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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