When will I see you again?

It’s Monday morning and you wake up with a sniffle. Do you: a)
Ring in sick and spend the rest of the day on the sofa? Or b) Tell
yourself your stuffy head isn’t really that bad and force yourself
to go to work?

While some people do throw the occasional sickie, an exclusive
Community Care survey last month revealed a far more serious
problem – long-term sick leave. During 2004, an estimated 20,000
social services staff were signed off work for two months or
more.

The reasons why social services staff take time off sick are well
documented.

Unsurprisingly, stress tops the list. In January a study of more
than 25,000 employees found that social work was the most stressful
job of 24 occupations. Social workers had poor physical health and
psychological well-being as a result of stress and they tended to
suppress their emotions. Their stress levels were increased by the
“emotional labour” involved in face-to-face contact with
clients.

Social work staff have always experienced stress, but are now more
likely to express it, says Mandy Wright, associate director of the
Employers’ Organisation. Hostile press coverage of high-profile
child protection cases focuses on the negative aspects of the
profession and adds to the pressures on staff, she says.

But stress isn’t the only cause of sick leave. Figures from the
Employers’ Organisation show that while 36 per cent of long-term
sick leave (lasting more than a month) was due to stress in 2001-2,
27 per cent was because of back and muscular skeletal problems, and
37 per cent due to other ailments.

But is there a risk that staff on long-term sick leave are not
really ill but just malingering?

Not according to Bernard Walker, secretary of the human resources
committee of the Association of Directors of Social Services and
social services director for Wigan Council. “It’s a myth that
people malinger and want to stay home and watch Wimbledon on the
television,” he says.

Owen Davies, Unison’s national officer for social services, agrees,
citing chronic staff shortages and difficult caseloads as the
reasons for ill health. He says that Unison supports the sickness
management programmes being developed by local authorities, but is
concerned that some start from the position that everyone is a
malingerer. “This is counter-productive,” he says.

But although workers often say they feel stressed, are they really
as ill as they think they are?

David Wainwright, a senior lecturer at the centre for health
services studies at the University of Kent, is not convinced. He
thinks that staff these days tend to medicalise their problems
whereas in the past they would have regarded them as part of the
ups and downs of working life.

“There has been a sociological and cultural shift in people’s
resilience, and people have a heightened sense of their physical
and emotional vulnerability,” he says. “If people get excited,
their heart rate rises and this stress response helps them do their
job. But this has become pathologised; it is now seen as bad for
them and something that will do them harm.”

Inevitably some employees will become ill and be off work for a
lengthy period. When this happens, how should their return to work
be handled?

For a start, they should not be pressurised to return to work, says
Davies. Rather than being asked when they plan to return, they
should be asked how they are.

Wright advises employers to create an action plan covering phased
returns, necessary job adjustments, and any relevant refresher
training.

An even better strategy is to adopt practices that don’t push staff
into extended sick leave in the first place.
Fostering an environment where the focus is on attendance rather
than absence is vital. “It is about helping staff be as fit and
well as possible as well as creating a positive working
environment,” says Wright.

Davies thinks local authorities would do well to examine working
conditions. “We have heard anecdotal evidence of employers setting
themselves targets to reduce levels of sick leave but they should
look at the workplace to see what can be improved rather than have
it as a target to reduce sick leave rates.”

And if all measures fail, it could be worth giving bribery a go.
Royal Mail recently gave cars worth £12,000 to 37 employees as
a reward for not taking a day off sick for six months. How this
approach would go down in social care, one can only wonder.

‘I ignored the warning signs’
Hindsight is a wonderful thing, says Emma Hebden,* a
local authority child care social worker with 10 years’ experience
in social care. Just over a month ago she returned to work after
being off sick for six months recovering from a breakdown.

Emma says she now recognises her illness started in September 2003
when her team was badly understaffed for three months. On top of
her caseload of 25, she covered for two colleagues and took all
duty enquiries.

In March last year she went to her GP because, unusually for her,
she was crying a lot at work. Her GP advised her to take time off
but she just took a week’s holiday. She continued to feel run down
and in July was tested for glandular fever. The test proved
negative and in August Emma began waking up feeling nauseous and
being sick. “Then I’d come to work, charge around all day dealing
with the inevitable crises, and go home and feel dreadful,” she
says.

The turning point came when she woke up one October morning and
felt an overwhelming desire to run away.

“I wanted to leave the house, my partner, my job. I was terrified
and felt completely numb to the people I normally loved.” She was
gripped by waves of terror lasting for hours and her teeth
constantly chattered. Her mother told her to go to the
doctor.

She was signed off work and prescribed beta-blockers and
anti-depressants for anxiety and depression. “Part of me could not
believe it was happening – I still can’t. I’m a bouncing-around
sort of person and had never had any of these symptoms
before.”

Emma feels responsible in part because she did not recognise the
warning signs. However, she believes her council and line manager –
who was also under considerable pressure – must share some of the
burden.

Now she works three days a week and has a weekly supervision
lasting 90 minutes. She has a new line manager and an improved
attitude to how she works. But she has a warning for others: “What
happened to me could happen to child care social workers in the
vast majority of local authorities; there was nothing particularly
bad about my local authority.”

* Not her real name.

‘The new manager was a bully’
After two decades as a mental health social worker,
Adrienne Morris* went on sick leave last year because of
work-related stress. 

She had been working in a community mental health team for three
years when, four years ago, a new senior manager was
appointed. 

Initially Adrienne got on well with him even though her colleagues
found his management style abrasive. “People felt threatened by him
because he overruled their decisions and called them stupid,” she
says. 

Her colleagues began to leave the team, unhappy with the office
atmosphere and high workload. 

Eventually Adrienne began to receive what she describes as
“bullying e-mails” from the senior manager, which she says were
“shocking and offensive”. When she challenged him, he apologised
but the e-mails soon started up again. 

Eventually Adrienne was signed off sick for a week by her doctor.
“I was in tears all the time, my performance went down and I wasn’t
polite as I usually was.” 

The newly appointed assistant director Adrienne had turned to for
support had not addressed the bullying and it continued after she
returned to work.

Several months later Adrienne was signed off for a further two
weeks because of the stress. She felt suicidal and had flashbacks,
and needed counselling and medication. While she was ill no one
from her team contacted her. “I had always got on well with them
but it was like I had a disease. I had worked with them for seven
years and was really hurt.”

When Adrienne returned she spent half a day in the office before
handing in her notice and going off sick again. “I said to my team
manager that I wasn’t sure if I should be resigning when I was in
this state of mind and she said that I should.” 

Adrienne had wanted the assistant director to have a meeting with
her and the senior manager to discuss the impact of his behaviour
but this never happened. “If they’d have done that they would have
retained me and he’d have learned  a lesson.”

Adrienne now works for another local authority and is slowly
getting her confidence back. Her previous position remains vacant
and the senior manager is still in post. 

* Not her real name

Work-related stress busters
At work:

• Talk to your employer: if they don’t know there’s a problem,
  they can’t help. If you don’t feel able to, ask a trade union or
  other representative to raise the issue on your behalf.
• Support colleagues suffering from work-related stress.
  Encourage them to talk to their manager. 
• Discuss with your manager whether it is possible to alter your
  job to make it less stressful. 
• Channel your energy into solving the problem rather than just
  worrying about it. Think about what would make you happier at work
  and discuss this with your employer. 

Out of work:

• Eat healthily.
• Stop smoking – it doesn’t help  you to relax.
• Try to keep within the government recommendations for alcohol
  intake – alcohol acts as a depressant and can leave you feeling
  down.
• Watch your caffeine intake as it  may make you more
  anxious.
• Be physically active – it will give you more energy.
• Talk to family and friends about your feelings.
• Learn relaxation techniques. 

Source: Tackling Work-Related Stress, Health and Safety
Executive