for Occupational Health and Safety TAIEX Workshop on EU legislation on OSH Internal Market 53901 TAIEX Workshop Ankara, 7-8th October 20131

2. Legal Frame Employers have an obligation to manage work-related stress, through the Framework Directive 89/391/ EEC. This Directive and the legislation it needs at Member State level, place work-related stress firmly within the legal domain of occupational safety and health. They set the strong expectation that it is approached in the same logical and systematic way as other health and safety issues by applying the risk management model, with special emphasis on preventive action. TAIEX Workshop Ankara, 7-8th October 20132

3. Management of Psychosocial Risks Risk assessment for stress involves the same basic principles and processes as for other workplace hazards – identifying hazards, deciding what action needs to be taken, communicating the results of the assessment, and reviewing it at appropriate intervals. Including workers and their representatives in the process is crucial to success. TAIEX Workshop Ankara, 7-8th October 20133

4. Sources of stress High demand/low control (Karasek et al 1981; Erikson and Ursen 2004) Lack of control and poor decision making latitude (Stansfeld et al., 1999) Low social support (Bildt & Michélsen, 2001) Effort and reward imbalance (Stansfeld et al 1999; Siegrist et al 2004) Monotony (Suadicani et al 1993; Alfredsson et al 1985 Poor communication and information (Corey&Wolf, 1992) Unclear/ ambiguous instructions and role, unclear organisational and personal goals ((Kahn 1973; Ingersoll et al 1999; Margolis et al. 1974) Lack of participation (French et.a. 1982) Emotionally distressing human services work (for example health care, teaching) (Cox T. &Griffiths 1995) Job insecurity (Ferrie et al 1999) Time pressure (Jones et.al. 1998;Schriber & Gutek 1987) Bullying (Vartia, 2001), harassment (Richman et al, 1999) and violence Organisational change (Karasek & Theorell 1990 TAIEX Workshop Ankara, 7-8th October 20134

5. There are so many stress concepts! The Job –Demand – Control model of Karasek. Karasek defines jobs and their associated stress levels by their particular demand-control combination. Karasek's High Demand-Low Control Model defines high stress, unhealthy jobs as those with low control and high demand conditions. Low control conditions include de-skilled labour and reduced decision making autonomy. Employees in this position are not given the leeway to make decisions regarding their work or work environment. They also do not have the opportunity to learn new skills on the job or problem solve. High demand conditions include inadequate time to meet job demands and excessive workload. When asked about their workload, employees in high demand situations often say, "I work very fast and/or hard," and, "There is not enough time to get the job done." TAIEX Workshop Ankara, 7-8th October 20135

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7. The transactional Modell The Transactional Model of Stress and Coping is a framework for evaluating the processes of coping with stressful events. Stressful experiences are construed as person-environment transactions. These transactions depend on the impact of the external stressor. This is mediated by firstly the person’s appraisal of the stressor and secondly on the social and cultural resources at his or her disposal. When faced with a stressor, a person evaluates the potential threat (primary appraisal). Primary appraisal is a person’s judgment about the significance of an event as stressful, positive, controllable, challenging or irrelevant. Facing a stressor, the second appraisal follows, which is an assessment of people’s coping resources and options. Secondary appraisals address what one can do about the situation. Actual coping efforts aimed at regulation of the problem give rise to outcomes of the coping process. TAIEX Workshop Ankara, 7-8th October 20137

8. Reward Imbalance Model Siegrist proposes a model (Reward Imbalance Model) of gratification crises to explain negative effects on health. When high performance is reciprocated with low gratification (income, reward/support, status) he predicts high risk of health deterioration. This model claims an exchange of expectations and obligations with rewards. TAIEX Workshop Ankara, 7-8th October 20138

9. JD-R Model The Job Demands Resource Model (JD-R) was developed in an attempt to overcome some of the limitations that characterize earlier research models in the field of work psychology, including the Job Demands Control Model and the Effort Reward Imbalance Model. One of the drawbacks of these earlier models is their focus upon negative aspects of work (e.g., excessive workload, insufficient rewards) and negative consequences of work (e.g., strain, physical health problems). The JD-R model, in contrast, adopts a more positive view. Along with the negative aspects of work, this model examines positive job characteristics and studies their health-enhancing effects. TAIEX Workshop Ankara, 7-8th October 20139

10. Definition of mental stress DIN EN ISO 10075 The totality of all influences that people are subject to from the world around them and that affect them mentally:  This involves …the sensory organs and perception, …thinking, learning and memory, …feelings, impulses and sensations TAIEX Workshop Ankara, 7-8th October 2013 10

11. Sources of StressSymptoms of Stress Disease Relationship at work Intrinsic to the job Career development Organisational structure an climate Home-work interface Role in the org. Individual symptoms Raised blood pressure depressed mood excessive drinking irritability chest pains Organisational symptoms High absenteeism High Labour turnover industrial relations difficulties poor quality control Individual Mental illness Coronary heart Demotivation Apathy Frequent and severe accidents ? ? Cooper’s model of the dynamics of work stress TAIEX Workshop Ankara, 7-8th October 201311

12. Person and environment Both mental wellbeing and stress are complex issues. The contemporary view of stress is to consider it in terms of a transaction between the individual and the environment. In this way stress does not reside solely in the individual nor in the environment, but in the transaction between the two. It is through the dynamics of this transaction that levels of wellbeing and stress are determined. TAIEX Workshop Ankara, 7-8th October 201312

13. Prevention of Stress Work-related stress is preventable, and action to reduce it can be very cost-effective. Each workplace is different, and work practices and solutions to problems must be matched to particular situations by carrying out a risk assessment. TAIEX Workshop Ankara, 7-8th October 201313

14. TAIEX Workshop Ankara, 7-8th October 2013 The stress situation and its effect The effect of a stress situation also depends on the personal perception and assessment of the stress The quality and intensity of the perception and assessment also depend on personal experiences, traits and abilities (internal resources) 14

15. TAIEX Workshop Ankara, 7-8th October 2013 „The word around the office is that you have serious attitude problem.........“ 15

16. TAIEX Workshop Ankara, 7-8th October 2013 The stress situation and coping with it How a person copes with a stress situation depends on their abilities, traits and approaches. But environmental conditions (external resources) also play a role the extent of social support (offers of help) the latitude found for decision-making and action 16

17. TAIEX Workshop Ankara, 7-8th October 2013 Determination and performance of measures It is usually easier to make a diagnosis and determine stress in the workplace than to initiate and sustain a change in the situation. Why: There are no quick fixes; instead, approaches to solving problems must be worked out and adapted to the establishment Changes usually are made as a process, take a long time and cannot be achieved on a rush basis 17

18. The HSE Management Standards cover six key areas of work design Demands – this includes issues such as workload, work patterns and the work environment. Demands Control – how much say the person has in the way they do their work. Control Support – this includes the encouragement, sponsorship and resources provided by the organization, line management and colleagues. Support Relationships – this includes promoting positive working to avoid conflict and dealing with unacceptable behavior. Relationships Role – whether people understand their role within the organization and whether the organization ensures that they do not have conflicting roles. Role Change – how organizational change (large or small) is managed and communicated in the organization Change TAIEX Workshop Ankara, 7-8th October 201318

19. European Framework for psychosocial risk management (PRIMA-EF) It provides guidance on the European framework for psychosocial risk management (PRI MA-EF) and concerns the management of psychosocial risks at the workplace, aiming at the prevention of work-related stress, workplace violence and bullying. Such a framework, bringing together a number of key issues in the area and providing guidance on them, has so far been lacking and is necessary for employer and worker representatives to take effective action to address the issues of concern. TAIEX Workshop Ankara, 7-8th October 201319

20. TAIEX Workshop Ankara, 7-8th October 2013 Survey tools Various tools can be used for investigation and assessment. The distinguishing feature is how the data are collected Data collected objectively (sickness figures, accidents, turnover, overtime hours, examinations by company physicians) Data collected subjectively (questionnaires, checklists, complaint boxes) Productivity figures (errors, wastage) Data collected interactively (interviews) Workplace assessment tools 20

21. Development of an action plan What is being targeted how by whom (who is responsible) who else needs to be involved what the time schedule will be what resources will be required what will be the expected (health and business) benefits ohow they can be measured how the action plan and its effects wil l be evaluated. TAIEX Workshop Ankara, 7-8th October 201321

22. TAIEX Workshop Ankara, 7-8th October 2013 Stress management: When  Three strategies can be successfully employed in the company:  Preventing stress before it occurs  Coping with stress in stress situations  Stress reduction afterwards Not to forget:  Develop a concept for mental health promotion in PA 22

23. TAIEX Workshop Ankara, 7-8th October 2013 23 Some Features of Mental Health Mental health and well-being are issues of everyday life Mental health is seen as an essential component of general health Mental health is a result of various predisposing factors, precipitating factors, social context and individual resources Positive mental health refer to MH as a capacity to perceive, comprehend and interpret our surroundings, to adapt to them and to change them if necessary, to think and speak, and to communicate. MH is determined by individual factors and experiences, social interaction, societal structures and resources, and cultural values. 23

24. TAIEX Workshop Ankara, 7-8th October 2013 Mental Health: Two concepts Mental health promotion emphasizes two key concepts: power and resilience. Power is defined as a person’s, group’s or community’s sense of control over life and the ability to be resilient. Building on one’s existing capacities can increase power and control. Resilience has been defined as “the ability to manage or cope with significant adversity or stress in ways that are not only effective, but may result in an increased ability to respond to future adversity”. Resilience is influenced by risk factors and protective factors. * 24

25. Mental Health Promotion and levels of interventions individual level: for example improvement of coping skills to prevent stress and burnout, empowerment in order to be able to manage transition periods and interpersonal relationships, social environment: creation of social supportive structures (corporate culture), development of policies against bullying or moral harassment working conditions: for example reduction of risk- factors, design of workplaces, work organisation (for example supportive structures for women combining work and children-care) TAIEX Workshop Ankara, 7-8th October 201325

26. What keeps us healthy? Finding answers to the questions: What do we enjoy? What are we proud of? What would we not want to miss? What gives meaning? Decision-making power and latitude for action Support Learning and development Diversity and variety Wholeness and completeness Recognition Understandability TAIEX Workshop Ankara, 7-8th October 201326

27. TAIEX Workshop Ankara, 7-8th October 2013 GERMANY: Self-competence and self- responsibility – methods to optimise resources (Sero) SERO co-ordinated by the DaimlerChrysler AG, is implemented in the Sindelfingen and Untertürkheim plants. Aims of the project  Enhancing self-responsibility and self-initiative regarding health and safety at work.  Decreasing stress symptoms.  Increasing the ability to cope with changes, higher motivation to actively participate in change processes.  Increasing the levels of well-being, satisfaction and identification with work. 27

28. TAIEX Workshop Ankara, 7-8th October 2013 UNITED KINGDOM Work Well The programme helps people to improve their well-being through gaining their understanding of the key issues and providing practical guidance on how to develop workable solutions. Marks and Spencer have a long tradition in realising Workplace Health Promotion.  Improving the psychosocial health and remove stigma associated with mental health in the workplace.  Improving the skills, well-being and behaviour of the line managers.  Providing a mechanism for early detection and intervention of mental health issues.  Creating a more positive attitude in the stores.  Increasing the quality of the customer experience and the level of discretionary effort.  Increasing staff attendance levels. 28

29. TAIEX Workshop Ankara, 7-8th October 2013 Good practice should Include early detection (early warning system) Involve the participants in every stage of the project management Be integrated in the management philosophy Include interventions on different levels, i.e. affecting the individual, the social environment and the working conditions Focus on mental health promotion Cover different levels: promotion, primary prevention and secondary prevention Include various actions, for example training, counselling, surveys and be proven to be effective. 29

30. TAIEX Workshop Ankara, 7-8th October 2013 Characteristics of successful Interventions Clearly stated outcome targets comprehensive support systems with multiple approaches, including emotional, physical and social support, together with tangible assistance. intervention in multiple settings, provision of screening and early interventions for mental health problems at all stages of the lifespan involvement of relevant parts of the target group’s social network intervention over an extended period long-term investment in program planning, development and evaluation 30

31. Links http://www.mentalhealthpromotion.net/?i=promenpol.en.ho me http://www.mentalhealthpromotion.net/?i=promenpol.en.ho me EUROPEAN AGENCY FOR THE 5AFETY &. HEALTH AT WORK: http://osha.europa.eu/en/topics/stresshttp://osha.europa.eu/en/topics/stress EUROPEAN AGENCY FOR 5AFETY &. HEALTH AT WORK - FACT5HEET ON BULLYING AT WORK http://osha.europa.eu/en/publications/factsheets/23/view http://osha.europa.eu/en/publications/factsheets/23/view FRAMEWORK AGREEMENT ON HARASSMENT AND VIOLENCE AT WORK: https://osha.europa.eu/es/legislation/guidelines/provisions_w orkload/index_html https://osha.europa.eu/es/legislation/guidelines/provisions_w orkload/index_html European Commission guidance on work-related stress: https://osha.europa.eu/data/links/guidance-on-work-related- stress https://osha.europa.eu/data/links/guidance-on-work-related- stress TAIEX Workshop Ankara, 7-8th October 201331

32. TAIEX Workshop Ankara, 7-8th October 201332 Thank you for your attention kkuhndo@t-online.de