The cost of workplace stress is persuading insurers to adopt psychological rehabilitation. Caroline Jordan investigates

It's a depressing fact for insurers that stress and related areas such as depression are costing them so much money. The CBI has estimated the total cost to the UK economy as being £5bn a year in terms of days taken off through stress. And, according to figures from the Health and Safety Executive (HSE), some 13.4 million working days a year are lost because employees can't cope with the pressures of office life - the equivalent of each sufferer taking 29 days sick leave.The HSE says cases of stress, depression and anxiety have doubled in the past seven years, with one in five employees reporting that they feel stressed.This is a view backed up by the insurance industry. UnumProvident chief medical officer Michael O'Donnell says the past decade has seen an explosion of claims for mental and psychological problems, which scarcely existed a generation ago. In 1995, only one in eight claims was for mental illness, while by last year it had ballooned to almost a quarter. It has overtaken back problems and complaints linked to industrial work, such as breathing difficulties.UnumProvident specialises in income protection insurance, which can pay out until retirement age if an employee is unable to return to work. O'Donnell is a firm believer in early intervention when an employee first becomes ill: "You can't expect a doctor to get involved. They often don't have time and the easiest option can be to sign someone off with stress. And, if someone has been off for several months, then the employer may not feel comfortable with starting a dialogue with the employee."As a company with an American parent, UnumProvident is known as an insurer that is not afraid to encourage a return to work, and will use a variety of methods to encourage this. Others are far more likely to take a more British stance and continue to pay the cheques as well as retain scepticism for the effectiveness of psychological treatments.But, as O'Donnell points out: "We don't want the individual to be financially disadvantaged - that's why they have insurance. But, work is largely beneficial to those suffering from depression and in most cases, being off from work is not good for people. There are a range of options that should be explored and we look to do this with the claimant."

Maximising workforceAbsence management can be viewed by some employers as an unnecessary addition to the payroll, and in the UK has a relatively low take up. But, as the cost of premiums soars to meet the cost of stress claims, providers believe its use will become far more commonplace.Mark Simpson, managing director of AXA PPP Healthcare's occupational health division says: "You can have someone who hasn't ever taken a day off sick, but is clearly troubled and underperforming. A good absence management programme will spot this . What is more, getting in contact with someone who has just self certified themselves for a few days sick leave is important, or else the problem could escalate."Claims for repetitive strain injuries have rocketed in the past few years and Simpson says there is a proven link between these and depression in many cases: "If someone is complaining of an upper limb disorder, then it's possible they are also depressed. It's vital the employer knows what is going on."In these days of political correctness, insurers are reluctant to suggest that some people would simply rather receive cheques from insurers or state benefit than earn them.But some are prepared to say that stress is now viewed as too acceptable in society as a reason for not working. And that it's very much in vogue too.As Simpson comments: "We have to ask why stress has increased tenfold in the past 15 years. Has work really become so much more stressful?" He adds that some forms of depressive illness do mean an individual is unable to work. "There are some very sad cases where only medication may provide some alleviation, but not all claims fit into this category."In the case of employers' liability cases, insurers such as Zurich Municipal and Norwich Union have had a rough ride in the local authority sector. There have been high value claims from council workers, and police and teachers are similarly angst ridden. The HSE recently announced a national inquiry into stress levels among teachers. It will unveil guidelines for headmasters to diagnose stressed-out staff later this year. A teacher retiring years before retirement age and claiming for stress can prove massively expensive. But, there are also services available for shorter term claims such as payment protection insurance, linked to mortgages and insurance, which pays typically for up to 12 months.

Telephone counsellingConnectmi targets this sector and offers a telephone based counselling service, which it says can mean a prompt return to work - hence saving the insurer money. Business development manager Sarah Kyle says the three most common reasons for referral to its services are workplace stress, bereavement and anxiety, accounting for 69% of the total referrals.The Connectmi counsellor conducts an initial assessment of the claimant's current condition by telephone, estimates the likely duration of the condition and claim, and finds out what treatment the claimant is currently receiving. During the initial telephone review the claimant is made aware of treatment options available and is encouraged to access treatment through his GP. Although offering a telephone based service is obviously cheaper than face-to-face counselling, Kyle says it also can bring the claimant advantages: "For many claimants, the anonymity and power of talking on the telephone has enabled them to talk much more freely than they could in a traditional clinical environment."The service can also incorporate career counselling, which looks at the individual's approach to coping with stress and provides ways of coping. "This should mean they can either go back to their existing job or find an alternative," Kyle says.More complex treatments can run into many thousands of pounds for each claimant. The difficulty for the insurer is to balance whether it will bring savings against the cost of claims for a long term claim for income protection or employers' liability.Moving Minds marketing director Bob Lewer works for an organisation that uses a network of mental health professionals, specialising in insurance cases. He says bringing in the right people is essential. "Too often a counsellor can do more harm than good. Anyone can set up as one and just prying into the past may cause more damage. "What can often help most of all is starting up a dialogue ealry with the employee and this is where the insurer, working with the employer, should start the ball rolling."