Two years ago, I gave a presentation to a group of executive Risk Managers representing many of the top one hundred companies in the United States. These "best practice" corporations had been on the cutting edge of disability management and to date had established programs that had saved their corporations hundreds of millions of dollars. The topic of my presentation was the evolution of corporate disability management programs during the last ten years. Everyone was feeling good about the report until I asked what they thought the fastest growing and most difficult employee health challenge would be over the next ten years.

The answer was immediate and unanimous. Employee stress and psychiatric conditions were identified as the clear winner. I then asked how many of the managers were satisfied with how their current disability management programs were dealing with this issue. Not a hand was raised. I asked how many were currently in the process of developing a corporate strategy to address the problem. Still not a hand.

As a consultant who develops and implements these programs for industry and government, the Risk Managers' responses were not surprising to me. It is not unusual for companies with otherwise top-of-the-line occupational and non-occupational return-to-work and disability management practices and procedures to simply "freeze like a deer in the lights" when confronted with an employee undergoing stress, whether the stress is work related or not. It would be a unique organization indeed that handled employees with stress and psychiatric conditions as simply and as straightforwardly as they do employees with physical injuries and illnesses.

Yet after two years of research and working through this problem, I have come to the conclusion that treating them the same is exactly what we should be doing. It is not that our present disability management and return-to-work programs do not work with this population; it is that we are reluctant, even afraid, to let them try.

That is not to say that there is not much for disability managers and return-to-work coordinators to learn about bringing persons with stress and psychiatric conditions back into the workplace. It is to say that once they do learn, they find out that the basic principles of return-to-work for stress and say "back injuries," for instance, are basically the same. The problem of disability management and return to work for employees with stress, especially if it is identified as work-related stress, may be less a matter of the employee's condition and more our reaction to it.

What is work-related stress?

To understand work-related stress, we must first consider stress itself. We are all under stress. There is no such thing as a stress-free life. There is obviously no such thing as a stress-free job. Everyone is exposed to daily pressures. Most people cope with, even flourish on modest amounts of stress without suffering any ill effects. (Another name for this kind of stress could be challenge.) Challenges can come from our work as well as our private lives. Challenges may confront us, but if we feel that we are in control, stress can be experienced as a positive thing. It drives us to perform at the top of our game.

While there are many theories of stress, experts agree that the principal difference between healthy "challenge" and unhealthy "stress" is the reality or the perception of the person being able to control or impact the outcome. When the sense of control over the situation is lost and coping mechanisms break down, a potentially healthy challenge can become dangerous stress. Untreated and unrecognized, this stress can affect employee productivity, attendance, attitude, and often physical and mental health.

Work or Home?

It is frequently very difficult to determine where stress comes from. Employers often ask the question, "Is it the stress from work or stress from the employee’s personal life that is the main cause of his or her problem?" Take the example of an employee who is going through a reorganization at work and a divorce at home. Which is the main cause of the employee’s stress? Common sense tells us that it is hard to identify where one begins and the other ends.

On the plus side, the effects of stress are usually short-lived. Once the challenges cease and/or the sense of control returns, the employee’s perceived stress generally returns to normal. However, serious difficulties can occur when the pressures are extreme, drawn out and/or the sense of control is completely lost.

Is Stress All in the Employee's Mind?

It is hard to separate the body from the mind. Rather than trying to judge whether an employee’s reaction to stress is appropriate or an overreaction, it is valuable to understand what is happening to a human being who is undergoing stress.

PHYSICAL AND EMOTIONAL RESPONSES TO STRESS

Simply put, stress causes a state of arousal that triggers physical, psychological and biochemical changes in the body. The stress itself can emanate from a variety of sources, such as:

1. Personal issues, such as worry about finances or the health of a family member.

2. Environmental conditions, such as excessive noise.

3. Work-related pressures, such as conflicting assignments or intimidating supervisors.

4. Traumatic incidents, such as a death in the family, divorce or job change.

5. Growth or change, such as marriage, buying a house or having a child.

As long as stress is short lived, these reactions can be considered a natural part of life and key to survival. However, when the stress does not resolve and the employee feels that there is no solution in sight, serious problems can occur. Heightened and prolonged levels of hormones and other biochemical changes associated with stress can lead to:

	Exhaustion,
	Insomnia,
	Depression,
	Anxiety,
	Headaches,
	High blood pressure,
	Weakened immune systems,
	Back pain, and
	Increased risk of heart attack.