Tuesday, July 31, 2007


I have practiced Occupational Medicine(OM) for over 35 years in several settings in the US. Even though I am not a psychiatrist I became very interested in the stress workers would report to me and its impact on employee health,safety,well being, work satisfaction and and productivity. This lead to my chairing the mental health committee of the American College of Occupational and Environmental Medicine (ACOEM) from 1996 to 2001) and by being named as the only physician to a government(NIOSH) team which was defining research priorities in work stress and what NIOSH called Organization of Work(OOW)

But this essay is about a sister profession-namely the corporate Employee Assistance Program or EAPs as they have become to be know. I happened to be at the very beginning of this important profession's birth in the late 1970s and early 1980s which historically grew out of addressing alcoholism at the workplace but since, to its credit, has markedly expanded its scope of practice. The primary worldwide professional organization which now provides a home for most of the professionals in the field is EAPA.

I guess from the very beginning of my observation of how corporate EAPs operated I was struck the good work that they were doing but their failure -even to this day- to adequately and formally address the work stress issue.

In short in reading the EAPA Association Standards I could not locate any portion of the standards that even used the term "work stress". What???? I noted that in the metrics that they tend to utilize the phrase "work adjustment" which really scares me. (soviet psychiatry redux?) The basic definition of EAPs from EAPA I guess tells the story. It says "Employee Assistance Program" or "EAP" is a worksite-based program designed to assist:

(1) work organizations in addressing productivity issues, and

(2) "employee clients" in identifying and resolving personal concerns,including, but not limited to, health, marital, family, financial,alcohol, drug, legal, emotional, stress, or other personal issues that may affect job performance"

This is fine BUT where is the proverbial "arrow going the other way" meaning that the workplace psycho-social environment may very well be the single most important contributor to most of the problems that EAPs seek to address?

We can theorize why this is not addressed by EAPs

1)The word "stress" for years was "fuzzy" -now it is well defined

2)Teasing out work stress from other stressors we all have at home and in our culture is not easy (hence the workers compensation profession doesn't award too many stress claims either)

3)Most importantly and very sadly the EAP professionals are paid as employees or consultants to the corporations in which they work. Would they dare to state that employees of those who hire them are stressed from work?. After all, this is a direct indictment of managements inability to provide a work environment that might be harming people? As an Occupational Physician I understand the EAP professionals dilemma in the US but I refuse to accept it.

Many fine courageous researchers including those from academia and government have unequivocally proven that work stress is a major epidemic and is harming US workers- big time! I cite the US National Institute for Occupational Safety and Health(NIOSH)who published an excellent publication on work stress

Furthermore the empirical evidence for work stress in particular contributing to or causing cardio-vascular(heart)disease (America's number 1 killer) is voluminous and robust..In my opinion no reputable occupational physician, eap professional or cardiologist could deny the rigor and strength of this compelling data.The work the pioneering and new leaders in this field can be fully explored at The Job Stress Network website If you explore this website, believe me, you will get an excellent education!

I would also like to recognize The American Institute of Stress(AIS) and the The American Psychological Association(APA) for assuming leadership roles in this matter of extreme importance to the health of Americans.

I personally have no doubt remaining whatsoever that work stress is both harming and killing employees in many US workplaces.

Here is what I propose

-That the EAPA immediately develop a formal position paper on work stress and incorporate it into their formal standards. To not do so perpetuates the glaring omission at best -the lack of basic professional ethics at worst.ACOEM needs to do so likewise

-That NIOSH (nested in the US CDC) and other independent excellent researchers provide to the OSHA (nested in the US Department of Labor) which is formally charged under law with protecting the health and Safety of US workers the necessary data to begin the process of publishing a formal enforcable OSHA standard on the issue of work stress.

- That education and certification of both occupational physicians and nurses and, most importantly EAP professionals, be dependent on demonstrating competency in recognizing, measuring and mitigating a major killer of American workers- Work Stress

Thank you for your continued interest in this topic and please let me hear from you. Tell me your stories about work stress by posting a comment om this blog.

Be Well

PS-Find and do safe, healthy, meaningful work till the day you die.

Dr. Rick Lippin