Introducing a Primary Prevention Programme against mental ill health at work

1.
Building resilience – an organisational
cultural approach to mental health and
wellbeing at work. A primary prevention
programme
Derek Mowbray

2.
Introduction
Despite the increasing provision of secondary prevention services to employees in
the UK (EAPs, Counselling, Awareness training, Occupational Health services), the
incidence of stress and mental distress in the workplace continues to be a
significant factor affecting business and service performance, as measured by
sickness, absence, staff turnover, the Iceberg Effect and productivity. This chapter
is about preventing the risk of stress and mental ill health arising by focusing on
the inter‐play between organisations, the ‘rules’ relating to behaviour in
organisations, and the skills, knowledge and experience of leaders and managers
in their interaction with employees. The overriding emphasis is on the creation
and sustainability of trust, commitment and a strong psychological contract
between employees and their employers.
This chapter explores the problems within organisations, outlines a strategy for
addressing these, offers a primary prevention programme, describes the
appropriate behaviours in leaders to prevent stress, and offers a method of
implementation.
Our aspirations
Our purpose is to promote a strong relationship between organisational
aspirations and individual responses – in the context of appropriate ‘rules’ and
training that are actively in place within organisations.
“We wish to see organisations which have a clear, unambiguous purpose,
expressed as a simple ‘big idea’, an idea which all the staff relate to closely, and
are proud to discuss with friends and colleagues. We wish to see an atmosphere
of confidence, where all the staff are interested in each other, support each
other, and project this confidence towards clients and customers. We wish to see
organisations where staff behave respectfully towards each other, value each
others views and opinions, work in teams which are places of mutual support,
where anything is debated without a hint of humiliation, where the critique of
individual and team work is welcomed, discussed and where lessons are learnt
and implemented. We wish to see organisations where staff ‘go the extra mile’ by

3. providing unsolicited ideas, thoughts, stimulus to each other, and where their
interest in their customers offers something more than is expected, beyond
courtesy, and beyond service, offering attentiveness and personal interest. We
wish to see organisations that challenge their staff, that provide opportunities for
personal development through new experiences, that treats everyone with
fairness and understanding. We wish to see organisations where staff are
personally driven towards organisation and personal success ‐ intellectually,
financially, socially, and emotionally” (Mowbray 2004).
These aspirations are derived from empirical research into the key factors that
draw a distinction between the highly successful and other organisations. The
features will be reviewed later as part of a process of creating trust, commitment 1
(Porter et al 1974) and a strong psychological contract 2 (McLean et al 1998)
between employees and their employers. Trust, commitment and a strong
psychological contract are evidenced as having a significant impact on sickness,
absence, staff turnover, and the factors which lead up to these events (Purcell
2004; Hutchinson et al 2003; West et al 2002; Firth‐Cozens 2004; Atkinson 2007).
It is the creation of a culture of trust and commitment which attenuates a risk of
stress and mental distress in the workplace and offers primary prevention against
stress at work.
The problems within organisations
Probably the most significant problem within organisations arises from the lack of
determination by leaders and managers to address the serious issues surrounding
stress and mental distress at work. A possible reason is the complexity, ambiguity
and idiosyncratic nature of stress, and the difficulty of dealing with the
consequences of exposing the problems to analysis and resolution.
The fundamental problem facing organisations and their leaders is the behaviour
between leaders and followers. The interaction between two or more people is
crucial to the success of an organisation (Mangham 2005), and where this
interaction breaks down, or fails to occur, stress and mental distress commences.
1
A strong belief and commitment to organisation goals; a willingness to exert effort on behalf of the organisation;
a strong desire to retain membership of the organisation.
2
‘the idiosyncratic set of reciprocal expectations held by the employees concerning their obligations and their
entitlements’.

4. The problems within organisations are manifested in the levels of sickness,
absence, and staff turnover as well as under‐performance. Other indicators
include the numbers of staff suffering from harassment, bullying, various forms of
discrimination, and a host of other stressors such as lack of personal control,
fatigue, ‘burn out’ and boredom (Spiers 2003). These, below the surface, activities
are a major contributor to low performance as they involve diverted attention,
anxiety, depression, ambiguity, lack of safety, and a growing desire ‘to escape’,
creating an ‘Iceberg Effect’ (Diagram 1). Services exist to support staff enduring
misery, but they have little direct effect on the numbers eventually escaping to
‘freedom’. The national average of staff turning over is 18% some of whom leave
for ‘positive’ reasons, such as moving location, or changing career. The majority,
however, are ‘pushed’ by organisational events (CIPD 2006).
Diagram 1
The problem – The Iceberg Effect
L absence/turnover
O
W freedom
P
E procedures employee assistance
R programmes (EAP)
F policies
O occupational
R health
misery
M
A
N
C heavy workload
E poor relationships trapped no involvement
boredom
rotten culture discrimination
rigid working practices
harassment exhaustion
no challenge poor communication
©Derek Mowbray
In the Sunday Times survey (March 2007) of the Best Companies to Work For
most of the companies voted for by staff had a staff turnover of over 10% per
annum. The CIPD survey of costs of staff turnover (CIPD 2006) showed that only
8% of all companies knew how much they were spending on filling vacancies and

5. using temporary staff. The average cost per employee turning over was
established in 2006 as £8000. In the Sunday Times Survey only 9 companies with
more than 500 staff were spending less than £500,000 on staff turnover. Eleven
companies were spending between £2m and £6m per annum on staff turnover,
most of which is effectively avoidable. The costs only include the visible costs. The
Iceberg Effect is the period of time that staff think about leaving, when their
concentration is elsewhere, and their productivity is low. The costs of this period
is unknown, but will be substantial.
The average staff turnover percentage for the Top 100 Companies is 16% close to
the national average of 18%. The table below shows the distribution and range.
% Number of companies
In top 100 to work for 31
30 Turnover of staff 2006
Top 100 Companies to Work For
25
Source: Sunday Times March 2007)
22
20
14
15
11
10 8
7
5 4
0‐5 6‐10 11‐15 16‐20 21‐25 26‐30 Over 35
Percentage of all staff turnover pa
Unwarranted absence is another problem within organisations. In the CBI/AXA
Healthcare annual survey (April 2007) it was revealed that 12% of all sickness and
absence is unjustified and taken by employees as a routine, tacked on to the
beginning and end of a weekend or bank holiday. The survey estimates that the
absence costs per employee amount to £537. For a company of 250 employees
this amounts to £134,250 per annum plus loss of productivity. All of this cost is
avoidable.

6. The causes of problems within organisations.
The causes of problems in the workplace can be identified as being associated
with four dimensions of organisations. Organisation purpose, organisation
architecture, the ‘rules’ about organisation behaviour and processes, and the
ways in which leaders and managers interact with their employees or ‘play the
game’ (Mowbray 1994).
The OrganisationHealth Questionnaire (2007) is an instrument based on the
Organisation Development model (Mowbray 1994) which helps leaders, managers
and staff assess the degrees of commitment and trust which exist in the
workplace. The approach is to assess the organisation as context for nurturing
commitment and trust, not to assess the type and degree of individual
commitment and trust.
The benchmarks against which the assessment is made comes from empirical
research. An unambiguous purpose aids commitment (Purcell 2004); a flat
architecture enhances decision making and involvement (Hankinson 1999); the
size of the organisation being led has a significant influence on triggering stressors
(Wall et al 1997); the team that encourages positive involvement, critical analysis
without any form of humiliation, and the mutually supportive environment limits
risks of stress and enhances resilience (Firth‐Cozens 2001).
STOP stress at work strategy
The following strategic framework is adapted from Mowbray (1994) and contains
five strategic purposes:

7. STOP stress and conflict at work ‐ Strategic framework
Prevention Prevent deterioration
(STOP stress from happening in the first place) (STOP stress in its tracks)
The organisation, leaders and managers Leaders, managers and individual employees
Assessment (degrees of trust and commitment) Stress audits
Organisation purpose Policy construction and implementation
Organisation architecture Awareness training
Organisation ‘rules’ Individual and collective supporting services
How leaders and managers ‘play the game’.
Delivered by: Occupational Health Services
Delivered by: Organisation Health Psychologists Occupational Psychologists
HR Specialists Occupational Health Psychologists
HR Specialists
The next generation Employee Assistance Programmes
(STOP stress from happening again) Trainers
Health and Safety Advisors
Leaders and managers
Training
Coaching and mentoring
Performance appraisal
Palliation Delivered by: HR Specialists Restoration
(Doing something else about stress)
Occupational Psychologists (getting over stress)
Business coaches
Individuals
Individuals
Capacity to work assessment
Capacity to work assessment
Individual support and therapy
Individual support and therapy
Absence management
Absence management
Career guidance
Training
Legal support services
Training
Delivered by: Occupational Health Services
Occupational Psychologists
Delivered by: Occupational Health Services
Occupational Health Psychologists
Occupational Psychologists
Clinical Psychologists
Occupational Health Psychologists
Employee Assistance Programmes
Clinical Psychologists
Absence Management Programmes
Employee Assistance Programmes
HR Specialists
Absence Management Programmes
Trainers
Legal services
Trainers
©Derek Mowbray (adapted) 1994
Prevention (primary prevention)–to prevent stress and conflict occurring.
Prevent deterioration (secondary prevention) – to stop stress in its tracks, once it
is identified as existing in the organisation.
Restoration (tertiary prevention) – to restore an individual back to their normal
working life.
Palliation – to ensure that the individual undertakes some form of work, whether
paid or voluntary, in the knowledge that the person will not return to the place of
work where the incident of stress originally occurred.
The next generation – to ensure that once the prevention strategy is
implemented, future generations of leaders and managers continue to sustain the
structures, rules and behaviours which ensure that the risks of stress is prevented
from arising.
Building resilience – an organisational cultural approach to mental
health and wellbeing at work
Building resilience focuses on the primary prevention strategy. The emphasis is
on creating, maintaining and sustaining trust, commitment and a strong

8. psychological contract between employees and their leaders. The creation of
trust and commitment requires a focus on the organisation as the context for
personal interaction. It, also, requires the training and development of leaders
and managers in the attributes which foster trust and commitment.
The Resilience Model has been constructed from empirical research into the
influences which support trust and commitment, and the factors which create a
strong psychological contract between the employee, leaders and managers.
The model has nine components, divided between
purpose, architecture, ‘rules’ and’ how to play the
Resilience model
game’. These components may be divided between
relationship items, such as security and career
prospects; transactional items, such as working
together in a pleasant team environment; and
promises, such as the opportunity to advance and
grow. The approaches which leaders take to each
component will vary according to the nature of the
component and the likely responses employees
have to each item and its presentation. Critical to
the implementation of the model is the behaviour
of the leaders towards the followers.
Below is a further description of each component,
together with the benefits and risks associated with
each. The appraisal is made in relation to the
©Derek Mowbray
degree of trust and commitment each component
is expected to create.

9. Creating trust and commitment
Dimension Positive Negative
focus
benefits risks
A clear, simple, Ambiguity causes
The ‘big idea’ – purpose of the unambiguous genuine confusion, suspicion, and,
Purpose organisation purpose for the ultimately, a lack of
organization which interest resulting in no
explains to others what it trust nor commitment in
does will gain the the organization.
commitment of the
employee to the
organization.
Flat organisations Multi‐tiered organisations
Structure increase involvement in increase the risk of remote
Organisation decision making, eases decision making, poor
architecture communication, and decisions, lack of
improves commitment to involvement of
the organisation employees, reducing their
interest and commitment
to the organisation
The job
Matching personality, A focus on procedure,
skills, knowledge and governance and avoidance
The rules ‐ Recruitment experience to the of contravening
expectations of both the regulations and laws
employer and without addressing
prospective employee personality, skills,
results in a ‘fit’ which knowledge and
enables the employee to experience, may lead to a
gain confidence in his/her mismatch, and high costs
work. Confidence creates of continuance or
trust. replacement.

10. ‐ Pay Fairness, as perceived by Collective pay scales
the employee, is critical reward the ‘group’ and
in issues of pay. Pay that not the individual – unless
reflects a reasonable discretion is applied on an
expectation is likely to be individual basis. Pay scales
The rules regarded as fair, and fair applied without discretion
pay creates commitment may result in a perception
by the individual to the of ‘unfairness’ by the
organization. individual which erodes
his/her commitment in
the organization.
‐ Challenge Individuals look for Routine, non challenging
challenges in their job – work allows the individual
their creation will assist to think of other
in the generation of challenges; dulls the
commitment by the interest in the
individual to the organization, and diverts
organization, so long as attention to more
the challenge is not interesting things.
beyond the individual’s Commitment is lost.
personality, skills,
knowledge and
experience.
‐ Security Knowing that there is a Ambiguity over the
job to be undertaken and continuation of a piece of
completed within an work erodes the sense of
identified and agreed security, and causes
time scale provides the employees to consider
level of security which other opportunities. Trust
gains the trust of the and commitment is lost.
employee in the
organization.
How to play the game Training and development Continuous personal and Little or no training and
professional development can place
development offers employees at risk and
opportunities for threaten their personal
personal growth which security and confidence; it
gains the commitment of also signals little interest
the employee to the by the organisation in the
organization. employee and results in
no reciprocal trust or
commitment

11. ‐ Teamwork Teams that work well Groupthink is a risk – this
have an atmosphere or phenomenon occurs
culture of mutual where a team cannot
benefits based on mutual respond to internal or
trust and commitment to external stimuli to think
each other. This enables differently resulting in the
‐ Openness each team member to be team becoming an
open in their impediment to change
observations of each and development. The
other without fear of team will lose
humiliation or commitment and trust
retribution. This creates from the organization to
trust and commitment in the team.
the team and in the
organization if similar
teams act in similar ways.
‐ Involvement Teams exist to make the
whole team more No involvement = no
effective than individuals commitment
How to play the game acting alone. Achieving
this requires each team
member to be involved in
each others affairs
without any sense of
resentment or
discomfort. Active
involvement of each
team member in each
others affairs, and in the
wider interests of the
organization is actively
encouraged. This creates
commitment by the
employee in the team
and the organization.
‐ Communication Successful teams are
made of members who Inappropriate or lack of
look out for each other, communication creates
and alert each other to isolation leading to lack of
any matters which will confidence and suspicion.
improve the overall This in turn erodes trust
effectiveness of the team and commitment by
through improving the employees in their
contribution of the organization.
individual. This relies on
clear communication
between individuals and
between the team and
the wider organization.
When this is reciprocated
by other teams it creates
a culture of trust and
commitment between
the team members, the
teams and the
organization

12.
Attentiveness by Inflexible responses to
managers to individual individual circumstances
Worklife balance circumstances and the demonstrates the
needs of employees overriding dominance of
demonstrates a personal the organization over the
interest which gains the individual, which the
commitment of the employee will regard as
employee to the unfair and unreasonable,
organization. leading to a lack of trust
and commitment to the
organization.
‘Trust in the individual Managers who fail to offer
and the individual will encouragement or
How to play the game Management encouragement trust in the organisation’. support to their
Encouraging risk taking, employees will discover
innovation, challenges that they receive no
are all part of a fulfilling encouragement or
work experience, and support in return.
gains the commitment of Commitment is lost.
the employee to the
organization
Offering opportunities for Limited career
career development, opportunities results in
Career opportunity particularly within the employees either
How to play the game same organization, will remaining without
gain the commitment of developing, which may
the employee in the have an adverse effect on
organization. the organization, or
employees thinking of
leaving and finally leaving,
demonstrating a lack of
commitment
This crucial relationship Poor relationships are the
must reflect root cause of much of the
Manager/employee relations attentiveness in the high levels of staff
manager towards the turnover and mental
employee and deliver on distress – it erodes any
all the items described prospect of trust and
above to create trust and commitment between the
commitment between employee and the
the employee and the organization.
organization.

13. Leadership behaviours
Implementing the Resilience Model requires leaders and managers to adapt their
behaviour in a way which nurtures commitment, trust and a strong psychological
contract. Good leadership needs to go beyond performance monitoring and to
look at the effects on staff wellbeing (Firth‐Cozens and Mowbray 2001).
The behaviours required by leaders and managers in their interaction with
employees are identified in the literature relating to seduction (Calas and
Smircich 1991; Persaud 2006), transformational leadership (Burns 1978 ), emotion
management (Landen 2002), impression management (Rosenfeld et al 1995) and
charismatic leadership (House 1977). From these the main competence to be
developed is attentiveness – a focus on the individual in a manner which
deliberately entices the person into an act. The more genuine the leader is in
displaying attentiveness the stronger the seductive power. It is, therefore,
important for leaders to be committed to and trust in their organisation, to the
same depth as they expect others to be committed.
Other competencies that aid seduction are ‐ being able to offer direction with
committed ambition; being someone who attracts Psychological status, who
possesses levels of intelligence with humour, who can generate an impact by
addressing the individual needs of the employee, who can create stress and then
deflate it (developed from Persaud 2006)
A Quick Leadership Assessment Q has been devised to include competencies
proposed by different research approaches. This is completed by both the leader
and followers and aims to identify where individual development work needs to
focus in order to help the leader create trust and commitment amongst followers.

14. Quick Leadership Assessment Q Overall
performance
© Derek Mowbray
10
Leading change
through others 10 Trustworthiness
10
1
1 1
Intellectual Collaborative
flexibility
10 1 Trust 1 10 working
and
commitment
1 1
Attentiveness 10 Decision making
10 skills
1 1
1
10 10 Ability to
1 = not good Humour empower others
10 = good 10
Effective at
influencing
Implementation
The preferred form of implementation follows the action research and learning
methodologies (Johnson 1998) with the addition of workshops on each of the
topics outlined in the Resilience Model. The process, therefore, is to select leaders
and managers to join action learning sets made up of about 8 people and a
facilitator. These sets meet each month over a span of twelve months minimum,
and on each occasion a selected topic is examined with a view to members of the
set bringing about change in their own behaviour as well as in others. In between
the set meetings, each member is expected to bring about a change in the
organisation, using one of the Resilience topics as the focus. On each occasion the
learning set meets, each member learns from each other about the successes and
challenges they face in the change process, and use the resources of the other
members of the set to help overcome the challenges and celebrate the successes.
Word count 3082

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