Read the passage below and answer to the problems which follow.
 
WORKPLACE COUNSELLING-An appeal for evidence
 
Mental health problems at work are big news; hardly a week passes without a new report highlighting stress at work or the proportion of absences for psychiatric causes. The numbers involved are  enormous, to the point  that one might be concerned that it was yet another public health issue. Both unions and employers perceived a problem, though it is by no means clear  that they perceive the same problem. It is perhaps not surprising that they tend to advocate different solutions.
 
While occupational factors such as stress have demonstrable health outcomes, workplace stress has also major economic implications. One report has suggested that it cost the UK three billion pound per year—significant  in  relation to the eleven billion pound  that the CBI find outs sickness  absences as a whole costs the economy. Besides sick pay, replacements costs and loss productivity, an increasing proportion of this burden is comprised of compensation pay-outs. The TUC reported that there was a twelve-fold increase in case of stress at work; the value of claims is over three hundred million pound.
 
The Walker case, in which a social worker successfully sued his employers  for psychiatric illness caused by his work, underlined the duty of care that employers have to their employees  and confirmed that harsh financial penalties could  result from failing in this duty of care. This issue received publicity recently with an appeal court ruling which, in redefining those circumstances under which an employee can claim for damages, may curb the number of such cases coming before the courts. In three out of four cases before  them, the judges allowed the appeals, removing almost two hundred pound from claimants who  had originally  been  awarded compensation for stress related illnesses.

“Any alleged harm must be a demonstrable injury to health”  
 
There is much within the guidance from the judges to applaud. They confirmed that psychiatric and physical illness should be addressed in the same way, and there are no specific occupations which are intrinsically dangerous to mental health. Any alleged harm must be a demonstrable injury to health, not simply “occupational stress”, and must be attributable directly to work. This  is  especially important as stress at work  is common and only infrequently damages health. They stated that employers are entitled to assume that employee can withstand normal pressure of work and to take what is said to them by employees at face value. Thus an employee returning to work after a period of sickness absence who does not disclose ongoing concerns in implying that he is fit to perform his previous duties.
 
More controversial was the guidance about employers’ responsibilities; “An employer who offers a  confidential advice service with referral to appropriate counselling and treatment services is unlikely to be found in breach of duty”. Such a ruling may have dramatic implications, leading to the explosion of the provision of workplace counselling. Many employers and their  staff  currently favour such an intervention over more practical measures such as reducing hours worked or increasing staff numbers. However,  the judges also stated that ”an employer can only reasonably be expected to take steps which are likely to do  some good: the court is likely to need expert evidence on this”, Where might one find such evidence?
 
Counselling in the workplace: the facts was published in January 2001 by The British Association for Counselling and Psychotherapy, and  could be seen as a timely and convenient answer to this problem. Its publication was reported in the British Medical  Journal under the headline “Review confirms workplace counselling reduces stress”. It describe itself as “an independent critical scoping  search of research into workplace counselling” and “the most comprehensive possible review of all English-Language studies of counselling in the workplace”.  It is certainly substantial, running to over 100 pages and has identified more that  80 pieces of work. Its review methodology is well presented and each piece of work is described and connected on using the language of evidence based medicine. The conclusions are clear and unequivocal. It claims that after counselling, work related symptoms return to normal in more than half of all clients, and sickness absence is reduced by over 25%; that workplace counselling is an effective treatment for anxiety, depression and substance misuse as well as “stress”. It is claimed that such results can be produced by as little as three sessions of any style of counselling as they turn out to be effective. Was this the expert evidence that the judges referred to?
 
A more detailed reading of the report raises problem as to whether its conclusions can be justified. No studies were  found that reported a negative outcome. This is surprising record of psychotherapy research. There is no funnel plot and the term “publication bias” is not mentioned. Having proclaimed the value of “methodological pluralism” whereby qualitative studies were included, the report dives into all those found into three categories; “best’, “supporting”, and “authenticating” evidence (there is no category for negative evidence)  .Serious doubts about the report’s claims emerge on the examination of those 19 studies described as “best evidence”. Within the work that was published in peer reviewed journals there is a description of eight years of a “Peer Assistance Programme” for nurses with substance abuse problems and two reports each by employees of an Employees Assistance Programme simply describing their work. The most common format was a before and  after study, typically comparing two different models of counselling. Three papers emerging from the Second Sheffield Psychotherapy Project describe many of  the same patients. There are other exs of unrecognized duplicate publication; two pairs of papers comprising early and late reports of the same study are included. The report states that it found randomized controlled trials. In one, “where a cluster randomisation was performed, it was felt to be unethical to withhold counseling from those who wanted it, and the method broke down. This is one of the few studies to show no benefit from counselling. The other paper, while describing as a randomised controlled trial in the report, had no element of randomization in it. 
 
The negative effect of counselling    
 
That counselling or a psychotherapeutic intervention might do harm is ignored by the author, although there is ample evidence that this can be the case. Indeed we have yet to encounter any treatments without side effects. With all treatments there is a balance to be struck between risks and benefits. Such adverse effects may include increased distress and dependency. This may occur by placing emphasis on the domain of the individual when the real problem is at the level of the organization.

Psychiatric disorders have many causes and falsely assuming problems that emerge in the workplace are due to work alone, may lead to other areas such as home and family problems being overlooked. At the middle end of the scale, distress is a normal, and often short lived, human emotion which not necessarily  benefit from being medical.
 
All evidence is useful, but any conclusions must be governed by the quality of that evidence. Counselling in the workplace: the facts suggest  that for one  reason or another the negative studies on workplace counselling have not come to light. We accept that good quality evidence can be difficult to obtain for some psychotherapeutic interventions, but this does not reduce the need for RCTs in this field……

Now answer to the following problems.

a) What are the benefits of workplace counselling?
 
b) Show 2 shortcomings of the abovementioned report?

c) What problems other than workplace that can cause stress to workers.

d) Name 2 implications of stress in the workplace.