For most people, stress just comes with the job. For a growing number of workers, however, that stress is becoming a health problem keeping them from work.
"The issue is: How do you distinguish between ordinary stress and something that is considered a serious health condition?" said Natasha Wilson, an attorney with Greenberg Traurig in Atlanta who has written on the topic.
The Family Medical Leave Act, the most common vehicle used for stress leave, defines a serious health condition as a medical condition that lasts for three or more consecutive days and requires a doctor's treatment, she said.
Employees, employers and health care providers are grappling with the question of when does stress rise to a level severe enough to justify leave.
The Mountain States Employers Council, which advises many of Colorado's largest employers, is devoting more training resources on handling the nuances of mental-health conditions, including stress-related disorders, in the workplace, said David Dixon, a staff attorney with the council in Fort Collins.
Employers report a rising number of employees seeking time off for stress-related conditions through the FMLA, which allows up to 12 weeks of unpaid leave.
"Just being stressed, and who isn't, is not allowable under the law for leave," said Allan Estroff, manager of representation at the MSEC in Denver.
Courts have ruled against employees citing generalized complaints of stress, but they have ruled in their favor when mental problems, such as panic attacks, and physical manifestations of stress, such as high blood pressure and severe headaches, were present.
Another worry, Dixon said, are broader psychological diagnostic criteria coming out this month that could expand the number of stress-related conditions eligible for leave or even disability.
"They are attempting to medicalize stress," said Jim Turner, a San Diego psychologist who works with the MSEC and sides with professionals who think the new diagnostic manual goes too far.
Turner cites the example of grief over the death of a loved one, which was considered problematic if it went beyond six months. The new standards are expected to shorten it to two weeks, he said.
The economic downturn forced many employers to pare their staffs, adding more duties on those left behind, often without any added pay.
A weak labor market has also left fewer alternatives for those unhappy in their jobs, another source of stress. And households continue to face greater financial strains than they did before the recession.
Sharp rise since 2008
All that is resulting in more stress-related complaints and requests for leave from workers, experts said.
"We are seeing an increase in cases that are being filed by employees alleging FMLA interference," Wilson said.
The U.S. Equal Employment Opportunity Commission has seen a sharp rise since 2008 in disputes over disability claims, which had been holding steady below 20,000 a year from 1997 to 2008, said Dixon.
They have since ballooned to 26,000, Dixon said, and the thinking is that much of the increase is tied to mental-health issues.
A fear among some employers is that some workers may try to abuse the system. A scan can show a damaged knee, but getting inside a broken psyche is more difficult, especially if it falls outside standard diagnoses, such as bipolar disorder, schizophrenia or severe depression.
"To expect you can go to a stress-free environment and the job won't require stress is a fiction for an employee. Stress is something that we will all encounter not only in the workplace but in our everyday lives," Wilson said.
Further complicating matters, not everyone deals with stress in the same way. And even the same person may handle workplace stress differently depending on other things going on at a given time.
"Because of the potential for malingering, some people dismiss stress claims as being bogus," said David Lee, principal at HumanNature@Work in Maine.
But ignoring workplace stress can leave employers open to a multitude of problems, including poor customer relations, absenteeism, increased physical injuries, turnover and even workplace violence.
Stress Directions Inc., an online resource on stress, estimates that 40 percent of turnover, half of absences and a third of worker's compensation claims are tied to stress.
It is also a big factor in "presenteeism" — workers who are on the clock but not productive.
"People are physically present at work, but they are not focused. They are doing other things," said Maureen Carney, manager for an employee-assistance program in Denver.
Loss of control
Lee works with employers to eliminate what he calls "unnecessary" sources of stress, such as outdated computer systems and inadequate training and support for new employees.
"Perhaps the most fundamental driver of stress is the loss of control or perceiving that you have lost control," he said.
Accelerated layoffs and economic uncertainty contribute to that, but so do poor communication and bad managers.
Employers sometimes jump to the wrong conclusion about the sources of stress in the workplace.
Lee said he worked with one company that attributed stress among its customer-service workers to rude customers, when in reality the issue was poor quality control that allowed too many defective products to get to market.
The surge in stress-related cases has prompted some attorneys to recommend that job descriptions include a line stating "must be able to handle stress" or something similar as a condition of employment.
"That is kind of borderline to me," said Elwyn Schaefer, a Denver attorney who represents employees.
"You are looking to filter out individuals who may have impairments of some sort."
About 15 percent of Americans receive mental-health assistance in any given year. Also, some veterans returning from Iraq and Afghanistan suffer from post-traumatic stress disorders.
If employees like the job and think they can repair themselves within the 12 weeks allowed under FMLA, then Schaefer recommends they go that route.
"If there is a point where you can't physically or emotionally continue, then you need to get out of there," he advises.
Software developer Chad Gibbons took nine months off when the stress of working at a high-tech startup became too much. He wasn't so much sick as just burned out.
Gibbons said the time off was exactly what he needed and that he has become a firm believer in taking leave rather than stewing inside.
"I think frequent sabbaticals are a good idea in most professions, not just ours," he said. "I would like to take a year off every five years or so, and I think everyone would be better off if they could do so."
But not everyone can afford to do that. And some workers may prefer to try to get healthy again while keeping the job they have.
Employers have the right to ask employees to have a care provider certify leave on more detailed forms they provide, and to ask for recertification and for more flexibility on intermittent leave, such as when therapist visits are scheduled.
But they also need to be careful about second-guessing a valid medical diagnosis.
"Employers don't want to be the health care provider. It is not a good practice for employers to form their own conclusions," Dixon said.
Aldo Svaldi: 303-954-1410, email@example.com or twitter.com/aldosvaldi