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Social work is a psychologically dangerous occupation. Stress levels are often high, leading to exhaustion, burnout, depression and mental illness. It has often been viewed as an occupational hazard, something that comes with the territory.

A Community Care study of more than 500 social workers with depression earlier this year found that almost three-quarters said that their depression had started after entering social work.¹ Eighty per cent identified their job as a cause.

Employers can no longer afford to ignore the consequences. Last month, the Audit Commission published a report on the factors behind the accelerating recruitment and retention crisis in the public sector. It confirmed what many have suspected for a long time: stress is the number one reason people decide to leave their jobs.2

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Even when people don't make the decision to quit, sometimes it is made for them. The Institute for Public Policy Research (IPPR) suggests that a decade ago, muscular, skeletal or cardiovascular problems were most commonly cited as reasons for not being able to work. Now, mental health issues, often linked to workplace stress, dominate.

Is working in social care particularly stressful? "Yes," says Terry Dadswell, who runs the British Association of Social Workers' advice and representation service. "Staff in social care are more susceptible because it's such a grinding business. They deal with misery, illness and poverty all the time. They see people who are desperate, violent or abusive. It's a very fraught job."

But these pressures have always existed. The difference now is the environment within which people have to deal with the inherent stress of the job. Teams are understaffed and overworked, regularly pilloried in the media and treated with hostility by the public. They don't have the resources to do their jobs properly, and dedicated staff feel they have to drive themselves harder and harder to ensure that clients don't suffer as a consequence.

As Owen Davies, Unison's senior national officer for local government, puts it: "It is partly about increasing pressure, but it's also about the way public sector workers are seen as lazy and feckless. People can take a bit of stress if they feel what they do is valued and respected."

The effects that stress and any resulting mental ill-health have on teams are not good. Team members go off sick or simply resign, leaving remaining team members with additional burdens. Or stressed employees manage to keep going, barely keeping their head above water, but performing poorly and possibly putting clients at risk.

In this context it seems a little ironic that, amid the plethora of public sector performance targets and indicators, there isn't a single one asking how an organisation looks after its staff.

Mike Leadbetter, outgoing president of the Association of Directors of Social Services, acknowledges that these are vital issues for employers. He says: "For staff to focus on the needs of service users, their employer has to focus on their needs." As a result of this recognition, Essex introduced revised grievance procedures, new whistleblowing policies, and made available two counsellors to whom staff can (and do) self-refer. There are now also more opportunities for secondment, and the option to take a year's career break to work overseas.

More importantly, says Leadbetter, managers have to be willing and able to act when they feel something is wrong. "It's absolutely pivotal that you have a robust supervision policy which means managers can say to someone 'I don't think you are well, we're going to stop this session, and I want you to go home and see your GP'."

Employers also have a legal responsibility, under employment legislation, to protect employees from the damaging effects of stress. According to Simon Foster, principal solicitor at mental health charity Mind, "The main one, under employment legislation, is to ensure there is a 'safe system of work' in place, which means that if someone is being made ill by work the employer must deal with it. It is the same as the duty to deal with a dodgy electrical cable - employers have to take steps to deal with the stress people are under if it's making them ill."

But the options are limited for employers faced with staff who can no longer do their original job. According to Dadswell: "In offices where all the fat has been trimmed away, it's proving very difficult to find people other jobs that they can do - particularly in small teams. We're now seeing something called a 'capability dismissal' where no other job can be found for someone. And even if another job is found it's very dubious whether you'd get the same level of salary for very long."


But there are other options. Cary Cooper is Bupa professor of organisational psychology and health at Manchester School of Management, and a stress expert. He says there are two issues: "The first is about how we give people the skills to manage their stress. There are lots of things that people do badly that add to their stress - they don't manage their time, they don't prioritise their workload. That can be improved with appropriate training.

"The second is about structural issues. This includes bad managers, not enough support, uncontrolled workloads, or bad relationships between work colleagues. Individuals don't have any power over these factors. In my experience there are more bad managers in the public sector, perhaps because there's less good management training.

"Organisations should undertake stress audits. There are lots of tools to do that, but essentially, someone independent and impartial from outside the organisation comes in to diagnose the problems, and a working party consisting of managers, front-line staff and unions is responsible for taking the findings of that diagnosis and acting fully on them, without leaving out the difficult or inconvenient bits."

Cooper has little time for the idea that public sector staff simply whinge more than those in the private sector. "There is a reality to the complaints made by social workers - they are under stress, they are overworked, their pay rates are terrible compared with the private sector. There's a support issue too, because local authorities have become too mean and too lean. But they have better support from their unions, which means their ability to pursue their grievances is greater."

But Cooper adds: "Whatever the reasons people give and the truth behind them, as an employer, if you have a lot of people who simply don't want to come to work, shouldn't that trouble you? Employers should look at the bigger picture and ask themselves, why is it that so many people don't want to come to work?"

For anyone facing the decision to quit or go under, the newly launched General Social Care Council code of practice for social work employees and employers includes a number of relevant clauses. These include a duty to report and to deal with "dangerous or discriminatory practice", and a responsibility to "respond appropriately to social care workers who do not feel able to carry out their duties". Another demands that employers, while ensuring that the care and safety of service users is the first priority, must ensure that social care staff affected by ill-health are supported and their workloads subject to clear limits.

Perhaps these government-supported codes will give employers the leverage they need to demand resources necessary to care for and support their staff.

¹ "Down on record"
² Audit Commission, Recruitment and Retention, 2002, from www.audit-commission.gov.uk/